Further investigation of resurgence following schedule thinning: Extension to an inpatient setting

The team watched every FCT case on an inpatient unit for one year. They noted when staff began thinning the reinforcement schedule after teaching a new communicative response.

They simply counted how often the old problem behavior popped back up during thinning. No new treatment was tested; they tracked what normally happens.

Resurgence showed up in 91 out of 100 thinning attempts. In other words, nine times out of ten the old behavior returned.

The study confirms that resurgence is the rule, not the exception, when you thin reinforcement after FCT in an inpatient setting.

Muething et al. (2021) saw the same pattern in a broader sample, finding resurgence in 41% of thinning steps. The lower number likely reflects different settings and thinner measurement slices, but both studies agree relapse is common.

Briggs et al. (2018) reported 76% of steps produced resurgence. Kranak’s 91% in the hospital extends that warning into intensive care, showing the risk is even higher where baseline rates are already severe.

Fuhrman et al. (2016) seems to contradict the bad news: they showed resurgence can be cut with multiple-schedule thinning. The difference is focus; Kranak counted how often relapse happens under usual care, while Fuhrman tested a way to stop it.

Strohmeier et al. (2024) now supersedes older thinning methods. Their terminal-probe approach produced far less resurgence than the 91% Kranak documented, giving clinicians an updated tool.

Expect resurgence every time you thin. Write a relapse plan before you start: pre-teach tolerance responses, schedule booster FCT sessions, and brief staff on how to react. Consider trying the newer terminal-probe method instead of dense-to-lean steps. If you work on an inpatient unit, track resurgence as a quality indicator and adjust caseload staffing accordingly.