ON THE EFFECTIVENESS OF AND PREFERENCE FOR
PUNISHMENT AND EXTINCTION COMPONENTS OF
FUNCTION-BASED INTERVENTIONS
GREGORY P. HANLEY
UNIVERSITY OF KANSAS
CATHLEEN C. PIAZZA AND WAYNE W. FISHER
MARCUS INSTITUTE AND JOHNS HOPKINS UNIVERSITY
SCHOOL OF MEDICINE
AND
KRISTEN A. MAGLIERI
UNIVERSITY OF NEVADA, RENO
The current study describes an assessment sequence that may be used to identify individualized,
effective, and preferred interventions for severe problem behavior in lieu of relying on a restricted
set of treatment options that are assumed to be in the best interest of consumers. The relative
effectiveness of functional communication training (FCT) with and without a punishment
component was evaluated with 2 children for whom functional analyses demonstrated behavioral
maintenance via social positive reinforcement. The results showed that FCT plus punishment
was more effective than FCT in reducing problem behavior. Subsequently, participants’ relative
preference for each treatment was evaluated in a concurrent-chains arrangement, and both
participants demonstrated a clear preference for FCT with punishment. These findings suggest
that the treatment-selection process may be guided by person-centered and evidence-based
values.
DESCRIPTORS: aversive, choice, concurrent chains, developmental disabilities, evidence-
based values, functional analysis, functional communication training, punishment
_______________________________________________________________________________
Selecting interventions that are most effective
in reducing problem behavior and promoting
desirable behavior over the short and long term
has been advocated for many years (Iwata,
1988; Perone, 2003; Van Houten et al., 1988).
Nevertheless, many researchers and practi-
tioners continue to select treatments based on
structure or name alone (e.g., antecedent-based
or positive-reinforcement-based treatment) or
on values that are assumed to be in the best
interest of the person with the problem
behaviors. The current zeitgeist of providing
exclusively positive behavioral interventions
(positive behavior support [PBS]; E. G. Carr
et al., 2002) is consistent with the approach of
restricting treatment options to those that
appear to be consumer friendly. More specifi-
cally, PBS implies that antecedent-oriented and
reinforcement-based interventions should be
developed to the exclusion of interventions
involving punishment (E. G. Carr et al.).
Although this approach seems to be grounded
in the antiaversives movement (LaVigna &
Donnellan, 1986), it is also predicated on the
practices that have emerged from a behavior-
analytic approach to understanding and treat-
ing problem behavior (J. E. Carr & Sidener,
2002).
This investigation was supported in part by Grant
MCJ249149-02 from the Maternal and Child Health
Service of the U.S. Department of Health and Human
Services.
Requests for reprints should be addressed to Gregory P.
Hanley, Department of Applied Behavioral Science,
University of Kansas, 1000 Sunnyside Ave., Lawrence,
Kansas 66045 (e-mail: ghanley@ku.edu).
doi: 10.1901/jaba.2005.6-04
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2005, 38,
51
–65 NUMBER 1 (SPRING 2005)
51
Functional analysis, which is used to deter-
mine the reinforcing functions of problem
behavior and to identify influential establishing
operations and discriminative stimuli (Iwata,
Pace, Dorsey, et al., 1994), presumably sets the
occasion for a focus on positive behavioral
interventions (Pelios, Morren, Tesch, &
Axelrod, 1999). Once the reinforcer for pro-
blem behavior is identified via analysis, treat-
ments can be developed in which the
maintaining reinforcer is delivered differentially
or noncontingently and withheld following
problem behavior (i.e., extinction). Although
function-based treatments have been proven
effective for a variety of behavior disorders (e.g.,
Fisher, Piazza, & Page, 1989; Iwata, Pace,
Dorsey, et al., 1994; Mace & Lalli, 1991; Piazza
et al., 1997; Piazza, Hanley, & Fisher, 1996;
Thompson, Fisher, Piazza, & Kuhn, 1998;
Vollmer, Northup, Ringdahl, LeBlanc, &
Chauvin, 1996), several rigorous component
evaluations have shown that these treatments
may not be effective for all individuals (Fisher
et al., 1993; Hagopian, Fisher, Sullivan,
Acquisto, & LeBlanc, 1998; Wacker et al.,
1990).
For example, Hagopian et al. (1998) sum-
marized the results of 21 clinical cases involving
functional communication training (FCT) as
the primary intervention. FCT is differential
reinforcement of alternative behavior (DRA),
but the reinforcer that maintains problem
behavior, rather than an arbitrary reinforcer, is
arranged for a socially recognizable alternative
response (i.e., the response specifies the rein-
forcer). In addition, the consequence for
problem behavior is often explicitly described
in FCT treatments (i.e., extinction, punish-
ment, or continued reinforcement is scheduled
for problem behavior). Hagopian et al. found
that only 1 of 10 applications were successful
(success being defined as a reduction in problem
behavior of 80% or better) when problem
behavior and the alternative response both
resulted in reinforcement. An improvement
was seen when extinction for problem behavior
was arranged, but still only 17 of 31 applica-
tions of FCT plus extinction were successful.
Finally, the authors found that FCT was
successful when combined with punishment in
17 of 17 applications.
Although these data are compelling, a recent
review of the treatment literature suggests that
the use of programmed punishment is low
(Pelios et al., 1999). This apparent decreased
reliance on punishment may be related to the
increased dependence on functional analysis for
treatment development (Pelios et al.), but is
probably also related to the fact that the social
acceptability of punishment is low (Blampied &
Kahan, 1992; Kazdin, 1980; Miltenberger,
Suda, Lennox, & Lindeman, 1991).
Even though questionnaires or rating
scales may be appropriate for evaluating the
acceptability of an intervention with critical
stakeholders in the intervention process (care-
givers, teachers, or community members;
Miltenberger, 1990), these indirect methods
are not appropriate for individuals who cannot
readily express their preferences verbally. It
may be reasonable for friends, family, and
advocates to inform the process of selecting
behavioral interventions, as in person-centered
planning (Holburn, 1997; Whitney-Thomas,
Shaw, Honey, & Butterworth, 1998); however,
reliance on the values and preferences of others
may not always be in the best interest of the
consumer.
As an alternative to both approaches, Hanley,
Piazza, Fisher, Contrucci, and Maglieri (1997)
described a method for assessing the social
acceptability of and preference for behavioral
interventions by presenting multiple treatment
alternatives in a choice arrangement to the
actual person receiving the treatment. In this
procedure, referred to as a concurrent-chains
arrangement, two function-based interventions,
one involving differential reinforcement of an
alternative response (i.e., FCT) and the other
involving the time-based delivery of the same
52 GREGORY P. HANLEY et al.
amount and type of reinforcement (i.e., non-
contingent reinforcement [NCR]), were evalu-
ated with 2 children with developmental
disabilities. The children were then given an
opportunity to choose from among the treat-
ment options (FCT, NCR, and extinction only)
by pressing one of three colored switches that
were associated with each of the treatments.
Each switch press resulted in a brief experience
with the selected treatment. Although FCT and
NCR were equally effective in reducing prob-
lem behavior, both children preferred the FCT
intervention.
Instead of relying on a restricted set of
treatment options that are assumed to be in the
best interest of the consumer, the methods
described by Hanley et al. (1997) may be used
to identify the most effective and preferred
interventions. In other words, the values that
guide the selection of particular assessment
and treatment strategies can be data based.
Furthermore, continued direct evaluation of
child and caregiver preferences may ultimately
yield an evolving set of evidence-based values
that may provide a more solid advocacy
foundation for individuals who require or seek
evaluation and support services. Finally, the
practice of allowing individuals who cannot
readily express their biases to participate directly
in the treatment-selection process seems to be
most consistent with placing the person in the
center of the habilitative planning process
(Holburn, 1997; Whitney-Thomas et al.,
1998) and providing effective and preferred
behavioral supports (see also Hanley, Iwata, &
Lindberg, 1999).
Therefore, the preference assessment meth-
ods described by Hanley et al. (1997) were used
in the current investigation to evaluate chil-
dren’s preference for function-based interven-
tions that did and did not involve a punishment
contingency. More specifically, the effectiveness
of several function-based treatment packages
was evaluated with 2 children whose problem
behavior was sensitive to adult attention as
reinforcement. Following demonstrations of
the relative effectiveness of treatments that did
and did not involve punishment contingencies,
a concurrent-chains procedure was arranged to
evaluate children’s preferences for the treat-
ments that they had experienced.
METHOD
Participants
Two children with severe behavior disorders
had been admitted to an inpatient unit special-
izing in the assessment and treatment of
problem behavior. Jay was a 5-year-old boy
who had been diagnosed with moderate mental
retardation, autism, and a seizure disorder. He
lived at home with his mother and attended a
public preschool with specialized programming
for children with autism. His problem behavior
included self-injury (hitting and slapping head
with hands, hitting head with objects, biting
arms, and eye poking), aggression (hitting,
kicking, pushing, pinching, hair pulling,
scratching, and head butting), and disruption
(throwing objects, breaking objects, knocking
objects to the floor). He followed simple
one- and two-step instructions and ambulated
without assistance.
Betty was an 8-year-old girl who had been
diagnosed with mild to moderate mental
retardation, attention deficit disorder, and
oppositional defiant disorder. She also lived at
home with her parents, attended a public ele-
mentary school with specialized programming,
was ambulatory, and followed simple one- and
two-step instructions. Betty’s aggression (hitting,
kicking, pinching, scratching, biting, pulling
hair, and throwing objects at people) was the
problem behavior in the current investigation.
Betty also engaged in pica and self-injury,
which were assessed and treated separately from
her aggression (due mainly to different beha-
vioral functions). Jay and Betty were included
in this series of evaluations because two specific
types of treatment (one involving extinction
and one involving punishment) were shown to
EVIDENCE-BASED VALUES 53
be effective to varying degrees in reducing
problem behavior and because each child was
available in the inpatient unit for further
evaluation of other problem behavior (Betty)
or for caregiver training (Jay).
PHASE 1: FUNCTIONAL ANALYSIS
Design, Setting, and
Procedure
Functional analyses (Iwata, Pace, Dorsey,
et al., 1994) were conducted with both partici-
pants. Sessions were 10 min in duration and
were conducted in therapy rooms (3 m by 3 m)
equipped with one-way mirrors. Approximately
three to five sessions were conducted per session
block (six to 10 sessions per day), and a 5-min
break occurred between each 10-min session.
Sessions were conducted in a random order
within a multielement design for each partici-
pant. Levels of problem behavior were assessed
across three to five conditions: attention, escape,
tangible (Jay only), alone (Jay only), and play.
Prior to attention sessions, the child was
given toys and was prompted to play while the
therapist engaged in a task (e.g., reading a
magazine). During sessions, the therapist pro-
vided attention in the form of a brief (5-s)
verbal reprimand following each problem
behavior. All other responses of the child were
ignored. During the escape condition, the
therapist delivered sequential verbal, gestural,
and physical prompts to complete an academic
or self-care task every 10 s until either the child
complied with the instruction or engaged in a
problem behavior. If the child complied with
the instruction following a verbal or gestural
prompt, he or she received praise from the
therapist. If the child displayed problem
behavior, the therapist terminated the instruc-
tions and removed the task materials for 30 s
(i.e., escape was provided).
Tangible sessions were conducted with Jay
because his mother reported that she often
provided Jay with preferred toys to ‘‘calm him
down’’ during episodes of problem behavior.
Jay was allowed to play with preferred activities
(a mirror, Pla-DohH, and a rubber ball) for
2 min prior to the start of the tangible sessions.
The therapist withdrew the preferred objects at
the onset of the session and returned the items
for 30 s following each occurrence of problem
behavior. All other responses of the child were
ignored. An alone condition also was conducted
with Jay to determine if his self-injurious or
disruptive behaviors would persist in the
absence of any programmed social stimulation.
Jay was alone in an otherwise empty room
during the alone condition. Toys were available
freely, and the therapist delivered attention at
least every 30 s during the play condition,
which served as the control for the potential
reinforcement contingencies arranged in the
previously described test conditions.
Data Collection and Interobserver Agreement
Trained observers used laptop computers to
record the frequency of problem behaviors for
all participants (see topographies and defini-
tions above). Two observers scored problem
behaviors simultaneously but independently
during 54% and 32% of the sessions for Jay
and Betty, respectively. Agreement coefficients
were calculated by partitioning each session into
consecutive 10-s intervals and dividing the
number of exact agreements on the occurrence
of behavior by the sum of agreements plus
disagreements. This number was then multi-
plied by 100%. The mean exact agreement
coefficients for problem behavior were 99%
(range, 95% to 100%) for Jay and 80% (range,
46% to 100%) for Betty. Low agreement scores
for Betty in this analysis (and the treatment
analysis) were correlated with sessions during
which the highest amounts of aggression
occurred. This scoring difficulty was at least
partly due to the fact that aggression often
occurred in bursts of multiple forms of the
response (i.e., hitting, kicking, etc.).
PHASE 2: TREATMENT EVALUATION
Design, Setting, and Procedure
Several function-based treatments were eval-
uated in single-subject designs (reversal and
54 GREGORY P. HANLEY et al.
multielement) for each participant. All sessions
were conducted in individual treatment rooms
(3 m by 3 m) equipped with one-way mirrors.
Approximately three to five sessions were
conducted per session block (six to 10 sessions
per day), and a 5-min break occurred between
each 10-min session.
Baseline. The baseline condition was simi-
lar to the attention condition of the functional
analysis. The child was provided with activities
and was instructed to play while the therapist
attended to a task (e.g., reading a magazine).
The therapist delivered approximately 20 s of
attention in the form of mild verbal reprimands
(e.g., ‘‘Don’t do that’’) and statements of
concern (e.g., ‘‘You might hurt yourself ’’)
following problem behavior. All other responses
were ignored.
FCT training trials. Following baseline but
prior to the FCT (and NCR for Jay) evaluation,
training trials were conducted to teach the
participants alternative responses that would
result in access to adult attention. The alter-
native responses were selected based on the
individual’s expressive language abilities and the
advice of the consulting speech pathologists.
The alternative response for Jay was handing a
yellow card containing the printed word ‘‘play’’
to the therapist. The alternative response for
Betty was saying ‘‘attention, please’’ or ‘‘excuse
me.’’ Nine 10-min training sessions were
conducted with Jay, and two 10-min training
sessions were conducted with Betty to teach the
alternative responses.
Training consisted of backward chaining in
which Jay was initially physically guided to
hand the card to the therapist to obtain 20 s of
attention. No attention was provided for prob-
lem behavior (i.e., extinction was programmed
for problem behavior). The amount of guidance
provided to hand the card to the therapist was
decreased to a vocal prompt over the course of
the training sessions. Subsequently, the vocal
prompting was eliminated, and Jay indepen-
dently engaged in the alternative response
throughout the last two training sessions. The
therapist vocally prompted Betty to emit either
of the two vocal responses to request attention
every 30 s, and problem behavior no longer
produced attention (extinction) in the initial
training session. Betty independently engaged
in the alternative response during both training
sessions.
FCT. The conditions were the same as
those described in baseline with the following
exceptions. If the child emitted the alternative
response (i.e., saying ‘‘attention, please’’ or
‘‘excuse me’’ for Betty; handing the card to
the therapist for Jay), the therapist delivered
20 s of attention (verbal praise and interactive
play). If the child engaged in problem behavior,
no differential consequence occurred (i.e.,
extinction). In addition, a blue laminated
posterboard (80 cm by 52 cm) was placed on
the wall during the FCT treatment sessions for
Jay. This item was included in an attempt to
establish an association with a salient stimulus
(blue posterboard) and the FCT treatment
contingencies and to promote discriminated
performances during his comparative treatment
analysis (similar condition-correlated stimuli
were not used with Betty because she experien-
ced only one intervention at a time).
NCR. This intervention was evaluated with
Jay only. The conditions were similar to those
described for the FCT sessions with the
following exceptions: The communication card
was not available, a green posterboard (80 cm
by 52 cm) was placed on the wall, both
problem behavior and alternative responding
resulted in no differential consequences, and the
therapist delivered 20 s of attention (verbal
praise and interactive play) on a time-based
schedule. The schedule of attention delivery in
the NCR sessions was yoked to the preceding
FCT session. During the FCT sessions, a data
collector recorded the occurrence of each
communicative response on a sheet that was
partitioned into 60 10-s intervals. During NCR
sessions, 20 s of attention was delivered at the
EVIDENCE-BASED VALUES 55
approximate times (in the same intervals) that
attention had been delivered in the previous
FCT session. This procedure resulted in the
same amount and temporal distribution of
reinforcement delivered across FCT and NCR
sessions. Both FCT and NCR were evaluated
with Jay to determine if either treatment was
more effective in reducing problem behavior
(see Kahng, Iwata, DeLeon, & Worsdell, 1997,
and Hanley et al., 1997, for similar comparative
analyses). NCR was not evaluated with Betty
because strengthening socially appropriate vocal
behavior was a primary goal of her admission.
FCT plus punishment. These conditions
were the same as the FCT conditions except
that each instance of problem behavior resulted
in a 30-s hands-down procedure for Jay (the
therapist stood behind Jay and held his hands to
his sides) and a 30-s hands-down and visual-
screen procedure for Betty (the therapist stood
behind the child and placed one arm around the
child’s arms while placing the other hand over
the child’s eyes; Fisher, Piazza, Bowman,
Hagopian, & Langdon, 1994). These particular
procedures were selected because they both have
empirical support (Fisher et al.) and could be
implemented safely and consistently by thera-
pists and caregivers with these children. The
procedures differed for each child based on
caregiver preference. Caregivers were provided
with a description of nine potential punishment
procedures (Fisher et al.) and were asked to
select the procedure they thought would be
most effective and one that they would be
willing to implement consistently. Overall
session length varied in this condition because
the session clock was stopped each time a
punishment procedure was implemented (i.e.,
each session represents 10 min in which all
target responses could occur). Also, for Jay, a
red posterboard was present during the FCT
plus punishment sessions.
Data Collection and Interobserver Agreement
During all treatment analysis sessions, trained
observers used laptop computers to record the
frequency of problem behaviors and alternative
responses. Two independent observers recorded
target responses simultaneously but indepen-
dently during 50% and 58% of the sessions for
Jay and Betty, respectively. Mean exact agree-
ment for problem behavior was 99% (range,
87% to 100%) and 88% (range, 56% to 100%)
for Jay and Betty, respectively. Mean exact
agreement for the alternative behavior was 90%
(range, 88% to 100%) and 95% (range, 87%
to 100%) for Jay and Betty, respectively. Fre-
quency data also were collected during all
waking hours on Jay’s problem behavior on
the living unit by direct-care staff using paper
and pencil. These data were collected during
baseline, FCT, and FCT plus punishment
conditions and are reported as responses per
hour.
PHASE 3:
TREATMENT PREFERENCE EVALUATION
General Description
Each child’s relative preference for several
treatments was evaluated using a modified
concurrent-chains procedure (Hanley et al.,
1997). In this arrangement, three equal
(fixed-ratio 1) and independent schedules were
arranged for pressing one of three micro-
switches; these were the initial links of the
chain. Responding on different-colored micro-
switches resulted in access to the different
treatments; these were the terminal links in
the chain. This procedure has been used to eval-
uate preference for different types or schedules
of reinforcement because responding to produce
access to the terminal links (reinforcing effec-
tiveness of the terminal links) is separated
from the contingencies that maintain respond-
ing in the terminal links (Catania, 1963). Three
switches were available in the initial links, and
three treatment procedures—FCT, FCT plus
punishment, and punishment only—were avail-
able in the terminal links. Switch pressing
outside a therapy room (initial links) resulted in
a 2-min period inside the room (terminal links)
in which the contingencies varied according to
56 GREGORY P. HANLEY et al.
the switch that was pressed. The treatment
contingencies were the same as those described
in Phase 2.
Procedure
Three switches (22 cm by 14 cm), each
covered with a different-colored piece of
construction paper (blue, red, or white), were
located on a table outside of a therapy room.
Each colored switch was paired with a different
treatment: the blue switch with FCT, the red
switch with FCT plus punishment, and the
white switch with punishment only. Pressing
any switch resulted in immediate praise from
the therapist (e.g., ‘‘Good pressing the red
switch’’) and access to the terminal link (i.e., the
child entered the therapy room and experienced
the treatment contingencies associated with the
pressed switch for 2 min). The FCT and FCT
plus punishment arrangements were similar
to those described above for the treatment
evaluation. The only difference between these
two interventions was the presence or absence
of the punishment procedure. During the
punishment-only condition, problem behavior
resulted in a 30-s hands-down procedure for Jay
or a 30-s hands-down and visual-screen proce-
dure for Betty; attention was otherwise unavail-
able. This option was included to distinguish
between indiscriminate initial-link respond-
ing (represented by equal responding on all
switches) and no preference between the two
target treatments (represented by approximately
50% of responding to each FCT intervention)
(i.e., given the results of the functional analyses,
it was assumed that the child would not respond
for the terminal link that was devoid of atten-
tion). The child exited the room after 2 min
and was repositioned in front of the switches.
This procedure was repeated until 20 min had
elapsed for Jay or 10 initial-link responses were
recorded for Betty. The change from the time-
based to the response-based termination criter-
ion ensured that the same number of choice
opportunities would be arranged in each session
(this procedural modification was introduced by
Hanley et al., 1999; it occurred after Jay’s
assessment but before Betty’s assessment). The
materials in the terminal links were the same as
those described for all assessment conditions
(i.e., therapist, chair, and toys), except that
colored posterboards corresponding to the
treatment contingencies were posted in the
terminal links (blue for FCT, red for FCT plus
punishment, and white for punishment only).
Prior to the evaluation of treatment pref-
erence, prompted choice trials were conducted
to expose the participants to the different
contingencies arranged for pressing each of the
switches. During each participant’s first expo-
sure session, the therapist physically guided Jay
or Betty to press a switch. The order of switch
pressing was determined randomly. In addition
to exposing the children to the consequences
for pressing each of the three switches, the
contingencies also were described to Betty
to facilitate discriminated switch pressing. In
subsequent exposure sessions, the therapist
stood behind the participant and verbally
prompted him or her to press a switch once
every 20 s if the participant did not press a
switch independently. Exposure sessions were
conducted with Jay until he pressed any of the
three switches independently on five consecu-
tive trials; this occurred in the fourth exposure
session. Two 20-min exposure sessions were
conducted with Betty.
Treatment preference assessment sessions
then were conducted using similar procedures.
Participants were physically guided to press each
switch (red, blue, and white) once and contact
the contingencies associated with each switch in
the terminal links prior to the onset of each
preference assessment session. Several controls
for unwanted bias were programmed. The same
therapist implemented each of the three treat-
ments in the terminal links to insure that the
procedures were implemented similarly within a
session and to control for the participant press-
ing a switch to gain access to a particular thera-
pist (different individuals served as therapists
EVIDENCE-BASED VALUES 57
across sessions). The same materials also were
present in the therapy room (toys, chair) for all
treatments. The therapists were trained to issue
all prompts (‘‘Press the switch’’) in a neutral
tone of voice, to deliver all praise statements in
the same tone of voice following all switch
presses, and to implement attention and
punishment procedures in an identical manner
across treatments. Finally, the position of the
switches was altered randomly after the partici-
pant pressed a switch and entered the room.
Data Collection and Interobserver Agreement
During all treatment preference evaluation
sessions, two trained observers independently
recorded the number of switch presses for Jay
and Betty using paper and pencil. An agreement
was scored if both observers recorded the same
switch pressed for a given trial. An agreement
coefficient was calculated for each participant’s
treatment preference evaluation by dividing the
number of agreements by the total number of
agreements plus disagreements and multiplying
by 100%. Interobserver agreement was collected
for 100% of the sessions for Jay and Betty and
was 100%. Data were not collected on problem
and alternative behaviors in the terminal links.
RESULTS
Phase 1
Results of the functional analyses for both
participants are presented in Figure 1. Attention
was the only condition in which rates of
problem behavior were consistently higher than
the control condition for Jay (M 5 1.5 and 0.1
responses per minute, respectively), suggesting
that his problem behavior was sensitive to
attention as reinforcement. Betty’s aggression
was observed at high rates in the attention (M 5
8.4) and escape (M 5 2.9) conditions relative to
the play condition (M 5 0), suggesting both
attention and escape functions. However, the
treatment analyses focused exclusively on
Figure 1. Problem behaviors per minute during the functional analyses for Jay (top) and Betty (bottom).
58 GREGORY P. HANLEY et al.
Betty’s attention-maintained aggression (the
escape function was addressed in another
assessment not presented here).
Phase 2
The results of the treatment analyses are
presented in Figure 2. Jay engaged in a rate of
problem behavior in the treatment baseline
conditions (M 5 1.5 responses per minute)
similar to that observed in the attention
condition of the functional analysis. A reduc-
tion in problem behavior was observed with
both NCR and FCT; however, variable and
sometimes high rates of responding were
observed in both conditions (M 5 1.7 for
NCR, M 5 0.6 for FCT). A return to baseline
resulted in higher and variable rates of problem
behavior (M 5 3.7). The reintroduction of
both interventions resulted in an overall
decrease in responding from baseline (M 5
0.7 for NCR, M 5 0.9 for FCT); however,
high rates of problem behavior were intermit-
tently observed in both treatment conditions.
The alternative response for Jay (handing a
picture card to the therapist) persisted at low
rates during all FCT sessions (M 5 0.4, range,
0.1 to 1.1; data not shown).
Although both interventions resulted in
similarly moderate reductions in problem
behavior, FCT was implemented across the
day as the primary intervention because it
involved the strengthening of an adaptive
behavior and allowed attention to be delivered
at times when it was presumably most valuable
to Jay (Hanley et al., 1997). Data collected
throughout the day on the living unit showed
that problem behavior was lower when FCT
was in effect (M 5 10.8 responses per hour)
than in baseline (M 5 15.4 responses per hour).
Nevertheless, problem behavior persisted at
Figure 2. Problem behaviors per minute during the treatment evaluations for Jay (top) and Betty (bottom).
EVIDENCE-BASED VALUES 59
unacceptable rates. An FCT baseline was then
reestablished, and high and variable rates of
problem behavior were observed (M 5 2.8
responses per minute). FCT plus punishment
resulted in a reduction in the level and
variability of problem behavior (M 5 0.7).
High rates of problem behavior were recovered
during the FCT intervention (M 5 5.0), and
near-zero rates of problem behavior were
observed during the final FCT plus punishment
condition (M 5 0.3). The alternative response
was emitted at variable rates throughout the
FCT and FCT plus punishment conditions
(Ms 5 0.6 and 0.7, respectively). The FCT
plus punishment intervention was implemen-
ted across the day and was associated with the
lowest rates of problem behavior on the living
unit (M 5 3.4 responses per hour).
The results of Betty’s treatment evaluation are
shown in the bottom panel of Figure 2. She
engaged in extremely high levels of aggression
under baseline conditions (M 5 21.4 responses
per minute). Although an immediate reduction
in aggression was observed when an alternative
response resulted in attention and aggression was
placed on extinction (FCT; M 5 4.7), aggression
continued to occur at rates above 5 per minute
during 50% of FCT sessions. An immediate and
sustained reduction in aggression was observed
when punishment was added to the FCT
intervention (M 5 0.5). High levels of aggression
were observed when the punishment contingency
was withdrawn (M 5 9.0), and low levels of
aggression were recovered when the punishment
contingency was reinstated (M 5 0.4). The
alternative response was emitted at variable rates
Figure 3. Number of switch presses during the evaluation of preference for functional communication training
(FCT), FCT combined with punishment, or punishment only for Jay (top) and Betty (bottom).
60 GREGORY P. HANLEY et al.
throughout the FCT conditions; however,
slightly elevated rates of the alternative response
were observed during FCT plus punishment
(M 5 1.7) relative to FCT (M 5 0.8).
In sum, function-based interventions involv-
ing differential or noncontingent reinforcement
and an explicit extinction contingency resulted
in reductions in problem behavior for Jay and
Betty; however, problem behavior was observed
intermittently at high rates under these condi-
tions. The addition of the punishment proce-
dures to the FCT interventions resulted in
sustained low rates of problem behavior and
maintenance of the alternative responses for
both children.
Phase 3
The results of the treatment preference evalu-
ation are presented in Figure 3. Throughout the
evaluation, Jay allocated the majority (79.3%)
of his switch presses to the FCT plus punish-
ment intervention. A preference for FCT plus
punishment emerged during Betty’s evaluation,
in that all switch presses were allocated to FCT
plus punishment in the final five sessions. These
data provide direct evidence that the function-
based treatments involving punishment con-
tingencies were more preferred (reinforcing)
than similar function-based treatments invol-
ving extinction or interventions consisting of
punishment alone.
DISCUSSION
Functional analysis results showed that the
problem behavior (aggression, self-injury, and
disruption) of 2 children was maintained by
adult attention. Function-based treatments,
which included the differential or noncontin-
gent delivery of attention and the withholding
of the same reinforcer following problem
behavior (i.e., extinction), were shown to
partially, but not satisfactorily, reduce problem
behavior. Adding punishment contingencies to
the function-based treatments resulted in sus-
tained near-zero rates of problem behavior and
maintenance of an alternative response for both
participants. Finally, and perhaps most impor-
tant, when the children were given the oppor-
tunity to select behavioral interventions, they
chose the intervention that involved both a
reinforcement contingency for alternative behav-
ior and a punishment contingency for problem
behavior.
Interventions based on a functional analysis
(Iwata, Pace, Dorsey, et al., 1994) typically
involve either contingent (e.g., E. G. Carr &
Durand, 1985) or time-based (e.g., Vollmer,
Iwata, Zarcone, Smith, & Mazaleski, 1993)
delivery of maintaining reinforcers, and extinc-
tion is explicitly arranged for problem behavior
(e.g., Iwata, Pace, Cowdery, & Miltenberger,
1994). Reinforcement and extinction packages
have been shown to be effective in reducing
problem behavior (Lalli, Casey, & Kates, 1995;
Lovaas, Freitag, Gold, & Kassorla, 1965;
Mazaleski, Iwata, Vollmer, Zarcone, & Smith,
1993). However, several other studies have
shown that the differential delivery of the
maintaining reinforcer may not be sufficient
for reducing problem behavior to acceptable
levels (Fisher et al., 1993; Hagopian et al.,
1998; Wacker et al., 1990). These parti-
cular studies showed that the combination of
function-based interventions and punishment
contingencies resulted in the largest reductions
in problem behavior. The results of the
current study are consistent with the latter set
of studies in that punishment contingencies
were necessary to reduce behavior to acceptable
levels.
The fact that children in the current study
committed to treatment conditions involving
punishment contingencies is seemingly at odds
with the antiaversives movement (LaVigna &
Donnellan, 1986) and the recent practice of
designing positive behavioral interventions for
individuals with problem behavior (E. G. Carr
et al., 2002). If treatment options were
restricted to those considered nonaversive or
positive, the participants in the current study
EVIDENCE-BASED VALUES 61
would have been prescribed treatments that
were both ineffective and nonpreferred. These
data clearly emphasize the notion that evid-
ence-based values can and should guide the
treatment-selection process.
Nevertheless, it appears somewhat counter-
intuitive that children would prefer conditions
that involve punishment contingencies. One
explanation for this preference is that the hands-
down and visual-screen procedures were not
actually punishment procedures. It is possible
that the procedures contained elements that
were similar to the attention that served as
reinforcement for problem and alternative
behavior (e.g., an adult approaching the child,
physical contact). However, if the procedures
were reinforcing, an increase in problem
behavior would be expected to occur when the
procedures were provided contingent on prob-
lem behavior during the FCT plus punish-
ment conditions. This clearly was not the case
(see Figure 2); therefore, the procedures and
their effects satisfy the functional criteria of a
punisher (Azrin & Holz, 1966). It also might be
argued that the procedures reduced problem
behavior by merely interrupting a burst or
cluster of behavior, a process that might be less
consistent with punishment. However, problem
behavior did not usually appear in clusters for
Jay, and the frequency of behavior clusters was
reduced as were the number of instances (i.e.,
there were several sessions for both Jay and
Betty in which no problem behaviors were
observed during FCT plus punishment).
The children may have preferred FCT plus
punishment if more reinforcers (20-s periods
of adult attention) were delivered during the
FCT plus punishment condition than the FCT
condition (preference for greater overall amount
of reinforcement). However, limitations of the
current study, which include the lack of data
collected on the number of reinforcers delivered
during the treatment assessment and the lack
of data collected on relevant child–therapist
interactions during the terminal links of the
preference assessment, prohibit complete anal-
yses of these variables. However, because a
reinforcer was scheduled to follow each alter-
native response, the number of alternative
responses emitted during both FCT and FCT
plus punishment during the treatment analysis
would be suggestive of differing levels of
reinforcement. Jay’s data showed no difference
in the rate of alternative responses emitted
during FCT and FCT plus punishment (Ms 5
0.6 and 0.7 responses per minute, respectively)
during the treatment analysis. Betty engaged in
the alternative response at higher rates during
FCT plus punishment (M 5 1.7) than in FCT
(M 5 0.8), suggesting that the higher overall
level of reinforcement in FCT plus punishment
experienced during her treatment analysis may
have been responsible for her preference.
There was, however, a difference in the per-
centage of responses that resulted in reinforce-
ment across FCT plus punishment and FCT
conditions during the treatment analyses. Because
problem behavior persisted during extinction for
both children, only a small percentage of the
children’s overall responses resulted in reinforce-
ment. But when the suppressive effects of
punishment were arranged, the majority of
behavior emitted resulted in reinforcement.
Therefore, it seems plausible that the higher
probability of reinforcement per response was
responsible for the children’s preference for the
interventions involving punishment. Generally
speaking, this suggests that the children preferred
conditions in which they were more effective (or
efficient). However, this explanation is merely
suggested by correlational and indirect means. In
other words, the higher percentage of reinforce-
ment per response may be associated with the
punishment condition, but this particular factor
may not have been the variable that exerted
control over children’s preferences. Future
research may be best directed towards determin-
ing the specific variables that control children’s
preference for treatments involving punishment,
or other intervention components, via functional
62 GREGORY P. HANLEY et al.
analysis (i.e., systematic manipulation of the
suspected variables that control preference for a
particular context).
Although children’s preferences may have been
a function of the increased likelihood of reinforce-
ment per response, it is also possible that selec-
tion responses in the initial link functioned partly
to avoid the FCT intervention (i.e., treatment
selections may have been controlled by both the
reinforcing context of FCT plus punishment and
the nonreinforcing or aversive aspects of FCT
plus extinction). The aversiveness of punishment
procedures is presupposed; an event would not
function as a punisher unless it was indeed
aversive (see a recent discussion by Perone,
2003). The data in the current study suggested
that the punishment procedures were sufficiently
aversive to decrease problem behavior, but the
context involving extinction only for problem
behavior may have been more aversive than the
context in which punishment was arranged for
problem behavior. Hence, under some conditions
it is plausible that extinction might be more
aversive than punishment.
As noted earlier, FCT is a DRA procedure,
and all DRA procedures necessarily involve
extinction (i.e., some responses are reinforced
while others are not). Therefore, selecting
interventions based on their nonaversive proper-
ties may be a bit more complicated than simply
discerning the presence or absence of an explicit
punishment contingency. Instead of attempting
to discern the appropriateness of a given
intervention based on its name, structure, or
presumed aversiveness, perhaps we should con-
tinue to systematically establish the effectiveness
of function-based interventions and ask the
consumers which interventions they prefer. The
data from the present study, and the methods
used to yield the data, suggest that the
consumers of our interventions can and should
contribute directly to the value systems that
guide the treatment-selection process.
It may also be important to begin to under-
stand the conditions in which the aversiveness
of situations involving punishment is mini-
mized. Various basic and applied studies
demonstrate or suggest strategies for minimiz-
ing the aversiveness of situations involving
punishment; these strategies include scheduling
reinforcement for a competing response,
increasing the overall density of reinforcement,
and making the punishment schedule contin-
gent, signaled, and predictable (Badia, Coker,
& Harsh, 1973; Farley, 1980; Harsh & Badia,
1975; Hoffman & Fleshler, 1965; Lerman &
Vorndran, 2002; MacDonald, 1973; Orne-
Johnson & Yarczower, 1974; Thompson,
Iwata, Conners, & Roscoe, 1999). From this,
we speculate that our participants would not
have chosen the intervention involving punish-
ment if reinforcement for an intact competing
response was unavailable or if the punishment
procedures were noncontingent or unpredict-
able. However, continued research on these
variables as they affect the effectiveness and
value of interventions is needed. Specifically,
research findings that lead to more effective
punishers (Lerman & Vorndran) while mini-
mizing the aversiveness of situations in which
punishment is delivered may optimize inter-
ventions for the most intractable behavior
problems, enhance their value to the persons
who experience the treatments, and pro-
mote the adoption of the most effective
interventions.
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Received January 13, 2004
Final acceptance October 19, 2004
Action Editor, Dorothea Lerman
STUDY QUESTIONS
1. According to the authors, what two factors might account for the apparent decrease in the use of
punishment?
2. How were Jay’s FCT and NCR conditions (a) similar and (b) different?
3. What punishment procedures were used, and how were they selected?
4. Summarize the results obtained during treatment.
5. Describe the concurrent-chains procedure used to assess treatment preference.
6. What was the purpose of the punishment-only condition during Phase 3?
7. Summarize participants’ performance during the preference assessment.
8. What two factors were suggested to account for participants’ selections? What data contained in the
article were consistent with this account, and what additional data would have been helpful?
Questions prepared by David Wilson and Jennifer Fritz, University of Florida
EVIDENCE-BASED VALUES 65