Updated by:
Frank Cicero, PhD, BCBA
Seton Hall University and the Association for Science in Autism Treatment

Description

Autism Treatments SummaryFunctional communication training (FCT) is a behaviorally-based procedure used to increase effective communication behavior and reduce inappropriate/challenging behavior that is not effective because it does not communicate the person’s wants or needs clearly and/or does not fit with the social norms of the environment. First described by Carr and Durand (1985), FCT is a method whereby inappropriate behavior is decreased within a four-step model. First, the purpose (function) of the inappropriate behavior is identified through a functional behavior assessment (FBA). Second, an alternative communication response that serves the same purpose as the inappropriate behavior is identified and taught. Third, the person is given what they desire after they make the alternative communication response; and fourth, the person is not given what they desire following the inappropriate behavior. In other words, the person is taught to communicate their wants and needs in a way that is more appropriate than the behavior in which they were previously engaging. Since first being discussed by Carr and Durand, FCT is now one of the most widely studied interventions to treat inappropriate behavior (Gerow et al., 2018b). Inappropriate behavior has been found to serve three potential functions that can be substituted by more appropriate communicative requests: escaping unpreferred situations, gaining access to attention from others, and gaining access to preferred objects and activities. For example, if a child is hitting peers to get access to their cookies, an instructor or parent would teach the child to ask for cookies instead of hitting them. This is done by consistently reinforcing the child with cookies when he asks for them while not allowing the child to have cookies after he hits his peers. The child learns that asking for cookies is an easy way to get access to what he wants while hitting is not successful. Requesting, therefore, will increase and hitting will decrease. Regarding the mode of communication that is introduced, research indicates that various forms of requests can be taught to replace challenging behavior successfully. Modes of communication can include verbal requests (e.g., saying “Can I have a cookie?”) or augmentative forms of communication (i.e., sign language, picture exchanges, voice output devices, pointing, etc.) (Carr & Durand, 1985; Chezan et al., 2018; Gregori et al., 2020). Selection of the most beneficial form of communication should be individualized to the person.

Research Summary

As one of the most widely studied interventions to treat challenging behavior (Gerow et al., 2018b), FCT has already been the focus of several systematic reviews, quality reviews, and meta-analyses (Gregori et al., 2020). In their meta-analysis of FCT studies, Chezan et al. (2018) found 26 studies that met the What Works Clearinghouse (WWC) criteria for strong research quality, with large effect sizes obtained for both the reduction of challenging behavior and the acquisition of communicative responses. In their systematic review of the effectiveness of FCT across various disability categories, Gerow et al. (2018a) concluded that FCT was effective in the reduction of challenging behavior for 136 participants within 216 studies that met WWC quality standards. FCT interventions were found to be effective across participants with IDEA classifications of IDD, ASD, other health impairments, and multiple disabilities. In a systematic review investigating the effectiveness of parent-implemented FCT for children with ASD, Gerow et al. (2018b) found that challenging behavior was effectively treated by parent-implemented FCT in 69 participants across 26 studies. It is important to note that parents often implemented FCT within natural settings and that the treatments were rated as socially significant and meaningful by the parents. About teacher-implemented FCT, Walker et al. (2018) conducted a meta-analysis of the effects of FCT on the reduction of challenging behavior in school settings. Results indicated that FCT, implemented in natural school settings, resulted in the reduction of challenging behavior across a range of participant disabilities and conditions. Unfortunately, the authors found that most studies did not adequately describe the treatment methods that were used to teach the alternative communicative responses, rendering some limitations to replication, as well as clinical application. They also found that participants who engaged in less intensive challenging behavior (i.e., noncompliance, stereotypy) showed greater skill acquisition of the communicative response as compared to participants who engaged in more severe forms of challenging behavior (i.e., physical aggression, self-injury).

Whereas many studies have a focus on children, Gregori et al. (2020) conducted a systematic review of FCT effectiveness for adults with ASD. They identified 20 studies investigating the effects of FCT on the treatment of challenging behavior in adults with ASD. Consistent with the pediatric literature, they found that FCT was effective for the treatment of challenging behavior in the adult population. Taken together, literature reviews such as these provide strong support for the effectiveness of FCT in both children and adults with ASD across a range of challenging behaviors, treatment implementers, and settings.

Several autism treatment task forces have also provided strong support for the use of FCT with individuals on the autism spectrum. Steinbrenner et al. (2020) and Hume et al. (2021) reviewed the results of 31 single case research design studies published between 1990 and 2017 and concluded that FCT has enough research support to be considered an evidence-based practice for use with children, adolescents, and young adults with ASD. Results of the National Autism Center’s National Standards Project, Phase 2, published in 2015, categorized FCT as an emerging intervention for children with ASD under the age of 22 (emerging was defined as “although one or more studies suggest that an intervention produces favorable outcomes for individuals with ASD, additional high-quality studies must consistently show this outcome before we can draw firm conclusions about intervention effectiveness.” (NAC, 2015, p. 34). The Center’s National Standards Project categorized FCT as an established intervention for adults over the age of 22 (established was defined as “sufficient evidence is available to confidently determine that an intervention produces favorable outcomes for individuals on the autism spectrum.” (NAC, 2015, p. 34). It is important to note that although each task force uses specified evaluative criteria for classifying interventions as evidence based or non-evidence based, the criteria that are used are not consistent across task forces. Therefore, the definition of “evidence-based practice” is not a set definition that is agreed upon by all researchers. The task force reviews do, however, agree that there is support for the use of FCT when treating challenging behavior for persons on the autism spectrum.

Recommendations

Since it was first described by Carr and Durand in 1985, FCT has been shown to be successful in the treatment of challenging behavior in persons with and without ASD across decades of published literature. Its use has been supported by numerous literature reviews and it has been classified as either an established or an emerging intervention by several well-respected autism treatment task forces. Additionally, intervention strategies rooted in the principles and procedures of applied behavior analysis, including FCT, have been deemed effective and often medically necessary treatments for persons with autism (CASP, 2024). As such, the research evidence supports the implementation of FCT when treating challenging behavior.

When considering the implementation of FCT, it is important to note that it is a multi-component intervention. A well conducted functional behavior assessment (FBA) is the basis of any FCT procedure. Treatment providers must use proper procedures for conducting an FBA before attempting to design an FCT intervention. It is also important to select a communication response that is appropriate for the individual client as well as the setting in which the client will be expected to communicate. A poorly chosen communication response will prevent skill acquisition and will be less likely to be used in natural settings, therefore not producing the desired reduction in inappropriate behavior. As needed, treatment providers and parents should consult with their client’s/child’s speech therapist before choosing an alternative communicative response. A third component of an effective FCT intervention is the teaching strategy that is used to increase the alternative communicative response. Treatment providers should be aware of empirically supported behavioral teaching procedures such as differential reinforcement, prompting, modeling, and shaping before attempting to introduce FCT to a client. Finally, inappropriate behavior is less likely to decrease, and alternative communication is less likely to increase if the inappropriate behavior continues to be rewarded in natural settings. For example, not allowing a child to escape a non-preferred activity such as doing homework through engagement in tantrum behavior; however, providing him a break from his homework if he requests a short break. When implemented correctly and consistently, FCT is an effective treatment for the reduction of challenging behavior in persons with autism, across settings and behaviors, as well as resulting in an increase in appropriate and effective communication.

Selected References

Systematic Reviews and Meta-Analyses of Scientific Findings

Chezan, L. C., Wolfe, K., & Drasgow, E. (2018). A meta-analysis of functional communication training effects on problem behavior and alternative communicative responses. Focus on Autism and Other Developmental Disabilities, 33(4), 195-205.

Gerow, S., Davis, T., Radhakrishnan, S., Gregori, E., & Rivera, G. (2018). Functional communication training: The strength of evidence across disabilities. Exceptional Children, 85(1), 86-103.

Gerow, S., Hagan-Burke, S., Rispoli, M., Gregori, E., Mason, R., & Ninci, J. (2018). A systematic review of parent-implemented functional communication training for children with ASD. Behavior Modification, 42(3), 335-363.

Gregori, E., Wendt, O., Gerow, S., Peltier, C., Genc-Tosun, D., Lory, C., & Gold, Z. S. (2020). Functional communication training for adults with autism spectrum disorder: A systematic review and quality appraisal. Journal of Behavioral Education, 29, 42-63.

Walker, V. L., Lyon, K. J., Loman, S. L., & Sennott, S. (2018). A systematic review of Functional Communication Training (FCT) interventions involving augmentative and alternative communication in school settings. Augmentative and Alternative Communication, 34(2), 118-129.

Task Force Findings

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yucesoy-Ozkan, S. & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 1-20.

National Autism Center. (2015). Findings and conclusions: National Standards Project, phase 2. Author.

Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S, McIntyre, N. S., Yucesoy-Ozkan, S. & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with autism. FPG child development institute.

Selected Scientific Studies:

Banerjee, I., Lambert, J. M., Copeland, B. A., Paranczak, J. L., Bailey, K. M., & Standish, C. M. (2022). Extending functional communication training to multiple language contexts in bilingual learners with challenging behavior. Journal of Applied Behavior Analysis, 55(1), 80-100.

Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18(2), 111-126.

Danov, S. E., Hartman, E., McComas, J. J., & Symons, F. J. (2010). Evaluation of two communicative response modalities for a child with autism and self-injury. The Journal of Speech and Language Pathology–Applied Behavior Analysis, 5(1), 70.

Lindgren, S., Wacker, D., Schieltz, K., Suess, A., Pelzel, K., Kopelman, T., Lee, J., Romani, P., & O’Brien, M. (2020). A randomized controlled trial of functional communication training via telehealth for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50, 4449-4462.

Schmidt, J. D., Drasgow, E., Halle, J. W., Martin, C. A., & Bliss, S. A. (2014). Discrete-trial functional analysis and functional communication training with three individuals with autism and severe problem behavior. Journal of Positive Behavior Interventions, 16(1), 44-55.

Other Works

The Council of Autism Service Providers (CASP). (2024). Applied Behavior Analysis Practice Guidelines for the Treatment of Autism Spectrum Disorder. Author.

Citation for this article:

Cicero, F. (2024). A treatment summary of functional communication training. Science in Autism Treatment, 21(7).

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