Mitteer Daniel R, Greer Brian D, Fisher Wayne W, Briggs Adam M, Wacker David P
University of Nebraska Medical Center's Munroe-Meyer Institute.
University of Iowa.
J Exp Anal Behav. 2018 Sep;110(2):252-266. doi: 10.1002/jeab.462. Epub 2018 Jul 20.
The success of behavioral treatments like functional communication training depends on their continued implementation outside of the clinical context, where failures in caregiver treatment adherence can lead to the relapse of destructive behavior. In the present study, we developed a laboratory model for evaluating the relapse of undesirable caregiver behavior that simulates two common sources of disruption (i.e., changes in context and in treatment efficacy) believed to affect caregiver treatment adherence using simulated confederate destructive behavior. In Phase 1, the caregiver's delivery of reinforcers for destructive behavior terminated confederate destructive behavior in a home-like context. In Phase 2, the caregiver implemented functional communication training in a clinical context in which providing reinforcers for destructive or alternative behavior terminated confederate destructive behavior. In Phase 3, the caregiver returned to the home-like context, and caregiver behavior produced no effect on confederate destructive or alternative behavior, simulating an inconsolable child. Undesirable caregiver behavior relapsed in three of four treatment-adherence challenges.
诸如功能性沟通训练等行为治疗的成功取决于它们在临床环境之外的持续实施，因为在这种情况下，照顾者治疗依从性的失败可能导致破坏性行为的复发。在本研究中，我们开发了一个实验室模型，用于评估不良照顾者行为的复发，该模型使用模拟的同盟破坏性行为来模拟被认为会影响照顾者治疗依从性的两种常见干扰源（即环境变化和治疗效果变化）。在第一阶段，照顾者对破坏性行为给予强化物，在类似家庭的环境中终止了同盟的破坏性行为。在第二阶段，照顾者在临床环境中实施功能性沟通训练，在该环境中，对破坏性行为或替代行为给予强化物会终止同盟的破坏性行为。在第三阶段，照顾者回到类似家庭的环境中，照顾者的行为对同盟的破坏性行为或替代行为没有影响，模拟了一个无法安慰的孩子。在四个治疗依从性挑战中，有三个出现了不良照顾者行为的复发。
