An ABA-based Intervention Package for Treating the Inappropriate Use of a Communication Device Within Autistic Populations

The principles of applied behaviour analysis (ABA) are widely used with autistic populations in managing challenging behaviour. The following paper will review supporting literature for creating a treatment package for targeting the misuse of a communication device in brief detail by using key elements in ABA. It will examine various types of attention (or response) that may reinforce the problem behaviour, as well as intervention methods, such as functional communication training and noncontingent reinforcement. In addition, the necessity of extinction for effective intervention will be considered. A review of the literature may help inform the development of a successful treatment package that could be implemented within applied settings. Additional desirable outcomes include: reduction in aberrant behaviour, accessing attention appropriately, establishing the correct use of the communication device and increase in manding levels.

to draw conclusions about relationships between those events. It is important to note, that ABA should not be equated with a specific type of programme delivery but viewed as a foundation for the practice of a science from which teaching methods and educational programmes are constructed (Psychological Society of Ireland, 2010). Various ABA principles include (among others): positive and negative reinforcement, time out, extinction, and functional communication training.
As an illustrative case, this review will explore ABA methods that could be adapted for use with a non-verbal 10-year-old boy with a diagnosis of autism. This individual (a case study) engages in attention-maintained aberrant behaviour by not using the ACC device "Go Talk 20+" functionally, but instead in a toy like manner, as icons are being pressed randomly and excessively. At present, he has no fluently established communication method. According to the Verbal Behaviour Milestones Assessment and Placement Program (Sundberg, 2008), his manding abilities are at level 1 (0-18 months). Manding refers to asking or requesting desired items (Skinner, 1957).
Being able to use an ACC device appropriately, such as "Go Talk 20+", would allow this individual to produce over 100 messages through voice output by pressing icons, which include requesting desired items, answering questions, learning concepts (e.g. colours, shapes) and many more. Full comprehension of the communication device can expand independence and help interaction with others, by giving more suitable ways for gaining access to attention from others or request removal from aversive situations and stimuli (Hodge, 2007). An AAC device is also a good method for pairing images with sounds, which strengthens perceptual learning (Shams & Seitz, 2008).

Topographies of Attention
Firstly, it is important to look at various topographies of attention that could maintain the undesirable behaviour.
Gaining attention from others is one of the possible functions of the behaviour and is categorised as a social positive reinforcement. Challenging behaviour often receives immediate reaction (i.e. inappropriate attention) from others in a form of reprimands, statements related to behaviour, laughing, head turns etc. Problematic behaviour can occur when the individual has not learnt to access attention in a more desirable way, when the attention is infrequent, when others in the environment are occupied, or because it is better to obtain attention through reprimands or punishment, than receive no attention at all (Cooper et al., 2007). Therefore, aberrant behavior may be functioning as a method of communication for the individual. Kodak, Northup, and Kelley (2007) (Kodak et al., 2007).

Functional Communication Training
Functional communication training (FCT) focuses on replacing the problem behaviour with a more appropriate alternative response (i.e. mand) that would lead to reinforcement and access to a desired item. FCT is a widely used intervention method and numerous studies have demonstrated its effectiveness in reducing problem behaviour maintained by social reinforcement (Tiger, Hanley, & Bruzek, 2008) and in improving communication skills (Carr & Durand, 1985). Furthermore, numerous studies have confirmed that individuals with autism, across the range of ability, can learn to use AAC for functional communication (Mirenda, 2003). Research has demonstrated success in teaching individuals with autism to make a generalized "want" request (Sigafoos & Drasgow, 2001), requests for desired items such as drink (Dyches, 1998) or preferred activities (Brady, 2000), and respond to questions and make social comments (Schepis, Reid, Behrmann, & Sutton, 1998).
Research from FCT also demonstrates that children may engage in manding as it requires less effort than exhibiting challenging behaviours (Richman, Wacker & Winborn, 2001).

Establishing Operations
Establishing Operations (EO) are factors that can increase the value of the reinforcement and can be compared to motivation or desirability (Skinner, 1957). Therefore, EO should be taken into consideration when introducing AAC to clients due to an increase in appropriate manding. For a successful acquisition, it is vital to begin the teaching with requesting for concrete, highly desirable items that can be provided immediately (Frost & Bondy, 2002). Brown et al. (2000) highlighted the importance of EO, but because FCT was combined with punishment, the authors could not determine whether the presence of EO alone would have led to improvements, nor if functional equivalence was responsible for successful treatment. In addition, the authors suggested that some mands may not be acquired simply through skills training, as there was a prolonged prior pairing history with reinforcement and the response cost 2 . Therefore, the type of mands that are most suitable for an effective FCT treatment package remains unclear.

Mand Selection
2 Response cost or negative punishment is another way to make behaviour less frequent. It occurs when a stimulus is taken away as a consequence of behaviour and the effect is to reduce the frequency of the behaviour.
Winbom, Wacker, Riehman, Asmus, and Geier (2002) focused specifically on mand selection using FCT. They compared the effectiveness of using already existing mands, such as saying ''no'', ''all done,'' or shaking his head from side to side, with novel ones like pressing a microswitch with the message, ''Break, please'' or handing the therapist a communication card with the word ''break'', which could be used to replace the problem behaviour.
There were two participants with developmental disabilities, both between two and three years of age. The experiment consisted of three phases: functional analysis (FA); training the existing and novel mands using differential reinforcement of alternate behaviour (DRAwhere desirable substitute to problem behaviour is reinforced); and choice analysis. In addition, the problem behaviour was placed under extinction by discontinuing the previous reinforcement of the behaviour. Substantial increases in independent manding were observed after the initial mand training. Overall, results revealed that both mands were effective in suppressing the aberrant behaviour and were exhibited independently after the training sessions (where DRA was implemented alongside extinction). Nevertheless, when both existing and novel mands were presented concurrently in the choice analysis, the preference towards existing mands was more frequent than for novel ones.
However, it is important to note that the preference for existing mands was associated with lower levels of manding and higher percentages of aberrant behaviour, which was possibly related to prior reinforcement history. that the combination of these two methods increased manding and was effective in suppressing problem behaviour. Interestingly, problem behaviour decreased slightly more in the alternative stimuli condition than in the FCT condition without the extinction phase. In addition, manding also occurred at a higher rate.
However, the greater reduction in using alternative stimuli (Doughty & Anderson, 2006) may have occurred due to time spent on consumption, the type of attention used for reinforcement not being functionally equivalent to the attention maintaining the problem behaviour, or because of an accidental reinforcement due to an initially dense schedule. It was also highlighted that extinction 3 When operant behavior that has been previously reinforced no longer produces reinforcing consequences, the behaviour gradually stops occurring may be a necessary component to this treatment package when thinning the NCR reinforcement schedule.
Regardless of these limitations, the authors emphasised the practical implications for using arbitrary preferred stimuli for intervention as it may not always be possible to address specific behavioural functions due to limited resources or when dealing with several clients simultaneously in a school setting. Hagopian, Contrucci Kuhn, Long, and Rush (2005) acknowledged the issue of schedule thinning, since reinforcement for appropriate communication cannot Therefore, DRA can be implemented effectively without the extinction component.

Conclusion
The