Functional communication training: From efficacy to effectiveness
FCT already works in clinics; new telehealth and school studies show it can work in everyday life, too.
01Research in Context
What this study did
Ghaemmaghami et al. (2021) looked at every FCT paper they could find. They asked: do we have proof the plan works outside the lab?
They used APA rules to rate the evidence. They wanted the label “evidence-based practice,” not just “works in clinics.”
What they found
FCT cut problem behavior in most lab studies. Yet the team said, “We still need proof it lasts at home, school, and in the community.”
Because that proof is thin, FCT stays in the “efficacious” box, not the top “evidence-based” tier.
How this fits with other research
Gerber et al. (2011) used the same APA rules ten years earlier. They gave FCT the gold star for kids with ID or autism. Ghaemmaghami et al. (2021) moved the goal posts: they now want real-life data, too.
Lindgren et al. (2020) gave them that data. Parents coached over Zoom ran FCT at home. Problem behavior dropped 98% in 12 weeks. One lab review says “not enough proof,” but a fresh RCT shows big real-world gains.
Corr et al. (2025) add even more weight. Their mega-review of six FCT papers finds steady success in schools. The gap Ghaemmaghami spotted is closing fast.
Why it matters
You can keep using FCT with confidence. Pair it with brief parent or teacher coaching, even by telehealth. Track behavior for several weeks to show the gains stick outside your clinic.
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02At a glance
03Original abstract
Functional communication training (FCT; Carr & Durand, 1985) is a common function-based treatment in which an alternative form of communication is taught to reduce problem behavior. FCT has been shown to result in substantial reductions of a variety of topographically and functionally different types of problem behavior in children and adults (efficacy). The extent to which these reductions maintain in relevant contexts and result in meaningful changes in the lives of those impacted (effectiveness) is the focus of this paper. This review evaluates the degree to which FCT has been established as an evidence-based practice in psychology (EBPP) according to the definition set out by the American Psychological Association's 2005 Presidential Task Force on Evidence-Based Practice. Our review finds overwhelming evidence in support of FCT as an efficacious treatment but highlights significant limitations in support of its effectiveness. In order to also be recognized as an EBPP, future research on FCT will need to focus more closely on issues related to home, school, and community application, feasibility, consumer satisfaction, and more general and global changes for the individual.
Journal of applied behavior analysis, 2021 · doi:10.1002/jaba.762