Effectiveness of functional communication training with and without extinction and punishment: a summary of 21 inpatient cases.
FCT plus extinction works for most clients; add punishment only after gentler refinements fail.
01Research in Context
What this study did
The team looked at 21 hospital inpatients with severe problem behavior. All clients got functional communication training. Some also got extinction, punishment, or demand fading.
The goal was to see which add-ons pushed reduction past 90 percent.
What they found
FCT plus extinction helped most clients. When that mix stalled, adding a punishment part cut problem behavior by 90 percent or more in every case.
Demand or delay fading sometimes made results worse, not better.
How this fits with other research
Al-Jawahiri et al. (2019) pooled 28 later studies and still found FCT plus extinction works, but they never needed punishment. The meta focused on young children with some speech; the 1998 cases were older, non-verbal inpatients.
Sumter et al. (2020) show you can skip punishment if you give alternative reinforcers during post-FCT delays. Their clients had milder behavior and shorter wait times.
Murphy et al. (2014) extend the idea: when FCT alone fails, add response restriction instead of punishment. Their kids had already flunked regular FCT, yet restriction fixed the issue without aversives.
Why it matters
If you run FCT plus extinction and the graph flat-lines, do not rush to punishment. First check client age, communication level, and wait time. Try alternative reinforcers or response restriction first. Reserve punishment for the few inpatients who still pose extreme risk after these steps.
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02At a glance
03Original abstract
Functional communication training (FCT) is a frequently used treatment for reducing problem behavior exhibited by individuals with developmental disabilities. Once the operant function of problem behavior is identified by a functional analysis, the client is taught to emit an appropriate communicative response to obtain the reinforcer that is responsible for behavioral maintenance. Studies on FCT have typically used small numbers of participants, have reported primarily on clients for whom FCT was successful, and have varied with respect to their use of other treatment components. The main purposes of the present study were to evaluate the efficacy of FCT for treating severe problem behavior in a relatively large sample of individuals with mental retardation (N = 21) and to determine the contribution of extinction and punishment components to FCT treatment packages. FCT with extinction was effective in reducing problem behavior for the majority of clients and resulted in at least a 90% reduction in problem behavior in nearly half the applications. However, when demand or delay-to-reinforcement fading was added to FCT with extinction, treatment efficacy was reduced in about one half of the applications. FCT with punishment (both with and without fading) resulted in at least a 90% reduction in problem behavior for every case in which it was applied.
Journal of applied behavior analysis, 1998 · doi:10.1901/jaba.1998.31-211