Category: Essay

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FUNCTION-BASED TREATMENTS FOR TODDLERS

Effectiveness of Function-Based Treatments Versus Non-Function-Based Treatments on Disruptive Behaviors for Toddlers with Developmental Disabilities

Young children with disruptive behaviours are more likely to be removed from early childhood programs (Brauner & Stephens, 2006; Webster-Stratton & Reid, 2003). Disruptive behaviours are a kind of problem behaviours. These behaviours are called disruptive since children with disruptive problem behaviours factually disrupt the individuals and activities around them at different settings, such as at home, at school, and outdoors (Sun & Shek, 2012). Arnold, McWilliams, and Arnold (1998) reported that these disruptive behaviours are one of the most problem behaviours faced by instructors.

Research revealed that the most common disruptive behaviours were crying, screaming, and yelling, followed by turning over materials, pushing materials away, and hiding (Sun & Shek, 2012). The results showed that instructors perceived student disruptive behaviours as those behaviours involving running around the classroom, pushing the task away, and being out-of-seat, disturbing learning and teaching, which mostly needed intervention from instructors (Sun & Shek, 2012).

Failure to address these disruptive behaviours with early and effective interventions may leave these children at risk for later academic and social failure (Campbell, 1995; Dunlap et al., 2006; Webster-Stratton & Taylor, 2001). Additionally, children with disruptive behaviours are three times more vulnerable to suspension from schools than are other children in K-12 (Gilliam, 2005), which cause a substantial reduction in social and academic learning opportunities (Wood, Ferro, Umbreit, & Liaupsin, 2011).

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Function-based treatments identify the reasons why children with developmental disabilities exhibit those disruptive behaviours (Horner, 1994). These treatments are designed and developed based on the findings of a functional behavior assessment (FBA), which determines the antecedents that precede the disruptive behaviours and the consequences that reinforce such behaviours (Sugai, Sprague, Horner, & Walker, 2000).

To decrease these disruptive behaviours, it is necessary to employ functional behaviour assessment (FBA), which identifies the antecedents that trigger and the consequences that maintain such behaviours (Dunlap & Fox, 2011). FBA consists of a variety of assessment approaches, including indirect descriptive assessments (e.g., rating scales, checklists, record reviews, and structured behavioural interviews), direct descriptive assessments (e.g., scatter plots, direct observations and recordings of antecedents and consequences, and conditional probability assessments), and experimental functional analysis, in which antecedent and consequent events are manipulated to identify the functional relationship between these events and the disruptive behaviour (Poole, 2011).

Following FBA, a function-based treatment can be developed and designed to; (a) eliminate the antecedents that lead to the disruptive behaviour, (b) teach replacement behaviours that serve the same function as the disruptive behaviours, and (c) provide consequences that reinforce the replacement behaviours (Sugai, Sprague, Horner, & Walker, 2000).  

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Reviewers of function-based treatments have reported that researchers have adequately described how to implement these treatments, but have failed to provide full details about how to design and develop treatments based on FBA results (Scott et al., 2005). To remedy this, Umbreit, Ferro, Liaupsin, and Lane (2007) developed the Decision Model, which is a systematic process for designing and developing function-based treatments based on FBA data.

The Decision Model has been used to design and develop function-based treatments in general education, special education, and inclusive settings for children with intellectual disabilities (ID) (Blair, Liaupsin, Umbreit, & Kweon, 2006; Wood, Ferro, Umbreit, & Liaupsin, 2011), emotional and behavioural disorder (EBD) (Lane, Smither, Huseman, Guffey, & Fox, 2007; Nahgahgwon, 2008; Turton, Umbreit, Liaupsin, & Bartley, 2007), attention deficit hyperactivity disorder (ADHD) (Stahr, Cushing, Lane, & Fox, 2006; Wood et al., 2011), deafness and hard of hearing (DHH) (Liaupsin, Umbreit, Ferro, Urso, & Upreti, 2006), and autism spectrum disorder (ASD) (Reeves, Umbreit, Ferro, & Liaupsin, 2013; Wood et al., 2011).

For function-based treatments to be used in early childhood programs, comparisons must be made between the effectiveness of treatments that are and are not matched to behavioural function. Very few such evaluations have been carried out, though researchers have compared those interventions in a range of general education, special education, and inclusive settings for children with ID (Ellingson, Miltenberger, Stricker, Galensky, & Garlinghouse, 2000), learning disabilities (LD) (Meyer, 1999), ASD (Taylor & Miller, 1997), mild cerebral palsy (Ellingson et al., 2000), EBD (Meyer, 1999),

Down syndrome (Taylor & Miller, 1997), other health impairments (Newcomer & Lewis, 2004), and those with no disabilities (Bellone, Dufrene, Tingstrom, Olmi, & Barry, 2014; Ingram, Lewis-Palmer, Sugai, 2005).

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Previous studies have investigated the effectiveness of function-based treatments on problem behaviours compared to ‘time out’ (Repp, Felce, & Barton, 1998), standard treatment that may or may not be matched to the function of the problem behaviour (Schill, Kratochwill, & Elliott, 1998), positive behaviour support (BIP) treatment based on alternative hypotheses (Ingram et al., 2005), treatment based on the topography of the problem behaviour (Newcomer & Lewis, 2004), and Mystery Motivator (MM) treatment not matched to the behavioural function of the disruptive behaviour (Bellone et al., 2014).

All these studies demonstrated that the function-based treatment was more successful at reducing problem behaviours; however, inadequate evidence exists to conclude function-based treatments are more effective at decreasing disruptive behaviours than MM treatments that are selected based on their effectiveness at reducing disruptive behaviours with similar topographies (Bellone et al., 2014).

MM treatment uses randomized reward uncertainty to decrease the disruptive behaviour (Musser, Bray, Kehle, & Jenson, 2001; Schanding & Sterling-Turner, 2010; Theodore, Bray, Kehle, & Jenson, 2001) and increase the replacement behaviour (Jenson, Rhode, & Reavis, 1994). MM treatment includes two major elements: (a) a variety of unknown and appealing reinforcers, and (b) a variable schedule of reinforcement (Moore, Waguespack, Wickstrom, Witt, & Gaydos, 1994).

MM treatment has been used to decrease disruptive behaviours in high school, elementary school, and preschool programs for children with selective mutism (Kehle, Madaus, & Baratta, 1998), ADHD (Musser, et al., 2001), serious emotional disturbances (SED) (Musser et al., 2001), ID (LeBlanc, 1998), cerebral palsy (LeBlanc, 1998), oppositional defiant disorder (ODD) (Musser et al., 2001), LD (Valum, 1995), other developmental disabilities (LeBlanc, 1998), and no disabilities (Bellone et al., 2014; Murphy, Theodore, Aloiso, Alric-Edwards, & Hughes, 2007; Schanding & Sterling-Turner, 2010).

Previous studies have empirically demonstrated MM treatments can be effective in decreasing disruptive behaviours and increasing replacement behaviours. Some have argued that function-based treatments are more empirically substantiated than MM treatments (Bellone et al., 2014); however, there has been no research investigating the effectiveness of function-based treatments compared to MM treatments. It will be beneficial for specialists and other researchers to fill this research gap to provide and help special education teachers choose the best treatments for toddlers with disabilities.

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            The intent of the present study was to extend FBA research by comparing the effectiveness of function-based and MM treatments at reducing the disruptive behaviours of toddlers with developmental disabilities. This research was conducted in three parts. In Part 1, an FBA was conducted to identify the function of the disruptive behaviour. In Part 2, both a function-based treatment and an MM treatment were developed and designed for each toddler. In Part 3, both treatments were implemented in the inclusive toddler program during the most problematic activities for each toddler.

Method

Participants and Setting

Each classroom had one early childhood and one special education teacher. Five special education teachers selected one toddler each from five different inclusive toddler classrooms from the same school district. Each classroom had one toddler out of five with an Individualized Family Service Plan (IFSP). All children received speech-language pathology services outside the classroom, so there were no language concerns. The special educators only provided support to the children with IFSPs.

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The special education teachers had between 15 and 20 years of teaching experience. All were experienced with the FBA process and completed at least 20 FBAs per year. Each teacher was involved in special education programs consisting of students diagnosed with developmental disabilities. All teachers had a bachelor’s degree in applied behaviour analysis (ABA) and participated in yearly intensive professional development workshops. Written informed consent was obtained from each participant’s parents and the teachers prior to the study.

The five toddlers were selected based on the following criteria: (a) the presence of consistently occurring disruptive behaviours leading to disrupted learning, (b) having an IFSP, (c) having their teachers contact their parent(s) at least three times (via calls or notes sent home) within the previous four weeks due to disruptive behaviour, (d) the absence of self-injury behaviour (SIB), (e) attending class five days per week for at least four hours each day, and (f) the independent confirmation of DSM-IV criteria by at least two professionals with expertise in the child’s disorder.

The following toddlers were selected for this study. Marcus was a 33-month-old boy who had been diagnosed with ASD. He lives with his both parents and he has two brothers with typically development. He received social skill therapy for two hours three times per week as part of a small group. His vocabulary consisted of 8 words. He displayed a variety of disruptive behaviours that included out-of-seat, crying, and turning over classroom materials (e.g., pushing over a bookshelf in the reading area).

Treatment and baseline sessions were conducted within the classroom during centre activities. Noah was a 34-month-old boy who had been diagnosed with mild ID. He lives with his mother and his oldest sister. His sister has diagnosed with ASD. He goes with his sister to his father home one time in a month. His spontaneous speech consisted of 2–3 word utterances. He displayed a variety of disruptive behaviours that included out-of-seat, pushing the task away, and hiding under his desk.

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Treatment and baseline sessions were conducted within the classroom during centre activities. Aubrey was a 32-month-old girl who had been diagnosed with ASD. She lives with her father and her grandparents. She is only child. Her mother died. She received individualized speech therapy for two hours four times per week.  Her spontaneous language consisted of 10 words and sounds (e.g., ‘no’, ‘bye’, ‘hi’). She displayed a variety of disruptive behaviours that included screaming, crying, and running around the classroom.

Treatment and baseline sessions were conducted within the classroom during circle time. James was a 32-month-old boy who had been diagnosed with Down syndrome. He lives with his both parents and two sisters and one brother. His brother had diagnosed with mild intellectual disability. He received individualized social skills therapy for 1 hour four times per week.

He also received speech therapy for two hours four times per week. He was nonverbal, but had been taught a few signs (e.g., ‘help’, ‘more’, ‘bathroom/toilet’). He displayed a variety of disruptive behaviours that included yelling, crying, and closing his eyes (e.g., closing eyes when asked to look at a picture). Treatment and baseline sessions were conducted within the classroom during circle time. Kali was a 33-month-old girl who had been diagnosed with ID.

She lives with her mother and her stepfather. She has stepbrother with typically development.  She received individualized speech therapy for two hours four times per week.  Her vocabulary consisted of 8 words. She displayed a variety of disruptive behaviours that included yelling, pushing the task away, and hiding under her desk. Treatment and baseline sessions were conducted within the classroom during centre activities.

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Part 1: Functional Behavioural Assessment

Functional Assessment Interview. Each special education teacher interviewed each toddler’s parent using the Functional Assessment Interview Form (FAI; O’Neill, Horner, Albin, Sprague, Storey, & Newton, 1997). The special educators did not receive any additional FAI training. The FAI was used to identify information about the features of the disruptive behaviours (i.e., duration, frequency, topography, and intensity), the immediate antecedent events that triggered the disruptive behaviours, and the consequences that might reinforce the disruptive behaviours.

Certain items provided information about the ecological events that set up the disruptive behaviour, replacement behaviours, communication strategies used by the toddler, previously successful strategies, reinforcers, and the history of disruptive behaviour. Once the FAI was completed, a master’s level behaviour analyst identified the function of the disruptive behaviour and rated their assessment of it using a 6-point Likert scale from 1 (extremely uncertain) to 6 (strongly certain).

The researcher then interviewed each special education teacher using the same FAI forms to collect more details associated with each item. The researcher did not read the FAI form teachers administered to the parents. Again, using the FAI responses, the behaviour analyst identified and rated their certainty of the function of the disruptive behaviour.

For reliability, a second master’s level behaviour analyst examined the teacher and parent FAI responses, independently identified the function of the disruptive behaviour, and rated it using the same certainty scale. Both master’s level behaviour analysts were research assistants with BCBA certification.

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Student Observation. Using the Functional Analysis Observation Form (FAO; O’Neill, Horner, Albin, Storey, & Sprague, 1990), special education teachers observed each toddler’s disruptive behaviours, as indicated by the FAI results, while an early childhood teacher conducted their typical activities. Each observation consisted of five 20-minute sessions. The special educators did not receive additional FAO training. By using these event recording procedures, the special education teachers identified disruptive behaviours, antecedents, consequences, and the function of the disruptive behaviour.

The FAO sessions only occurred during centre activities (Marcus, Noah, and Kali) and circle time (Aubrey and James). Using a video recording, the first behaviour analyst observed the toddlers during the same observation period as the teachers and filled out an identical FAO. When a disruptive behaviour occurred, the behaviour analyst individually recorded the exact time, consequences, antecedents, and disruptive behaviours on the FAO.

The conditional FAO probabilities were examined to look for patterns related to antecedents and consequences related to the disruptive behaviours. The conditional probabilities were determined by following formula: the number of times each consequence and the antecedents occurred divided by the sum of the number of disruptive behaviour occurrences, multiplied by 100. The researcher interpreted these probabilities independently to identify the functions.

Inter-observer agreement. Agreement between the special education teacher and the behaviour analyst regarding the disruptive behaviour was indicated when each independently recorded the occurrence of disruptive behaviours within 5 seconds. Agreement between both observers on consequences and antecedents was indicated when they recorded the same antecedents and consequences associated with a disruptive behaviour. Inter-observer agreement (IOA) was calculated by dividing the number of agreements by the total number of both disagreements and agreements.

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Functional Assessment Results. We discuss the results of the functional assessments for each toddler, in turn.

            Marcus. During the FAI, Marcus’s disruptive behaviour was consistently followed by peer attention with a confidence rating of 6 (indicating strong certainty). The results of the FAO indicated that his disruptive behaviours were consistently followed by peer attention particularly during centre activities. The IOA between the special education teacher and the behaviour analyst was high (range: 99–100%; mean: 99.6%).

            Noah. During Noah’s FAI, his disruptive behaviour was consistently followed by teacher attention with a confidence rating of 5 (indicating moderate certainty). The results of the FAO indicated that his disruptive behaviours were consistently followed by special education teacher attention during centre activities. The IOA between the special education teacher and the behaviour analyst was high (range: 98–100%; mean: 99.4%).

Aubrey. During Aubrey’s FAI, her disruptive behaviour was consistently followed by attention from the special education teacher with a confidence rating of 6 (strong certainty). The results of the FAO indicated that her disruptive behaviours were consistently followed by special education teacher attention during circle time. The IOA between the special education teacher and behaviour analyst was high (range: 98–100%; mean: 99.4%).

James. During James’s FAI, his disruptive behaviour was consistently followed by special education teacher attention with a confidence rating of 6 (strong certainty). The results of the FAO indicated that his disruptive behaviours were consistently followed by special education teacher attention during the circle time. The IOA between the special education teacher and the behaviour analyst was high (range: 99–100%; mean: 99.6%).

Kali. During Kali’s FAI, her disruptive behaviour was consistently followed by peer attention with a confidence rating of 5 (moderate certainty). The results of the FAO indicated that her disruptive behaviours were consistently followed by peer attention during centre activities. The IOA between the special education teacher and first behaviour analyst was high (range: 99–100%; mean: 99.6%).

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Part 2: Treatment Development

Function-based Treatments. The Decision Model was used to design treatments based on the functions of the disruptive behaviour as assessed in the previous section. The Decision Model has three basic components: reinforcement of the replacement behaviour, antecedent modifications, and extinction of the disruptive behaviour. This model uses the two following questions: ‘Do the antecedent incidents indicate an evidence-based best strategy?’ and ‘Can the toddler perform the replacement behaviour?’

The answers to these two questions are used to select one of following four treatment methods. Method One, Teaching the Replacement Behaviour, is selected when the toddler cannot perform the replacement behaviour, even if the antecedent incidents indicate an evidence-based best strategy. Method Two, Improving the Environment, is selected when the toddler can perform the replacement behaviour but the antecedent incidents do not indicate an evidence-based best strategy.

Method Three, Adjusting the Contingencies, is selected when the child can perform the replacement behaviour and the antecedent incidents indicate an evidence-based best strategy. Methods One and Two are combined when the toddler cannotperform the replacement behaviour and the antecedent incidents do not indicate an evidence-based best strategy.

Treatment design and development. The researcher, the behaviour analyst, and the special education teachers were all involved in designing and developing function-based treatments using the Decision Model. The team was familiar with and frequently discussed the Decision Model process. The selected treatment methods addressed the function of the disruptive behaviours and each classroom’s needs. Below, we discuss how the treatment strategy decision was made for each toddler.

Marcus. Marcus was able to perform the replacement behaviours for centre activities with peers, which were sitting for the entire 10-min table activity, looking at storybooks, and playing with toys. The antecedent events indicated an effective intervention strategy for him. In the classrooms, visuals were used to show the order of steps necessary for the different activities, and visual rules were used to remind toddlers of ‘centre activity expectations’ (e.g., a picture demonstrating sitting in a chair).

Samples of the finished products were provided to help orient the toddlers to the task. Teachers provided attention and praise as these replacement behaviours were followed. Most other toddlers responded well to teacher praise. However, for Marcus the schedule of reinforcement did not maintain these replacement behaviours. Therefore, Method Three was selected to develop a function-based treatment. Marcus’s treatment is described in Table 1.

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Noah. Noah was able to perform the replacement behaviours, which were sitting for the entire 10-min table activity, colouring, and cutting. The antecedent incidents indicated an effective intervention strategy. As was the case with Marcus, visuals were used to show the order of the steps necessary to complete the activities (e.g., a photo of scissors for cutting), and visual rules were used to remind the toddlers of ‘centre activity expectations’.

Samples of the finished products were provided to help orient them to the task. Teachers provided attention and praise as these replacement behaviours were followed. Most other toddlers responded well to teacher praise. However, the schedule of reinforcement did not maintain the replacement behaviours for Noah. Therefore, Method Three was selected to develop a function-based treatment. Noah’s treatment is described in Table 2.

Aubrey. Aubrey was able to perform the replacement behaviours, which were looking at the teacher and verbally responding to the teacher’s questions during story time. The antecedent incidents indicated an effective strategy. Visual schedules were used to show the order of the circle-time activities. Visual rules were used to remind the toddlers of ‘circle time expectations’. A song was repeated to signal the beginning and end of circle time. Large, colourful books were used.

Each toddler’s name was placed on the floor around the circle, indicating the beginning of story time and his or her designated seats. Teachers provided attention and praise for Aubrey’s replacement behaviours. Most other toddlers responded well to teacher praise. However, the schedule of reinforcement did not maintain these replacement behaviours. Therefore, Method Three was selected to design a function-based treatment. Aubrey’s treatment is described in Table 3.

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James. James was able to perform the replacement behaviours, which were looking at the teacher and storybook during story time. The antecedent incidents represented an effective strategy. As was the case with Aubrey, visual schedules were used to show the order of the circle-time activities. Visual rules were used to remind the toddlers of ‘circle time expectations’. A song was repeated to signal the beginning and the end of circle time. Large, colourful books were used.

Each toddler’s name was placed on the floor around the circle, indicating the beginning of story time his or her designated seats. During circle time, the toddlers were directed to face the teacher. Teachers provided attention and praise for his replacement behaviours. The other toddlers responded well to teacher praise. However, the schedule of reinforcement did not maintain James’s replacement behaviour. Therefore, Method Three was selected to design a function-based treatment. James’s treatment is described in Table 4.

Kali. Kali was able to perform the replacement behaviours with her peers, which were sitting in her chair, playing with Play-Doh™, and drawing. As with the other toddlers in our study, visual rules and instructions were provided to remind them of ‘centre activity expectations’ (e.g., a picture demonstrating sitting in a chair). Samples of the finished products were provided to help orient the toddlers to the task.

Teachers provided attention and praise as these replacement behaviours were followed. Most other toddlers responded well to teacher praise. However, the schedule of teacher praise and attention reinforcement did not maintain the replacement behaviours for Kali. Again, Method Three was selected to design a function-based treatment. Kali’s treatment is described in Table 5.

Mystery Motivator Treatment. The MM was based on the alternative hypothesis that access to tangible rewards could promote replacement behaviours. Since gaining attention was identified as the primary function of disruptive behaviours across toddlers, teachers provided no attention to the toddler contingent on the occurrence of the replacement behaviour. The MM treatment focused instead on a tangible non-function-based reinforcement.

The toddlers and teachers underwent practice sessions to learn the process. The visual rules were posted on the board at the front of the classroom. At the beginning of each session, the special education teachers reminded the toddlers that if they followed the classroom rules, they would receive a check on their chart. If they earned five or more checks, they could choose a card from the MM box containing ten cards with pictures of surprise rewards.

Parents and teachers suggested what to include in the MM box. Children knew they had received all five checks and could pick a prize when the teachers handed them the box with minimal attention. If a child missed a check, they were told at the end of the session. At the end of each session, if a toddler met the criterion, he or she immediately chose a card from the MM box and received the corresponding reward (e.g., small toy car, popcorn, doll).

Toddlers who did not meet the criterion were told by the teachers that they would get another chance in the next session. The activities were the same during baseline, MM, and function-based phases.

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Part 3: Treatment Implementation

Method. A multiple-treatment reversal design was used to compare behavioural disruptions during: (a) baseline sessions, (b) sessions with function-based treatments, and (c) sessions with MM treatments. We observed toddlers during the sessions in which their behavioural disruptions were the most problematic. Baseline, treatment, and maintenance data were collected during centre activities (Marcus, Noah, and Kali) and circle time (Aubrey and James).

All sessions were video recorded. Data were collected using 10-second partial intervalsof 10 minutes in total duration. The teachers used the tone of the timer to signal the beginning of a new interval. By using the VCR timer, the behaviour analyst independently recorded the start and end times of the disruptive behaviours. The design consisted of alternating baseline (‘A’) and treatment phases (either function-based, ‘Treatment B’, or MM treatments, ‘Treatment C’).

Baseline sessions consisted of the early childhood teachers leading activities as usual, with no treatments or planned contingencies being utilized. Following the baseline measures, we counterbalanced and returned to the baseline phase between the treatments for each toddler to minimize internal validity threats and multiple-treatment interference.

The function-based treatment phase (B) was implemented first for Marcus, Aubrey, and James (i.e., ABACAB), while the MM treatment phase (C) was implemented first for Noah and Kali (i.e., ACABAB). The teachers reminded the toddlers of which treatment would be administered that day to ensure the toddlers could discriminate between the two treatments. The maintenance phase was conducted at the end of the final phase. The more effective treatment was implemented for a minimum of two weeks. Data were collected daily from recorded video sessions.

Inter-observer agreement. During IOA, video data were collected using the same methods, and all sessions were recoded. Training occurred to check for reliability before the video coding began. A secondbehaviour analyst independently collected data for 70% of each phase per participant to calculate the IOA. Using an interval-by-interval method, IOA for disruptivebehaviour was calculated by dividing the total agreements by the total number of observed intervals, multiplied by 100.

Treatment integrity.   The behaviour analyst completed a treatment-specific yes/no checklist concerning theintegrity of the treatment and maintenance observations. There were 15 components for function-based and MM sessions. Treatment integrity was calculated by dividing the accurately completed components (i.e., adhering to the treatment) by the total number of treatment components, multiplied by 100. A second behaviour analyst independently completed this checklist for 70% of the treatment and maintenance phases. IOA for treatment integrity was calculated by dividing the total agreements by the total number of treatment components, multiplied by 100.

Social validity. At the end of the study, each teacher independently completed the Treatment Acceptability Rating Form-Revised (TARF-R) (Reimers, Wacker, Cooper, & DeRaad, 1992), which consists of 17 questions assessing each treatment’s disruptiveness/time required, side effects, effectiveness, willingness, cost, and reasonableness for use in the classroom. Responses are indicated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The total scores range from 17 to 119, with higher scores indicating higher acceptability and social validity.

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Results

Marcus (ABACAB)

During five baseline sessions, Marcus’s disruptive behaviour ranged from 80 to 90%, with a mean of 88%. When Treatment B (the function-based treatment) was implemented for six sessions, his disruptive behaviour decreased substantially to an average of 3.17% (range: 1–5%). His disruptive behaviour later increased back to an average of 83.3% (range: 70–90%) with a three-session return to baseline. When Treatment C (MM treatment) was implemented for six sessions, his disruptive behaviour decreased slightly to 15.2% (range: 14–17%).

With a final return to baseline for three sessions, his disruptive behaviour remained at an average of 90%. During the maintenance phase (Treatment B), his disruptive behaviour continued to decrease, ranging from 0 to 1% with a mean of 0.4%. The IOA for disruptive behaviour was 100% for all phases. Treatment integrity averaged 100% and the IOA for treatment integrity was 100% during the treatment and maintenance phases. Using the TARF-R, his teacher rated Treatment B at 118 and Treatment C at 100.

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Noah (ACABAB)

During five baseline sessions, Noah’s disruptive behaviour ranged from 60 to 65%, with a mean of 63%. When Treatment C (MM) was implemented for seven sessions, his disruptive behaviour slightly decreased to 13% (range: 10–16%). With a three-session return to baseline, his disruptive behaviour increased to levels similar to those of his first baseline sessions, with a mean of 66.7% (range: 65–70%). When Treatment B (function-based) was implemented for six sessions, his disruptive behaviour decreased dramatically to 2% (range: 1–3%).

With an additional three-session return to baseline, his disruptive behaviour remained at an average of 65%. During the maintenance phase (Treatment B), his disruptive behaviour immediately decreased to 0.03% (range: 0–1%). The IOA for disruptive behaviour reached 100% for each phase. Treatment integrity averaged 100% and the IOA for treatment integrity was 100% during the treatment and maintenance phases. Using the TARF-R, his teacher rated Treatment B at 117 and Treatment C at 104.

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Aubrey (ABACAB)

During five baseline sessions, Aubrey’s disruptive behaviour ranged from 85 to 90%, with a mean of 89%. When Treatment B (function-based) was implemented for seven sessions, her disruptive behaviour decreased substantially to an average of 2.5% (range: 1–5%). With a three-session return to baseline, her disruptive behaviour rapidly increased to an average of 90%. When Treatment C (MM) was implemented for seven sessions, her disruptive behaviour gradually decreased to 13.7% (range: 11–17%).

Her disruptive behaviour returned to a frequency similar to the first baseline sessions, 88.3% (range: 85–90%), after an additional three-session return to baseline. During the maintenance phase (Treatment B), her disruptive behaviour decreased again to 0.02% (range: 0–1%). The IOA for disruptive behaviour reached 100% for each phase. Treatment integrity averaged 100% and the IOA for treatment integrity was 100% during the treatment and maintenance phases. Using the TARF-R, her teacher rated Treatment B at 118 and Treatment C at 105.

James (ABACAB)

During five baseline sessions, James’s disruptive behaviour ranged from 65 to 70%, with a mean of 68%. When Treatment B (function-based) was implemented for seven sessions, his disruptive behaviour decreased dramatically to 1.8% (range: 1–3%). With a three-session return to baseline, his disruptive behaviour increased to levels similar to those observed during the first baseline phase, with a mean of 65%. When Treatment C (MM) was implemented for six sessions, his disruptive behaviour gradually decreased to 13.5% (range: 11–16%).

His disruptive behaviour increased dramatically, with a range of 65% to 70% and a mean of 68.3%, following a three-session return to baseline. During the maintenance phase (Treatment B), his disruptive behaviour decreased again to 0.1% (range: 0–1%). The IOA for disruptive behaviour reached 100% for each phase. Treatment integrity averaged 100% and the IOA for treatment integrity was 100% during the treatment and maintenance phases. Using the TARF-R, his teacher rated Treatment B at 117 and Treatment C at 102.

Kali (ACABAB)

During five baseline sessions, Kali’s disruptive behaviour ranged from 85 to 90%, with a mean of 89%. When Treatment C (MM) was implemented for seven sessions, her disruptive behaviour slightly decreased to 15.5% (range: 14–17%). With a three-session return to the baseline phase, her disruptive behaviour increased to levels similar to those observed seen during the first baseline with a mean of 88.3% (range: 85–90%). When Treatment B (function-based) was implemented for six sessions, her disruptive behaviour decreased substantially to an average of 2.2% (range: 1–4%).

Her disruptive behaviour returned to an average of 90% following a three-session return to baseline. During the maintenance phase (Treatment B), her disruptive behaviour immediately decreased to 0.2% (range 0–1%). The IOA for disruptive behaviour reached 100% for each phase. Treatment integrity averaged 100% and the IOA for treatment integrity was 100% during the treatment and maintenance phases. Using the TARF-R, her teacher rated Treatment B at 118 and Treatment C at 105.

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Discussion

The purpose of the current study was to compare the effectiveness of function-based and MM treatments for the disruptive behaviours of toddlers with developmental disabilities. Both types of treatments were implemented in a counterbalanced manner across toddlers to minimize treatment-order effects. Marcus, Aubrey, and James received function-based treatments first, whereas Noah and Kali experienced the MM treatment first. All toddlers’ disruptive behaviours improved during both treatments as measured by direct observations during typical classroom activities. However, disruptive behaviours decreased more following function-based than following MM treatments.

One explanation for the different treatment outcomes on disruptive behaviours may be due to matching the treatment to the function of the behaviour. In function-based treatments, delivering praise and paying attention were more prominent reinforcers for decreasing disruptive behaviours, which was consistent with the attention-seeking function of the behaviours.

The MM treatment was designed to help the toddlers adjust their behaviours to gain tangible items unrelated to the function of the disruptive behaviours. Another explanation for the greater decrease in disruptive behaviour under function-based treatments is the use of an extinction component. In the MM treatment, teachers withheld tangible reinforcers and rewards contingent on disruptive behaviour. In function-based treatment, teachers ignored the occurrences of disruptive behaviour, which may have more significantly weakened the disruptive behaviours than did withholding the rewards.

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A greater decrease in disruptive behaviour under the MM treatment was observed for Noah, Aubrey, and James than for Marcus and Kali. This may have been due to interactions between teachers and toddlers during the MM treatment’s chart-checking process. Chart checking allowed the toddlers to receive attention from an adult at the start and end of the activity, possibly serving the attention-seeking functions of Noah, Aubrey, and James.

The alternating baseline phases were counterbalanced between the treatment B, Function-Based Treatment and the treatment C, Mystery Motivator Treatment (MM) for each toddler to minimize internal validity threats and the likelihood of interference and interaction that might impact the behaviours of each toddler. Responding in each treatment provides baseline phase for subsequent treatment in order to decrease sequence effects on each toddler’s behaviour. In counterbalancing, the treatments are withdrawn in order to reproduce the level of disruptive observed in a previous treatment.

Data collected on treatment integrity for all sessions of the treatment and maintenance phases showed that both treatments were implemented with high levels of fidelity. The measurement of treatment integrity allowed the validation and assessment of the functional relationship between treatments and disruptive behaviours. Our results highlight the significance of consistent data collection for ensuring treatment integrity in evaluating implementation outcomes (Horner et al., 2005). With these data, special education teachers can evaluate the internal and external consistency of the treatments delivered over time (Horner et al, 2005).

Finally, the special education teachers were satisfied with both treatments. Using the TARF-R (Reimers et al., 1992), they rated the feasibility, appropriateness, and design of the function-based treatments developed using the Decision Model as socially valid and more acceptable than MM treatment. Horner et al. (2005), and Newcomer and Lewis (2004) considered social validity an important indicator of the quality and effectiveness of a function-based treatment designed using the Decision Model.

Arelationship existed between the function-based treatments and the reduced occurrence of disruptive behaviours; the reduction in disruptive behaviours was maintained by fulfilling the function of gaining attention from adult and peers. For all toddlers, disruptive behaviour continuedto be reduced for 16 sessions under the function-based treatments. The results of this study are in line with findings of previous studies showing the effectiveness of function-based treatments (i.e., Blair et al., 2006; Lane et al., 2007; Liaupsin et al., 2006; Nahgahgwon, 2008; Reeves et al., 2013; Stahr et al., 2006; Turton et al., 2007; Umbreit, Lane, & Dejud, 2004; Underwood, Umbreit, & Liaupsin, 2009; Wood et al., 2011; Wood, Umbreit, Liaupsin, & Gresham, 2007).

This study also adds to the previous research by examining the effectiveness of function-based treatments using the Decision Model with toddlers with developmental disabilities conducted in inclusive early childhood classrooms. These results support and extend findings showing that function-based treatments that match the behavioural function of the disruptive behaviour decrease that disruptive behaviour.

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Limitations and Future Research

Several limitations should be addressed. First, the data were collected only in toddler classrooms. Disruptive behaviours do not happen in only one setting. Future research should extend the treatments across home and non-classroom settings (Dunlap et al., 2006; Powell, Dunlap, & Fox, 2006), with multiple, setting-specific, function-based treatments for those toddlers. Second, the results of this study have limited generalizability because data were collected only for toddlers with ASD, ID, and Down syndrome who displayed disruptive behaviour.

Additional research is needed to extend findings across different types of problem behaviours and different diagnoses. Third, a descriptive assessment was used to corroborate the function of the five toddlers’ disruptive behaviours. Future studies should replicate this study and utilize functional analysis to confirm that attention seeking is often a primary function that maintains the disruptive behaviours.

Finally, there were special education and early childhood teachers in all the inclusive toddler classrooms in this study. The special education teacher provided extensive attention to the selected toddlers during the FBA and treatment implementations, while the early childhood teacher conducted the typical activities. Future research should be conducted to determine the efficacy of conducting the FBA and implementing treatments in a classroom with only one teacher.

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Acknowledgments

The author would like to thank the behaviour analysts, teachers, and parents of the children for participating in this study.

Conflict of Interest

The author declares no conflicts of interest.

Funding

The authors received no financial support for the research and/or authorship of this article.

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