Communication Modality Preference and the Social Validity of Functional Communication and Mand Training
Saved in:
| Title: | Communication Modality Preference and the Social Validity of Functional Communication and Mand Training |
|---|---|
| Language: | English |
| Authors: | Joel E. Ringdahl (ORCID |
| Source: | Journal of Developmental and Physical Disabilities. 2025 37(3):411-428. |
| Availability: | Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ |
| Peer Reviewed: | Y |
| Page Count: | 18 |
| Publication Date: | 2025 |
| Sponsoring Agency: | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH) National Institute on Deafness and Other Communication Disorders (NIDCD) (DHHS/NIH) |
| Contract Number: | R01HD069377 R21DC015021 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Interpersonal Communication, Intellectual Disability, Developmental Disabilities, Communication Skills, Behavior Modification, Preferences, Training, Program Effectiveness, Communication Strategies |
| DOI: | 10.1007/s10882-024-09956-6 |
| ISSN: | 1056-263X 1573-3580 |
| Abstract: | Researchers have shown that behavioral interventions that incorporate communication as a focus have demonstrated efficacy for individuals with intellectual and developmental disabilities (IDD). Researchers have demonstrated that individuals with IDD allocate responding to one communicative response modality over others when multiple communicative modalities produce reinforcement in the context of a concurrent-schedules arrangement. Identifying preference for communicative response modality provides one approach to incorporating aspects of social validity in the design of behavioral interventions for individuals with IDD, placing additional importance on demonstrations of the robustness of this preference. In the current study, we evaluated preference among concurrently available communication modalities for 14 individuals with IDD. Results of the study replicated previous, similar research in that the vast majority of individuals demonstrated a preference between communicative response modalities. We discuss the results within the context of social validity and implications for intervention. |
| Abstractor: | As Provided |
| Entry Date: | 2025 |
| Accession Number: | EJ1472209 |
| Database: | ERIC |
|
Full text is not displayed to guests.
Login for full access.
|
|
| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwGuTw9fBGmlj1zxqNBkPpjFAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDN0Ds0zakdct5JMvTwIBEICBm8YZTQm7rkHwUZ7r98kjvIf2tZrPnlMMlwQFoeaL9BJ_N0Ruicg1DyRfwu9yWB6T0at8segoasLbEU773fR4IYy1OPLZ4hc012SCCnUTSTda50z3xjZ4rkMOtcDk1Of5QJBa0Zzjg8-aRmn3_xQTN0zDqVherB581-Njazuy4DK0UuKvxPXyJgGhWXpKgs4f0kEVXjdhEjvcah-C Text: Availability: 1 Value: <anid>AN0185422488;jdp01jun.25;2025May28.05:04;v2.2.500</anid> <title id="AN0185422488-1">Communication Modality Preference and the Social Validity of Functional Communication and Mand Training </title> <p>Researchers have shown that behavioral interventions that incorporate communication as a focus have demonstrated efficacy for individuals with intellectual and developmental disabilities (IDD). Researchers have demonstrated that individuals with IDD allocate responding to one communicative response modality over others when multiple communicative modalities produce reinforcement in the context of a concurrent-schedules arrangement. Identifying preference for communicative response modality provides one approach to incorporating aspects of social validity in the design of behavioral interventions for individuals with IDD, placing additional importance on demonstrations of the robustness of this preference. In the current study, we evaluated preference among concurrently available communication modalities for 14 individuals with IDD. Results of the study replicated previous, similar research in that the vast majority of individuals demonstrated a preference between communicative response modalities. We discuss the results within the context of social validity and implications for intervention.</p> <p>Keywords: Autism spectrum disorder; Intellectual disability; Functional communication training; Preference; Social validity; Psychology and Cognitive Sciences Psychology</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>In recent years, researchers and practitioners from the field of applied behavior analysis have refocused their attention to issues of social validity. By way of example, the 2022 convention for the Association for Behavior Analysis International (ABAI) included 107 presentations with "social validity" as a keyword. Prior to 2022, the most recent, in-person ABAI convention ([<reflink idref="bib1" id="ref1">1</reflink>]) included 68 presentations with "social validity" as a keyword. The earliest searchable database for ABAI convention programs (2004) listed 39 presentations with "social validity" as a keyword. Issues related to social validity are not a new focus. Wolf ([<reflink idref="bib24" id="ref2">24</reflink>]) wrote a defining paper related to the importance of, types of, and methods for obtaining social validity, including the social acceptance of utilized procedures. Wolf described the process of assessing acceptance as a subjective, though necessary, aspect of applied behavior analysis. In application, this process has been undertaken through interviews or questionnaires with implementers (e.g., teachers), when conducted at all (Ferguson et al., [<reflink idref="bib7" id="ref3">7</reflink>]). Additionally, when social validity is measured at the level of the consumer, it remains unclear if the consumer is a parent or other stakeholder, or if the consumer is the individual (Callahan et al., [<reflink idref="bib6" id="ref4">6</reflink>]).</p> <p>Several behavior analytic researchers (e.g., Bannerman et al.,[<reflink idref="bib5" id="ref5">5</reflink>]; Peterson et al., [<reflink idref="bib14" id="ref6">14</reflink>]), have noted that one way to incorporate the opinions of those receiving behavior analytic services is to offer choices within the context of intervention. As Peterson et al. ([<reflink idref="bib14" id="ref7">14</reflink>]) noted, self-determination can be conceptualized as including choice opportunities. Concurrent reinforcement schedule arrangements (including concurrent chains schedules) offer one way for practitioners and researchers to evaluate the choices of those receiving services, and they offer a means for those receiving services to demonstrate an opinion of intervention structure and/or intervention components, regardless of the client's level of communication. Hanley et al. ([<reflink idref="bib11" id="ref8">11</reflink>]) provided an example of this type of intervention choice arrangement. In this study, two individuals were presented with a choice between functional communication training (FCT) and noncontingent reinforcement (NCR) using a concurrent chains schedule. Both individuals demonstrated a preference for the FCT-based intervention, as indicated by allocation to selection responses that led to FCT implementation more often than NCR implementation. Although the impact of preference on intervention efficacy was beyond its scope, the study provided a demonstration of how individual preference for known efficacious interventions can be determined. Such opportunities allow individuals to play an active role in their intervention services.</p> <p>In another example using choice, Schieltz et al. ([<reflink idref="bib19" id="ref9">19</reflink>]) used a concurrent schedule arrangement to identify the preferred academic intervention package for an elementary-aged child with a reading disorder. Prior to the choice evaluation, the effects of contingent positive reinforcement alone and in combination with one of two similar but different instructional strategies (preview reading, model reading) on the child's academic performance and challenging behavior was conducted. The child showed better academic performance and lower challenging behavior when contingent reinforcement plus model reading was conducted than when contingent reinforcement was conducted alone or in combination with preview reading. When given the choice of intervention packages, the child selected the most effective academic intervention package most often.</p> <p>Some researchers have also evaluated individuals' preference for components within an intervention. Winborn-Kemmerer et al. ([<reflink idref="bib23" id="ref10">23</reflink>]) used a concurrent schedule arrangement to identify individual preference for communication modalities with two individuals receiving FCT. Results showed that both participants allocated responding to one of two available communication options reinforced on identical fixed ratio (FR) 1 schedules. Ringdahl et al. ([<reflink idref="bib16" id="ref11">16</reflink>]) reported this same phenomenon with 18 individuals with intellectual and developmental disabilities (IDD) whose intervention goals included identification of alternative and augmentative communication (AAC) strategies. All 18 participants differentially allocated responding to one of two available options in the context of a concurrent FR 1/FR 1 schedule, following a brief history of reinforcement under single FR 1 schedules arranged in a multielement design. Collectively, the results of Winborn-Kemmerer et al. and Ringdahl et al. established that individuals with IDD exhibited a preference for a communication modality.</p> <p>FCT represents one of, if not the most, widely researched intervention programs for addressing challenging behavior exhibited by individuals with IDD (Tiger et al., [<reflink idref="bib20" id="ref12">20</reflink>]). As a result, communication goals are often part of the clinical scope for this population. Thus, further establishing the robust nature of communication modality preference may have implications for this common intervention focus and may provide practitioners with both a rationale and a means to incorporate individual choice into intervention design. The immediate purpose of the current study was to directly replicate the concurrent schedule arrangement used to identify communication modality preference for individuals with IDD as implemented by Winborn-Kemmerer et al. ([<reflink idref="bib23" id="ref13">23</reflink>]) and Ringdahl et al. ([<reflink idref="bib16" id="ref14">16</reflink>]). The broader purpose of the study was to provide a more solid foundation upon which to make recommendations related to identification of individual preference for communication modality as a means of integrating individual choice into behavioral interventions. Specifically, the current study evaluated whether individuals diagnosed with IDD would demonstrate a preference among communication modalities in the context of FCT or mand training, and the project highlighted the relevance of the results to social validity.</p> <hd id="AN0185422488-2">Method</hd> <p>The current study occurred at two research sites and across four phases. Phases 1and 2 consisted of pre−intervention assessments, including a functional analysis (Iwata et al., 1982/[<reflink idref="bib12" id="ref15">12</reflink>])/stimulus preference assessment (Fisher et al., 1992; Harding et al., [<reflink idref="bib13" id="ref16">13</reflink>]; Roane et al., 1998; Phase 1) and a mand modality proficiency assessment (Ringdahl et al., [<reflink idref="bib15" id="ref17">15</reflink>]; Phase 2). In Phase 3, FCT or mand training (labeled "FCTA/Mand Training A" because communication modality alternated session−by−session) were implemented. In Phase 4, individual communication response preference (labeled "FCTC/Mand Training C" because communication modalities were concurrently available) was assessed. Because this study focuses on the outcomes of Phases 3 and 4, the method related to those procedures appear here. Specific details on the exact procedures implemented at each site and across Phases 1 and 2, can be found in Ringdahl et al. (2016) and Girtler et al. (2023)</p> <hd id="AN0185422488-3">Participants, Settings, and Materials</hd> <p>[<reflink idref="bib1" id="ref18">1</reflink>]Fourteen of the initial 21 individuals enrolled completed the study. These 14 individuals exhibited two proficient communication strategies, researchers identified functional reinforcers, and family schedules allowed completion of the study (see Table 1 for a summary of relevant participant demographics at the time of the study)[<reflink idref="bib2" id="ref19">2</reflink>]<sups>2</sups>. Overall, participants were between the ages of 2 and 21 years (<emph>M</emph> = 7 years; 5 males, 9 females) and diagnosed with one or more IDD (e.g., autism spectrum disorder, intellectual disability, Rett syndrome). The majority of participants were White (86%) and non-Hispanic (64%). English was the primary language spoken in the home for 64% of participants, and Spanish was the primary language for 36% of participants. Approximately half (57%) of the participants had a history of AAC use prior to this study (i.e., microswitch, picture exchange, communication book, WeGo, Tobii i13, and applications including LAMP and Proloquo2Go). Of the 14 participants, challenging behavior was a reported concern for 11 participants (79%). However, challenging behavior was only observed during the functional analysis of challenging behavior for four participants (36% of those with challenging behavior reported as a concern). These individuals participated in the study as part of an evaluation of FCT as an intervention for challenging behavior. The remaining 10 participants took part in the study to evaluate the efficacy of multiple AAC strategies to support communication specific to requesting reinforcers (i.e., mands). Their evaluation is referred to as mand training.</p> <p>Table 1 Participant demographics</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Participant&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Project Enrolled&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Age at Enrollment (in years)&lt;sup&gt;1&lt;/sup&gt;&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Sex&lt;sup&gt;2&lt;/sup&gt;&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Race&lt;sup&gt;3&lt;/sup&gt;&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Ethnicity&lt;sup&gt;4&lt;/sup&gt;&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Diagnoses&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Primary Language Spoken in the Home&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;History with AAC&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="9"&gt;&lt;p&gt;&lt;italic&gt;Confirmed Presence of Challenging Behavior&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Aria&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Microswitch, PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Elena&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Wallis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Lacea&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;H&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;S&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="9"&gt;&lt;p&gt;&lt;italic&gt;No Confirmed Presence of Challenging Behavior&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Andre&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;H&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;S&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nita&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;H&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;S&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Henri&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CP, Dysphasia&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sophie&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD, Mod ID&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;LAMP, PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Armand&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;H&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD, DD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;S&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Juliet&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Multi&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;H&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Trisomy 4P, DD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;S&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Xerxes&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Alice&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;WeGo with TouchChat and/or Proloquo2Go, PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nina&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;21&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;iPad with Proloquo2Go, PECS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Courtney&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;F&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;W&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NH&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;E&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tobii i13 with Snap Core First, Communication book&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Note</emph> <sups>1</sups>age at enrollment for the three participants in Project 2 reflects their ages at the time of this study rather than their ages at the time of enrollment in their host project; <sups>2</sups>sex = sex designated at birth with F = female, M = male; <sups>3</sups>race = racial categories of the National Institutes of Health with A = Asian, Multi = multi-race, W = White; <sups>4</sups>ethnicity categories of the National Institutes of Health with H = Hispanic, NH = non-Hispanic; Other abbreviations include: ASD = autism spectrum disorder; CP = cerebral palsy; DD = developmental delay; Mod ID = moderate intellectual disability; RS = Rett syndrome; E = English; S = Spanish; AAC = alternative and augmentative communication; PECS = picture exchange communication system</p> <p>Sessions took place in clinic therapy rooms measuring 20–25 m<sups>2</sups> or in rooms of the participants' homes (e.g., bedroom) via telehealth. During all sessions, relevant session-related materials (e.g., preferred items) were present. Toys and leisure activities were identified through a combination of free operant (Roane et al., [<reflink idref="bib18" id="ref20">18</reflink>]) and paired choice (Fisher et al., [<reflink idref="bib8" id="ref21">8</reflink>]) preference assessments, which were used in subsequent analyses. Several high-tech communication response options were used, including a BIGmack switch, iPad with Proloquo2Go application, iPad with SoundingBoard application, Wego™, and Tobii i13 with Snap Core First application. Low-tech communication response options included picture cards using Boardmaker® software and a communication book with Boardmaker® pictures. For each participant, a single, specific icon (for all high-tech options except for the BIGmack switch, which had no picture affixed to it) or picture card (low-tech options) depicting the reinforcer being requested was used during all FCT or mand training procedures, including the mand modality proficiency assessment. The voice output on any device was set to match the picture or icon (e.g., an icon depicting toys resulted in the vocal output of "toys" or "toys please").</p> <hd id="AN0185422488-4">Response Definitions</hd> <p>Challenging behavior was individually defined for the four individuals who participated as part of an FCT-based intervention evaluation and included aggression (e.g., hitting, biting), self-injurious behavior (e.g., head banging), property destruction (e.g., throwing items), and disruptive behavior (e.g., screaming, crying). For all participants, appropriate communication responses were defined as activating a BIGmack switch (touching the device such that it played the voice output recording), touching a picture card (contact between any part of the participant's hand and the picture card), touching a screen (contact between any part of the participant's hand and the screen of a communication device or tablet with a communication app such that the device played the voice output recording), activating a screen (eye gaze with a communication app such that the device played the voice output recording), eye pointing (holding eye gaze for at least 2 s on a picture symbol), and using manual sign (hand gestures that communicated a targeted outcome such as placing a hand to the chest for "please," tapping tips of fingers of both hands together for "more," or pointing to an ear for "phone"). See Table 2 for a list of participants' targeted challenging behavior (if applicable) and communication modalities assessed in the mand modality proficiency assessment and subsequently chosen as targets for the FCTA/Mand Training A and FCTC/Mand Training C phases.</p> <p>Table 2 Participant targeted challenging behavior topographies and communication modalities</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Participant&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Challenging Behavior Topographies&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;High-Tech Option&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Low-Tech Option&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Manual Signing&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Vocalizations&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="6"&gt;&lt;p&gt;&lt;italic&gt;Confirmed Presence of Challenging Behavior&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Aria&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Aggression, Self-Injury&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"iPad, please"&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Elena&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Aggression, Disruptive Behavior&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SB activation: touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"Please"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"Toys"&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Wallis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Aggression, Self-Injury, Property Destruction&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"Please" or "Phone"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Lacea&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Aggression, Self-Injury, Property Destruction, Disruptive Behavior&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"Toys, please"&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="6"&gt;&lt;p&gt;&lt;italic&gt;No Confirmed Presence of Challenging Behavior&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Andre&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation; SB activation: touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nita&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"More"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Henri&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"Play"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sophie&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"Toys, please"&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Armand&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"More"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"More toys"&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Juliet&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"More"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Xerxes&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW activation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;"More"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Alice&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;WeGo activation: touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nina&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;iPad activation: eye gaze&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC touch&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Courtney&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tobii activation: eye gaze&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CB eye point&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Note</emph> MSW = microswitch; SB = sounding board app on an iPad; PC = picture card; CB = communication book</p> <p>Observers collected data in-vivo or via video recordings using laptop/desktop computers or iPads equipped with behavioral data collection software (e.g., BORIS; Friard &amp; Gamba, [<reflink idref="bib9" id="ref22">9</reflink>]). The software included count- and duration-based response recording. For count responses (e.g., aggression, appropriate communication), behavior was calculated as responses per minute (RPM; frequency of behavior divided by the session time in minutes). For duration responses, behavior was calculated as a percentage of session time (duration of behavior in seconds divided by the session time in seconds and multiplied by 100). When both count and duration responses were measured (e.g., aggression as a count measure, disruptive behavior as a duration measure), behavior was calculated as a percentage of 10 s intervals. That is, each session was divided into equal 10-s intervals, and an interval was counted as an occurrence if at least one behavior occurred within the interval. All intervals scored with an occurrence of behavior were summed, divided by the total number of session intervals, and multiplied by 100.</p> <hd id="AN0185422488-5">Interobserver Agreement</hd> <p>Interobserver agreement (IOA) was calculated for FCTA/Mand Training A and the FCTC/Mand Training C phases. During each phase, two trained data collectors independently observed the sessions and recorded the relevant responses for each participant. Observations took place either in-vivo or via video recordings. Across both FCT/Mand Training phases, IOA was calculated for challenging behavior and appropriate communication (mands) by dividing each session into 10-s intervals and conducting an interval-by-interval comparison of the observers' records. The number of intervals with exact agreement were summed and then divided by the total number of intervals for the session (i.e., agreements plus disagreements). The quotient was then multiplied by 100 to obtain the agreement percentage for that variable for that session. Reliability data were collected for at least 32% of all FCTA/Mand Training A sessions (<emph>M</emph> = 41.7%) across participants. Agreement scores ranged between 97% and 100% for challenging behavior (<emph>M</emph> = 98.9%) and 80% and 100% for appropriate communication (<emph>M</emph> = 96.3%). For the FCTC/Mand Training C phase, reliability data were collected for at least 20% of all sessions (<emph>M</emph> = 39.5%) across participants. Agreement on the occurrence of challenging behavior was 100% and ranged between 87 and 100% (<emph>M</emph> = 96.9%) for appropriate communication.</p> <hd id="AN0185422488-6">Procedures and Experimental Designs</hd> <p></p> <hd id="AN0185422488-7">Phase 3: FCTA or Mand Training A (FCTA/Mand Training A, Alternating Treatments)</hd> <p>These sessions were conducted with participants to provide a reinforcement history for using both communication response options in the relevant functional context. Sessions were conducted in a counterbalanced manner (i.e., one communication response reinforced in any given session) in an alternating treatments design. Across communication response conditions, the programmed reinforcer was restricted at the outset of the session (e.g., restricted access to leisure items or attention, presentation of demand instructions). If the individual did not exhibit the programmed communication response within 5 s, a graduated prompting sequence (vocal, model, physical) was followed. Communication responses resulted in 30 s to 1 min of access to the programmed reinforcers (e.g., access to attention or leisure items, break from the demand). Challenging behavior was placed on extinction for the four participants whose challenging behavior was confirmed in the functional analysis. For all other participants, there was no programmed consequence for challenging behavior if it were to occur. Sessions consisted of five response-reinforcer trials or were 5 min in duration. This phase continued until the following criteria were met: (a) five consecutive sessions with an 80% reduction in challenging behavior for each communication option (4 participants only), (b) independent mands were exhibited on greater than 80% of trials (all participants), and (c) reinforcement rates were within 10% for each communication response option (participants enrolled at Site 1); or, until 80% or more independent and accurate communication responses occurred across three consecutive sessions (participants enrolled at Site 2). Representative data from this phase are presented in the Results section; data from the FCTA/Mand Training A phase for the remaining participants are available from the first author upon request.</p> <hd id="AN0185422488-8">Phase 4: FCTC/Mand Training C (Mand Modality Preference Assessment, Concurrent)</hd> <p>After the participant completed FCTA/Mand Training A, the procedures were altered so that preference between the two communication response options could be determined in the context of a concurrent schedule. Sessions were 5 min in duration or consisted of 5 trials. The therapist utilized procedures similar to FCTA/Mand Training A, with the following changes: (a) reinforcement was delivered following either communicative response on an FR 1 schedule (i.e., concurrent FR 1/FR 1 schedule of reinforcement), and (b) the therapist delivered nonspecific prompts (e.g., "If you want something, let me know" or "If you need a break, let me know") when the communication response options were presented to the participant. Communication response options were placed equidistant to the participant and were alternated across sides in a counterbalanced manner. For communication response options that included manual sign or vocalizations, a signal was used to show its concurrent availability (e.g., open empty hand for manual sign while the other hand held the picture card). Preference was defined as differentiated response allocation favoring one of the two communicative responses for five consecutive sessions. The level of differentiation was not part of the determination of response preference. That is, we judged a stable 60/40 split in response allocation across five sessions to indicate preference equally to a 100/0 split.</p> <hd id="AN0185422488-9">Procedural Fidelity</hd> <p>Procedural fidelity data were collected across all study phases by scoring the presence or absence of procedural components according to task analyses created for each type of assessment and/or condition (e.g., conditions of the functional analysis such as free play and attention) conducted. Procedural fidelity was calculated by summing the total number of procedural components scored as present, dividing the sum by the total number of procedural components possible, and multiplying by 100. Procedural fidelity data were collected for at least 20% (range, 20–100%) of all sessions conducted in each FCT/Mand training phase. Specific procedural fidelity scores for FCTA/Mand Training A and FCTC/Mand Training C averaged 97.7% (range, 84–100%) and 95.7% (range, 85–100%), respectively.</p> <hd id="AN0185422488-10">Social Validity</hd> <p>Social significance of the goals was addressed by consulting with the care providers regarding the specific behaviors targeted for reduction and support, as well as which communication modalities to evaluate during intervention. Social acceptability of the procedures was addressed by determining individuals' preference for specific communication responses. Social impact of the outcomes was not directly addressed in the current study, though the individuals enrolled in Project 1 moved into a study designed to evaluate the impact of preferred communication strategies on longer term intervention maintenance, and the participants enrolled in Project 2 moved into a study designed to evaluate explicit instruction on navigating among categories, pages, and messages on their high-tech devices. Thus, the preference identification sets the occasion for investigation of social impact of the outcomes of intervention.</p> <hd id="AN0185422488-11">Results</hd> <p></p> <hd id="AN0185422488-12">Pre-Intervention Assessments</hd> <p>The results of the pre-intervention assessments identified either the functional reinforcers for challenging behavior or potentially reinforcing stimuli. A tangible context was identified for six participants, an attention context for one participant, an escape context for two participants, and a combination attention and tangible context for three participants. These results are summarized by participant in Table 3 (second and third columns). Additionally, two similarly proficient communication modalities were identified for the 11 participants from Project 1 (see the fourth column of Table 3 for the mand modalities selected for each participant). For Project 2, communication modalities utilized were those with which participants had a known history.</p> <p>Table 3 Participant outcomes across the pre-intervention, proficiency of mand modality, and FCTC/Mand Training C assessments</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Participant&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Functional Analysis Outcome&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Concurrent Operants Assessment Outcome&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Mand Modality Proficiency Assessment Outcome&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Mand Modality Preference Assessment Outcome&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Number of Sessions to Reach Differentiation&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;&lt;italic&gt;Confirmed Presence of Challenging Behavior&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Aria&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Vocalization, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Vocalization&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Elena&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SB, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SB&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Wallis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;bold&gt;Tangible&lt;/bold&gt;, Escape&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Manual sign, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Manual sign&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Lacea&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Escape&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;&lt;italic&gt;No Confirmed Presence of Challenging Behavior&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Andre&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Attention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SB, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;No preference&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nita&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Henri&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible + Attention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sophie&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Armand&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible + Attention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Juliet&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible + Attention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Xerxes&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tangible&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW, PC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MSW&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Alice&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;WeGo&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nina&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;iPad&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Courtney&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tobii&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Note</emph> Bold text = targeted functional context for subsequent study phases; PC = picture card; SB = sounding board app on an iPad; MSW = microswitch</p> <hd id="AN0185422488-13">Phase 3: FCTA or Mand Training A</hd> <p>Results of FCT or mand training yielded similar outcomes across participants. Specifically, all participants in Project 1 showed acquisition (<emph>M</emph> = 8 sessions/condition; range, 5–24 sessions/condition) of mands at similar rates (<emph>M =</emph> 1.06 RPM; range, 0.40–2.80 RPM) across both mand modalities. These results did not substantially differ between participants with and without confirmed challenging behavior. Specifically, for participants with challenging behavior, independent manding averaged 1.01 RPM (range, 0.40–1.61 RPM) across conditions and was achieved in an average of 12.8 sessions/condition (range, 5–24 sessions/condition). For participants without challenging behavior, independent manding averaged 1.09 RPM (range, 0.46–2.80 RPM) across conditions and was achieved in an average of 5.3 sessions/condition (range, 5–7 sessions/condition). Similar results were obtained for all participants in Project 2, wherein acquisition of independent manding occurred in an average of 10.2 sessions/condition (range, 5–17 sessions/condition). Across all of these participants, 80–100% independent and accurate communication responses were achieved for the final three Mand Training A sessions.</p> <hd id="AN0185422488-14">Phase 4: FCTC or Mand Training C (Mand Modality Preference Assessment)</hd> <p>Thirteen of the 14 participants who completed this study demonstrated differential responding (i.e., a preference) during FCTC/Mand Training C (Table 3, fifth column). Similar to Ringdahl et al. ([<reflink idref="bib16" id="ref23">16</reflink>]), different response patterns were identified. Nine individuals (64%) displayed a preference in the minimum number of sessions (<emph>N</emph> = 5) required by the definition of preference used in this investigation. For some participants (e.g., Nita, Sophie) responding favored one communication modality almost exclusively across all five sessions. For other participants (e.g., Elena), both responses occurred in the first few sessions of the mand modality preference assessment, followed by exclusive allocation toward the end of the assessment. Two of the 14 (14%) individuals displayed initially undifferentiated allocation that produced an indication of preference within 10 sessions. Two of the 14 (14%) individuals required greater than 10 sessions to demonstrate preference. For example, Aria's preference emerged after 13 sessions had been conducted. During the final five sessions of the assessment, she allocated responding almost exclusively to vocal requests. Across the 13 participants for whom a preference was identified, preference was determined in an average 6.6 sessions (range, 5–13 sessions). One individual, Andre, did not demonstrate a preference after 15 sessions.</p> <p>Relative to communication modality, 83% of participants (10 of 12) showed a preference for the high-tech option, whereas 8% of participants (1 of 12) showed a preference for the low-tech option. For the participant who showed no clear preference following 15 Mand Training C sessions, further analysis of the data showed that he exhibited more high-tech responses (74 requests) than low-tech responses (42 requests). When vocalizations (1 participant; Aria) or manual signs (1 participant; Wallis) were concurrently available with a low-tech option (picture card), neither participant (2 of 2) preferred the low-tech option; rather the unaided option was identified as preferred (vocalization for one participant, manual signs for one participant).</p> <hd id="AN0185422488-15">Representative Results</hd> <p>Figure 1 displays the results for Elena (top panel; participant who exhibited challenging behavior) and Aria (bottom panel; participant who did not exhibit challenging behavior). For Elena, independent manding during the FCTA phase occurred at similar rates across both communication modalities (<emph>M</emph> = 1.27 RPM, range, 1.17–1.50 RPM for sounding board; <emph>M</emph> = 1.35 RPM, range, 1.08–1.61 RPM for picture card) and challenging behavior never occurred. During the FCTC phase, Elena allocated responding to both communication modalities at similar rates in the first session (1.76 RPM for sounding board; 1.47 RPM for picture card) with sounding board responding becoming exclusive during the final three sessions. Because responding was slightly higher with the sounding board in the first session, preference for Sounding Board was identified within 5 sessions. Challenging behavior did not occur in any sessions.</p> <p>Graph: Fig. 1 Responses per minute of independent manding and challenging behavior during the FCTA and FCTC assessments for Elena (top panel) and Aria (bottom panel)</p> <p>For Aria, independent manding during the FCTA phase occurred at an average 0.87 RPM (range, 0.75–0.90 RPM) and 0.89 RPM (range, 0.77–1.09 RPM) across vocalization and picture card modalities, respectively. Challenging behavior occurred at a higher average rate during the picture card condition (<emph>M</emph> = 0.08 RPM, range, 0-0.73 RPM) when compared to the vocalization condition (<emph>M</emph> = 0.01 RPM, range, 0-0.14 RPM). During the FCTC phase, responding to one communication modality over the other communication modality was variable. Specifically, manding occurred at equal rates across both modalities in the first session and then shifted to vocalizations in the next four sessions before switching back to equal or near equal rates for both modalities. The final five sessions demonstrated an almost exclusive shift to the vocalization modality, which was identified as the preferred modality after 13 sessions. Across all sessions in this phase, challenging behavior did not occur.</p> <p>Figure 2 displays the results for Sophie (top panel) and Armand (bottom panel). For Sophie, independent manding during the Mand Training A phase occurred at similar rates (<emph>M</emph> = 0.80 RPM, range, 0.80–0.80 RPM for microswitch; <emph>M</emph> = 0.92 RPM, range, 0.80-1.00 RPM for picture card) across both communication modalities. During the Mand Training C phase, Sophie allocated responding almost exclusively to the microswitch (<emph>M</emph> = 0.76 RPM, range, 0.60-1.00 RPM) when the picture card modality (<emph>M</emph> = 0.04 RPM, range, 0-0.20 RPM) was concurrently available. Preference for communication modality was identified within five consecutive sessions.</p> <p>Graph: Fig. 2 Responses per minute of independent manding during the Mand Training A and Mand Training C assessments for Sophie (top panel) and Armand (bottom panel)</p> <p>For Armand, independent manding occurred at similar rates across both the microswitch (<emph>M</emph> = 0.96 RPM, range, 0.80–1.2 RPM) and picture card (<emph>M</emph> = 0.84 RPM, range, 0.80-1.00 RPM) modalities during the Mand Training A phase. During the Mand Training C phase, following variable responding during the first four sessions, Armand's responding shifted to the microswitch (<emph>M</emph> = 0.6 RPM, range, 0.20–0.80 RPM) when the picture card modality (<emph>M</emph> = 0.16 RPM, range, 0-0.60 RPM) was concurrently available. Preference for communication modality was identified within nine consecutive sessions.</p> <hd id="AN0185422488-16">Discussion</hd> <p>Preference for communication modality was assessed for 14 individuals with IDD referred for treatment of challenging behavior and/or mand training. Thirteen of the 14 individuals exhibited a preference for one modality when responses were reinforced in a concurrent schedule (FR 1/FR 1). These results replicated previous findings (Ringdahl et al., [<reflink idref="bib16" id="ref24">16</reflink>]; Winborn-Kemmerer et al., [<reflink idref="bib23" id="ref25">23</reflink>]). Replication studies, such as the current study, are needed to enhance the validity of previous findings and strengthen our confidence in their outcomes (Tincani &amp; Travers, [<reflink idref="bib21" id="ref26">21</reflink>]). Collectively, the current results and the results of Ringdahl et al. and Winborn-Kemmerer et al. provide repeated demonstrations that individuals with IDD exhibit preferences for the manner by which they communicate.</p> <p>A notable finding from the current study was that the participants did not exhibit uniform preference. That is, 10 individuals preferred high-tech modalities, one individual preferred low-tech modalities, and two individuals preferred unaided modalities, such as vocalizations (<emph>n</emph> = 1) or manual sign (<emph>n</emph> = 1). Thus, a preference could not have been assumed based on the array of communication modalities available. Instead, preference identification required direct observation of response allocation during a systematic investigation. One potential reason for the varied individual preference may be related to the specific attributes of a response modality and the potential that these attributes function on their own as reinforcers. Communication modality preference may be related to the response modality producing both the programmed session reinforcers (e.g., access to preferred stimuli) and response-related reinforcers (e.g., click, voice recording, or visual output). Identifying these potential extraneous reinforcers may have implications for designing alternative responses on an individual-by-individual basis. For example, exploring voice output devices may be important for an individual with known preference for auditory stimuli, while exploring devices with visual aspects may be important for an individual with known preference for visual stimuli.</p> <p>Given that preference, as defined in this and other investigations, describes a pattern or response allocation, reinforcement schedule related variables known to impact response allocation likely play a role. For example, if less effort is required for a particular response modality, the individual may allocate a greater proportion of responding to that modality. Similarly, if an individual's extra-experimental history includes reinforcement for a particular modality, or a modality similar to one included in the mand modality preference assessment (e.g., a different app-based modality on an iPad), the individual may allocate a greater proportion of responding to that modality.</p> <p>Finally, discriminability of the response option may play a role in preference. This variable may be of particular relevance when the available response modalities include an aided response such as a device or picture card and an unaided response such as a vocal or manual sign response. The mere presence of an external device or card may provide additional salience related to the reinforcement contingency in place. When response allocation among externally generated and person-generated options takes place, the device incorporated into the externally generated response must be present. Although we tried to make it clear that the person-generated response would produce reinforcement by including the unique stimuli associated with both responses in the concurrent-schedules arrangement, the externally generated option still had the benefit of two schedule-correlated stimuli (i.e., the unique stimulus and the device or card) present in each session.</p> <p>Regardless of the underlying reason for preference, understanding individual preference for communication modality is clinically important for several reasons. First, identifying and then using preferred communication strategies allows behavior analysts to weave social validity, particularly social acceptance of procedures as indicated by service recipients, into their practice with individuals with IDD. Individuals receiving services for communication delay have, by definition, challenges making their wants and needs known. The use of preference assessment strategies allows individuals to exhibit autonomy and actively contribute to the design of interventions they experience. Second, and closely related to social validity, conducting mand modality preference assessments can remove practitioner bias when developing communication-based interventions. These data, along with previously published studies, demonstrate individuals with IDD can make these selections. Third, identifying preferred communication strategies may enhance long-term maintenance of intervention effects. Ringdahl et al. ([<reflink idref="bib17" id="ref27">17</reflink>]) reported systematic differences in persistence of communicative responses as a function of response preference. Specifically, when individuals used high preferred communication modalities, their responses persisted to a greater extent when the intervention was challenged than when they used low preferred communication modalities. In addition, a subset of participants for whom challenging behavior was a clinical concern exhibited less relapse of challenging behavior in contexts associated with high preferred responses compared to contexts associated with low preferred responses. Thus, if communication-based interventions can be designed around highly preferred strategies, the clinical impact may continue when challenges to implementation are encountered in the natural environment.</p> <p>Several limitations of these findings also deserve discussion. Identifying the preferred modality may decrease the likelihood the individual will abandon the communication modality (see Bailey et al., [<reflink idref="bib4" id="ref28">4</reflink>]) and demonstrates respect for the individual by honoring their preference. Nonetheless, it is plausible that some individuals' preference might vary by context. For example, at home, an individual might prefer to use an eye-gaze activated speech-generating device but at a sibling's soccer game, the same individual might prefer to use picture cards because calibrating the eye-gaze device is very difficult on uneven surfaces. Similarly, an individual might prefer to use picture cards at home because they are more efficient to use in the home than a speech-generating device but prefer to use the speech-generating device at extracurricular activities because their friends engage more with the individual when they have their device. The current investigation did not evaluate these potential contexts by modality interactions. Moving forward, researchers would be wise to consider preference for communication modality as they do other preferences – dynamic and influenced by numerous factors, including dimensions of reinforcement and context that might influence those dimensions.</p> <p>Moving forward, additional research in the area of communication preference should be pursued along several lines. First, results of this investigation provide descriptions regarding differences in the "magnitude" of preference based on the number of sessions required to reach the preference criterion. However, the investigation did not evaluate if these qualitative differences translated to any functional differences related to intervention success and/or maintenance and generalization of communication-based interventions. Future studies could be designed to incorporate magnitude of preference as an independent variable in either within- or across-subjects research designs. Such studies could evaluate the predictive validity of preference magnitude on immediacy of intervention success, schedule thinning, and maintenance. Second, the practicality of the preferred communication modality may limit its application across contexts. In such situations, it may be possible that the preference of alternative, previously less preferred communication modalities, could be enhanced through systematically improving the response's reinforcement history. Future studies could be designed to determine (a) if preference for communication modality is dynamic, (b) the variables that contribute to changing this preference, and (c) if these changes in preference correspond with the previously described clinical benefits of incorporating preferred communication modalities into intervention (i.e., increased persistence of the response and limited relapse of challenging behavior). Finally, future research could focus on evaluation of societal by behavioral interactions. For example, it may be possible that socioeconomic status influences access to high-tech AAC options which may result in a preference for those approaches.</p> <p>The current study reported the communication modality preference for 14 individuals. The results replicated previous, similar research demonstrating response preference (e.g., Ringdahl et al., [<reflink idref="bib16" id="ref29">16</reflink>]; Winborn-Kemmerer et al., [<reflink idref="bib23" id="ref30">23</reflink>]). Given the robust nature of the finding and the potential clinical benefit, it seems prudent for clinicians to take intentional steps to incorporate preferred modalities in the communication-based interventions they design for individuals with IDD. This consideration also provides an important opportunity for practitioners to enhance the social validity of their interventions and include the individuals for whom they work as an active participant in intervention design.</p> <hd id="AN0185422488-17">Funding</hd> <p>This research was supported by the Eunice Kennedy Shriver National Institutes of Child Health &amp; Human Development (award R01HD069377) and the National Institutes of Deafness and Other Communication Disorders (award R21DC015021) of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.</p> <hd id="AN0185422488-18">Declarations</hd> <p></p> <hd id="AN0185422488-19">Ethical Approval</hd> <p>Approval for this study was obtained from the ethics committees of the University of Georgia and the University of Minnesota. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.</p> <hd id="AN0185422488-20">Informed Consent</hd> <p>Signed informed consent, including consent regarding the publication of their data, was obtained from legal guardians.</p> <hd id="AN0185422488-21">Conflict of Interest</hd> <p>The authors have no relevant financial or non-financial interests to disclose.</p> <hd id="AN0185422488-22">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0185422488-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Association for Behavior Analysis International (2004). 30th annual convention; Boston, MA; 2004; Program search resultshttps://<ulink href="http://www.abainternational.org/events/program-details/search-result.aspx?stpConvId=31&amp;stpIsExact=false&amp;stpSearchType1=KeyPhrase&amp;stpSearchValue1=social+validity">www.abainternational.org/events/program-details/search-result.aspx?stpConvId=31&amp;stpIsExact=false&amp;stpSearchType1=KeyPhrase&amp;stpSearchValue1=social+validity</ulink></bibtext> </blist> <blist> <bibl id="bib2" idref="ref19" type="bt">2</bibl> <bibtext> Association for Behavior Analysis International (2022). 48th annual convention; Boston, MA; 2022; Program search resultshttps://<ulink href="http://www.abainternational.org/events/program-details/search-result.aspx?stpConvId=90&amp;stpIsExact=false&amp;stpSearchType1=KeyPhrase&amp;stpSearchValue1=social+validity">www.abainternational.org/events/program-details/search-result.aspx?stpConvId=90&amp;stpIsExact=false&amp;stpSearchType1=KeyPhrase&amp;stpSearchValue1=social+validity</ulink></bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext> Association for Behavior Analysis International. (2019). 45th annual convention: Chicago, IL; 2019; program search results. &amp;stpIsExact=false&amp;stpSearchType1=KeyPhrase&amp;stpSearchValue1=social+validity. https://<ulink href="http://www.abainternational.org/events/program-details/search-result.aspx?stpConvId=57">www.abainternational.org/events/program-details/search-result.aspx?stpConvId=57</ulink>.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref28" type="bt">4</bibl> <bibtext> Bailey J, McComas JJ, Benavides C, Lovascz C. Functional assessment in a residential setting: Identifying an effective communicative replacement response for aggressive behavior. Journal of Developmental and Physical Disabilities. 2002; 14; 4: 353-369. 10.1023/A:1020382819146</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> Bannerman DJ, Sheldon JB, Sherman JA, Harchik AE. Balancing the right to habilitation with the right to personal liberties: The rights of people with developmental disabilities to eat too many doughnuts and take a nap. Journal of Applied Behavior Analysis. 1990; 23; 1: 79-89. 10.1901/jaba.1990.23-79. 2186017. 1286212</bibtext> </blist> <blist> <bibl id="bib6" idref="ref4" type="bt">6</bibl> <bibtext> Callahan K, Hughes HL, Mehta S, Toussaint KA, Nichols SM, Ma PS, Kutlu M, Wang H-T. Social validity of evidence-based practices and emerging interventions in autism. Focus on Autism and Other Developmental Disabilities. 2017; 32; 3: 188-197. 10.1177/1088357616632446</bibtext> </blist> <blist> <bibl id="bib7" idref="ref3" type="bt">7</bibl> <bibtext> Ferguson JL, Cihon JH, Leaf JB, Van Meter SM, McEachin J, Leaf R. Assessment of social validity trends in the journal of applied behavior analysis. European Journal of Behavior Analysis. 2019; 20; 1: 146-157. 10.1080/15021149.2018.1534771</bibtext> </blist> <blist> <bibl id="bib8" idref="ref21" type="bt">8</bibl> <bibtext> Fisher W, Piazza CC, Bowman LG, Hagopian LP, Owens JC, Slevin I. A comparison of two approaches for identifying reinforcers for persons with severe and profound disabilities. Journal of Applied Behavior Analysis. 1992; 25; 2: 491-498. 10.1901/jaba.1992.25-491. 1634435. 1279726</bibtext> </blist> <blist> <bibl id="bib9" idref="ref22" type="bt">9</bibl> <bibtext> Friard O, Gamba M, Fitzjohn R. BORIS: A free, versatile open-source event‐logging software for video/audio coding and live observations. Methods in Ecology and Evolution. 2016; 7; 11: 1325-1330. 10.1111/2041-210X.12584</bibtext> </blist> <blist> <bibtext> Girtler SN, Unholz-Bowden EK, Shipchandler A, McComas JJ, Kolb R. Use of augmentative and alternative communication by individuals with Rett Syndrome, Part 1: Page-linking. Journal of Developmental and Physical Disabilities. 2023. 10.1007/s10882-023-09903-x. 38449899. 10102680Advance online publication</bibtext> </blist> <blist> <bibtext> Hanley GP, Piazza CC, Fisher WW, Contrucci SA, Maglieri KA. Evaluation of client preference for function-based treatment packages. Journal of Applied Behavior Analysis. 1997; 30; 3: 459-473. 10.1901/jab.1997.30-459. 9316259. 1284062</bibtext> </blist> <blist> <bibtext> Harding JW, Wacker DP, Berg WK, Cooper LJ, Asmus J, Mlela K, Muller J. An analysis of choice making in the assessment of young children with severe behavior problems. Journal of Applied Behavior Analysis. 1999; 32; 1: 63-82. 10.1901/jaba.1999.32-63. 10201104. 1284541</bibtext> </blist> <blist> <bibtext> Iwata, B. A, Dorsey, M. F, Slifer, K. J, Bauman, K. E, &amp; Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27(2), 197–209. https://doi.org/10.1901/jaba.1994.27-197 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2(1), 3–20, 1982; https://doi.org/10.1016/0270-4684(82)90003-9).</bibtext> </blist> <blist> <bibtext> Peterson SM, Aljadeff-Abergel E, Eldridge RR, VanderWeele NJ, Acker NS. Conceptualizing self-determination from a behavioral perspective: The role of choice, self-control, and self-management. Journal of Behavioral Education. 2021; 30: 299-318. 10.1007/s10864-020-09368-4</bibtext> </blist> <blist> <bibtext> Ringdahl JE, Falcomata TS, Christensen TJ, Bass-Ringdahl SM, Lentz A, Dutt A, Schuh-Claus J. Evaluation of a pre-treatment assessment to select mand topographies for functional communication training. Research in Developmental Disabilities. 2009; 30; 2: 330-341. 10.1016/j.ridd.2008.06.002. 18672344</bibtext> </blist> <blist> <bibtext> Ringdahl JE, Berg WK, Wacker DP, Ryan S, Ryan A, Crook K, Molony M. Further demonstrations of individual preference among mand modalities during functional communication training. Journal of Developmental and Physical Disabilities. 2016; 28; 6: 905-917. 10.1007/s10882-016-9518-9. 29563763. 5858729</bibtext> </blist> <blist> <bibtext> Ringdahl JE, Berg WK, Wacker DP, Crook K, Molony MA, Vargo KK, Neurnberger JE, Zabala K, Taylor CJ. Effects of response preference on resistance to change. Journal of the Experimental Analysis of Behavior. 2018; 109; 1: 265-280. 10.1002/jeab.308. 29319190</bibtext> </blist> <blist> <bibtext> Roane HS, Vollmer TR, Ringdahl JE, Marcus BA. Evaluation of a brief stimulus preference assessment. Journal of Applied Behavior Analysis. 1998; 31; 4: 605-620. 10.1901/jaba.1998.31-605. 9891397. 1284151</bibtext> </blist> <blist> <bibtext> Schieltz KM, Wacker DP, Suess AN, Graber JE, Lustig NH, Detrick J. Evaluating the effects of positive reinforcement, instructional strategies, and negative reinforcement on problem behavior and academic performance: An experimental analysis. Journal of Developmental and Physical Disabilities. 2020; 32: 339-363. 10.1007/s10882-019-09696-y</bibtext> </blist> <blist> <bibtext> Tiger JH, Hanley GP, Bruzek J. Functional communication training: A review and practical guide. Behavior Analysis in Practice. 2008; 1; 1: 16-23. 10.1007/BF03391716. 22477675. 2846575</bibtext> </blist> <blist> <bibtext> Tincani M, Travers J. Replication research, publication bias, and applied behavior analysis. Perspectives on Behavior Science. 2019; 42; 1: 59-75. 10.1007/s40614-019-00191-5. 31976421. 6701502</bibtext> </blist> <blist> <bibtext> Unholz-Bowden EK, Girtler SN, Shipchandler A, McComas JJ, Kolb R. Use of augmentative and alternative communication by individuals with Rett Syndrome Part 2: High-tech and low-tech devices. Journal of Developmental and Physical Disabilities. 2023. 10.1007/s10882-023-09902-y. 38449899. 10102680Advance online publication</bibtext> </blist> <blist> <bibtext> Winborn-Kemmerer L, Ringdahl JE, Wacker DP, Kitsukawa K. A demonstration of individual preference for novel mands during functional communication training. Journal of Applied Behavior Analysis. 2009; 42; 1: 185-189. 10.1901/jaba.2009.42-185. 19721740. 2649840</bibtext> </blist> <blist> <bibtext> Wolf MM. Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis. 1978; 11; 2: 203-214. 10.1901/jab.1978.11-203. 16795590. 1311293</bibtext> </blist> </ref> <ref id="AN0185422488-24"> <title> Footnotes </title> <blist> <bibtext> The study took place across two university based applied behavior analysis research enterprises. While many of the procedures were similar across sites, some variations existed.</bibtext> </blist> <blist> <bibtext> Different aspects of the data from the three participants in project 2 are summarized in Girtler et al. ([10]) and Unholz-Bowden et al. ([22]).</bibtext> </blist> </ref> <aug> <p>By Joel E. Ringdahl; Kelly M. Schieltz; Matthew J. O'Brien; Jennifer J. McComas; Rose M. Morlino; Karla A. Zabala-Snow; Emily K. Unholz-Bowden and Shawn N. Girtler</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib24" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib14" firstref="ref6"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref8"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib23" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib16" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib20" firstref="ref12"></nolink> <nolink nlid="nl8" bibid="bib12" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib13" firstref="ref16"></nolink> <nolink nlid="nl10" bibid="bib15" firstref="ref17"></nolink> <nolink nlid="nl11" bibid="bib18" firstref="ref20"></nolink> <nolink nlid="nl12" bibid="bib21" firstref="ref26"></nolink> <nolink nlid="nl13" bibid="bib17" firstref="ref27"></nolink> |
|---|---|
| Header | DbId: eric DbLabel: ERIC An: EJ1472209 AccessLevel: 3 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
| IllustrationInfo | |
| Items | – Name: Title Label: Title Group: Ti Data: Communication Modality Preference and the Social Validity of Functional Communication and Mand Training – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Joel+E%2E+Ringdahl%22">Joel E. Ringdahl</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4282-5150">0000-0003-4282-5150</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kelly+M%2E+Schieltz%22">Kelly M. Schieltz</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7335-0624">0000-0001-7335-0624</externalLink>)<br /><searchLink fieldCode="AR" term="%22Matthew+J%2E+O'Brien%22">Matthew J. O'Brien</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9096-3585">0000-0002-9096-3585</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jennifer+J%2E+McComas%22">Jennifer J. McComas</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9539-7079">0000-0001-9539-7079</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rose+M%2E+Morlino%22">Rose M. Morlino</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1368-1813">0000-0003-1368-1813</externalLink>)<br /><searchLink fieldCode="AR" term="%22Karla+A%2E+Zabala-Snow%22">Karla A. Zabala-Snow</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5399-1686">0000-0001-5399-1686</externalLink>)<br /><searchLink fieldCode="AR" term="%22Emily+K%2E+Unholz-Bowden%22">Emily K. Unholz-Bowden</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0924-9518">0000-0003-0924-9518</externalLink>)<br /><searchLink fieldCode="AR" term="%22Shawn+N%2E+Girtler%22">Shawn N. Girtler</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6698-3685">0000-0001-6698-3685</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Developmental+and+Physical+Disabilities%22"><i>Journal of Developmental and Physical Disabilities</i></searchLink>. 2025 37(3):411-428. – Name: Avail Label: Availability Group: Avail Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 18 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: SourceSuprt Label: Sponsoring Agency Group: SrcSuprt Data: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)<br />National Institute on Deafness and Other Communication Disorders (NIDCD) (DHHS/NIH) – Name: NumberContract Label: Contract Number Group: NumCntrct Data: R01HD069377<br />R21DC015021 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Disabilities%22">Developmental Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Skills%22">Communication Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Preferences%22">Preferences</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Strategies%22">Communication Strategies</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s10882-024-09956-6 – Name: ISSN Label: ISSN Group: ISSN Data: 1056-263X<br />1573-3580 – Name: Abstract Label: Abstract Group: Ab Data: Researchers have shown that behavioral interventions that incorporate communication as a focus have demonstrated efficacy for individuals with intellectual and developmental disabilities (IDD). Researchers have demonstrated that individuals with IDD allocate responding to one communicative response modality over others when multiple communicative modalities produce reinforcement in the context of a concurrent-schedules arrangement. Identifying preference for communicative response modality provides one approach to incorporating aspects of social validity in the design of behavioral interventions for individuals with IDD, placing additional importance on demonstrations of the robustness of this preference. In the current study, we evaluated preference among concurrently available communication modalities for 14 individuals with IDD. Results of the study replicated previous, similar research in that the vast majority of individuals demonstrated a preference between communicative response modalities. We discuss the results within the context of social validity and implications for intervention. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2025 – Name: AN Label: Accession Number Group: ID Data: EJ1472209 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1472209 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10882-024-09956-6 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 18 StartPage: 411 Subjects: – SubjectFull: Interpersonal Communication Type: general – SubjectFull: Intellectual Disability Type: general – SubjectFull: Developmental Disabilities Type: general – SubjectFull: Communication Skills Type: general – SubjectFull: Behavior Modification Type: general – SubjectFull: Preferences Type: general – SubjectFull: Training Type: general – SubjectFull: Program Effectiveness Type: general – SubjectFull: Communication Strategies Type: general Titles: – TitleFull: Communication Modality Preference and the Social Validity of Functional Communication and Mand Training Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Joel E. Ringdahl – PersonEntity: Name: NameFull: Kelly M. Schieltz – PersonEntity: Name: NameFull: Matthew J. O'Brien – PersonEntity: Name: NameFull: Jennifer J. McComas – PersonEntity: Name: NameFull: Rose M. Morlino – PersonEntity: Name: NameFull: Karla A. Zabala-Snow – PersonEntity: Name: NameFull: Emily K. Unholz-Bowden – PersonEntity: Name: NameFull: Shawn N. Girtler IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 06 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 1056-263X – Type: issn-electronic Value: 1573-3580 Numbering: – Type: volume Value: 37 – Type: issue Value: 3 Titles: – TitleFull: Journal of Developmental and Physical Disabilities Type: main |
| ResultId | 1 |
