Transfer of Behavioral Function as a Contributing Factor in Treatment Relapse

Abstract

When relapse occurs following successful treatment to reduce problem behavior, it is often attributed to inconsistent implementation of maintenance programs. Although less likely, another potential cause for relapse is a change in the behavior's maintaining contingency over time. To examine this possibility, additional assessment was conducted with 4 individuals who were rereferred to a daytreatment program due to recurrence of their self-injurious behavior (SIB) 2 months to 2 years following successful treatment. In each case, the original treatment had been developed and implemented based on the outcome of functional analysis assessments. For 1 subject, results of a second functional analysis were consistent with those from the original assessment, indicating that the function of her SIB had remained unchanged. For the other 3 subjects, results of the second assessment suggested that their SIB had acquired new or additional functions. These findings indicate that factors other than program inconsistency can lead to relapse, and that clinical reevaluation for such cases should include a current functional analysis to determine if new treatment components are needed.

Basic and translational evaluation of renewal of operant responding

“…One strategy for improving treatment outcomes is to conduct systematic research on the basic processes that contribute to treatment failure. In practice, interventions may fail for a variety of reasons, including lapses in treatment integrity (St. Peter Pipkin, Vollmer, & Sloman, 2010), changes in motivational variables (Murphy, McSweeney, Smith, & McComas, ), and changes in the function of behavior (Lerman, Iwata, Smith, Zarcone, & Vollmer, ), among others. Variables of treatment failure are often labeled with descriptive terms (e.g., “lapse in treatment integrity”) that may be neither linked to identifiable conceptual systems nor suggestive of a strategy for remediation (however, see St. Peter Pipkin et al, 2010, for an in‐depth discussion and suggestions for potential ways to mitigate lapses in treatment integrity).…”

Functional Assessment: Contributions and Future Directions

“…In fact, treatment plans often change over time, and these changes should be influenced by assessment data in the same way as the original intervention plan (Lerman, Iwata, Smith, Zarcone, & Vollmer, 1994 (Carr, in press;Durand, 1990 (Homer, O'Neill, & Flannery, 1993).…”

Applied Behavior Analysis for Children with Autism Spectrum Disorders

“…In addition, poor reliability between two observers may be due to the fact that the behavior serves different functions in the presence of different people or environments. Furthermore, if the two assessments are temporally distant, poor reliability scores may be caused by a change in behavioral function over time (e.g., Lerman, Iwata, Smith, Zarcone, & Vollmer, 1994). Thus, the reliability of indirect assessments may be improved by administering them in a small time window to individuals in the same environment who have similar exposure to the SIB.…”