1) The document discusses the importance of considering an individual's genetics, learning history, current environment, and biological factors when conducting a functional behavior assessment (FBA), regardless of whether they have a psychiatric diagnosis. 2) It emphasizes that the goal of an FBA is to objectively define, measure, and understand the functions or reinforcers maintaining problematic behavior in order to develop effective behavioral interventions. 3) Medications can impact behavior in various ways by altering sensitivity to reinforcement or punishment, but their effects must be considered in the context of each individual's unique contingencies of reinforcement as understood through an FBA.

1. Terri Rodgers, Ph.D. BCBA Chief Behavior Analyst Department of Mental Health Division of Developmental Disabilities April 13, 2010 Functional Assessment & Data Analysis

2. FBA and Psychiatric Diagnoses “A person is first of all an organism, a member of a species and a subspecies, possessing a genetic endowment of anatomical, physiological and chemical characteristics, which are the products of the contingencies of survival to which the species and each organism has been exposed in the process of evolution. Each person acquires a repertoire of behavior and becomes an individual as it contacts unique contingencies, grounded by consequences, to which it is exposed in its lifetime. Each individual is able to acquire such a repertoire because of its evolved susceptibility to the processes of conditioning. The behavior an individual exhibits at any moment is under the unique control her/his genetic endowment, learning history and the current setting.”

3. Diagnosis or No Diagnosis Different categories of behavior result from different biological, neurological chemical makeup, and different experiences (environmental interactions).

4. The FBA Process is the Same All individuals have environmental, biological, neurological and chemical differences, and they are often changing. Our eyesight, hearing, pain thresholds, hormones, chemistry, self induced chemicals, diets, learning history (via parents, siblings, friends, experiences) All of us are affected by environmental events (behavioral processes) Because of all of the above each of us are affected somewhat differently.

5. The FBA Process is the Same There are Sd’s but their effects are slightly different There are MO’s but their effects are slightly different There are Reinforcers, but their effects are slightly different Therefore, our Behaviors are slightly different Whether or not there is a psychiatric diagnosis, empirical observations and systematic recording of the effects of these processes lead to the most effective environmental interventions (i.e., BSP’s)

6. Psychiatric diagnosis and Intellectual disabilities Diagnoses primarily based on verbal report of symptoms – ID may need to look for behavior and biologic signs that likely relate to symptoms Utilize reports of support people and observations Psychiatric diagnosis – medical model while ID area operates on a learning based model Manifestations of ID may overshadow psychiatric symptoms

7. Issues to consider The existence of behavior problems are not sufficient for a psychiatric diagnosis Behavior problems may be related to a number of physical illnesses Behavior problems may have been learned and maintained in pathogenic environments Environmental variables influence behavior regardless of “cause”

8. Goals of FBA Define the problem behavior and desirable behavior (measurable manner) Identify the events, times, situations that describe and predict high and low rates of behavior Identify the typical, likely consequences related to the behavior(s) Generate hypotheses about the function(s) of the problem behavior(s)

9. About Behavior Specific actions – well defined Desirable behaviors that should be occurring are as important as the undesirable behaviors Think about what dimension(s) of behavior you want and measure those

10. Functions of behavior or contributions of environment Consequences of behavior Get something – positive reinforcement Tangible items-food, money, cigs Social consequence – reaction, attention, interactions, move near people, touch Get away from something – negative reinforcement Demands stopped, eliminated or reduced demands Aversive stimulation terminated or mitigated – move from chaotic environment to quiet, away from people

11. Antecedents to Behavior Immediate Pain, aversive stimuli or coercion Get away and escape – see consequences Get even- might include variety of emotional responses and aggressive, destructive behaviors- pain on part of others more reinforcing, or less punishing Conditioned situations in which any of above consequences or stimuli occurred Generalization to like situations, people, tones of voice, facial expressions

12. Antecedents to Behavior cont. Motivating Operations- more distant, states of being Illness, fatigue, hunger, thirst, pain, Episode of depression, paranoia, delusions, mania Effects of medications (more /less sensitive to reinforcement, more/less sensitive to aversive stimuli)

13. Examples of behavioral mechanisms of action for psychotropic medications Respiradol -(Moore, et al. 2009) Has little effect on behaviors that are sensitive to or maintained by positive reinforcement including social contingencies Has some suppressive effect on behaviors sensitive to or maintained by negative reinforcement Has some suppressive effect on behavior that are sensitive to non - social contingencies May have more effect on suppressing positively reinforced self injury than on positively reinforced aggression

14. Metheylphenidate (MHP) MHP acts as an establishing operation increasing the relative effectiveness of environmental stimuli as reinforcers

15. Behavioral mechanisms continued Anti -anxiety meds seem to reduce the reinforcing properties of escape from aversive stimuli (reduce the negative effects of aversive stimuli) Anti depressants increase the sensitivity to reinforcement

16. Must consider how medication effects will interact with the functions of behavior Anti depressant with hitting occurring when told “no” or if want something -attention (positively reinforced) – may make hitting occur more frequently Respiradol – may have little effect on hitting reinforced by social contingencies (attention or interaction) however, if hitting is getting the person out of situations, may reduce frequency

17. Other effects of medications Antipsychotics frequently cause sedation and compromise cognitive functioning and self help skills Extrapyramidal side effects possible Other side effects including akathisia (restlessness and irritability)

18. Understanding Functions and measurement of effects important Situations in which behavior likely or unlikely Effects of meds in these situations Effects of skill building and reinforcement in these situations Effects of fading medications when intervention/teaching is working across these situations

19. Data Collection Tips The more specific the behavior the better Smaller units of behavior counted more analysis At least look at time of day, activity for the behavior daily Teach the definition and data collection Frequently follow up for accuracy

20. Graphing Conventions Electronic Graph data in finer detail for analysis – daily vs monthly summary Label the axes and keep the scale the same Look at the graphic data over time, not 1 month at a time Maximum of 4 data trails on a graph Account for significant events on the graph Look for trends Account for blips

21. DATA Collection for Anxiety Disorder FBA Example

22. Anxiety Disorder Example

23. FBA Data Collection Example for Demand Hypothesis

24. Example of FBA with medications Interventions – skill building, change High FBA on medications Taper medications, cont On Medications dayprogram, reinf high prob demands rates interventions Hitting others or windows in demand situations Hitting others or windows no demands B Psychotic symptoms e h Replacement skills a v i o r s Low rates