Sara Kupferschmidt, M.A., BCBA
*Note: This article was originally published in the October 2016 issue of Behavior Analysis Quarterly, Vol 2(4). Please download the issue for access to figures.
Innovations in technology have the potential to impact human behavior in significant ways. Check out my article in Behavioral Science in 21st Century discussing how technology may innovate treatment for individuals with autism. Considering challenging behavior, remarkable work has already been done in the area of functional behavior assessment. Treating challenging behavior, based on a functional behavior assessment (FBA), as opposed to a topography or other arbitrary reason, is now a standard component of any intervention that is based on Behavior Science (Carr, 1994). The evidence is clear, in order to make a meaningful difference in a person’s life who is engaging in challenging behavior, we must get to the bottom of why it is occurring in the first place. Essentially, interventions are more likely to be effective when they are function-based. This article will discuss one way that technology may enhance an FBA for challenging behavior, and the treatment that is informed by the results of that assessment.
An FBA can include an experimental functional analysis, which is considered by many to be the most rigorous means of identifying a function for a challenging behavior (e.g., Thompson & Iwata, 2007). In some cases, an experimental functional analysis may be contraindicated for a variety of reasons including the topography of the challenging behavior (e.g., self-injurious behavior that is too intense/severe, that produces physical injury; (Borrerro & Borrerro, 2008). One way that researchers are attempting to address this safety concern is by taking a look at an individual’s precursor behavior. Researchers have demonstrated that precursor behavior, (i.e., behavior that is presumably from the same response class as the challenging behavior, but also immediately precedes the challenging behavior) can be used to assess function in an experimental functional analysis and yield similar results (Najdowski, et al., 2008, Smith & Churchill, 2002). Moreover, when a function is identified and an intervention is applied to the precursor behavior itself, it may be just as effective (Najdowski, et al., 2008). If we can identify a function based on the precursor behavior and then intervene on the precursor behavior itself, we may be able to help an individual with challenging behavior without them having to engage in the potentially more intense challenging behavior. More research is warranted however it is nonetheless a promising line of research.
There is also a growing body of research that encourages the inclusion of physiological measures in an FBA. Researchers have assessed the relation between heart rate and challenging behavior, and found that it is possible to identify reliable patterns in an individual’s heart rate before, during and after episodes/instances of challenging behavior (Barrera, Violo, & Graver, 2007, Freeman, & Horner, 1999). This line of research is particularly relevant when assessing what may otherwise be described as anxious behavior. It is widely accepted that there is a relation in many instances between challenging behavior that may be called anxious behavior and an individual’s heart rate (Hassett & Danforth, 1982). In some cases, anxious behavior may even be directly related to this change in heart rate (e.g., change in heart rate may be a discriminative stimulus) and/or the anxious behavior may be a function of experiential avoidance to those changes in heart rate (Friman, Wilson, & Hayes, 1998). For a review of an account of a behavior analytic view of anxiety or anxious behavior there is no need to look very far. Earlier this year, Amber Crane provided a nice summary in an article for BAQ. Check it out here. Ultimately, it is critical to assess each individual’s unique situation to determine whether heart rate affects his/her challenging behavior.
Collectively, these lines of research may lead to a better understanding of challenging behavior, and more specifically anxious behavior. Including heart rate and precursor behavior in an FBA for challenging behavior could potentially enhance the assessment results and perhaps lead to better interventions and outcomes based on those findings. Furthermore, this may be particularly relevant to helping individuals with anxiety or anxious behavior.
A few months ago I happened to read about a company called Awake Labs. They are developing a wearable device that may be able to do exactly what the research described above suggests. It is being developed and marketed for children with autism as a means to enhance an FBA and/or intervention for anxious behavior. Specifically when a child with autism is wearing the wristband it will measure in real time his/her heart rate, temperature, and electrodermal activity through a pair of electrodes. It is connected to an app on a caregiver’s smartphone and will notify the caregiver of a change in those measures that has been associated with challenging behavior. As changes in those measures occur, the caregiver will be able to enter contextual data to describe what is happening in the environment so that a unique and customized profile is developed for the child with autism. This is important because the changes in those measures may not only be associated with anxious behavior (e.g., could be related to exercise or exhiliration) and so ongoing data collection of those measures as well as the observations of the contextual variables at the time of those changes, will potentially lead to a customized profile that is helpful in predicting challenging behavior. Ultimately, once an FBA has been completed that includes the measures of Reveal to enhance the results, the wristband may then also be included in a customized intervention plan. Specifically, it may provide caregivers with a prompt that challenging behavior is imminent or that precursor behavior is present. A caregiver can observe the context and situation, and determine whether or not intervention is warranted at that moment based on the prompt from the app on his/her smartphone. Furthermore, if a pattern is revealed, this information can then be used in a function-based intervention that includes self-monitoring for the individual with autism him/herself.
Implementing an FBA by including precursor behavior and potentially heart rate may enhance the results and potentially even enhance a function-based intervention. It would appear that Awake Labs has developed a tool that could be used towards that end. More research is warranted to evaluate whether this would be the case or not, but it would appear to be a plausible solution and/or addition to how we support individuals with complex challenging behavior.
Barrera, F.J., Violo, R.A. and Graver, E.E. (2007). On the Form and Function of Severe Self- Injurious Behavior. Behavioral Interventions,22: 5-33.
Borrero, C. S. W., & Borrero, J. C. (2008). Descriptive and experimental analyses of potential precursors to problem behavior. Journal of Applied Behavior Analysis, 41,83–96. doi:10.1901/jaba.2008.41-83.
Carr E.G., (1994). Emerging themes in the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 27(2), 393-399.
Freeman, R.L. & Horner, R.H., 1999. Relation between heart rate and Problem Behaviours. American Journal on Mental Retardation, 104 (4), 330-345.
Friman, P. C., Wilson, K. G., & Hayes, S. C. (1998). Why behavior analysts should study emotion: The example of anxiety. Journal of Applied Behavior Analysis, 31, 137-156.
Hassett, J., & Danforth, D. (1982). An introduction to the cardiovascular system. In J. T. Cacioppo & R. E. Petty (Eds.), Perspectives in cardiovascular psycho- physiology (pp. 418). New York: Guilford Press.
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Najdowski, A.C., Wallace, M.D., Ellsworth, C.L., MacAleese, A.N., Cleveland, J.M., (2008). Functional Analyses and Treatment of Precursor Behavior. Journal of Applied Behavior Analysis, 41, 97-105.
Smith, R. G., & Churchill, R. M. (2002). Identification of environmental determinants of behavior disorders through functional analysis of precursor behaviors. Journal of Applied Behavior Analysis, 35, 125–136.
Thompson, R.H., Iwata, B.A., (2007). A Comparison of Outcomes from Descriptive and Functional Analyses of Problem Behavior. Journal of Applied Behavior Analysis, 40 (2), 333-338.