A Quantitative Synthesis of Developmental Disability Research: The Impact of Functional Assessment Methodology on Treatment Effectiveness.

Abstract

Although not essential for a diagnosis, Autism Spectrum Disorders (ASD) and Intellectual Disability (ID) are commonly associated with a broad range of maladaptive behaviors including self-injurious behavior (SIB), property destruction, aggression towards others, severe disruptions, and stereotypic behaviors (e.g., body rocking). Maladaptive behaviors can lead to poor social relationships; poor academic success, destruction of property, and serious medical problems, such as tissue damage. For these reasons, the assessment and treatment of such behaviors in individuals with ASD and ID is an important component of any comprehensive approach to rehabilitation. A behavioral approach to intervening with maladaptive behaviors has been consistently documented as the most efficacious approach for treating aberrant behaviors (Gresham et al., 2004; Campbell, Herzinger, & James, 2007). The key to effective treatment is the identification of the function, or purpose, of the behavior. The most current taxonomy of behavioral function focuses on three types of reinforcement as the major mechanisms maintaining behavior: (a) positive reinforcement, (b) negative reinforcement, and (c) automatic reinforcement. In the last 25 years, there has been a trend toward developing treatments for maladaptive behaviors following determination of the hypothesized functions of the behaviors through Functional Behavior Assessments (FBA). Based on the ascribed function of the target behavior, an appropriate treatment package can be selected. Researchers assessing maladaptive behaviors agree that identifying the function of the target behavior is integral in the treatment selection process; thus FBAs are a core feature in the development of interventions designed to ameliorate aberrant behaviors (Yarborough & Carr, 2000) and required by federal education law (e.g., Individuals with Disabilities Education Act [IDEA], P.L. 105-117, 1997). Although required by law in some cases, the term FBA is still somewhat vague. Generally, FBA refers to any methodology used to identify the purpose of behavior and encompasses indirect assessments, (e.g., interviews, rating scales), descriptive assessments (e.g., A-B-C sheets, direct observation with no variable or environment manipulation); and functional analyses (FA; e.g., analogue conditions in which antecedent or consequent variables are systematically manipulated within an experimental design). For the purposes of this paper, we are using the term FA to describe all experimental analyses. The term Behavioral Assessment (BA) refers to those assessments which are non-experimental in nature and includes both indirect and descriptive assessments. Several researchers have made comparisons across FBA methodologies and, in general, the findings support the FA as the "gold standard" for ascribing function and consequently developing function-based treatments. Paclawskyj et al. (2001) and Durand and Crimmins (1988) both reported positive correlations when comparing FA outcomes to the functions hypothesized by the Questions About Behavioral Function (QABF; Matson & Vollmer, 1995) and the Motivation Assessment Scale (MAS; Durand & Crimmins, 1992), respectively. In contrast, Hall (2005) found that descriptive and experimental methods of FBA agreed only 25% of the time. In almost all published accounts of comparison data, the FA represented the gold standard for validity tests of other types of assessment. Others have looked beyond comparisons of ascribed function across FBA types and instead assessed intervention outcomes across methodologies. Knowing which FBA methodology is associated with more successful treatment outcomes is imperative. Didden, Korzilius, van Oorsouw, and Sturmey (2006) made comparisons across descriptive and experimental FBAs and found that treatments based on experimental methods resulted in significantly higher treatment effectiveness scores. Herzinger and Campbell (2007) conducted a meta-analysis of autism literature on the assessment and treatment of maladaptive behaviors. …