Eliminating Challenging Behaviors in Multiple Environments Throughout the Entire Day

This study examined the potential of functional assessment-based intervention applied in multiple natural environments throughout the entire day. Helen, a 25-year-old woman affected by deaf-blindness and severe retardation, lived in a supervised apartment and attended a day activity program for several hours each weekday. For many years, Helen had frequently aggressed toward others, destroyed property (often resulting in injury to herself or others), and run away, often into potentially dangerous environments (e.g., a parking lot). These acts were always preceded by a request that a staff member exert brief but firm pressure to one of her wrists. Assessment and intervention involved a two-phase study. Phase 1 (functional assessment) included structured interviews and observations, hypothesis development, and hypothesis testing throughout the day within the context of naturally occurring routines and activities. This process identified that Helen's challenging behaviors were attention-motivated. During Phase 2 (intervention), a staff member increased the amount of attention Helen received by interacting more frequently with her. The intervention immediately eliminated all of Helen's challenging behaviors throughout the data collection period (more than 8 months) and was easily incorporated into the routines and activities that typically occurred throughout the day. Equally important, the intervention received very high treatment acceptability ratings from all of the staff who were responsible for its implementation.