On the scope and characteristics of relapse when treating severe destructive behavior
Plan for relapse in two-thirds of FCT cases when you thin reinforcement or change rooms, and check that the new communication response survives the shift.
01Research in Context
What this study did
Mitteer et al. (2022) watched what happens when you thin reinforcement or move to a new room after FCT. They tracked both problem behavior and the new communication response.
The team used a case-series design. They counted how often resurgence and renewal popped up during routine schedule thinning.
What they found
About seven in ten FCT cases saw a relapse. Problem behavior came back when reinforcement got thinner or the setting changed.
The same disruption hit the functional communication response. Kids stopped asking and started hitting again.
How this fits with other research
Briggs et al. (2018) saw resurgence in 76% of thinning steps. Mitteer adds renewal and shows the communication response drops too.
Muething et al. (2021) found only 41% resurgence. The difference is method: Muething used multiple schedules that signal thin periods, while Mitteer captured typical clinical thinning without those signals.
Kranak et al. (2021) pushed the count to 91% in an inpatient unit. Mitteer’s 70% sits between the signaled low and the hospital high, giving a real-world benchmark.
Why it matters
Expect relapse in most cases and watch both behaviors. Put resurgence and renewal on your treatment plan like you plan for extinction bursts. Add booster FCT trials before each thinning step and probe the communication response, not just problem behavior.
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02At a glance
03Original abstract
Prior studies on treatment relapse have typically examined the prevalence of resurgence or renewal of target behavior (e.g., destructive behavior) in isolation. This study analyzed both types of relapse during 25 consecutive treatments involving functional communication training during worsening reinforcement conditions for alternative behavior (i.e., schedule thinning) or following context changes. We also examined disruption of alternative behavior (i.e., functional communication requests, compliance). Resurgence and renewal of destructive behavior occurred in 76% and 69% of treatments, respectively, and in approximately a third of changes in reinforcement or context. Relapse of destructive behavior predicted alternative-response disruption and vice versa; the co-occurrence of these two events always exceeded the background probabilities of either event occurring in isolation. General reductions in treatment efficacy occurred across changes in reinforcement or context, with no apparent decrease in likelihood in later transitions. We discuss implications of our findings with respect to future studies examining treatment durability.
Journal of Applied Behavior Analysis, 2022 · doi:10.1002/jaba.912