Reduction in Restraints Following a Functional Analysis of Severe Problem Behavior and Communication Training

Abstract

We combined a functional analysis of precursors and problem behavior with subsequent communication training to reduce time spent in restraint. The patient was a man in his thirties with autism and life-long severe problem behaviors resulting in restraint. The highest frequencies of both problem behavior and precursors were observed in the demand conditions of the functional analysis. However, the precursors were observed across all conditions. Based on these findings we introduced functional communication training to establish an alternative functional response. He was taught to ask for a break when demands where presented, first in an analog setting and later in natural settings throughout his daily life. This resulted in a significant reduction in problem behavior and what followed was a significant reduction in the time spent in restraints. The much-reduced level of restraint was maintained in the patient’s natural environment at a 12-month follow-up assessment. Our findings suggest that a functional analysis and functional communication training may be an approach to consider when the ultimate goal is to reduce the time spent in restraint. These findings need to be replicated with a better experimental design.