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Functional Communication Training: The Strength of Evidence across Disabilities

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Title: Functional Communication Training: The Strength of Evidence across Disabilities
Language: English
Authors: Gerow, Stephanie, Davis, Tonya, Radhakrishnan, Supriya, Gregori, Emily, Rivera, Gabby
Source: Exceptional Children. Oct 2018 85(1):86-103.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
Peer Reviewed: Y
Page Count: 18
Publication Date: 2018
Document Type: Journal Articles
Reports - Research
Descriptors: Communication Strategies, Training, Intervention, Behavior Modification, Behavior Problems, Program Effectiveness, Disabilities, Child Behavior, Functional Behavioral Assessment, Reinforcement, Evidence Based Practice, Educational Legislation, Federal Legislation
Laws, Policies and Program Identifiers: Individuals with Disabilities Education Act
DOI: 10.1177/0014402918793399
ISSN: 0014-4029
Abstract: Functional communication training (FCT) is a commonly used, often recommended intervention that involves teaching a functionally equivalent communicative response to replace challenging behavior. The purpose of this literature review was to evaluate the strength of the evidence for the use of FCT. A systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior for individuals diagnosed with a disability. FCT resulted in a decrease in challenging behavior for 135 participants. The reviewers rated FCT as an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities based on What Works Clearinghouse standards. Overall, the extant literature indicates FCT consistently results in the reduction of challenging behavior in children with disabilities. Implications for practice and directions for future research are discussed.
Abstractor: As Provided
Number of References: 51
Entry Date: 2018
Accession Number: EJ1192713
Database: ERIC
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  Value: <anid>AN0132113747;exc01oct.18;2018Oct04.10:21;v2.2.500</anid> <title id="AN0132113747-1">Functional Communication Training: The Strength of Evidence Across Disabilities </title> <p>Functional communication training (FCT) is a commonly used, often recommended intervention that involves teaching a functionally equivalent communicative response to replace challenging behavior. The purpose of this literature review was to evaluate the strength of the evidence for the use of FCT. A systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior for individuals diagnosed with a disability. FCT resulted in a decrease in challenging behavior for 135 participants. The reviewers rated FCT as an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities based on What Works Clearinghouse standards. Overall, the extant literature indicates FCT consistently results in the reduction of challenging behavior in children with disabilities. Implications for practice and directions for future research are discussed.</p> <p>Children with disabilities are more likely to engage in challenging behavior, such as aggression, self-injury, and property destruction, than their typically developing peers ([<reflink idref="bib10" id="ref1">10</reflink>] ; [<reflink idref="bib31" id="ref2">31</reflink>] ; [<reflink idref="bib36" id="ref3">36</reflink>] ). Challenging behaviors are defined as those that are not socially acceptable, impede an individual’s daily functioning, or are physically dangerous to the health and safety of self or others (e.g., hitting others, throwing toys, screaming in class; [<reflink idref="bib34" id="ref4">34</reflink>] ). Prevalence rates of challenging behavior among children with intellectual disability range from 22.5% ([<reflink idref="bib10" id="ref5">10</reflink>] ) to 52% ([<reflink idref="bib18" id="ref6">18</reflink>] ). Children with intellectual disability are 3 to 7 times more likely to engage in challenging behavior than typically developing children ([<reflink idref="bib1" id="ref7">1</reflink>] ). Prevalence rates of challenging behavior among children with autism are as high as 94% ([<reflink idref="bib36" id="ref8">36</reflink>] ), with commonly reported behaviors including tantrums, aggression, and self-injury ([<reflink idref="bib36" id="ref9">36</reflink>] ).</p> <p>Challenging behaviors can have a variety of negative consequences, including social isolation, interference with effective education opportunities, exclusion from community and education programs, poor academic outcomes, social isolation, restricted independence, injury to self and others, and increased exposure to restraint ([<reflink idref="bib2" id="ref10">2</reflink>] ; [<reflink idref="bib19" id="ref11">19</reflink>] ; [<reflink idref="bib31" id="ref12">31</reflink>] ; [<reflink idref="bib35" id="ref13">35</reflink>] ; [<reflink idref="bib37" id="ref14">37</reflink>] ; [<reflink idref="bib42" id="ref15">42</reflink>] ). In addition, challenging behavior affects the lives of teachers and caregivers. More than half of special education teachers say that challenging behavior increases their stress, impedes the learning of the student, and affects the learning of the student’s classmates ([<reflink idref="bib48" id="ref16">48</reflink>] ; [<reflink idref="bib51" id="ref17">51</reflink>] ). Parents of children with disabilities who engage in challenging behavior rate themselves lower on measures of mental health and rate themselves as receiving less support than other parents of children with disabilities ([<reflink idref="bib4" id="ref18">4</reflink>] ; [<reflink idref="bib3" id="ref19">3</reflink>] ; [<reflink idref="bib5" id="ref20">5</reflink>] ). Due to the prevalence and effect of challenging behavior, it is important to identify effective interventions to improve the behavior of children with disabilities.</p> <hd id="AN0132113747-2">Functional Communication Training (FCT)</hd> <p>FCT is a frequently used intervention to reduce challenging behavior ([<reflink idref="bib8" id="ref21">8</reflink>] ; [<reflink idref="bib44" id="ref22">44</reflink>] ). FCT involves identifying the function, or maintaining reinforcer, of challenging behavior, then teaching a socially appropriate communication response to replace the challenging behavior ([<reflink idref="bib22" id="ref23">22</reflink>] ). [<reflink idref="bib6" id="ref24">6</reflink>] first described the conceptual foundation that led to the development of FCT. Specifically, Carr suggested that environmental variables, such as access to attention and escape from academic tasks, or automatic reinforcement maintain challenging behavior. In addition, the paper described the importance of identifying the variables that maintain challenging behavior to develop an effective intervention. Subsequently, Iwata, Dorsey, Slifer, Bauman, and Richman (1982/[<reflink idref="bib28" id="ref25">28</reflink>] ) evaluated the use of a functional analysis, an experimental methodology for identifying the variables that maintain each individual’s challenging behavior. Following the introduction of the functional analysis, [<reflink idref="bib8" id="ref26">8</reflink>] described and evaluated the efficacy of an intervention that involved teaching a communicative response to replace challenging behavior, based on the environmental variables maintaining the challenging behavior, termed FCT. Subsequent work provided additional evidence of the efficacy of FCT across participants, implementers, and settings (e.g., [<reflink idref="bib7" id="ref27">7</reflink>] ; [<reflink idref="bib15" id="ref28">15</reflink>] ; [<reflink idref="bib16" id="ref29">16</reflink>] , [<reflink idref="bib17" id="ref30">17</reflink>] ). Further investigation has provided information regarding the mechanisms contributing to the success of FCT and integral procedural components, such as the importance of the individual controlling access to reinforcement, the added contribution of extinction, and the role of the efficiency of the communicative response ([<reflink idref="bib24" id="ref31">24</reflink>] ; [<reflink idref="bib26" id="ref32">26</reflink>] ; [<reflink idref="bib41" id="ref33">41</reflink>] ; [<reflink idref="bib47" id="ref34">47</reflink>] ).</p> <p>FCT involves identifying the function, or maintaining reinforcer, of challenging behavior, then teaching a socially appropriate communication response to replace the challenging behavior ([<reflink idref="bib22" id="ref35">22</reflink>] ).</p> <p>Using FCT as an intervention to reduce challenging behavior typically involves three steps: (<reflink idref="bib1" id="ref36">1</reflink>) implementing a functional behavior assessment (FBA), (<reflink idref="bib2" id="ref37">2</reflink>) selecting and teaching a socially appropriate communicative response, and (<reflink idref="bib3" id="ref38">3</reflink>) providing reinforcement contingent upon the communicative response ([<reflink idref="bib8" id="ref39">8</reflink>] ; [<reflink idref="bib44" id="ref40">44</reflink>] ). The FBA is used to identify the function of the individual’s challenging behavior and can involve interviews, observations, and functional analysis (Iwata et al., 1982/[<reflink idref="bib28" id="ref41">28</reflink>] , [<reflink idref="bib32" id="ref42">32</reflink>] ; [<reflink idref="bib33" id="ref43">33</reflink>] ; [<reflink idref="bib44" id="ref44">44</reflink>] ). Then, the implementer selects and teaches a socially appropriate communicative response and provides function-based reinforcement contingent upon the communicative response. The communicative response is individualized based on the function of the challenging behavior and the child’s current communication repertoire ([<reflink idref="bib32" id="ref45">32</reflink>] ; [<reflink idref="bib33" id="ref46">33</reflink>] ; [<reflink idref="bib44" id="ref47">44</reflink>] ). Specifically, the interventionist should choose an initial, socially appropriate, communicative response that (a) produces a consequence that is matched to the function of the challenging behavior, (b) results in more consistent reinforcement than the challenging behavior, and (c) requires less effort than the challenging behavior ([<reflink idref="bib26" id="ref48">26</reflink>] ). During the intervention, the implementer provides reinforcement contingent upon the communicative response. For example, the FBA might indicate a child is more likely to scream when screaming results in avoiding math work. FCT would involve teaching the child to say “break” or “help” to access a break or help, and screaming would no longer result in a break (i.e., extinction). Since its introduction in 1985, FCT has become one of the most commonly implemented and most published function-based treatments for problem behavior ([<reflink idref="bib8" id="ref49">8</reflink>] ; [<reflink idref="bib44" id="ref50">44</reflink>] ).</p> <p>To date, several reviews have been conducted on FCT. Both the National Professional Development Center on Autism Spectrum Disorder and the National Autism Center (NAC) have conducted systematic reviews of the extant literature evaluating educational and behavioral interventions for individuals with autism. Both of these reviews indicated that FCT is an evidence-based practice for children with autism ([<reflink idref="bib38" id="ref51">38</reflink>] ; [<reflink idref="bib50" id="ref52">50</reflink>] ). In addition, a previous review indicated that functional-based interventions are an evidence-based practice for individuals with emotional disturbance ([<reflink idref="bib46" id="ref53">46</reflink>] ). In addition to these disability-specific reviews, [<reflink idref="bib44" id="ref54">44</reflink>] conducted a review of the FCT literature published between 1985 and (21%). An additional, the authors summarized 91 studies and provided a guide for the implementation of FCT. However, the review did not include an evaluation of the methodological quality of the studies.</p> <p>Although several reviews of FCT have been conducted, many of these have been restricted to specific populations (e.g., autism) or techniques (e.g., schedule thinning; [<reflink idref="bib23" id="ref55">23</reflink>] ). [<reflink idref="bib44" id="ref56">44</reflink>] conducted a comprehensive review of studies evaluating FCT, but 10 years of new research has since been published; furthermore, the review did not include an evaluation of the quality of existing research. Therefore, an updated literature synthesis is warranted.</p> <hd id="AN0132113747-3">Evidence-Based Practices</hd> <p>Implementing evidence-based educational and behavioral interventions is crucial for the success of children with disabilities and is required in educational settings ([<reflink idref="bib27" id="ref57">27</reflink>] ). Moreover, the Council for Exceptional Children (CEC) endorses the use evidence-based educational practices. The Professional Ethics and Standards for special educators require the use of evidence and research to inform practice ([<reflink idref="bib12" id="ref58">12</reflink>] ). The growing emphasis on evidence-based practices instills responsibility in researchers to conduct methodologically rigorous studies and in practitioners to utilize interventions with sufficient research. Moreover, after several studies evaluating a particular intervention have been conducted, researchers must synthesize and critically analyze the extant body of work to determine whether there is sufficient research support for the intervention.</p> <p>A number of different methods have been suggested for evaluating the efficacy of educational and behavioral interventions (e.g., [<reflink idref="bib11" id="ref59">11</reflink>] ; [<reflink idref="bib38" id="ref60">38</reflink>] ; [<reflink idref="bib49" id="ref61">49</reflink>] ; [<reflink idref="bib50" id="ref62">50</reflink>] ). The standards set forth by WWC ([<reflink idref="bib30" id="ref63">30</reflink>] ; [<reflink idref="bib49" id="ref64">49</reflink>] ) are often used to rate the extent to which an educational or behavioral intervention is an evidence-based practice (e.g., [<reflink idref="bib21" id="ref65">21</reflink>] ; [<reflink idref="bib40" id="ref66">40</reflink>] ). The evidence-based practice review involves a three-step process: (<reflink idref="bib1" id="ref67">1</reflink>) evaluating the methodological rigor of individual studies, (<reflink idref="bib2" id="ref68">2</reflink>) assessing the efficacy of the intervention based on the results of individual studies, and (<reflink idref="bib3" id="ref69">3</reflink>) synthesizing the body of evidence supporting the use of the intervention ([<reflink idref="bib49" id="ref70">49</reflink>] ). Based on the amount of evidence in the current body of literature, the intervention either meets or does not meet criteria for an evidence-based practice. These guidelines assist researchers in utilizing a comprehensive and consistent system to evaluate the evidence base for a particular intervention or procedure.</p> <hd id="AN0132113747-4">Purpose</hd> <p>The purpose of the present review is to synthesize the FCT literature for individuals with disabilities. This synthesis will add to the existing literature by critically evaluating the current literature utilizing the WWC guidelines to determine if FCT is an evidence-based practice across disability categories ([<reflink idref="bib30" id="ref71">30</reflink>] ; [<reflink idref="bib49" id="ref72">49</reflink>] ). The specific research questions addressed in this synthesis include the following:</p> <p>What is the strength of evidence for the use of FCT to reduce challenging behavior in children with disabilities?</p> <p>What are the common features of participants for whom FCT is effective?</p> <p>What are the common characteristics of the intervention in the cases in which FCT is effective?</p> <hd id="AN0132113747-5">Method</hd> <p>The present review consisted of a systematic search, design quality evaluation, visual analysis evaluation, and synthesis of descriptive information. The authors, termed “reviewers,” conducted the search and collected data from included studies.</p> <hd id="AN0132113747-6">Inclusion Criteria</hd> <p>The articles included in the present review met the following criteria: (a) published in English, (b) published in a peer-reviewed journal, (c) evaluated FCT as an intervention to reduce challenging behavior, (d) included one or more participants with a disability, and (e) utilized a single-case design. FCT was defined as an intervention that included function-based differential reinforcement of a communicative response. In order for the intervention to be considered FCT, the article had to describe the method for evaluating the function of the child’s challenging behavior (e.g., interview, questionnaire, observation, functional analysis; Iwata et al., 1982/[<reflink idref="bib28" id="ref73">28</reflink>] ) and describe the identified function of the challenging behavior. If the article included both participants with a disability and typically developing participants, the article was included as long as the data for the participant(s) with a disability could be disaggregated from the typically developing participants’ data. For the single-case research design criterion, articles were included if they had a graph with a data path representing the repeated measurement of an individual’s challenging behavior over time. The extent to which the study included sufficient data points and phases to be rated as a quality single-case design was determined after the evaluation of the inclusion criteria.</p> <p>The authors included the use of single-case design as an inclusion criterion because it is not possible to aggregate across single-case and group designs within the WWC evidence-based practice standards ([<reflink idref="bib49" id="ref74">49</reflink>] ). In addition, a previous review on FCT for individuals with autism indicated that all included articles utilized a single-case design ([<reflink idref="bib50" id="ref75">50</reflink>] ). For the purpose of this review, only one article was excluded because it used a group design ([<reflink idref="bib39" id="ref76">39</reflink>] ).</p> <hd id="AN0132113747-7">Database Search</hd> <p>The purpose of the database search was to identify articles that utilized FCT as an intervention to reduce challenging behavior for individuals with disabilities. The database search was conducted in September of 2016. The reviewers searched for functional communication training, functional equivalence training, OR FCT in the following databases: PsycINFO, ERIC, Psychology and Behavioral Sciences Collection, and Education Research Complete. There were no restrictions on date or language entered in the database. A total of 520 articles were identified using these search terms. Of these articles, the reviewers removed 29 duplicate articles, for a total of 491 articles. The reviewers also removed 76 books, dissertations, and theses prior to the title and abstract review. Therefore, a total of 415 articles were evaluated based on the inclusion criteria. The reviewers first removed articles based on the title and abstract. For the articles that warranted further review (194 articles for the first reviewer and 199 articles for the second reviewer), the full text of the article was assessed based on the inclusion criteria. After the first and second reviewer discussed all disagreements (see Interrater Reliability section), 155 articles were included based on the inclusion criteria (see <ulink href="http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399,">http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399,</ulink> available online).</p> <hd id="AN0132113747-8">Ancillary Searches</hd> <p>In addition to the database search, ancillary searches were conducted. A reviewer conducted the hand search with the three journals that published the most articles included in the present review: Journal of Applied Behavior Analysis, Journal of Developmental and Physical Disabilities, and Behavior Modification. The hand search was conducted in December 2017 and included articles published from 2015 to advance online publications. In addition, a reviewer evaluated each of the reference lists of included articles. A reviewer applied the inclusion criteria described above to each of the articles identified. An additional 60 articles were identified based on the ancillary search, for a total of 215 articles included in the review.</p> <hd id="AN0132113747-9">Design Quality</hd> <p>One article could include one or more experiments (e.g., two or more multiple-baseline designs in one study, multiple dependent variables within a reversal design). For each article, the first author identified the experiments included in the study. A reviewer rated the quality of the included articles as meets standards, meets standards with reservations, or does not meet standards, based on the WWC design standards ([<reflink idref="bib49" id="ref77">49</reflink>] ). The design that was used to compare FCT to baseline procedures was evaluated for the purposes of the design quality rating. For example, if the study included a comparison of two types of FCT and a comparison of FCT to baseline, the reviewer rated the design used to compare FCT to baseline.</p> <p>For single-case design studies, the experimenter must actively manipulate the independent variable. In addition, the study must include the measurement of the dependent variable by a second reviewer for at least 20% of the sessions and must obtain acceptable interrater reliability data on average (80% or higher for percentage agreement and 0.60 or higher for Kappa). If the study did not meet both of those criteria, it was rated as does not meet standards. If the study met these criteria, the reviewer assessed the quality of the design.</p> <p>The following single-case designs can be evaluated based on the WWC design standards: reversal or withdrawal design, multiple-baseline design, multiple-probe design, and alternating-treatment design. To be rated as meet standards or meet standards with reservations, each of the required phases must be contiguous, and the design must include at least three opportunities to demonstrate effect at three different points in time. For a reversal or withdrawal design to meet standards, the study must include four or more phases with five or more data points in each phase. If the reversal or withdrawal design includes four phases, but one or more phases had three or four data points, the design was rated as meets standards with reservations. For the multiple-baseline and multiple-probe design, the design must include six or more phases (i.e., three A-B pairs) with five or more data points per phase to meet standards. If the design included six phases, but one or more of those phases had three or four data points, the design meets standards with reservations. Multiple-probe designs were required to meet each of the criteria for a multiple-baseline design and additional concurrence criteria (see description in [<reflink idref="bib49" id="ref78">49</reflink>] ). Alternating-treatment designs must have five or more data points per condition, with two or fewer consecutive data points in the same condition, to meet standards. If the design has at least four data points in both conditions and two or fewer consecutive data points in the same condition, the design meets standards with reservations.</p> <hd id="AN0132113747-10">Visual Analysis</hd> <p>Next, reviewers applied evidence standards to those experiments that met standards or met standards with reservations. For single-case designs, the data support a causal relation if the active manipulation of the independent variable consistently results in changes in the dependent variable that were otherwise unlikely to occur. These changes in the dependent variable, called demonstrations of effect, must occur at least three times at three different points in time to suggest a causal relation ([<reflink idref="bib49" id="ref79">49</reflink>] ). To identify demonstrations of effect, reviewers evaluate the data based on six features: (a) level, (b) trend, (c) variability, (d) immediacy of the effect, (e) overlap, and (f) consistency of patterns across similar phases. For this study, each of the visual analysis reviewers had completed graduate-level course work in single-case research design. In addition, the reviewers completed an online visual analysis training ([<reflink idref="bib43" id="ref80">43</reflink>] ), until they reached a score of 0.80 correlation or above and 80% or above for combined exact matches and within one match for each single-case design.</p> <p>The reviewers assessed the visual analysis features using the following four steps. First, the study needed to demonstrate a predictable baseline pattern that warranted intervention (Step 1). Studies that did not meet the criterion in Step 1 were rated as no evidence and were not reviewed further. The reviewer then evaluated the level, trend, and variability within each phase of the design. These within-phase patterns were compared across adjacent phases (e.g., Baseline 1 compared to Intervention 1) to evaluate the number of demonstrations of effect based on level, trend, and variability (Step 2). If these features indicated three demonstrations of the effect of the independent variable, the reviewer moved to the next step. Studies that did not meet the criterion in Step 2 were rated as no evidence and were not reviewed further. Next, for each demonstration of effect identified in Step 2, the reviewer evaluated between-phase features: (a) overlap and immediacy of effect for adjacent phases and (b) consistency of patterns across phases with similar conditions (e.g., Baseline 1 and Baseline 2). If the between-phase features supported at least three demonstrations of effect identified in Step 2, the reviewer moved to the next step. Studies that did not meet the criterion in Step 3 were rated as no evidence and were not reviewed further. Finally, the reviewer counted the number of effects that occurred at different points and time and the number of noneffects (Step 4). The reviewer rated the study as having strong evidence if visual analysis indicated three or more demonstrations of effect at three different points in time and zero demonstrations of noneffects. If the study included three demonstrations of effect and had an additional demonstration of noneffect (or a 3:1 ratio with more demonstrations), the reviewer rated the study as having moderate evidence. The reviewer rated all studies not meeting these criteria as having no evidence.</p> <hd id="AN0132113747-11">Descriptive Information</hd> <p>The reviewer recorded descriptive information for each participant in each of the included experiments with a high-quality design (design quality rating of meets standards or meets standards with reservations) and positive results for the efficacy of FCT (visual analysis rating of strong evidence or moderate evidence). If one participant had two or more experiments within the article meeting these criteria, the reviewer recorded descriptive information for the experiment that was conducted first.</p> <p>Participant characteristics included gender, age, race-ethnicity, disability category, topography of challenging behavior, topography of communication, and function of challenging behavior. Participant age categories were a birth to 35 months, 36 months to 5 years of age, 6 to 10 years of age, 11 to 21 years of age, and 22 years of age and older. Each participant was scored in each of the following race-ethnicity categories as defined by the U.S. Census Bureau: White, Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander ([<reflink idref="bib45" id="ref81">45</reflink>] ). An additional category, Hispanic, was added as an option for the race-ethnicity of the participant. The reviewer recorded participant disability based on the IDEA categories ([<reflink idref="bib27" id="ref82">27</reflink>] ): autism, deaf-blindness, hearing impairment (including deafness), emotional disturbance, intellectual disability, multiple disabilities, orthopedic impairment, other health impairments, specific learning disability, speech or language impairment, traumatic brain injury, visual impairment (including blindness), and developmental delay.</p> <p>For both challenging behavior and communication, reviewers recorded the topography listed as the dependent variable for the participant. The reviewer categorized the topography of each participant’s challenging behavior as property destruction, aggression, restrictive or repetitive behavior, self-injurious behavior, disruptive behavior, inappropriate sexual behavior, or multiple topographies. Property destruction was defined as behavior that increased the likelihood of damaging items. Aggression was defined as a behavior that increased the risk of injury to others, such as hitting, kicking, pinching, or throwing objects at another individual. Restrictive or repetitive behavior was defined as behavior that did not match the context, occurred multiple times (i.e., repetitive), or was challenging due to the restrictive nature (e.g., engaging in only one type of play). Self-injurious behavior was defined as behavior that caused or had the potential to cause bodily harm to the individual (e.g., self-scratching, biting himself or herself, eye gouging). Disruptive behavior was defined as a behavior that interrupts typical routines or academic tasks (e.g., crying, screaming, falling to the floor). Inappropriate sexual behavior was defined as behavior that was both inappropriate and sexual in nature (e.g., public masturbation). The topography of communication was categorized as vocal response, sign language, picture communication, gestures, speech-generating device, or multiple. The reviewer categorized the topography of challenging behavior or communication as multiple if the dependent variable met the definition for more than one topography (e.g., aggression and property destruction). The function of challenging behavior was categorized as access to attention, escape from demands, access to tangible, automatic reinforcement, or multiple functions. The recorded function was based on the author’s report of the function, as opposed to the reviewer’s interpretation of a graph or data from the study. Function was recorded in this way because each of the articles described the function of the challenging behavior, but the data reported about the function varied from article to article.</p> <p>Methodological characteristics included the implementer, setting, use of extinction, and use of additional reinforcement or punishment procedures. For each of the methodological characteristics, the reviewer rated the article based on the intervention phases included within the experimental design. For example, if the study utilized an ABABC with A representing baseline, B representing FCT, and C representing a different intervention, then the reviewer recorded the methodological characteristics in the two B phases. The implementer was defined as the person who conducted the majority of the intervention sessions. The categories for implementer were researcher, school professional, other professional, and parent or nonprofessional caregiver (e.g., grandparent). For the setting, the reviewer recorded the setting in which the majority of intervention sessions took place. The setting was recorded as a clincial setting (e.g., clinic, inpatient or outpatient unit, university laboratory), home or group home, school, or community setting (e.g., restaurant, store). The reviewers recorded whether the intervention included the use of extinction. Extinction was defined as not providing function-based reinforcement contingent upon challenging behavior. The reviewers also recorded whether an additional reinforcement procedure or a punishment procedure was included as part of the intervention. A reinforcement procedure was defined as adding or removing an activity contingent upon appropriate behavior in order to increase the behavior (e.g., token economy). The use of a chained schedule of reinforcement, other forms of schedule thinning, and the provision of activities or toys during a break were considered part of the FCT intervention and were not counted as additional reinforcement procedures. A punishment procedure was defined as adding or removing an activity contingent upon an inappropriate behavior in order to decrease the behavior (e.g., blocking challenging behavior, removing preferred activities).</p> <hd id="AN0132113747-12">Evidence</hd> <p>The reviewers evaluated the extent to which FCT is considered an evidenced-based practice for each IDEA disability category, based on the single-case research WWC standards ([<reflink idref="bib49" id="ref83">49</reflink>] ). The experiments with a design rating of meets standards or meets standards with reservations and a visual analysis rating of strong evidence or moderate evidence were included in the evidence-based-practice determination. Based on the standards, there needs to be five or more articles, with 20 or more participants, conducted across three or more research teams. A distinct research team was defined as no overlapping authors or institutions.</p> <hd id="AN0132113747-13">Interrater Reliability</hd> <p>For each phase of the study, every article was rated twice (i.e., interrater reliability information for 100% of the items and articles). The five authors served as reviewers for some or all of the phases of the project. Two of the reviewers had a doctoral degree in educational psychology or special education and were full-time faculty at a university. The remaining three reviewers were doctoral students in educational psychology or education studies and had completed a master’s degree. Each reviewer had experience conducting FCT and reading literature related to FCT prior to assisting with this study.</p> <p>For the database search, two reviewers independently evaluated each of the 415 articles identified based on the inclusion criteria. The two reviewers agreed on the inclusion or exclusion of 380 of the 415 articles (92%) based on the inclusion criteria. The reviewers discussed each disagreement to make a final determination regarding the inclusion of the study. Two reviewers conducted the initial ancillary searches, and three reviewers conduced the ancillary search a second time. The first and second searches resulted in independent lists of included articles. For any article that was not included on both lists, a reviewer from the initial search and a reviewer from the second search discussed and agreed upon whether the article should be included in the review.</p> <p>Two independent reviewers each rated 100% of the experiments based on the quality criteria. An agreement was scored if both reviewers chose the exact same rating for the item. The reviewers agreed on the systematic-manipulation rating for 97% of the experiments, on the rating of percentage of sessions with interobserver agreement (IOA) for 95% of the experiments, on the rating of adequacy of the IOA data obtained for 96% of the experiments, on the design rating for 85% of the experiments, and on the overall quality rating for 84% of the experiments. The average percentage agreement was 91% across quality ratings. The reviewers discussed all disagreements to reach a final decision for each item.</p> <p>One reviewer conducted visual analysis ratings for 100% of the experiments. Two other reviewers provided a second rating for each of the experiments. An agreement was scored if both reviewers chose the exact same rating for the item. The reviewers agreed on the rating for 92% of experiments on Step 1, 83% of the experiments on Step 2, 84% of the experiments on Step 3, 84% of experiments on Step 4, and 82% of experiments on the overall visual analysis rating. The average percentage agreement across visual analysis ratings was 85%. The reviewers discussed all disagreements to reach a final decision for each item.</p> <p>All five reviewers recorded descriptive information by participant, and each article was reviewed by two reviewers. An agreement was scored if both reviewers recorded the same category for that participant. The average IOA across all descriptive information items was 88% (range 80% to 99%). The reviewers discussed all disagreements to reach a final decision for each item.</p> <p>Finally, two reviewers rated the extent to which FCT was considered an evidence-based practice for each disability category, based on the number of participants, articles, and research teams. The reviewers agreed on the evidence-based practice determination for 100% of the disability categories.</p> <hd id="AN0132113747-14">Results</hd> <p>The systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior in children with disabilities (see <ulink href="http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399">http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399</ulink> for included articles, available online).</p> <hd id="AN0132113747-15">Quality Review and Visual Analysis</hd> <p>The 215 included studies contained 482 experiments. Each of these experiments was reviewed based on the quality criteria (see <ulink href="http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399,">http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399,</ulink> available online). Reviewers rated 44% of the experiments as meets standards or meets standards with reservations (n = 213). More specifically, 78 experiments received meets standards ratings (16%), 135 experiments received meets standards with reservations ratings (28%), and 269 experiments received does not meet standards ratings (56%). The 213 experiments that met standards or met standards with reservations spanned 108 included studies (50% of the total number of studies).</p> <p>Most of the experiments included systematic manipulation of the independent variable (n = 479, 99%), collected data on IOA for more than 20% of sessions on average (n = 457, 95%), and obtained acceptable IOA scores (n = 468, 97%). However, fewer than half of the experiments had a strong enough design to meet standards or meet standards with reservations (n = 225, 47%). Some of these studies would have met standards based on a different research question (e.g., comparing two interventions) but did not include a strong enough evaluation of the efficacy of FCT compared to baseline.</p> <p>The results of 212 experiments rated as meets standards or meets standards with reservations were reviewed based on the visual analysis criteria. One graph was not reviewed due to the reviewers being unable to identify the data points on the graph well enough to conduct visual analysis. Reviewers rated the experiments as providing strong or moderate evidence for 64% of those experiments (n = 135). More specifically, 132 experiments received a rating of strong evidence (62%), three experiments received a rating of moderate evidence (1%), and 77 experiments received a rating of no evidence (36%).</p> <hd id="AN0132113747-16">Descriptive Information</hd> <p>The 135 experiments with strong evidence or moderate evidence included 135 unique participants. Some experiments included multiple participants, and some experiments were not included because there were multiple experiments for one participant.</p> <hd id="AN0132113747-17">Participant description</hd> <p>[<reflink idref="bib1" id="ref84">1</reflink>] includes a summary of the participant information. The majority of participants were male (n = 94, 70%). In addition, most of the participants were younger than 10 years of age, with 3- to 5-year-olds constituting 27% of the sample (n = 37) and 6- to 10-year-olds constituting 29% of the sample (n = 39). Notably, most of the included participants would qualify for IDEA Part B services based on their age (n= 115, 85%). The race-ethnicity was not reported for 132 of the participants (98%).</p> <p>Summary of Participant Characteristics.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><tr><th align="left">Variable</th><th align="center">Number of participants</th><th align="center">Percentage of participants</th></tr><tr><td colspan="3">Gender</td></tr><tr><td> Female</td><td>33</td><td>24</td></tr><tr><td> Male</td><td>94</td><td>70</td></tr><tr><td> Not reported</td><td>8</td><td>6</td></tr><tr><td colspan="3">Age</td></tr><tr><td> Younger than 3 years old</td><td>6</td><td>4</td></tr><tr><td> 3 to 5 years</td><td>37</td><td>27</td></tr><tr><td> 6 to 10 years</td><td>39</td><td>29</td></tr><tr><td> 11 to 21 years</td><td>39</td><td>29</td></tr><tr><td> 22 years old and older</td><td>12</td><td>9</td></tr><tr><td> Not reported</td><td>2</td><td>1</td></tr><tr><td colspan="3">Race-ethnicity</td></tr><tr><td> American Indian or Alaska Native</td><td>0</td><td>0</td></tr><tr><td> Asian</td><td>0</td><td>0</td></tr><tr><td> Black or African American</td><td>1</td><td>1</td></tr><tr><td> Hispanic</td><td>1</td><td>1</td></tr><tr><td> Multiple races or ethnicities listed</td><td>0</td><td>0</td></tr><tr><td> Native Hawaiian or Other Pacific Islander</td><td>0</td><td>0</td></tr><tr><td> White</td><td>1</td><td>1</td></tr><tr><td> Not reported</td><td>132</td><td>98</td></tr><tr><td colspan="3">IDEA disability category</td></tr><tr><td> Autism</td><td>77</td><td>57</td></tr><tr><td> Deaf-blindness</td><td>0</td><td>0</td></tr><tr><td> Developmental delay</td><td>8</td><td>6</td></tr><tr><td> Emotional disturbance</td><td>17</td><td>13</td></tr><tr><td> Hearing impairment</td><td>1</td><td>1</td></tr><tr><td> Intellectual disability</td><td>55</td><td>41</td></tr><tr><td> Multiple disabilities</td><td>56</td><td>41</td></tr><tr><td> Orthopedic impairment</td><td>13</td><td>10</td></tr><tr><td> Other health impairment</td><td>20</td><td>15</td></tr><tr><td> Specific learning disability</td><td>0</td><td>0</td></tr><tr><td> Speech or language impairment</td><td>4</td><td>3</td></tr><tr><td> Traumatic brain injury</td><td>1</td><td>1</td></tr><tr><td> Visual impairment</td><td>5</td><td>4</td></tr><tr><td> Did not meet definition for any category</td><td>5</td><td>4</td></tr></table> </ephtml> </p> <p>-1 Note. IDEA = Individual With Disabilities Education Improvement Act. For disability categories, individuals in the multiple-disabilities category were also recorded in individual disability categories.</p> <p>Seventy-four participants’ reported disability met the definition for one disability category (55%), whereas 56 participants’ reported disability met the definition for more than one IDEA disability category (i.e., multiple disabilities were listed for participants that met the definition of different categories; 41%). Five participants’ disability did not clearly meet any of the IDEA disability categories (4%). These participants had a diagnosis of Rett syndrome, brain damage (without specifically stating a traumatic brain injury), or a disability description that was too broad to categorize. Each of the participants in the multiple-disabilities category was also scored as being in specific disability categories for the purpose of the rest of the review, due to the number of participants in the multiple-disabilities category. Once the disability categories were scored in this manner, the disability categories of autism (n = 77, 57%), intellectual disability (n = 55, 41%), and multiple disabilities (n = 56, 41%) had the most participants. There were also 20 participants in the category of other health impairments (15%). The most common diagnoses within this category were seizure disorder or epilepsy and attention deficit hyperactivity disorder.</p> <hd id="AN0132113747-18">Topography of challenging behavior and communication</hd> <p> <ulink href="http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399">http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399</ulink> (available online) includes information regarding the dependent variables. For most of the participants, multiple challenging-behavior topographies were reported (n = 78, 58%). The topography of challenging behavior was disruptive behavior for 23 participants (17%), aggression for 19 participants (14%), self-injurious behavior for nine participants (7%), and inappropriate sexual behavior for two participants (1%). The most common topography of communication was a vocal response (n = 49, 36%). Picture communication (n = 36, 27%), speech-generating devices (n = 14, 10%), and gestures (n = 7, 5%) were also recorded for many of the participants. For 17 participants, multiple communication topographies were recorded as dependent measures (13%).</p> <hd id="AN0132113747-19">Function of challenging behavior</hd> <p>Twenty-four participants engaged in challenging behavior to access attention (18%) and 29 participants engaged in challenging behavior to access tangible items or food (21%). An additional 34 participants engaged in challenging behavior to escape demands (25%). The challenging behavior served multiple functions for 40 included participants (30%). None of the included participants’ challenging behavior was maintained solely by automatic reinforcement. The function did not fit the typical categories assessed in an FBA for eight participants (e.g., access to implementer compliance with participant request; 6%).</p> <hd id="AN0132113747-20">Implementer and setting</hd> <p> <ulink href="http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399">http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399</ulink> (available online) includes information regarding the implementer and setting. For many of the participants, researchers implemented the intervention (n = 99, 73%). However, school professionals (n = 14, 10%), parents or caregivers (n = 13, 10%), and non–school professionals (e.g., job coach, group home staff) were also common implementers (n = 9, 7%). Similarly, the implementer conducted the intervention in a clinical setting for many of the participants (n = 66, 49%). The intervention was conducted in school (n = 31, 23%) or home settings (n = 25, 19%) for approximately half of the participants.</p> <hd id="AN0132113747-21">Intervention characteristics</hd> <p> <ulink href="http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399">http://journals.sagepub.com/doi/suppl/10.1177/0014402918793399</ulink> (available online) includes information regarding the intervention characteristics. For nearly all participants, extinction was used as a component of the FCT intervention (n = 128, 95%). In addition, for most of the participants, no other reinforcement strategies were used and no punishment strategies were used (i.e., the intervention consisted solely of FCT and extinction or FCT without extinction; n = 120, 89%). Punishment interventions (e.g., response blocking) were included as a component of the intervention for 15 participants (11%).</p> <hd id="AN0132113747-22">Evidence-Based Practice Review</hd> <p>The reviewers evaluated the extent to which FCT met the definition for an evidence-based practice for each disability category, based on the studies demonstrating strong evidence or moderate evidence for the efficacy of FCT. To be considered an evidence-based practice, there needed to be 20 or more participants across five or more articles and across three or more research teams for the disability category. Four disability categories included 20 or more participants: autism (n = 77), intellectual disability (n = 55), other health impairments (n = 20), and multiple disabilities (n = 56). For each of these disability categories, the participants spanned five or more articles and three or more research teams. Based on this information, FCT was considered an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities.</p> <hd id="AN0132113747-23">Discussion</hd> <p>The purpose of this review was to synthesize the current literature regarding the use of FCT to reduce challenging behavior in individuals with disabilities. Following the quality review and visual analysis, 135 experiments demonstrated strong or moderate evidence for the use of FCT to reduce challenging behavior.</p> <hd id="AN0132113747-24">Descriptive Information</hd> <p>Several themes emerged from the descriptive review based on the participant characteristics. The majority of the included participants were school-age children (i.e., 3 to 21 years old; n = 115, 85%), with few participants younger than 3 or older than 21 years. These data indicate that there is a large amount of evidence supporting the use of FCT for school-age children with disabilities. Based on the efficacy of FCT with this population, qualified teachers and school personnel should consider implementing FCT with students with disabilities. However, there is a need for additional research with children younger than 3 years old, who typically receive services through IDEA Part C providers. In addition, there is a need for more research on the efficacy of FCT with adults with disabilities, as only 12 included participants were over the age of 21 years. Many of the included children had a diagnosis of autism, intellectual disability, or multiple disabilities. It is important to note that nearly half of the included participants met the definition for multiple disabilities (n = 56, 41%), which may have affected the disability data.</p> <p>The results indicate that researchers, school personnel, and parents can effectively implement FCT to reduce challenging behavior for individuals with disabilities. In addition, the data indicate that FCT is effective in reducing challenging behavior across clinical, home, and school settings. FCT was effective in reducing a variety of topographies of challenging behaviors. Finally, the results indicate that FCT is effective in reducing challenging behavior maintained by access to tangible items, access to attention, and escape from demands. There is not sufficient support for the use of FCT to reduce automatically maintained challenging behavior. However, this finding was not surprising, considering that the intervention requires the implementer to provide access to the function-based reinforcement contingent upon appropriate communication. In many cases, it is unlikely that the implementer has sufficient control over the source of reinforcement for automatically maintained behavior to accurately implement FCT.</p> <p>In the vast majority of cases, FCT was implemented with extinction rather than continuing to allow the challenging behavior to contact reinforcement. This information suggests that research supports the use of FCT with extinction. Practitioners should use FCT with extinction, when it is possible to do so. There are some cases in which it is not possible to implement an extinction procedure (e.g., attention-maintained unsafe behavior). FCT without extinction has been effective in reducing challenging behavior for some participants, and in cases in which it is not possible to implement extinction, practitioners can consider using FCT without extinction (e.g., [<reflink idref="bib13" id="ref85">13</reflink>] ; [<reflink idref="bib14" id="ref86">14</reflink>] ; [<reflink idref="bib29" id="ref87">29</reflink>] ). However, previous research indicates extinction may be a necessary component of the intervention for some participants ([<reflink idref="bib24" id="ref88">24</reflink>] ). In addition, FCT was used in isolation rather than with other consequence strategies (e.g., other reinforcement procedures or punishment procedures) for nearly all of the participants. These data indicate that FCT with extinction is often effective in reducing challenging behavior but that in some cases, punishment procedures (e.g., response blocking) may be necessary to obtain clinically significant reductions in challenging behavior ([<reflink idref="bib22" id="ref89">22</reflink>] ; [<reflink idref="bib24" id="ref90">24</reflink>] ).</p> <hd id="AN0132113747-25">Quality Review and Visual Analysis</hd> <p>Of the 215 included studies, 108 (50%)included a design that compared baseline to FCT and met standards or met standards with reservations. These findings, that approximately half of included studies did not meet standards, may be due to a number of factors. First, the inclusion criterion with regard to design were broad—studies were required to include a line graph of the dependent variable. Due to this broad inclusion criterion, it is likely that many AB designs and other low-quality designs were included in the original 215 studies. Second, the reviewers rated studies based on the design used to compare baseline to FCT. This may have resulted in lower ratings for studies that would have otherwise met standards or met standards with reservations for a different research question (e.g., comparing the efficacy of two different interventions). Finally, there were no date restrictions for this literature review. Many of the commonly used quality criteria for single-case design were published within the last 10 years (e.g., [<reflink idref="bib11" id="ref91">11</reflink>] ; [<reflink idref="bib38" id="ref92">38</reflink>] ; [<reflink idref="bib50" id="ref93">50</reflink>] ; [<reflink idref="bib49" id="ref94">49</reflink>] ). For this reason, the older studies may have been less likely to adhere to the quality criteria used in this literature review, which were published in 2017 ([<reflink idref="bib49" id="ref95">49</reflink>] ). For example, the overall percentage of experiments receiving a rating of meets standards or meets standards with reservations was 44% across all included experiments, 37% for experiments published from 1985 to 1999, and 47% for experiments published from 2000 to 2017. These data suggest that the quality of research improved over time, although a more detailed analysis of this topic is warranted.</p> <p>Although half of the included studies did not meet standards, there were 108 studies that met standards or met standards with reservations. These data indicate that there is a large body of high-quality studies that have evaluated the efficacy of FCT. In addition, of the 212 experiments reviewed, the data from the majority of the experiments (n = 135, 64%) indicated that FCT was effective in reducing challenging behavior for the participants. In cases in which high-quality studies were conducted, the results typically supported the efficacy of FCT in reducing challenging behavior.</p> <p>In 36% of the experiments, the visual analysts rated the experiment as not demonstrating a functional relation. These data suggest that in some cases, FCT may not be effective in reducing challenging behavior. However, the frequency with which this occurs remains unclear. The experiments were required to include at least three demonstrations of effect to receive a rating of moderate evidence or strong evidence. The reviewers did not record the number of demonstrations of effect for the experiments rated as no evidence. Therefore, it remains unclear whether these experiments included some demonstrations of effect, no demonstrations of effect, or countertherapeutic effects (i.e., increases in challenging behavior during the intervention). For example, an experiment with a multiple-baseline-across-participants design could include three participants. In the experiment, two participants could have a demonstration of effect while one does not. Alternatively, all three participants could have no demonstrations of effect. In either case, the rating for these three participants would have been no effect for the purpose of this review because there were not three demonstrations of effect. Future reviews should record the number of demonstrations of effect, nondemonstrations, and countertherapeutic demonstrations in order to provide detailed information regarding the percentage of attempts to demonstrate an effect that resulted in no demonstration of effect.</p> <p>Current standards regarding the determination of evidence-based practices within single-case research do not provide clear guidance regarding experiments in which a functional relation was not identified (i.e., no evidence ratings). The recommendation, which involves having a sufficient number of studies, participants, and research teams (e.g., [<reflink idref="bib25" id="ref96">25</reflink>] ; [<reflink idref="bib49" id="ref97">49</reflink>] ), does not incorporate the information regarding the number of experiments in which no functional relation was demonstrated. An additional criterion for determining evidence-based practices via single-case research—that a certain proportion of studies must suggest a functional relation—may be necessary. Without this criterion, an intervention with sufficient testing could receive a designation as an evidence-based practice even if fewer than half of the experiments received a rating of strong evidence or moderate evidence. Similarly, a meta-analysis aggregating the findings across participants may provide more information regarding the overall average efficacy of the intervention and the circumstances in which FCT is effective and those in which FCT is ineffective.</p> <hd id="AN0132113747-26">Evidence Base for FCT by Disability Category</hd> <p>The results of the present review indicate that FCT is an evidence-based practice for children with autism, intellectual disability, other health impairments, and multiple disabilities. There was not sufficient evidence to consider FCT an evidence-based practice for the remaining disability categories: deaf-blindness, hearing impairment, emotional disturbance, orthopedic impairment, specific learning disability, speech or language impairment, traumatic brain injury, visual impairment, and developmental delay. Therefore, the strongest evidence supporting the use of FCT to reduce challenging behavior is with children with autism, intellectual disability, other health impairments, and multiple disabilities. However, the large body of evidence supporting the use of FCT to reduce challenging behavior for children with disabilities broadly should be noted.</p> <p>The results of the present review indicate that FCT is an evidence-based practice for children with autism, intellectual disability, other health impairments, and multiple disabilities.</p> <p>These findings support previous research and indicate there is a sufficient amount of high-quality literature to support the use of FCT in applied settings ([<reflink idref="bib44" id="ref98">44</reflink>] ) and that FCT is an evidence-based practice for children with autism ([<reflink idref="bib38" id="ref99">38</reflink>] ; [<reflink idref="bib50" id="ref100">50</reflink>] ). A previous review of the literature indicated that function-based interventions are an evidence-based practice for individuals with emotional disturbance ([<reflink idref="bib46" id="ref101">46</reflink>] ). However, there was not a sufficient number of participants in the present review to rate FCT as an evidence-based practice for individuals with emotional disturbance. This distinction is likely the case due to a portion of the studies in the previous review evaluating other function-based interventions, such as noncontingent reinforcement.</p> <hd id="AN0132113747-27">Limitations</hd> <p>The findings of the present review should be interpreted with caution, given some of the relevant limitations. We used the disability categories as defined in IDEA. Many included articles did not describe the participant’s disability based on the IDEA category. However, this method was chosen because many individuals with disabilities receive services through their school or other services provided under IDEA. In cases in which authors reported multiple diagnoses for a participant, we coded the participant under the multiple-disabilities category and under their individual disability categories. This decision was made because it was often unclear from the manuscript if the participant met the criterion for multiple disabilities as defined under IDEA or if the participant qualified for services under IDEA for only one of the disabilities listed. This may have led to an overrepresentation of participants under the multiple-disabilities category or individual disability categories. Another limitation is that we recorded descriptive information only for participants for whom FCT was found to be effective. We chose this method due to the research questions of the present review. The circumstances under which FCT is ineffective remain unclear, and future research should investigate the variables associated with FCT being less effective or ineffective.</p> <p>Finally, we did not conduct a calculation of effect sizes for the included studies. The purpose of this study was to evaluate the extent to which individual studies indicated a causal relation between FCT and reductions and challenging behavior and to evaluate the strength of the evidence for FCT. Future research should consider conducting statistical analyses that provide information regarding the common magnitude of effect from baseline to FCT across studies.</p> <hd id="AN0132113747-28">Directions for Future Research</hd> <p>The findings of this literature review resulted in the identification of a number of directions for future research. The extent to which the included participants reflected the population in the United States based on race-ethnicity remains unclear due to the vast majority of studies not reporting the race-ethnicity of the participants. Future research should include more detailed demographic information regarding included participants. Future research should continue to evaluate the efficacy of FCT with individuals ages birth to 3 years old and individuals older than 21 years of age. None of the included participants had a diagnosis of deaf-blindness or specific learning disability, indicating the need to conduct additional research on the efficacy of FCT with these populations. There is also a need for additional research in community settings because few studies were conducted in community settings.</p> <hd id="AN0132113747-29">Conclusions and Implications for Practice</hd> <p>The findings of the present review indicate that FCT is effective in reducing challenging behavior for individuals with disabilities. There is a large body of evidence supporting the use of FCT for school-age children with disabilities (i.e., 3–21 years old) and individuals with autism, intellectual disability, other health impairments, and multiple disabilities. Practitioners working with these populations should consider the use of FCT to reduce challenging behavior. In addition, the extant literature supports the use of FCT with extinction and indicates that the intervention is often effective without the use of additional reinforcement or punishment contingencies. Practitioners should consider implementing FCT with extinction prior to trying other variations of the intervention.</p> <p>Previous research indicates FCT can result in long-term maintenance and generalization of reductions in challenging behavior (e.g., [<reflink idref="bib9" id="ref102">9</reflink>] ; [<reflink idref="bib16" id="ref103">16</reflink>] ; [<reflink idref="bib20" id="ref104">20</reflink>] ). The results of this review, along with the previous research, support the efficacy of FCT in producing meaningful and sustained reductions in challenging behavior. School administrators should include training in the use of FCT for school personnel who work with children with disabilities and engage in challenging behavior. In addition, qualified specialists and in-home providers who work with parents should promote the use of this effective intervention in homes. In summary, there is ample evidence supporting the use of FCT across individuals with disabilities. Practitioners should strongly consider the use of FCT to reduce problem behavior based upon the decades of empirical evidence supporting its effectiveness.</p> <p>The results of this review, along with the previous research, support the efficacy of FCT in producing meaningful and sustained reductions in challenging behavior.</p> <hd id="AN0132113747-30">Supplemental Material</hd> <p>EC793399_Appendix_A_8.1.18 – Supplemental material for Functional Communication Training: The Strength of Evidence Across DisabilitiesSupplemental material, EC793399_Appendix_A_8.1.18 for Functional Communication Training: The Strength of Evidence Across Disabilities by Stephanie Gerow, Tonya Davis, Supriya Radhakrishnan, Emily Gregori and Gabby Rivera in Exceptional Children</p> <hd id="AN0132113747-31">Supplemental Material</hd> <p>EC793399__supplemental_Figure_1_8.3.18 – Supplemental material for Functional Communication Training: The Strength of Evidence Across DisabilitiesSupplemental material, EC793399__supplemental_Figure_1_8.3.18 for Functional Communication Training: The Strength of Evidence Across Disabilities by Stephanie Gerow, Tonya Davis, Supriya Radhakrishnan, Emily Gregori and Gabby Rivera in Exceptional Children</p> <hd id="AN0132113747-32">Supplemental Material</hd> <p>EC793399__supplemental_Table_2_8.3.18 – Supplemental material for Functional Communication Training: The Strength of Evidence Across DisabilitiesSupplemental material, EC793399__supplemental_Table_2_8.3.18 for Functional Communication Training: The Strength of Evidence Across Disabilities by Stephanie Gerow, Tonya Davis, Supriya Radhakrishnan, Emily Gregori and Gabby Rivera in Exceptional Children</p> <hd id="AN0132113747-33">Supplemental Material</hd> <p>EC793399__supplemental_Table_3_8.3.13 – Supplemental material for Functional Communication Training: The Strength of Evidence Across DisabilitiesSupplemental material, EC793399__supplemental_Table_3_8.3.13 for Functional Communication Training: The Strength of Evidence Across Disabilities by Stephanie Gerow, Tonya Davis, Supriya Radhakrishnan, Emily Gregori and Gabby Rivera in Exceptional Children</p> <hd id="AN0132113747-34">Supplemental Material</hd> <p>EC793399__supplemental_Table_4_8.13.13 – Supplemental material for Functional Communication Training: The Strength of Evidence Across DisabilitiesSupplemental material, EC793399__supplemental_Table_4_8.13.13 for Functional Communication Training: The Strength of Evidence Across Disabilities by Stephanie Gerow, Tonya Davis, Supriya Radhakrishnan, Emily Gregori and Gabby Rivera in Exceptional Children</p> <hd id="AN0132113747-35">Supplemental Material</hd> <p>EC_793399__supplemental_Figure_2_8.3.18 – Supplemental material for Functional Communication Training: The Strength of Evidence Across DisabilitiesSupplemental material, EC_793399__supplemental_Figure_2_8.3.18 for Functional Communication Training: The Strength of Evidence Across Disabilities by Stephanie Gerow, Tonya Davis, Supriya Radhakrishnan, Emily Gregori and Gabby Rivera in Exceptional Children</p> <ref id="AN0132113747-36"> <title>References</title> <blist> <bibl id="bib1" idref="ref7" type="bt">1</bibl> <bibtext>Alimovic S. 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  Data: Functional Communication Training: The Strength of Evidence across Disabilities
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  Data: <searchLink fieldCode="SO" term="%22Exceptional+Children%22"><i>Exceptional Children</i></searchLink>. Oct 2018 85(1):86-103.
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  Data: <searchLink fieldCode="DE" term="%22Communication+Strategies%22">Communication Strategies</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Disabilities%22">Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Functional+Behavioral+Assessment%22">Functional Behavioral Assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Reinforcement%22">Reinforcement</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Legislation%22">Educational Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Federal+Legislation%22">Federal Legislation</searchLink>
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  Data: 10.1177/0014402918793399
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  Data: Functional communication training (FCT) is a commonly used, often recommended intervention that involves teaching a functionally equivalent communicative response to replace challenging behavior. The purpose of this literature review was to evaluate the strength of the evidence for the use of FCT. A systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior for individuals diagnosed with a disability. FCT resulted in a decrease in challenging behavior for 135 participants. The reviewers rated FCT as an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities based on What Works Clearinghouse standards. Overall, the extant literature indicates FCT consistently results in the reduction of challenging behavior in children with disabilities. Implications for practice and directions for future research are discussed.
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        Value: 10.1177/0014402918793399
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 86
    Subjects:
      – SubjectFull: Communication Strategies
        Type: general
      – SubjectFull: Training
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Disabilities
        Type: general
      – SubjectFull: Child Behavior
        Type: general
      – SubjectFull: Functional Behavioral Assessment
        Type: general
      – SubjectFull: Reinforcement
        Type: general
      – SubjectFull: Evidence Based Practice
        Type: general
      – SubjectFull: Educational Legislation
        Type: general
      – SubjectFull: Federal Legislation
        Type: general
      – SubjectFull: Individuals with Disabilities Education Act
        Type: general
    Titles:
      – TitleFull: Functional Communication Training: The Strength of Evidence across Disabilities
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Gerow, Stephanie
      – PersonEntity:
          Name:
            NameFull: Davis, Tonya
      – PersonEntity:
          Name:
            NameFull: Radhakrishnan, Supriya
      – PersonEntity:
          Name:
            NameFull: Gregori, Emily
      – PersonEntity:
          Name:
            NameFull: Rivera, Gabby
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 10
              Type: published
              Y: 2018
          Identifiers:
            – Type: issn-print
              Value: 0014-4029
          Numbering:
            – Type: volume
              Value: 85
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Exceptional Children
              Type: main
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