FUNCTIONAL COMMUNICATION TRAINING Behavioural problems can often be viewed as a form of communication. This implies that behaviour problems are not random acts but rather purposeful in nature. An intervention approach to target such behaviours is Functional Communication Training (FCT). The focus of FCT intervention is to replace inappropriate or non-functional behaviour with functionally equivalent communicative alternatives (Saggers, 1995). FCT teaches a functionally appropriate and alternative response for the child to obtain reinforcement to replace non-functional behaviour (Brown et al., 2000). AUTISM AND FCT Children with autism have been found to differ from typically developing children in their use of communicative forms and behaviour. In the absence of a more formal communicative system, children with autism may come to rely on idiosyncratic and informal behaviours to communicate, e.g., informal gestures, head banging, echolalic speech and aggression. These behaviours can not only be dangerous and harmful but can also be difficult for an unfamiliar listener to recognise and interpret (Keen, Sigafoos & Woodyatt, 2000). IMPLEMENTATION OF FCT Assessment Intervention is based on information gathered from assessments to replace problem behaviours with a more appropriate communicative form (Keen et al., 2000). Assessment procedures used in FCT include an interview, a functional analysis and naturalistic observation to determine individual’s communicative potential (Sigafoos et al., 2000). Interview Caregivers and other health professionals involved are interviewed to gather information regarding the child’s behaviour and communicative attempts. Functional Analysis Communicative situations are structured, e.g., via the use of Communicative Temptations, to sample behaviours across a range of communicative functions (Keen et al., 2000). FCT is a reinforcement-based treatment that is directly based on the results of a functional analysis. Naturalistic Observation Information gained from naturalistic observation is used to complete the child’s profile of communicative and behavioural skills. Intervention As Dunlap and Duda (2001) state, FCT involves identifying the function or purpose of the child’s challenging or pre-linguistic behaviour and then teaching an appropriate more socially acceptable response that will serve the same purpose. The replacement stimulus, which is referred to as a mand, should involve functionally appropriate communication such as expressive output, gestures and pointing. Different types of mands have been successfully used in FCT including: verbalisations, manual signs, word or picture cards and gestures (Brown et al., 2000). Steps in treatment Target the behaviour identified for intervention. Select an appropriate mand to replace problem behaviour. Reinforce appropriate behaviour when used. Ignore problem behaviour. Source: (Derby et al., 1997). FCT initially begins in a highly structured and controlled environment where new communicative forms and behaviours can be taught displayed and reinforced, gradually generalising skills to a less controlled environment (Nelson, 2001). When choosing replacement behaviours or mands the following should be taken into account: The mand should be something within the child’s capability. The mand should be something that can be easily taught to the child. The mand should be easily noticed and acknowledged for immediate reinforcement. The mand should work quickly for the child. The mand should be readily available and appropriate to the child’s developmental level and skills. Source: (Dunlap & Duda, 2001) For example: A child who makes requests by grabbing or reaching may be taught to verbalise the word ‘want’ or use the Picture Exchange Communication System (PECS) symbol for ‘want’ as a replacement mand. When using FCT, it is important to remember the following: Reinforcement is vital in maintaining the new replacement behaviour. Ignoring the previous inappropriate behaviour and prompting and acknowledging the use of the replacement behaviour is important. Take advantage of natural opportunities to encourage and acknowledge the replacement behaviour. Ensure child’s requests are acknowledged so that FCT is effective. The replacement response must be more effective for the child than the previous behaviour so that the child is then more likely to use the new learnt response. It is important to be consistent until the child understands that the new skill will be useful in obtaining what he/she wants. Source: (Dunlap & Duda, 2001). Who can implement Functional Communication Training? Health professionals such as Psychologists, Speech Pathologists and Teachers can implement FCT. Parents and caregivers are also trained by a Psychologist or Speech Pathologist to implement FCT. Parent training can include: An assessment report stating target behaviours and treatment mands. A training session with the child, professional and parent. Feedback regarding their implementation of FCT. Source: (Derby et al., 1997). What is the timeframe for treatment? 10-30 minute training sessions daily with the child. Constant reinforcement of mands outside of treatment session. Continue until the problem behaviour is modified. Source: (Derby et al., 1997). RECEPTIVE LANGUAGE AND FCT FCT targets receptive language using strategies such as reducing the rate of speech to allow for maximum comprehension , prompting for a response, and tailoring language and responses to the child’s level. EXPRESSIVE LANGUAGE AND FCT Strategies used in FCT to target expressive language in autism include: Teaching a new more functional communicative form to replace existing communicative functions that may not be clearly expressed. Directly teaching specific communicative functions to the child using strategies such as: prompting, imitation, modelling, acknowledgment and reinforcement (Keen et al., 2000). Encourage caregivers to be highly responsive to child’s communicative attempts by interpreting and responding to the child’s potential communicative behaviour via techniques such as linguistic mapping and scaffolding (Keen et al., 2000). SPEECH AND FCT FCT targets speech intervention directly by teaching, encouraging, modelling and reinforcing appropriate communicative responses to replace inappropriate behaviour. Such responses include vocalising if the child is verbal. PRAGMATICS AND FCT Strategies such as acknowledging and responding to the child’s requests targets pragmatic skills in FCT. FCT also encourages pragmatic skills such as eye contact and joint attention. BEHAVIOUR AND SOCIAL SKILLS AND FCT: The child’s behaviour and social skills are targeted through replacing challenging behaviour and inappropriate communicative forms with socially acceptable and functional behaviour using strategies such as reinforcement of appropriate forms and ignoring inappropriate forms. Problem behaviours, such as head banging can be replaced with a more functional and socially accepted behaviour including the word ‘no’ or ‘I don’t like’ depending on the communicative intent of the behaviour. RESOURCES Resources for the assessment include: Initial interview/case history. Video recorder to record child’s responses and problem behaviour. Resources for intervention include: Video recorder for training parents. Informational handouts for the parents. ADVANTAGES OF FCT There are numerous advantages to using FCT, these include: Intervention uses natural opportunities to reinforce new appropriate behaviours. Parents are heavily involved in treatment. Can give meaning to problem behaviours. Can be used with Augmentative and Alternative Communication (AAC). DISADVANTAGES OF FCT The disadvantages of FCT include: Reinforcement is vital for carry over of new behaviour, this can be time consuming and difficult. In-depth assessment required. Problem behaviours may take months to suppress. EFFICACY OF FCT Some of the studies that support the efficacy of FCT include: Derby et al. (1997) demonstrated that long-term modification of problem behaviour is possible when functional analysis and FCT are implemented in the home setting. In all cases in this study positive social behaviour emerged. (Level III.1) (Refer to Evidence Table). In 2000 a study by Brown et al. found FCT to be an effective and often efficient treatment of problem behaviour in children with developmental disabilities when the treatment was appropriately matched to the results of a functional analysis. (Level III.2) A review of FCT and pre-linguistic communication behaviour of children with autism by Keen et al., (2000) suggested that FCT has proven effective in addressing problem behaviours for children with autism and noted this as an area for further study in targeting pre- linguistic behaviours. (Level I). There is strong evidence to support the efficacy of FCT in children with autism. Efficacy has been demonstrated with levels of evidence varying from I to IV. There is no one treatment that will be effective for all children with autism. It is important to identify the child’s individual needs and modify the treatment appropriately. Overall however, there is strong evidence to support the efficacy of FCT with this population.