An evaluation of changes in parent interaction quality as an indirect effect of functional communication training

Children who exhibit problem behavior on regular basis are at risk for impairment in many areas of functioning, such as poor academic outcomes, greater risk of physical injury, and poor social relationships with peers and families. Functional communication training (FCT) is an empirically validated behavioral treatment that reduces child problem behavior by replacing it with a more socially acceptable alternative, such as a recognizable form of communication. The literature suggests that FCT has a number of favorable indirect effects, such as decreasing non-targeted inappropriate behaviors, increasing related appropriate behaviors, and the emergence of pro-social behaviors. However, despite the extensive amount of research available on FCT, very few studies have evaluated whether caregiver interactions are impacted by reductions in problem behavior. Other treatment procedures, such as Parent-Child Interaction Therapy, hypothesize that as caregiver interaction quality is improved, reductions in child problem behavior will occur. The current study sought to evaluate whether reductions in child problem behavior will naturally lead to improvements in caregiver interaction quality.

Five caregiver-child pairs experienced assessment and treatment (FCT) for child problem behavior maintained by escape from nonpreferred activities. All children were diagnosed with autism, and all sessions were conducted in the participants’ homes with behavioral coaching delivered via telehealth. Caregiver behaviors were coded during all free play intervals that occurred throughout the entire evaluation. The results suggested that changes in child problem behavior were significantly correlated with changes in caregiver interaction quality for 4 out of 5 participants. However, for most caregivers, many of these positive benefits (e.g., reductions in child problem behavior leading to improvements in interaction quality) did not maintain throughout treatment, suggesting that further training may be necessary to sustain these beneficial effects.