EVALUATING THE PSYCHOMETRIC AND EXPERIMENTAL ROBUSTNESS OF DIFFERENTIAL CONSEQUENCE PROCEDURES IN FUNCTIONAL COMMUNICATION TRAINING: A RANDOMIZED CONTROLLED TRIAL IN CHILDREN WITH AUTISM SPECTRUM DISORDER

Abstract

Children with autism spectrum disorder are often characterized by different types of sensory hypersensitivities, and this can provoke high levels of self-injurious behavior (SIB) and self-stimulatory behavior (SSB). Despite the popularity of Functional Communication Training (FCT) as an evidence-based intervention in managing ASD, there is a lack of consensus on the most effective consequence procedures that would be able to maintain its effectiveness. This paper provided a comparative evaluation of three consequence measures, extinction, reinforcement, and punishment that were applied in FCT in randomized controlled settings, and how they relate to the ethical and practical ramification. This comparative efficacy study compared and contrasted three consequence-based Functional Communication Training (FCT) procedures, Extinction, Reinforcement, and Punishment with a Control condition. Thirty-two participants with ASD (ages 6-12 years) were randomly chosen (n = 8 in each arm). The 12-week (36 sessions; 45 min sessions) interventions were provided, and fidelity ≥ 90 and inter-observer agreement ≥ 85. Linear mixed-effects modeling showed a good Group x Time interaction in combined SIB and SSB F (3, 28) = 11.42, p <.001. The highest effect size (e2 =.40) was obtained with Punishment, then Reinforcement (e2 =.36) and Extinction (e2 =.29), which were all better than Control. Pairwise comparisons affirmed that Punishment and Reinforcement were statistically equal and they both performed better than Extinction and Control. Exploratory analyses in sensory-domain revealed that there was a difference in responsiveness with the greatest effects being on gustatory and proprioceptive domains. No serious adverse events were reported in safety monitoring, and two momentary bursts of extinction were noted in the Extinction arm and was controlled according to protocol. No withdrawals occurred. FCT interventions should be formulated by using Reinforcement-based interventions as they are effective and socially acceptable, and Punishment should be used as a last line intervention in case of severe (safety-critical) cases with some ethical precautions and with the consent of the caregivers. Such results indicate the need to customize the consequence procedures in FCT to maximize behavioral results on children with ASD.