Approaches for Treating Multiply Controlled Problem Behavior

Introduction

Understanding problem behavior is fundamental in applied behavior analysis (ABA). Problem behaviors can be maintained by different contingencies, which makes functional analysis (FA) critical in the assessment and treatment process. However, when behavior is maintained by more than one function, it is known as multiply controlled problem behavior (MCPB). MCPB presents additional complexities that require specialized treatments.

Research by Boyle et al. (2024) provides insights into effective approaches for addressing MCPB. This blog post will summarize key findings from their review, focusing on assessment methods, treatment strategies, and challenges related to managing MCPB.

Key Learning Outcomes

By reading this post, you will:

1. Understand what MCPB is and why it is distinct from singly controlled behavior.
2. Learn best practices for conducting functional analyses with MCPB.
3. Explore treatment strategies designed for MCPB.
4. Identify limitations in these treatments and potential solutions.
5. Consider future research directions to improve treatment efficacy.

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Understanding Multiply Controlled Problem Behavior (MCPB)

Definition & Prevalence

MCPB occurs when a single behavior is reinforced by more than one function. This can include social reinforcement (e.g., attention, escape, access to tangibles) and automatic reinforcement (e.g., sensory stimulation). Research indicates that approximately 15-17% of problem behaviors analyzed in FA studies are multiply controlled.

Common MCPB Contingencies

MCPB can involve various combinations of reinforcement, including:

• Social-Positive & Social-Negative Reinforcement: Behavior is reinforced by both gaining access to attention and escaping demands.
• Social & Automatic Reinforcement: Behavior serves both social purposes (e.g., access to attention) and sensory stimulation.
• Multiple Social-Positive Reinforcers: Behavior is reinforced by multiple social contingencies (e.g., access to both attention and tangible items).

Why is MCPB Complex?

Treating MCPB presents challenges not found with singly controlled problem behavior:

• Interventions must address multiple sources of reinforcement.
• Traditional treatments for one function may interfere with another.
• It is challenging to design interventions that successfully account for multiple contingencies.

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Conducting Functional Analyses (FA) for MCPB

To effectively treat MCPB, behavior analysts must first conduct a functional analysis (FA). However, assessing MCPB is more complex due to the overlapping reinforcement contingencies.

Best Practices in FA for MCPB

• Separate Response Classes: Ensure that different topographies are assessed independently when needed.
• Use Multiple Test Conditions: Running individual conditions for each function can prevent misidentification.
• Graph Separately: Analyzing data for multiple functions separately can help clarify different contingencies.

Common Challenges in FA for MCPB

1. Aggregation Errors: Combining separate functions into one may obscure accurate assessment.
2. Undifferentiated Results: Overlapping contingencies can make interpretation difficult.
3. False Positives: Including unnecessary test conditions can create misleading results.

Effective FA strategies should use careful data interpretation to avoid these pitfalls.

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Treatment Approaches for MCPB

Once MCPB is identified, treatment must address all maintaining functions. Unlike singly controlled behavior, treating MCPB often requires multi-component treatments.

Common Function-Based Treatment Approaches

1. Functional Communication Training (FCT)

   • Teaches the individual to request reinforcement in an appropriate way.
   • Requires systematic reinforcement of the alternative response.
   • Can include different requests for different functions (e.g., asking for a break vs. asking for attention).

2. Differential Reinforcement (DRA, DRO, DRI)

   • DRA (Differential Reinforcement of Alternative Behavior): Reinforcing alternative, appropriate behaviors.
   • DRO (Differential Reinforcement of Other Behavior): Reinforcing the absence of problem behavior.
   • DRI (Differential Reinforcement of Incompatible Behavior): Reinforcing behaviors that cannot occur simultaneously with problem behavior.

3. Multiple Schedules of Reinforcement

• Alternating availability of reinforcement based on specific conditions (e.g., reinforcement available only during certain times).
• Can help balance different sources of reinforcement while maintaining control over behavior.

4. Extinction Procedures for Specific Contingencies
   • Eliminating reinforcement for problem behavior across different functions requires careful planning.
   • Example: If MCPB is maintained by attention and escape, denying access to both while reinforcing an alternative response is essential.

Each of these approaches can be adjusted based on MCPB contingency, but no single method is universally effective.

Challenges & Solutions in MCPB Treatment

1. Competing Reinforcers

   • Challenge: The presence of multiple reinforcers complicates intervention.
   • Solution: Use stimulus-control-based interventions to guide access to reinforcers under specific conditions.

2. Treatment Interference

   • Challenge: Addressing one function may increase other problem behaviors.
   • Solution: Train differential response chains tailored to each function.

3. Generalization & Maintenance

• Challenge: MCPB treatment strategies sometimes fail to generalize.
• Solution: Teach caregivers to implement interventions in natural settings and fade reinforcement schedules systematically.

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Future Directions in MCPB Treatment Research

Research in MCPB treatment continues to evolve. Boyle et al. (2024) highlight areas that require further exploration:

• Technological Advancements in FA: How AI and automated tracking could improve functional analysis.
• Precision-Based FA Strategies: Optimizing FA methods for better differential results in MCPB.
• Long-Term Generalization Research: More studies on maintaining treatment effects outside clinical settings.

Expanding research in these areas can refine MCPB intervention strategies and improve outcomes for individuals with complex behavioral needs.

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Conclusion

Approaching MCPB requires specialized analysis and multi-component treatment strategies. Behavior analysts must conduct thorough functional analyses and implement treatments that address all maintaining contingencies.

By using strategies such as functional communication training (FCT), differential reinforcement, multiple schedules, and extinction, practitioners can effectively reduce problem behavior while promoting appropriate alternatives. However, ongoing research and innovation are necessary to refine interventions for long-term success.

If you're interested in further exploring evidence-based strategies for MCPB, read the full study by Boyle et al. (2024) here: https://doi.org/10.1007/s40617-023-00858-1.