Generality of the practical functional assessment and skill‐based treatment among individuals with autism and mental health disorders
The PFA/FCT package keeps problem behavior low and communication high even when autism is paired with anxiety or depression.
01Research in Context
What this study did
Coffey and team asked: does the practical functional assessment plus skill-based treatment work for autistic kids who also have anxiety or depression?
They ran the full package with two such children. First they did a quick, caregiver-led interview to guess why problem behavior happened. Then they tested the guess in a 30-minute play session. Last they taught the kids to ask for what they wanted and to tolerate ‘no’.
What they found
Problem behavior stayed low and clear communication rose for both kids. The gains held even when staff gave fewer rewards. Parents and teachers said the changes were big and helpful.
How this fits with other research
Sawyer et al. (2014) showed the same PFA-to-FCT steps wiped out severe behavior in three autistic kids without mental-health labels. Coffey’s 2021 study extends that win to kids who also carry anxiety or depression.
Chalfant et al. (2007) and McConachie et al. (2014) used group CBT to calm anxiety in autistic children. Their focus was internal worry; Coffey’s focus was outward behavior. The papers sit side-by-side: CBT for the anxiety, PFA/FCT for the behavior.
Fahmie et al. (2013) and Carson et al. (2017) found mindfulness and CBT help anxious autistic adults. Again, the target paper fills a gap—showing the PFA/FCT package also works when the extra diagnosis is present in youth.
Why it matters
If you have a client with autism plus anxiety or depression, you no longer need to choose between treating feelings or treating behavior. Run the practical functional assessment first, then teach function-based requests and tolerance. The same brief package that works for classic autism also works when mental-health labels pile on.
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02At a glance
03Original abstract
AbstractA practical functional assessment format was recently developed that informed a skill‐based treatment for the problem behavior of children diagnosed with autism spectrum disorder. Since its inception there have been multiple replications of the procedures; however, the comprehensive model has rarely been applied to populations with more complex comorbid disorders and severe problem behavior such as those diagnosed with anxiety or depression. We conducted the current study to systematically replicate the entire practical functional assessment and skill‐based treatment model with two participants diagnosed with multiple mental health disorders admitted to a severe behavior outpatient unit. The practical functional assessment identified reinforcers that were provided contingent on increasingly complex forms of communication. Problem behavior remained low for both participants after reinforcement was thinned by increasing a response requirement of completing difficult tasks. Furthermore, the results were socially validated by the parents and teachers and the treatment was extended to the home setting.
Behavioral Interventions, 2021 · doi:10.1002/bin.1755