Effects of Augmentative and Alternative Communication on Challenging Behavior: A Meta-Analysis

Figures & data

Table I. A Sample of Operational Coding Definitions.

Coding item	Definition
Expressive communication levels
Multiword	Non-rote combination of two or more words/symbols – grammatical constructions
Emerging language	Single words (any mode) or rote word combination (e.g., “Thank you.”)
Prelinguistic	No real words in any mode
Challenging behaviors
Destructive	Behaviors that are harmful or threaten the safety of the individual or others. Physical aggression (e.g., hitting, kicking, pulling, biting, scratching, spitting, breaking or throwing objects, self-injury, etc.)
Disruptive	Behaviors that do not immediately endanger the individual or others, but do interfere with everyday activities and experiences. Verbal aggression (e.g., threats, teasing, etc.) Disruptive verbal behavior (e.g., yelling, screaming, loudly talking over others, interrupting, crying as part of tantrum, etc.) Disruptive physical behavior (e.g., throwing oneself on the floor as part of a tantrum, running away from classroom, poking others, etc.)
Distracting	Behaviors that deviate from what is typically expected from individuals of the same age. Nonparticipation (e.g., ignoring teacher's request for action, saying “no” to others) Stereotypical behavior (e.g., pacing, rocking, etc.)
Intervention implementation method
Massed trial	One trial follows the next trial; trials scheduled by session rather than by natural opportunities.
Distributed trial	Trials are separated by variable amounts of time and are taught as part of a routine.
Decontextualized	Removed from natural communication environment; contrived for study rather than under natural conditions; pull-out; conditions are manipulated according to time or setting; individuals present that are strikingly different than scheduled routines.
Contextualized	Conducted in a natural communication environment; generally natural but experimenter can set up preferred materials in a classroom play area in their environment.
Functional behavior assessment
Descriptive	Direct observation of challenging behavior in the natural environment to identify conditions under which challenging behavior occurs and is maintained.
Experimental	Delivery of variables hypothesized to maintain challenging behavior contingent on the occurrence of challenging behavior within brief sessions.
Generalization	Skill or behavior transfer to new stimuli (partners, settings, materials) and responses.
Maintenance	Long-term retention of a target skill or behavior measured at least 3 months after conclusion of intervention.

Table II. Findings for Participant Characteristics.

Participant characteristics (n)	M NAP	Level of effect	SD	Mean rank	χ²
Gender
Female (32)	.89	Moderate	.19	62.0	−1.27^b
Male (79)	.86	Moderate	.18	53.6
Age
Greater than 12–18 years (23)	.91	Moderate	.08	45.1	18.02***
5 years or younger (35)	.86	Moderate	.17	61.6
Greater than 5–12 years (38)	.89	Moderate	.18	67.5
Greater than 18 years or older (15)	.74	Moderate	.27	30.5
Diagnoses^a
EBD (9)	.90	Moderate	.09	81.7	1.68
IDD (83)	.87	Moderate	.19	79.0
ASD (39)	.86	Moderate	.17	73.0
GD (10)	.84	Moderate	.20	65.8
SI (10)	.73	Moderate	.37	67.7
Expressive communication levels, pre-intervention
Multiword (20)	.94	Strong	.07	45.3	6.55*
Prelinguistic (22)	.89	Moderate	.17	46.3
Emerging (38)	.85	Moderate	.17	32.9
Communication modes, pre-intervention
Non-symbolic (36)	.90	Moderate	.14	97.7	1.49
AAC – unaided (21)	.89	Moderate	.15	96.5
Speech (41)	.87	Moderate	.16	94.0
AAC – no speech output device (14)	.87	Moderate	.13	104.0
Behavior, pre-intervention
Distracting (17)	.90	Moderate	.15	84.2	2.82
Disruptive (28)	.89	Moderate	.14	73.5
Destructive (95)	.85	Moderate	.19	67.2

Note. NAP Weak effects: 0–0.65; Medium or moderate effects: 0.66–0.92; Large or strong effects: 0.93–1.00.


χ² values are derived from Kruskal-Wallis test.

^aEBD = emotional behavior disorder, IDD = intellectual or developmental disability, ASD = autism spectrum disorder, GD = genetic disorder, SI = sensory impairment, ^bZ score (Mann-Whitney U).

*p < .05, **p < .01, ***p < .001 (alpha level refers to comparison across moderator levels).

Table III. Findings for Intervention Characteristics.

Intervention characteristic (n)	M NAP	Level of effect	SD	Mean rank	χ²
Intervention setting
Community (10)	.94	Strong	.08	85.0	3.63
Pull-out (31)	.88	Moderate	.12	67.7
Classroom (54)	.87	Moderate	.19	76.4
Other (22)	.85	Moderate	.18	69.8
Home (25)	.80	Moderate	.24	61.7
Implementation method
Massed trial (65)	.86	Moderate	.17	49.0	−0.02
Distributed trial (32)	.85	Moderate	.23	48.9
Decontextualized (42)	.86	Moderate	.15	48.5	−0.74
Contextualized (59)	.86	Moderate	.21	52.8
Person(s) delivering intervention
Paraprofessional (16)	.95	Strong	.07	83.8	8.06
Teacher (34)	.94	Strong	.08	82.3
Experimenter (27)	.89	Moderate	.17	73.9
Therapist (46)	.86	Moderate	.21	66.7
Parent (20)	.83	Moderate	.09	54.7
Type of intervention
FCT (93)	.87	Moderate	.18	53.4	−2.13^a*
PECS (9)	.74	Moderate	.22	31.9
Expressive communication, targeted
Speech (16)	.89	Moderate	.09	64.8	6.71
AAC – speech output device (31)	.89	Moderate	.20	85.4
AAC – no speech output device (61)	.85	Moderate	.16	65.5
Non-symbolic (10)	.85	Moderate	.14	58.8
AAC – unaided (23)	.84	Moderate	.27	75.9
Functional assessment
Yes (98)	.88	Moderate	.17	60.3	−3.05^a**
No (13)	.72	Moderate	.21	31.3
Type of functional behavior assessment
Experimental (75)	.90	Moderate	.24	55.5	−0.52^a
Descriptive (23)	.85	Moderate	.23	52.1

Note. NAP Weak effects: 0–0.65; Medium or moderate effects: 0.66–0.92; Large or strong effects: 0.93–1.00.

χ² values are derived from Kruskal-Wallis test.

^aZ score (Mann-Whitney U).

*p < .05, **p < .01, ***p < .001 (alpha level refers to comparison across moderator levels).

Table IV. Findings for Intervention Outcome Characteristics.

Intervention outcome characteristic (n)	M NAP	Level of effect	SD	Mean rank	χ²
Expressive communication levels, targeted
Emerging (88)	.86	Moderate	.19	57.1	5.18
Prelinguistic (8)	.82	Moderate	.14	40.3
Multiword (11)	.70	Moderate	.34	38.9
Behavior targeted
Distracting (27)	.89	Moderate	.15	73.7	1.24
Destructive (84)	.88	Moderate	.15	72.4
Disruptive (34)	.85	Moderate	.17	63.9

Note. NAP Weak effects: 0–0.65; Medium or moderate effects: 0.66–0.92; Large or strong effects: 0.93–1.00. χ² values are derived from Kruskal-Wallis test. *p < .05, **p < .01, ***p < .001 (alpha level refers to comparison across moderator levels).

Table V. Summary of Study Quality Characteristics, Including Number of Participants and Number who met Inclusion Criteria (# criteria), Intervention Type (IT), Functional Behavior Assessment (FBA), Social Validity (SV), and Intervention Fidelity (IF).

	# Participants	# who met criteria	IT	FBA	Reliability	Generalization	Maintenance	SV	IF
Bailey, McComas, Benavides, and Lovascz (2002)	1	1	FCT	Desc., Exp.	+		+	+	+
Bingham, Spooner, and Browder (2007)	3	3	Other		+				+
Bird, Dores, Moniz, and Robinson (1989)	1	1	FCT	Desc.	+		+
Buckley and Newchok (2005)	1	1	FCT	Exp.	+			+
Casey and Merical (2006)	1	1	FCT	Desc., Exp.	+	+	+
Charlop, Malmberg, and Berquist (2008)	3	2	PECS		+				+
Charlop-Christy et al. (2002)	3	2	PECS		+		+
Day, Horner, and O’Neill (1994)	3	3	FCT	Desc., Exp.	+
Day, Rea, Schussler, Larsen, and Johnson (1998)	3	2	FCT	Exp.	+	+			+
Derby (1995)	4	2	FCT	Desc., Exp.	+	+	+	+	+
Donovan (2003)	3	3	FCT	Desc., Exp.	+				+
Durand (1999)	5	5	FCT	Desc., Exp.	+	+			+
Durand and Kishi (1987)	5	5	FCT	Desc.	+		+
Fisher, Adelinis, Thompson, Worsdell, and Zarcone (1998)	2	2	FCT	Desc., Exp.	+
Fisher, Kuhn, and Thompson (1998)	2	1	FCT	Exp.	+
Franco et al. (2009)	1	1	FCT	Exp.	+	+	+		+
Frea, Arnold, and Vittimberga (2001)	1	1	Choice		+
Friedenthal (2009)	3	1	FCT	Desc., Exp.
Fyffe, Sung, Fittro, and Russell (2004)	1	1	FCT	Exp.	+
Ganz, Parker, and Benson (2009)	3	3	PECS		+	+	+		+
Hagopian, Kuhn, Long, and Rush (2005)	3	2	FCT	Exp.	+
Hanley, Iwata, and Thompson (2001)	3	2	FCT	Exp.	+				+
Hanley, Piazza, Fisher, and Maglieri (2005)	2	1	FCT	Exp.	+
Harding, Wacker, Berg, Winborn-Kemmerer and Lee (2009)	3	2	FCT	Exp.	+			+
Harding, Wacker, Berg, Winborn-Kemmerer, Lee, and Ibrahimovic (2009)	2	2	FCT	Exp.	+
Hetzroni and Roth (2003)	5	5	FCT	Desc.	+			+	+
Hines and Simonsen (2008)	1	1	FCT	Desc.	+
Horner et al. (1990)	1	1	FCT	Desc., Exp.	+				+
Hunt (1999)	8	8	FCT	Desc.	+			+
Hunt, Alwell, and Goetz (1988)	3	2	FCT	Desc.	+	+
Hunt, Alwell, Goetz, and Sailor (1990)	3	2	Other	Desc.	+	+			+
Kahng, Hendrickson, and Vu (2000)	1	1	FCT	Exp.	+
Kelley, Lerman, and Van Camp (2002)	3	1	FCT	Exp.	+
Kern, Gallagher, Starosta, Hickman, and George (2006)	1	1	FCT, Other	Desc.	+				+
Kettering (2009)	4	4	FCT	Exp.	+			+	+
Kuhn, Chirighin, and Zelenka (2010)	2	1	FCT	Exp.	+	+			+
Lalli, Casey, and Kates (1995)	3	2	Milieu	Exp.	+				+
Mancil, Conroy, and Haydon (2009)	3	3	FCT	Exp.	+	+		+	+
Moore, Gilles, McComas, and Symons (2010)	1	1	FCT	Desc., Exp.	+			+
Northup et al. (1994)	5	1	FCT	Desc., Exp.	+	+			+
O’Neill and Sweetland-Baker (2001)	2	2	FCT	Exp.	+	+
Schieltz et al. (2010)	10	3	FCT	Exp.	+	+
Schindler and Horner (2005)	3	2	FCT	Desc.	+	+		+	+
Sigafoos and Meikle (1996)	2	1	FCT	Exp.	+		+
Steege et al. (1990)	2	2	FCT	Exp.	+		+		+
Tang (2002)	6	1	FCT	Desc., Exp.	+
Thompson, Fisher, Piazza, and Kuhn (1998)	1	1	FCT	Exp.	+		+
Vollmer, Roane, Ringdahl, and Marcus (1999)	3	1	FCT	Exp.	+				+
Vollmer and Vorndran (1998)	1	1	FCT	Exp.	+
Wacker et al. (1990)	3	3	FCT	Exp.	+	+			+
Winborn, Wacker, Richman, Asmus, and Geirer (2002)	2	2	FCT	Exp.	+
Winborn-Kemmerer, Ringdahl, Wacker, and Kitsukawa (2009)	2	2	FCT	Exp.	+				+
Winborn-Kemmerer et al. (2010)	2	2	FCT	Exp.	+				+
Worsdell and Iwata (2000)	5	4	FCT	Exp.	+

*Bailey, J., McComas, J. J., Benavides, C., & Lovascz, C. (2002). Functional assessment in a residential setting: Identifying an effective communicative replacement response for aggressive behavior. Journal of Developmental and Physical Disabilities, 14, 353–369. doi:10.1023/A:1020382819146

 Web of Science ®Google Scholar

*Bird, F., Dores, P. A., Moniz, D., & Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with functional communication training. American Journal on Mental Retardation, 94, 37–48.

 PubMedGoogle Scholar

*Buckley, S. D., & Newchok, D. K. (2005). Differential impact of response effort within a response chain on use of mands in a student with autism. Research in Developmental Disabilities, 26, 77–85. doi:10.1016/j.ridd.2004.07.004

 PubMed Web of Science ®Google Scholar

*Casey, S. D., & Merical, C. L. (2006). The use of functional communication training without additional treatment procedures in an inclusive school setting. Behavioral Disorders, 32, 46–54.

 Web of Science ®Google Scholar

*Charlop, M. H., Malmberg, D. B., & Berquist, K. L. (2008). An application of the picture exchange communication system (PECS) with children with autism and a visually impaired therapist. Journal of Developmental and Physical Disabilities, 20, 509–525. doi:10.1007/s10882-008-9112-x

 Google Scholar

*Charlop-Christy, M., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35, 213–231. doi:10.1901/jaba.2002.35-213

 PubMed Web of Science ®Google Scholar

*Day, H. M., Horner, R. H., & O’Neill, R. E. (1994). Multiple functions of problem behaviors: Assessment and intervention. Journal of Applied Behavior Analysis, 27, 279–289. doi:10.1901/jaba.1994.27-279

 PubMed Web of Science ®Google Scholar

*Day, R., Rea, J., Schussler, N., Larsen, S., & Johnson, W. (1998). A functionally based approach to the treatment of self-injurious behavior. Behavior Modification, 12, 565–589.

 Google Scholar

*Derby, K. M. (1995). The long-term effects of functional communication training in a home setting (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (Dissertation No. 9513563)

 Google Scholar

*Donovan, A. L. (2003). Functional communication training in young deaf children: Effects of reinforcement magnitude on requesting and time on task (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (Dissertation No. 3087747)

 Google Scholar

*Durand, V. M. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis, 32, 247–267.

 PubMed Web of Science ®Google Scholar

*Durand, V. M., & Kishi, G. (1987). Reducing severe behavior problems among persons with dual sensory impairments: An evaluation of a technical assistance model. Journal of the Association for Persons with Severe Handicaps, 12, 2–10.

 Web of Science ®Google Scholar

*Fisher, W. W., Adelinis, J. D., Thompson, R. H., Worsdell, A. S., & Zarcone, J. R. (1998). Functional analysis and treatment of destructive behavior maintained by termination of “don’t” (and symmetrical “do”) requests. Journal of Applied Behavior Analysis, 31, 339–356. doi:10.1901/jaba.1998.31-339

 PubMedGoogle Scholar

*Fisher, W. W., Kuhn, D. E., & Thompson, R. H. (1998). Establishing discriminative control of responding using functional and alternative reinforcers during functional communication training. Journal of Applied Behavior Analysis, 31, 543–560. doi:10.1901/jaba.1998.31-543

 PubMed Web of Science ®Google Scholar

*Franco, J. H., Lang, R. L., O’Reilly, M. F., Chan, J. M., Sigafoos, J., & Rispoli, M. (2009). Functional analysis and treatment of inappropriate vocalizations using a speech-generating device for a child with autism. Focus on Autism and Other Developmental Disabilities, 24, 146–155.

 Google Scholar

*Frea, W. D., Arnold, C. L., & Vittimberga, G. L. (2001). A demonstration of the effects of augmentative communication on the extreme aggressive behavior of a child with autism within an integrated preschool setting. Journal of Positive Behavior Interventions, 3, 194–198. doi:10.1177/109830070100300401

 Google Scholar

*Friedenthal, D. (2009). School personnel establishing functional communication training based on a functional analysis with autistic students in a public school setting to reduce problem behaviors (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (Dissertation No. 3337228)

 Google Scholar

*Fyffe, C. E., Sung, W. K., Fittro, E., & Russell, D. (2004). Functional analysis and treatment of inappropriate sexual behavior. Journal of Applied Behavior Analysis, 37, 401–404.

 PubMed Web of Science ®Google Scholar

*Ganz, J. B., Parker, R., & Benson, J. (2009). Impact of the picture exchange communication system: Effects on communication and collateral effects on maladaptive behaviors. AAC: Augmentative & Alternative Communication, 25, 250–261. doi:10.3109/07434610903381111

 PubMed Web of Science ®Google Scholar

*Hagopian, L. P., Kuhn, S. A. C., Long, E. S., & Rush, K. S. (2005). Schedule thinning following communication training: Using competing stimuli to enhance tolerance to decrements in reinforcer density. Journal of Applied Behavior Analysis, 38, 177–193. doi:10.1901/jaba.2005.43-04

 PubMed Web of Science ®Google Scholar

*Hanley, G. P., Iwata, B. A., & Thompson, R. H. (2001). Reinforcement schedule thinning following treatment with functional communication training. Journal of Applied Behavior Analysis, 34, 17–38. doi:10.1901/jaba.2001.34-17

 PubMed Web of Science ®Google Scholar

*Hanley, G. P., Piazza, C. C., Fisher, W. W., & Maglieri, K. A. (2005). On the effectiveness of and preference for punishment and extinction components of function-based interventions. Journal of Applied Behavior Analysis, 38, 51–65. doi:10.1901/jaba.2005.6-04

 PubMed Web of Science ®Google Scholar

*Harding, J. W., Wacker, D. P., Berg, W. K., Winborn-Kemmerer, L., & Lee, J. F. (2009). Evaluation of choice allocation between positive and negative reinforcement during functional communication training with young children. Journal of Developmental and Physical Disabilities, 21, 443–456. doi:10.1007/10882-009-9155-7

 Web of Science ®Google Scholar

*Harding, J. W., Wacker, D. P., Berg, W. K., Winborn-Kemmerer, L., Lee, J. F., & Ibrahimovic, M. (2009). Analysis of multiple manding topographies during functional communication training. Education and Treatment of Children, 32, 21–36.

 PubMedGoogle Scholar

*Hetzroni, O. E., & Roth, T. (2003). Effects of a positive support approach to enhance communicative behaviors of children with mental retardation who have challenging behaviors. Education and Training in Developmental Disabilities, 38, 95–105.

 Google Scholar

*Hines, E., & Simonsen, B. (2008). The effects of picture icons on behavior for a young student with autism. Beyond Behavior, 18, 9–17.

 Google Scholar

*Horner, R. H., Sprague, J. R., O’Brien, M., & Heathfield, L. T. (1990). The role of response efficiency in the reduction of problem behaviors through functional equivalence training: A case study. Journal of the Association for Persons with Severe Handicaps (JASH), 15, 91–97

 Google Scholar

*Hunt, S. T. (1999). Using functional communication training to alleviate problem behaviors in young children (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (Dissertation No. 9839546)

 Google Scholar

*Hunt, P., Alwell, M., & Goetz, L. (1988). Acquisition of conversation skills and the reduction of inappropriate social interaction behaviors. Journal of the Association for Persons with Severe Handicaps (JASH), 13, 20–27

 Google Scholar

*Hunt, P., Alwell, M., Goetz, L., & Sailor, W. (1990). Generalized effects of conversation skill training. Journal of the Association for Persons with Severe Handicaps (JASH), 15, 250–60.

 Google Scholar

*Kahng, S. W., Hendrickson, D. J., & Vu, C. P. (2000). Comparison of single and multiple functional communication training responses for the treatment of problem behavior. Journal of Applied Behavior Analysis, 33, 321–324. doi:10.1901/jaba.2000.33-321

 PubMed Web of Science ®Google Scholar

*Kelley, M. E., Lerman, D. C., & Van Camp, C. M. (2002). The effects of competing reinforcement schedules on the acquisition of functional communication. Journal of Applied Behavior Analysis, 35, 59–63.

 PubMed Web of Science ®Google Scholar

*Kern, L., Gallagher, P., Starosta, K., Hickman, W., & George, M. (2006). Longitudinal outcomes of functional behavioral assessment-based intervention. Journal of Positive Behavior Interventions, 8, 67–78. doi:10.1177/10983007060080020501

 Web of Science ®Google Scholar

*Kettering, T. L. (2009). A comparison of procedures for unpairing conditioned reflexive establishing operations (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (Dissertation No. 3325748)

 Google Scholar

*Kuhn, D. E., Chirighin, A. E., & Zelenka, K. (2010). Discriminated functional communication: A procedural extension of functional communication training. Journal of Applied Behavior Analysis, 43, 249–264.

 PubMed Web of Science ®Google Scholar

*Lalli, J. S., Casey, S., & Kates, K. (1995). Reducing escape behavior and increasing task completion with functional communication training, extinction, and response chaining. Journal of Applied Behavior Analysis, 28, 261–68.

 PubMed Web of Science ®Google Scholar

*Mancil, G. R., Conroy, M. A., & Haydon, T. F. (2009). Effects of a modified milieu therapy intervention on the social communicative behaviors of young children with autism spectrum disorders. Journal of Autism & Developmental Disorders, 39, 149–163. doi:10.1007/s10803-008-0613-3

 PubMedGoogle Scholar

*Moore, T. R., Gilles, E., McComas, J. J., & Symons, F. J. (2010). Functional analysis and treatment of self-injurious behaviour in a young child with traumatic brain injury. Brain Injury, 24, 1511–1518. doi:10.3109/02699052.2010.523043

 PubMed Web of Science ®Google Scholar

*Northup, J., Wacker, D., P., Berg, W. K., Kelly, L., Sasso, G., & DeRaad, A. (1994). The treatment of severe behavior problems in school settings using a technical assistance model. Journal of Applied Behavior Analysis, 27, 33–47.

 PubMed Web of Science ®Google Scholar

*O’Neill, R. E., & Sweetland-Baker, M. (2001). Brief report: An assessment of stimulus generalization and contingency effects in functional communication training with two

 Google Scholar

*Schieltz, K. M., Wacker, D. P., Harding, J. W., Berg, W. K., Lee, J. F., & Dalmau, Y. C. P. (2010). An evaluation of manding across functions prior to functional communication training. Journal of Developmental and Physical Disabilities, 22, 131–147. doi:10.1007/s10882-009-9181-5

 PubMedGoogle Scholar

*Schindler, H. R., & Horner, R. H. (2005). Generalized reduction of problem behavior of young children with autism: Building trans-situational interventions. American Journal on Mental Retardation, 110, 36–47. doi:10.1352/0895-8017(2005)

 PubMedGoogle Scholar

*Sigafoos, J., & Meikle, B. (1996). Functional communication training for the treatment of multiply determined challenging behavior in two boys with autism. Behavior Modification, 20, 60–84. doi:10.1177/01454455960201003

 PubMedGoogle Scholar

*Steege, M. W., Wacker, D. P., Cigrand, K. C., Berg, W. K., Novak, C. G., Reimers, T. M., … DeRaad, A. (1990). Use of negative reinforcement in the treatment of self-injurious behavior.Journal of Applied Behavioral Analysis,23, 459–467.

 PubMed Web of Science ®Google Scholar

*Tang, J. (2002). Extended analysis and treatment of stereotypic behavior for persons with developmental disabilities (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (Dissertation No. 3025844)

 Google Scholar

*Thompson, R. H., Fisher, W. W., Piazza, C. C., & Kuhn, D. E. (1998). The evaluation and treatment of aggression maintained by attention and automatic reinforcement. Journal of Applied Behavior Analysis, 31, 103–116. doi:10.1901/jaba.1998.31-103

 PubMed Web of Science ®Google Scholar

*Vollmer, T. R., Roane, H. S., Ringdahl, J., & Marcus, B. (1999). Evaluating treatment challenges with differential reinforcement of alternative behavior. Journal of Applied Behavior Analysis, 32, 9–23.

 Web of Science ®Google Scholar

*Vollmer, T. R., & Vorndran, C. M. (1998). Assessment of self-injurious behavior maintained by access to self-restraint materials. Journal of Applied Behavior Analysis, 31, 647–650. doi:10.1901/jaba.1998.31-647

 PubMed Web of Science ®Google Scholar

*Wacker, D. P., Steege, M. W., Northup, J., Sasso, G., Berg, W., Reimers, T., .… Donn, L. (1990). A component analysis of functional communication training across three topographies of severe behavior problems. Journal of Applied Behavior Analysis, 23, 417–429. doi:10.1901/jaba.1990.23-417

 PubMed Web of Science ®Google Scholar

*Winborn, L., Wacker, D. P., Richman, D. M., Asmus, J., & Geier, D. (2002). Assessment of mand selection for functional communication training packages. Journal of Applied Behavior Analysis, 35, 295–298. doi:10.1901/jaba.2002.35-295

 PubMed Web of Science ®Google Scholar

*Winborn-Kemmerer, L., Ringdahl, J. E., Wacker, D. P., & Kitsukawa, K. (2009). A demonstration of individual preference for novel mands during functional communication training. Journal of Applied Behavior Analysis, 42, 185–189. doi:10.1901/jaba.2009.42-185

 PubMed Web of Science ®Google Scholar

*Winborn-Kemmerer, L., Wacker, D. P., Harding, J., Boelter, E., Berg, W., & Lee, J. (2010). Analysis of mand selection across different stimulus conditions. Education & Treatment of Children, 33, 49–64.

 PubMedGoogle Scholar

*Worsdell, A. S., & Iwata, B. A. (2000). Effects of continuous and intermittent reinforcement for problem behavior during functional communication training. Journal of Applied Behavior Analysis, 33, 167–179.

 PubMed Web of Science ®Google Scholar