FCT & Resurgence 1

Components of Functional communication training to reduce resurgence of problem

behvaiour
Problem behaviour affects all aspect of the individual's life and it also affects people around
them. We as practitioners should thank behaviour analytic treatment procedures and
researches that have been consistently producing significant results in reduction of problem
behaviours. Functional communication training (FCT) is one of the widely used function-
based treatment procedures to reduce problem behvaiour (Carr & Durand, 1985; Fisher et al.
1998; Hanley et al, 2001; Petscher et al. 2009; Tiger et al. 2008). During FCT, a functionally
equivalent response is taught and reinforced, hence the problem behaviour no longer contacts
the reinforcer (extinction). Carr and Durand (1985) initially demonstrated the efficacy of the
FCT where the intervention reduced problem behaviour in an ideal situation, such as
therapeutic set ups and laboratories. Since then, FCT has been used to successfully treat a
wide variety of socially mediated problem behaviours and has established itself as evidence-
based intervention.
 
Functional communication training
The efficacy of FCT was first proven by Carr and Durand (1985). This study identified that
altering the stimulus control in a sequential fashion between the problem behaviour and the
FCR will help mitigate the level of problem behavior. The success of FCT not only revolves
around the reduction of problem behvaiour, but also in teaching individuals with functionally
equivalent communicative response. In general, FCT falls under a form of reinforcement type
called differential reinforcement of alternative behaviour. It teaches function-based
communicative response (FCR) which provides the same reinforcer as the problem
behaviour. The communicative response can be taught through different mode of
communication techniques such as PECS, sign language and other Augmentative and
Alternative Communicative (AAC) devices (Mirenda, 1997). It is proven to be effective in
reduction of various topographies of problem behaviour such as social mediated problem
behaviour (Tiger et al., 2008), behaviour mediated by automatic reinforcers (Fisher et al.,
2000), and behaviours mediated by more than one function such as synthesised contingencies
(Ghaemmaghami et al.,2016).
There are three steps in FCT implementation:
(a) functional assessment - identifying the reinforcer/function that is maintaining the problem
behaviour,
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(b) teach a functional communicative response (FCR) which is socially appropriate and
functional equivalent, and
(c) generalisation - extending the efficacy of the intervention to other domains such as
different setting, people and behaviours.
Since FCT procedures are usually prescribed with functional assessment, it places problem
behaviour in extinction by replacing it with the functional communicative response. This
enables the individual to still access the reinforcer but in a socially appropriate way. Initially,
success of the procedure was viewed in terms of efficacy. Efficacy refers to the effect of an
intervention under ideal and controlled environment which included factors such as the extent
to which the reinforcers are provided for FCR to problem behaviour, and extend to which the
motivating operations are contrived.
 
Resurgence
In general, "resurgence is defined as the recurrence of previously reinforced responses when
reinforcement of alternative response is challenged" (Leitenberg et al., 1975; Lieving et al.,
2004; Lieving & Lattal, 2003). In a typical study, resurgence is a target response (R1) is
taught and reinforced in the phase 1. In phase 2, following the acquisition of the R1, it is then
extinguished and replaced with a new response (R2). Finally, in phase 3 both the responses
(R1 and R2) are placed on extinction. Following the removal of reinforcement process, there
is an increase in the level of R1 responses. And this phenomenon of re-emergence or
recurrence of the previously reinforced response during the extinction is called resurgence.
Resurgence was similar to other types of relapse seen after the extinction of any operant
behaviour such as renewal, reinstatement, and spontaneous recovery. This also shows that the
behaviour can ever be erased by extinction process.
There are three different reason for resurgence to occur. A study by Leitenberg et al., (1970)
showed that reinforcement of R2 led R2 to interfere with the R1, hence the organism did not
have the opportunities to learn that R1 is no longer been reinforced. Although this reason
sounds convincing in some circumstance, the resurgence of behaviour happened in high level
and immediately after phase 2 (reinforcement of R2) and resembled other side effects of
extinction such as extinction burst.
An alternative reason was supported by Nevin & Grace (2000) and Sweeney & Shahan
(2013) with the help of behavioural momentum metaphor. This model explains how resurges
of response occurs based on the assumption that the motion of reinforcement of R2 to the
extinction of R1 has affected the performance of R1. In phase 2, reinforcement of R2 disrupts
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R1 immensely because it is already been disrupted by the typical process of extinction.

Following phase 3, when R2 reinforcement was discontinued, the disruptors (reinforcement
of R2 and extinction of R1) placed on R1 were removed and the increased strength of R1
remains. This leads to resurgence.
The third reason for resurgence is explained in terms of contextual conditioning where the
delivery of a reinforcer for R2 during the phase2 carries a discriminatory property. For
instance, rats in the resurgence experiment has proven to learn to inhibit R1 in the context of
R2 reinforcement. The discontinuation reinforcement of R2 has created a change in the
context, hence the response R1 resurges. And this perspective was also supported by
alternating exposure of VI -10 (odd are reinforced and even are extinguished) followed by
extinction of R2 has shown to reduce the resurgence effect of R1 (Schepers & Boutons, 2015)
Similar results were observed among human participants, when previously reinforced
response was extinguished concurrently with reinforcement of the alternative response
(Hagopian et al., 2004; Fisher et al., 2000; Hanley et al., 2001). In applied settings, relapse of
problem behaviours is observed when extinction-based treatment such as FCT was
implemented.
  
FCT and resurgence of problem behaviour
Despite the FCT’s clinical significance and widespread use, it seems to be effective only
when implemented with high fidelity. High fidelity refers to when controlled in a contrived
environment, such as denser schedule of reinforcement and relatively high rate of
reinforcement in FCT condition rather than baseline. On the contrary, when implemented
with low fidelity (leaner schedule of reinforcement) in a more naturalistic environment by a
teacher or caregiver, the problem behaviour reemerges and this phenomenon is called as
Resurgence. These results were also observed among human participants. when moving from
dense to lean schedules of reinforcement for FCR have shown to produce resurgence or
reemergence of problem behvaiour (Volkert et al., 2009).
Literatures show that the resurgence of problem behvaiour during FCT may involve multiple
variables. Variables such as length of the training and schedules of reinforcement, delay to
reinforcement of FCR, presence and absence of discriminative stimulus (SD) during training,
history of extinction, and recency effect (when both problem behaviour and FCR are exposed
to extinction, most recently extinguished behaviour resurges) (Wacker et al., 2013; Hagopian
et al, 2004; Fisher et al.,2000, Wacker et al., 2011; Sweeney & Shahan, 2013).
FCT & Resurgence 4

It is important to be aware about the resurgence of problem behaviour while planning for
FCT, because when translating to a natural environmental condition, there is high risk of
maintaining high treatment fidelity. For example: the individual often might produce FCR at
high rates (rapid repetition of FCR) and it might be difficult for the caregiver to reinforce
every response that is emitted and this might place FCR in an unplanned period of extinction
and low rate of reinforcement which lead to resurgence of problem behaviour (Volkert et al.,
2009). This shows that schedules of reinforcement acts as an important component in FCT. It
is also shown that FCT fails when thinning of schedule of reinforcement as a standalone
technique in FCT to mitigate the rates of problem behaviour after extinction has failed to
produce socially significant results (Fisher et al., 2000; Hanley et al.,2001).
 
Ways to mitigate resurgence of problem behvaiour and increase FCR
The success of FCT is dependent on the use of FCR and zero or lower rates of problem
behaviour. FCT faces serious issues with generalisation and maintenance of FCR - where
FCR might occurs in higher rate which makes it difficult for caregivers to reinforce every
FCR. Thinning of schedule in FCT has shown to increase FCR rates in natural environment.
But not in traditional method of schedule thinning (gradual increase in the response rate per
reinforcement) instead thinning of schedule was viewed as reduction in the duration of
reinforcement component and promotion of duration of extinction component (Hagopian et
al.,2011). This is because the traditional schedule thinning procedure have shown re-
emergence of problem behaviour (Tiger et al.,2008). To combat this issue related to schedule
thinning, the studies have implemented four different components in thinning. There are (a)
delay schedule, (b) chain schedule, (c) multiple schedules, and (d) response restriction.

Delay schedule
Delay schedule is after obtaining therapeutic effects in the initial training procedures, a brief
pause is implemented between the FCR and reinforcer and this is signalled by a verbal SD or
textual SD card "wait". The duration of the "waiting period" is progressively increased. Even
though this procedure mimics the features of natural environment, it has shown to weaken the
response and reinforcer contingency and resulted in the re-emergence of problem behaviour
(Fisher et al., 2000; Hanley et al., 2001).

Chained schedule or demand fading

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Typically, demand fading procedure is used for behaviour maintained by escape from
demand where the FCR is requesting "break" from the demand. If not planned for thinning of
schedule during FCT conditions which may lead to excessive escape request. This procedure
is viewed as chained schedule where the completion of the initial link of chain (demand) may
lead to the onset of termination of the final link of the chain (FCR and reinforcer-escape)
(Davis et al.,2018). This helps in the individual to complete task or demand at the same time
escaping from the task by using FCR. Similar to delay schedule, the link between the FCR
and reinforcer can be systematically weakened when the individual request for "break" before
meeting the criteria for work demand (Hanley et al., 2001). This procedure is effective only
when it is presented with supplementary components such as escape extinction or
noncontingent punishment procedure (Fisher et al., 1993; Hagopian et al., 1996)

Multiple schedules
A minimum of two schedules of reinforcement are alternated; these components are
signalled with discriminative stimulus (SD) where the reinforcer is available for FCR and S
delta is presented where reinforcer is not available (extinction of FCR). Problem behaviour is
placed on extinction during both the conditions. Gradually, the duration of each condition is
manipulated (eg: in the initial phase, 4 minutes of SD and 1 minute of S-Delta is presented in
a total of 5-minute session). This procedure successfully creates a joint control of SD
correlated to the FCR and MO relevant to the problem behaviour, but when used contrived
SD which may not be available in the natural environment and eventually evoke problem
behaviour (Hanley et al.,2001).

Response restriction
Response restriction procedure can be implemented only when the FCR is emitted through an
external device or a picture exchange system. Here the access to the communication device is
restricted and this prevents from excessive use of FCR. Response restriction procedure
maintains the FCR-reinforcement contingency by restricting the access to the device. The
availability of the device acts as a SD through repeated pairing and may result in increase in
the emission of FCR in its presence (Fisher et al., 2014). This procedure cannot be used for
individuals who use augmentative communication device as their primary mode of
communication. The restriction period was gradually increased based on the rates of the
problem behaviour.
FCT & Resurgence 6

Serial functional communication training

This is a type of FCT where the individual is taught more than one alternative response (from
same response class). When the problem behaviour and alternative responses are placed on
extinction, the most recent response resurges and this is phenomenon is called as recency
effect (Lambert et al.,2020). The successful results are only seen with arbitrary responses and
not with social significant responses in humans. Further studies are needed to validate its
effectiveness as a procedure.
When we compare these components of schedule thinning to enhance FCT to produce FCR
with long term efficacy, multiple schedule components are the one which has been most
effective component of all (Hanley et al.,2001; Hagopian et al.,2004). Even though these
components of schedules produce increase in the rates of FCR but FCT even with these
alterations in the schedules has shown issues with re-emergence of problem behaviour
(Hagopian et al.,1998; Fisher et al.,2000; Hanley et al.,2001). Resurgence of problem
behaviour was confronted with the supplementary components beyond extinction in addition
to the FCT with schedule thinning. Supplementary components such as returning to denser
schedule (Fisher et al., 2000), noncontingent access to alternative activities (Hagopian et al.,
2005), and response reduction procedure such as punishment are used conjoint with the FCT
especially when the problem behvaiour is dangerous (Fisher et al.,1993).

Conclusion
FCT as a standalone treatment procedure in the reduction of problem behaviour may not
produce sustainable results in the long run in many cases. therefore, it is important to
consider other supplementary components such as schedule thinning and other additional
procedures to have a long-lasting effect. On the whole, there are three things to consider
while programming a FCT: (1) reduction of reinforcement of FCR can result in increase in
problem behaviour, therefore have a supplementary component and keep continuing the
procedure; (2) schedule thinning may help in reducing the rate of rapid and quick FCR and
maintain lower rates of problem behaviour; and (3) studies also show that reducing the MO
for problem behaviour (and FCR) by providing alternate reinforcers can produce sustainable
effectiveness.

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