On the scope and characteristics of relapse when treating severe destructive behavior

Area of Science:

• Behavioral Psychology
• Applied Behavior Analysis

Background:

• Previous research on treatment relapse often focused on resurgence or renewal of target behaviors in isolation.
• Understanding the interplay between different relapse phenomena and their impact on treatment efficacy is crucial for developing durable interventions.

Purpose of the Study:

• To analyze the prevalence of both resurgence and renewal of destructive behavior during functional communication training.
• To examine the disruption of alternative behaviors (e.g., functional communication requests, compliance) in conjunction with relapse.
• To investigate the impact of reinforcement changes (schedule thinning) and context changes on treatment relapse and efficacy.

Main Methods:

• Conducted 25 consecutive treatments utilizing functional communication training.
• Introduced schedule thinning or context changes to alter reinforcement conditions for alternative behaviors.
• Measured the occurrence of resurgence and renewal of destructive behavior.
• Assessed the disruption of alternative behaviors, including functional communication requests and compliance.

Main Results:

• Resurgence and renewal of destructive behavior were observed in 76% and 69% of treatments, respectively.
• Relapse events occurred in approximately one-third of reinforcement or context changes.
• Destructive behavior relapse predicted alternative-response disruption, and vice versa, with co-occurrence exceeding isolated probabilities.
• General reductions in treatment efficacy were noted across reinforcement or context changes, without a decrease in likelihood over time.

Conclusions:

• Both resurgence and renewal of destructive behavior are frequent during functional communication training, particularly under changing reinforcement or context conditions.
• The co-occurrence of destructive behavior relapse and alternative-response disruption suggests a complex interaction impacting treatment outcomes.
• Treatment efficacy generally decreased following environmental changes, highlighting the need for strategies to enhance treatment durability.