Chapter 10

Aggression and Noncompliance

James K. Luiselli

Aggression and noncompliance are common problem that are “matched” to FBA and FA outcomes. Here,
behaviors displayed by some children with ASD. I focus on both preventive (antecedent) and behavior-
Aggression in the form of hitting, kicking, and biting contingent (consequence) procedures that are supported
can cause serious injury to peers and adults, creating an empirically and have good social validity. The chapter
unsafe learning environment. Furthermore, aggressive concludes with recommendations for formulating, imple-
behavior interferes with instruction and skill acquisition. menting, and evaluating successful intervention plans.
The social consequences of chronic aggression also are
untoward: the child is avoided, perceived unfavorably,
and unlikely to establish friendships. Frequently, chil-
dren who demonstrate serious aggression are enrolled in Measurement
restrictive educational settings, sometimes exposed to
invasive treatment procedures (e.g., punishment) or Knowing how often aggression and noncompliance
ineffective pharmacotherapy. occur demands accurate measurement through system-
Like aggression, noncompliance has deleterious atic data collection. Measurement before intervention
effects on learning. A child who has ASD and noncom- establishes a baseline by which to evaluate the effects
pliant behavior receives inconsistent instruction because of behavior-change procedures. During intervention,
she/he does not respond uniformly to requests from a measurement documents response trends, enabling
teacher or parent. Noncompliance means that a child practitioners to make decisions about maintaining,
will not perform many appropriate behaviors that can be revising, or introducing procedures.
shaped and strengthened through positive reinforce-
ment. Note too that caregivers usually have a poor opin-
ion of children who “refuse” to carry out directions.
This chapter addresses assessment and intervention Aggression
for aggression and noncompliance. First, I discuss the
process of measuring these problem behaviors in Aggression usually consists of distinct responses that
applied settings, emphasizing the varied topographies can be categorized as “inappropriate physical contact”
of aggression and noncompliance and different meth- initiated by a child toward another person. Some repre-
ods for acquiring occurrence data. The next section of sentative topographies of aggression are hitting with
the chapter covers functional behavioral assessment open palm or closed fist, kicking, biting, pinching, and
(FBA) and functional analysis (FA) methodologies pulling hair. Many times, a child displays aggression
that are critical steps in designing an intervention plan. as a single response, for example, “grabbing and
My subsequent review of intervention covers procedures squeezing the therapist by the wrists or arms, attempts
to head butt the therapist, shoving, pulling hair, and
grabbing the therapist’s neck with one or both hands”
J.K. Luiselli (*)
(Progar et  al., 2001, p. 70). So defined, practitioners
May Institute, 41, Pacella Park Drive, Randolph,
MA, 02368, USA can document frequency of aggression on an event-
e-mail: [email protected] recording form, summing the total number of responses

J.L. Maston (ed.), Applied Behavior Analysis for Children with Autism Spectrum Disorders, 175
DOI 10.1007/978-1-4419-0088-3_10, © Springer Science+Business Media, LLC 2009
176 J.K. Luiselli

during a fixed-time period (e.g., 6-h school day) or cal- Frequency of noncompliance can be recorded as
culating rate of responding during variable recording long as the number of instructions or requests are held
segments (number of responses/time). constant. That is, it is reasonable to record noncompli-
There are situations in which a child exhibits aggres- ant responses by a child during 10 activities each day
sion repetitively, making it difficult to record separate and report data as frequency of noncompliance.
responses in isolation. In such cases, data collection However, frequency is not an appropriate measure
can target an “aggressive episode,” essentially multiple when opportunities to respond vary. To illustrate, a
responses exhibited within a defined period of time. child could be noncompliant with 5 out of 10 instruc-
For example, an episode would begin when a child dis- tions on one day and 5 of 20 instructions on another
plays the first aggressive response and terminates when day. Frequency on both days, although identical, is a
aggression ceases for 60 consecutive seconds (Luiselli, misleading statistic because it does not consider how
1990). The time between initial response and termina- many compliance opportunities were presented to the
tion criterion would be recorded so that a “duration per child. Therefore, noncompliance under such condi-
episode” measure is calculated. Frequency alone is an tions should be recorded as a percentage measure.
inadequate measure because the duration of an aggres- Noncompliance can occur as a “passive response,”
sive episode can vary. Accordingly, it is useful to com- as when a child does not carry out an instruction but
pute the average duration per episode. This type of refrains from challenging behavior. It also is common
measurement is valuable when the aggression being for noncompliance to occur contemperaneously with a
recorded is low frequency but high intensity (Kahng, behavior such as aggression. Thus, a child might strike
Abt, & Schonbachler, 2001). her/his teacher when given an instruction. As discussed
Latency-to-first-response is another measure that later in the chapter, the co-occurrence of aggression
should be considered when assessing and intervening and noncompliance has implications for intervention
with a serious behavior such as aggression. Picture a planning and implementation.
teacher who is confronted with aggression from a child
with ASD during 15-min instructional activities.
Instead of recording frequency of aggression through-
Functional Behavioral Assessment
out activities, the teacher would activate a timer when
they begin and stop the timer immediately following and Functional Analysis
the first aggressive response. The duration on the timer,
or latency-to-first response, would be brief during a Understanding the function or “purpose” of problem
baseline phase of evaluation and would increase with behaviors such as aggression and noncompliance is an
effective intervention. The practical advantage of this essential step in formulating an intervention plan
measurement methodology is that a practitioner does (Matson & Minshawi, 2007). Behavior analysts focus
not have to endure repetitive aggression that would be on three behavior–environment relationships to explain
required with frequency recording. the role of reinforcement in determining function: (1)
pleasurable social or tangible consequences (social
positive reinforcement), (2) termination of unpleasant
situations (social negative reinforcement), and (3)
Noncompliance behavior-elicited (nonsocial) stimulation (automatic
reinforcement). Functional behavioral assessment
Noncompliance usually is defined as a child failing to (FBA) and functional analysis (FA) are two method-
initiate desirable behavior when given a direction or ologies for isolating behavior function.
request. It is customary to include a latency criterion
such as “noncompliance should be recorded if the
specified response does not occur 5 s after stating the Functional Behavioral Assessment
instruction.” Generally, the instruction-to-response ini-
tiation latency is brief but can be adjusted depending FBA is the process of correlating environmental events
on the complexity of instruction and expected behavior with problem behaviors. One approach toward FBA relies
from the child. on indirect methods based principally on the subjective
10  Aggression and Noncompliance 177

reports of care-providers. Instruments such as Motivation Both indirect and descriptive FBA have the advan-
Assessment Scale (MAS) (Durand & Crimmins, 1988), tage of being easily administered by practitioners.
Functional Analysis Screening Tool (FAST) (Iwata, 1995), From a clinical perspective, it is important to gather
and Questions About Behavior Function (QABF) (Matson information from individuals who are knowledgeable
& Vollmer, 1995) are informant surveys that target social about the child with ASD and to document objectively
and nonsocial contingencies responsible for problem how often aggression and noncompliance occur and
behaviors. Cut-off scores derived from surveys are used to under what conditions. Typically, both assessment
endorse one or more sources of control (e.g., attention, tan- methods are performed together, for example, obtain-
gible, escape, automatic). ing informant produced impressions about behavior
The Functional Assessment Interview (FAI) (O’Neill, function followed by direct observation and data col-
Horner, Albin, Sprague, Storey, & Newton, 1997) is lection. To reiterate, FBA enables one to form a work-
another informant-driven protocol. During an inter- ing hypothesis (e.g., “The child’s aggression appears
view conducted by a responsible professional, the to be escape motivated.”) but not a confirmatory “cause
informant is asked questions about antecedent and and effect” relationship.
consequence events often associated with occurrence
and nonoccurrence of problem behaviors. The FAI
examines a variety of ecological events (e.g., medical
status, sleep patterns, mealtime routines) and interper- Functional Analysis
sonal contacts, thereby producing a comprehensive
formulation that guides intervention planning. In contrast to FBA, a FA measures aggression and non-
Descriptive methods are a second type of FBA, compliance during experimentally manipulated condi-
characterized by direct observation of a person under tions. In the seminal publication on this topic, Iwata,
naturalistic conditions. Bijou, Peterson, and Ault (1968) Dorsey, Slifer, Bauman, and Richman (1994) constructed
pioneered this approach with their presentation of ante- conditions to represent social positive reinforcement,
cedent-behavior-consequence (A-B-C) data collection. social negative reinforcement, and automatic reinforce-
For a child who has aggression and noncompliance, an ment functions. Iwata et  al. studied nine children who
observer would watch her/him participate in a variety had developmental disabilities and self-injurious behav-
of activities, noting particular events that immediately ior (SIB) during daily 15-min sessions with each session
precede (antecedents) and follow (consequences) the featuring a condition linked to one of four functions:
behaviors (Luiselli, 2006). The resulting data then are Social Disapproval. A therapist sat in a room and
evaluated to determine whether specific situations reli- allowed the child access to toys. The therapist sat
ably predict aggression and noncompliance. In doing away from the child, reading a book or magazine.
so, hypotheses about behavior can be inferred. When the child displayed SIB, the therapist disap-
Antecedent events can set the occasion for aggression proved by stating, “Don’t do that, you’re going to
and noncompliance through established stimulus control hurt yourself.” This condition provided social atten-
(Luiselli, 2008). Touchette, MacDonald, and Langer tion contingent on SIB.
(1985) presented a scatter-plot analysis as a first step Academic Demand. A therapist sat in a room with
toward confirming stimulus control over problem behav- the child and presented her/him with instructional tasks
iors. The recording protocol requires a practitioner to indi- that were difficult to complete. When the child dis-
cate if a child’s problem behaviors did not occur, occurred played SIB, the therapist removed the task, turned away
one time, or occurred two times or more during successive for 30 s, and then resumed instruction. This condition
30-min intervals within the day. By reviewing data over provided escape from demands contingent on SIB.
several days, “Problem behavior may be correlated with a Unstructured Play. A therapist sat in a room and allowed
time of day, the presence or absence of certain people, a the child access to toys. There were no consequences
social setting, a class of activities, a contingency of rein- for SIB. Instead, the therapist presented the child with
forcement, a physical environment, and combinations of social praise and brief physical contact (hand on shoulder)
these and other variables” (Touchette et  al., p. 345). every 30 s without SIB. “This condition served as a control
Accordingly, intervention can proceed by modifying one procedure for the presence of an experimenter, the avail-
or more of these behavior–environment relationships. ability of potentially stimulating materials, the absence of
178 J.K. Luiselli

demands, the delivery of social approval for appropriate and noncompliance, evidence-based intervention pro-
behavior, and the lack of approval for self-injury” (Iwata cedures would be those derived from research that has
et al., 1994, p. 203). sound internal (experimental control) and external
Alone. The child was present in the room without the (replication) validity. Evidence-based knowledge, in
therapist or access to toys or other potentially stimulat- turn, must be translated to the “real world” of practitio-
ing materials. This condition tested for automatic (sen- ners. Evaluation under these circumstances yields
sory) reinforcement as a source of control over SIB. empirically supported intervention procedures.
Iwata et  al. (1994) found that for six of the nine This section reviews several evidence-based and
children, higher frequencies of SIB were associated empirically supported intervention procedures for
with a specific experimental condition. When the data aggression and noncompliance. My review is not all
from a FA are graphed, the response differentiation inclusive because many procedures have been imple-
among conditions isolates controlling variables. Although mented for these problem behaviors during nearly four
Iwata et al. concentrated on SIB, FA methodology has decades of applied research (Luiselli, Russo, Christian,
been applied to aggression and noncompliance of chil- & Wilczynski, 2008; Matson, Laud, & Matson, 2004). I
dren who have a developmental disability including emphasize procedures that are linked to behavior-func-
ASD (Hanley, Iwata, & McCord, 2003). tion categorized as (1) social positive reinforcement, (2)
The advantages of FA notwithstanding, it requires social negative reinforcement, and (3) automatic rein-
greater sophistication than a typical FBA. Another forcement. Note that although aggression and noncom-
concern is the “ecological validity” of a FA, namely pliance often are exhibited by children who have ASD,
the fact that it is conducted under simulated (analog) surprisingly there is not a robust literature of interven-
conditions that are removed from the natural environ- tion research with this clinical population. Accordingly,
ment. Hanley et  al. (2003) concluded that there has I have included studies with other diagnostic groups
been, “Systematic growth in the use of functional anal- (e.g., children with mental retardation and multiple dis-
ysis methodology as a primary method of behavior abilities) to illustrate certain procedures that with confi-
assessment and, more generally, as a means of studying dence, can be extended to theASD group.
environment–behavior relations” (p. 178). Furthermore, Before describing specific intervention procedures,
many FAs have been performed in applied settings it is worthwhile to consider that a single problem
such as schools, and it appears that the time commit- behavior can have multiple functions. It is possible, for
ment is no greater than that required for a FBA (Iwata example, for a child’s aggression and noncompliance
et  al., 2000). Practitioners, in fact, can be taught the to be attention-maintained when she/he is playing with
skills to independently conduct a FA (Moore & Fisher, peers but escape motivated during academic sessions
2007; Moore et al., 2002). In summary, FA methodolo- with a teacher. In such situations, separate intervention
gies continue to be refined, adapted to clinical exigen- plans would have to be designed. Behavior function
cies, and represent the experimental standard when also can change overtime when problem behaviors
targeting problem behaviors. contact new sources of reinforcement. Revisions to an
intervention plan would be required in these cases.

Evidence-Based and Empirically

Supported Intervention Social Positive Reinforcement

Detrich (2008) proposed that “the terms evidence- Aggression and noncompliance that are maintained by
based interventions, evidence-based practices, empiri- social positive reinforcement is evident when the
cally supported treatments, and best practices have behaviors produce pleasurable attention and/or objects.
become ubiquitous in education and other human ser- Because practitioners sometimes respond to problem
vices disciplines” (p. 3). There are different definitions behaviors by reprimanding or verbally chastising a
and explanations of these terms but essentially, evi- child, such a consequence will function as reinforce-
dence-based means that scientific information informs ment if the child enjoys this social attention. Similarly,
decisions about intervention. With respect to aggression noncompliance will be reinforced if a practitioner
10  Aggression and Noncompliance 179

allows a child access to preferred objects when she/he administering a preference survey. However a study by
does not follow instructions. Mueller, Wilczynski, Moore, Fusilier, and Trahant
After confirming that a child’s aggression or non- (2001) demonstrates that ideally, reinforcers should be
compliance is maintained by attention or tangible selected through formal assessment of preferences
objects, a first-choice intervention would be eliminat- (Piazza, Fisher, Hagopian, Bowman, & Toole, 1996).
ing these sources of reinforcement through social They measured aggression (hitting, kicking, slapping,
extinction. Procedurally, social extinction operates by biting, pinching, and head butting) by an 8-year old
not reacting to problem behaviors with verbal com- boy with autism, first during an FA and subsequently
ments, nonverbal expressions, or other forms of atten- during an intervention evaluation. The FA confirmed
tion. Recent research has shown that social extinction that the boy’s aggression was maintained by access to
depends on knowing precisely what constitutes “atten- preferred objects. As determined by a preference
tion,” be it a simple glance toward, physical contact assessment, giving the boy noncontingent access to
with, or speaking to a child (Kodak, Northup, & Kelley, high-preference objects was associated with less fre-
2007). Additionally, for social extinction to be effec- quent aggression when compared to middle-preference and
tive, identified sources of positive reinforcement must low-preference stimuli. Absent a preference assess-
be withheld following every occurrence of aggression ment, the proper choice of objects to make available
and noncompliance. during intervention would not have been made.
Social extinction works best when combined with Noncontingent reinforcement (NCR) is the behav-
differential positive reinforcement. Kern and Kokina ior-independent delivery of pleasurable consequences
(2008) reviewed several differential positive reinforce- (Carr & LeBlanc, 2006). NCR actually is imprecise
ment procedures that have been successful in reducing terminology because reinforcement by definition can-
problem behaviors of children with ASD. The differen- not be noncontingent (Skinner, 1948). In practice,
tial reinforcement of other behavior (DRO) makes NCR is implemented by presenting stimuli on a fixed-
pleasurable consequences contingent on the absence of time (FT) or variable-time (VT) schedule. Hagopian,
problem behaviors during a specified period of time. Fisher, and Legacy (1994) reported NCR as an effec-
With the differential reinforcement of alternative behav- tive intervention procedure for attention-maintained
ior (DRA), particular behaviors and not simply the problem behaviors (aggression, disruption, self-injury)
absence of responding are reinforced. The third proce- in 5-year old female quadruplets diagnosed with PDD
dure, differential reinforcement of low rate behavior and mental retardation. Following a baseline phase, a
(DRL), provides positive reinforcement when problem therapist presented social attention to the children on
behaviors do not exceed a predetermined criterion. an FT 10s schedule (“dense” schedule condition), then
Concerning intervention for aggression, various dif- on an FT 5 min schedule (“lean” schedule condition).
ferential positive reinforcement procedures have been The “dense” schedule of reinforcement was associated
effective with children who have ASD when imple- with the largest decrease in problem behaviors, sug-
mented as the only procedure and when combined with gesting that at the onset of NCR intervention, the FT
other methods (Luiselli & Slocumb, 1984) Noncompliance schedule should be near continuous. Hagopian et  al.
can be addressed with DRA by positively reinforcing (1994) eventually were able to fade the delivery of
instruction-following (Wilder, Saulnier, Beavers, & social attention so that by conclusion of the study, a
Zonneveld, 2008). As reported by Russo, Cataldo, and near-zero rate of problem behaviors was maintained by
Cushing (1981), increasing child compliance through an FT 5 min schedule.
reinforcement procedures can effectively reduce co- Functional communication training (FCT),
occurring problem behaviors such as aggression. This reported initially by Carr and Durand (1985), teaches
outcome is possible when aggression and noncompli- a child with attention-maintained aggression and
ance share the same response class. noncompliance to contact pleasurable stimuli using
The preceding discussion highlights the importance an acceptable language response. In depiction, a child
of conducting preference assessment before imple- who has learned to hit her teacher to obtain a favorite
menting positive reinforcement procedures. Potential object could be taught to say, “Can I have that toy?”
reinforcing stimuli for a child can be identified through Or, when noncompliance is reinforced by parent
observation, asking the opinions of care-providers, and attention, an FCT alternative could be, “Talk to me,”
180 J.K. Luiselli

or “Look what I did.” Because language acquisition is is withdrawn when the behavior is performed. The
a dominant learning objective for children with ASD, effective use of guided compliance should be realized
it is expected that most practitioners would rank FCT by a child avoiding physical contact with a practitioner
as an acceptable procedure. Recent studies also have by complying with instructions. If a child consistently
shown that FCT can be combined efficaciously with resists guided compliance or struggles forcefully, the
other behavior-deceleration methods (O’Reilly, procedure should be reconsidered. Wilder et al. (2008),
Cannella, Sigafoos, & Lancioni, 2006). for example, found that two preschool-age children
with autism responded better to a positive reinforce-
ment procedure for compliant behavior than guided
compliance when they did not follow instructions.
Social Negative Reinforcement Whereas escape extinction and guided compli-
ance focus on the consequences of aggression and
Problem behaviors that are escape motivated are main- noncompliance, antecedent intervention manipulates
tained by social negative reinforcement. Non- behavior-provoking stimuli and conditions (Luiselli,
compliance, in particular, is demonstrated by many 2008). One antecedent influence on escape main-
children with ASD during “demanding” educational tained problem behaviors is how a practitioner deliv-
activities. Some features of teacher–child interaction ers a verbal instruction. For some children with
that provoke noncompliant behavior (sometimes aggression and noncompliance, it is helpful to reduce
accompanied by aggression) include rate of task deliv- the number of instructions they receive as a way to
ery (Smith, Iwata, Goh, & Shore, 1995), response improve compliance and then slowly present more
effort (Iwata, Pace, Kalsher, Cowdery, & Cataldo, instructions (Zarcone et al., 1993). With behavioral
1990), and objects that have acquired idiosyncratic momentum (Mace et al., 1988), a child is presented
stimulus control (Carr, Yarbrough, & Langdon, 1997). first with instructions that always produce compli-
Social negative reinforcement operates when non- ance (HPR: high-probability requests) followed by
compliance and aggression terminate the nonpreferred instructions that historically have been associated
interactions. with poor compliance (LPR: low-probability
A procedure termed escape extinction (Carr, Newsom, requests). This sequencing of HPR and LPR is
& Binkoff, 1980) maintains an ongoing interaction to thought to promote stimulus control over compli-
prevent negatively reinforcing aggression and non- ance. One additional instruction-giving manipula-
compliance. In responding to aggression, a practitio- tion is to shift from direct to indirect requests. For
ner would block and redirect a child from hitting, example, Adelinis and Hagopian (1999) were able to
kicking, and similar responses. Escape extinction for eliminate aggression by a 27-year old man who had
noncompliance might consist of re-presenting instruc- autism by interrupting his disruptive behavior using
tions until a child follows through appropriately. a “do” request (e.g., “Sit in a chair.”) instead of a
Although this procedure is matched functionally to “don’t” request (e.g., “Don’t lie on the floor.”).
escape maintained problem behavior, there are disad- Although the participant in this study was an adult,
vantages because it is not easy to implement, may manipulating verbal instructions to reduce problem
occasion other negative responses, and necessitates behaviors likely can be used with children who have
physical contact with a child. a similar presentation.
Guided compliance is similar to escape extinction Butler and Luiselli (2007) evaluated noncontin-
in that a practitioner physically stops the behaviors gent escape (NCE), a variant of NCR described
contingent on escape maintained aggression and non- previously, as an intervention procedure with a
compliance. Additional intervention then is provided 13-year old girl who had autism, aggression, and
by prompting alternative responses, starting with a poor compliance with academic task requests.
gentle touch (partial physical prompt) and increasing Following an FA that verified escape maintained
the guidance as needed to overcome resistance. Guided problem behaviors, she was permitted a break from
compliance usually is implemented several seconds academic activities on a FT-20s schedule that was
after a child does not initiate a requested behavior and progressively increased to a FT300s schedule over
10  Aggression and Noncompliance 181

the course of 18 sessions. Intervention also included topographies most often controlled by automatic
instructional fading by which academic requests ini- reinforcement, resulting from either pleasurable
tially were eliminated and later introduced in small sensory stimulation or attenuation of physical dis-
increments. NCE combined with instructional fading comfort (Lerman & Rapp, 2006). No studies have
essentially eliminated aggression and improved been reported in which child noncompliance was
compliance. As programed in this study, NCE usu- shown to be maintained by automatic reinforcement.
ally starts with a frequent FT schedule that overtime Concerning aggression, Thompson, Fisher, Piazza,
becomes more practical by progressively delaying and Kuhn (1998) found that hitting, kicking, pinch-
acceptable escape. ing, and scratching by a 7-year-old boy diagnosed
FCT also is a function-based intervention proce- with PDD were attention-maintained, while a sepa-
dure for escape-maintained problem behaviors. rate topography of “grinding” his chin against a per-
Johnson, McComas, Thompson, and Symons (2004) son’s body was automatically reinforced by tactile
evaluated FCT with an 11-year old boy who had stimulation. Intervention for the attention-main-
autism and displayed aggression (hitting, kicking, tained aggression consisted of FCT and social
pinching, biting, pulling hair) toward his mother and extinction. The procedures implemented to reduce
infant brother. An FA conducted in the boy’s home automatically reinforced aggression included
revealed that aggression was negatively reinforced response blocking and giving the child access to
by his mother picking up the infant brother and leav- alternative forms of chin stimulation. This study is
ing the room. Aggression was reduced to a near-zero instructive because it shows how multiple aggres-
rate by teaching the boy to request separation from sive responses can have different sources of operant
his mother and brother. Interestingly, the positive control and require separate function-based inter-
effect from FCT was more pronounced when the vention plans.
mother frequently prompted the boy to make requests. Future studies should explore other clinical situ-
Finally, a study by Peyton, Lindauer, and Richman ations in which aggression and noncompliance are
(2005) highlights the importance of properly assessing automatically reinforced. I have seen two cases
the source of control over escape maintained problem where behavior-contingent sensory consequences
behavior before formulating an intervention plan. The appeared to reinforce aggression. One case was an
participant was a 10-year-old girl with autism and adolescent boy with autism who slapped his teacher
vocal behavior involving a refusal to comply with and parents. Observation and FBA results pointed to
requests (e.g., “I won’t do it.”). An FA suggested that audible feedback as the source of reinforcement.
noncompliance was reinforced by escaping task That is, the boy displayed aggression because he
demands. One intervention evaluation showed that enjoyed the sound that his slapping produced! The
noncompliant vocal behavior persisted whether second case was a 6-year-old girl with autism who
demands were or were not accompanied by removal of demonstrated aggression towards peers and adults
task materials. When the manner of prompting the girl by pulling their hair. This behavior was evident in
included a nondirective request (e.g., “I wonder where many contexts, seemingly maintained by the girl
the --- is.”) instead of a direct request (e.g., “Show me visually inspecting strands of hair that she pulled.
the ---.”), noncompliance quickly extinguished. Similar to these examples, it is possible that non-
Therefore for this child, it was how requests were pre- compliance also could be automatically reinforced,
sented and not demands per se that occasioned the for example, through physical contact that is pro-
problem behavior. vided when a practitioner uses “hand over hand”
guidance to prompt responding. Although automatic
reinforcement is less likely to be the primary source
Automatic Reinforcement of control for child aggression and noncompliance
(Thompson & Iwata, 2001), all potential influences
Problem behaviors are automatically reinforced on behavior should be considered so that practitio-
when they occur independent of social conse- ners have available the greatest selection of poten-
quences. Stereotypy and self-injury are the behavior tially effective intervention procedures.
182 J.K. Luiselli

Intervention Recommendations from activities through FCT or having breaks sched-

uled noncontingently would be another alteration of
EOs.
The evidence-based and empirically supported proce-
Both distal events and biological conditions also
dures reviewed in this chapter give practitioners many
can function as EOs for problem behaviors by tempo-
options for intervention with children who have ASD,
rarily changing the impact of environmental contin-
aggression, and noncompliance. Whereas the earliest
gencies. Poor sleep the night before school could result
ABA approaches to aggression and noncompliance
in more frequent escape motivated noncompliance
were not function-based and often relied on punish-
compared to evenings without sleep disturbance
ment (Luiselli, 2004), our perspective on intervention
(O’Reilly, 1995). A child’s aggression towards teach-
has widened, emphasizing FBA, FA, antecedent con-
ers and parents may increase when she/he has allergy-
trol, and positive behavior support. Aggression and
induced distress (Kennedy & Meyer, 1996) or an ear
noncompliance certainly are two of the most difficult-
infection (Luiselli, Cochran, & Huber, 2005; O’Reilly,
to-manage problem behaviors confronting practitioners.
1997). Such influences must be assessed so that if
Notably, research has endorsed several intervention
applicable, proper behavioral intervention or medical
procedures that are well suited to school, home, and
treatment can be applied.
community settings. Nonetheless, there are additional
intervention recommendations, which I present in this
final section.

Intervention Integrity
Establishing Operations The most carefully formulated and function-based
intervention plan can only be effective if practitioners
Establishing operations (EOs) are defined as “events, implement it accurately. Intervention integrity refers
operations, or stimulus conditions that establish the to procedural fidelity: is a plan carried out as written?
capacity of classes of consequences to serve as rein- For aggression and noncompliance, the concern about
forcement and increase the frequency of behaviors that intervention integrity is particularly salient because
have produced members of these classes in the past” most plans combine antecedent and consequence pro-
(Friman & Hawkins, 2006, p. 33). In function, EOs cedures (Ricciardi, 2006). Furthermore, practitioners
relate to states of deprivation and satiation, most evi- typically are responsible for data collection as another
dent with food as primary reinforcement. Hunger component of intervention. The requirement of fol-
(a state of deprivation) will increase the reinforcing lowing a multi-procedural plan and recording data can
properties of food and the behavior of food-seeking. easily compromise implementation.
Conversely, when a person is not hungry (a state of Intervention integrity should be assessed routinely
satiation), food is less reinforcing and food-seeking by observing practitioners implement procedures and
stops. documenting their performance. The observer should
Detailed reviews of how EOs influence problem have a recording form that lists all procedures com-
behaviors can be found in McGill (1999) and Friman prising the intervention plan and a respective scoring
and Hawkins (2006). Imagine a child with ASD who section with integrity measures such as, “implemented
has attention-maintained aggression. Intervention based as written” and “not implemented as written”
on the concept of EOs might consist of giving the child (Codding, Feinberg, Dunn, & Pace, 2005). Immediately
social attention noncontingently on an FT schedule following observation, the performance results are
throughout the day. Providing attention this way would reviewed with the practitioners, pointing out accurate
function as intervention by eliminating the child’s implementation and correcting misapplication. This
motivation to seek social consequences through performance feedback can be delivered with written
aggression. Another example would be a child who comments and/or visual inspection of integrity data
shows escape motivated noncompliance during educa- (Hagermoser Sanetti, Luiselli, & Handler, 2007).
tional activities. Teaching the child to request a “break” Sufficient research exists supporting these methods
10  Aggression and Noncompliance 183

for improving intervention integrity (Hagermoser serious problem behaviors (Harris, 1996). When apply-
Sanetti & Kratochwill, 2008). ing physical restraint, one or more practitioners immo-
bilizes a person’s voluntary movement. Many times,
physical restraint is required to manage unanticipated
emergency situations where there is a threat of harm to
Social Validity self, others, and the environment. However, planned
physical restraint sometimes is justified as an accept-
How acceptable to practitioners are intervention pro- able behavior-reduction procedure within a compre-
cedures targeting aggression and noncompliance? hensive intervention plan (Federal Statutes and Policies
Procedures that are judged poorly can be a further Governing the ICF/MR Program, 2003).
impediment to intervention integrity because a prac- There are several studies in which physical restraint,
titioner may be reluctant to apply them conscien- alone and combined with other procedures, has
tiously. Social validity labeled as “consumer decreased aggression in people with ASD and related
satisfaction” has been a concern in ABA for some- developmental disabilities (Luiselli, Suskin,
time (Wolf, 1978). More recently, Kennedy (2002) & Slocumb, 1984; Matson & Keyes, 1988; Rolider,
proposed that limited maintenance outcomes from Williams, Cummings, & Van Houten, 1991). However,
behavioral intervention sometimes can be attributed physical restraint is an invasive procedure that can be
to poor acceptance by practitioners. Clearly, positive misapplied, causing injury to the person being restrained
results from intervention will not persist if practitio- and the people responsible for implementation (Hill &
ners resist implementation because they “don’t like” Spreat, 1987). Physical restraint also can provoke
the procedures. additional problem behaviors, seen typically when a
Cautious attention should be paid to the accept- person resists or struggles against being immobilized.
ability of intervention procedures in dealing with A further complication is that in some cases, physical
children who physically challenge practitioners with restraint could maintain problem behaviors because it
aggression and do not follow directions when functions as positive or negative reinforcement (Favell,
instructed. Facing actual or threatened aggression, McGimsey, & Jones, 1978; Magee & Ellis, 1988).
as well as chronic noncompliance, creates a burden And, although some practitioners may be inclined to
that is less apparent with children who do not have use physical restraint because it stops problem behav-
serious problem behaviors. Some of the consider- iors, many view the procedure as unacceptable
ations in selecting procedures are whether they (Cunningham, McDonnell, Easton, & Sturmey, 2003;
require physical contact with a child (e.g., guided McDonnell & Sturmey, 2000).
compliance, response blocking, physical restraint), Acknowledging the disadvantages of physical
include unique precautions (e.g., a practitioner restraint, it is desirable to reduce implementation to
wears protective equipment to prevent injury), or those cases where it is clinically justified. One inter-
are socially stigmatizing. Asking practitioners to vention approach, illustrated in a study by Luiselli,
judge procedures on these and similar characteris- Kane, Treml, and Young (2000), is to modify ante-
tics speaks to the sustainability of intervention cedent conditions that provoke the behaviors requir-
within natural settings (Dunlap, Carr, Horner, ing restraint. The participants were two boys, 14 and
Zarcone, & Schwartz, 2008). 16 years old, who had PDD and attended a residential
school. Both boys were aggressive towards peers and
staff (hitting, biting, scratching, kicking). During a
1-month baseline phase, staff implemented several
Restrictive Procedures procedures, including physical restraint, according to
student-specific intervention plans. The plans had
As noted, intervention procedures such as escape staff deliver pleasurable consequences to the students
extinction and guided compliance require physical when they demonstrated positive behavior and did
contact with a child. Physical restraint is another not exhibit aggression. Staff applied physical restraint
restrictive procedure that has been used as intervention with the boys when they determined that aggression
with people who have developmental disabilities and was unmanageable. Next, intervention was changed
184 J.K. Luiselli

so that physical restraint was implemented according research with children who have ASD: conversation,
to behavior-specific criteria and not arbitrarily deter- cooperation, nonverbal responding, pivotal behav-
mined by staff. A second intervention phase subse- iors, and play. Various procedures have been evalu-
quently was evaluated in which several antecedent ated with each of these social skills. Priming, as one
control procedures were introduced, each designed to example, is an antecedent procedure that includes
reduce the escape function of aggression and in con- modeling, instruction, and demonstration of behaviors
sequence, producing fewer incidents of physical to be performed and reinforced in a later social context
restraint. For one of the students, staff were taught to (Licciardello, Harchik & Luiselli, 2008; Zanolli &
detect behaviors indicating he was becoming upset Daggett, 1998). Peer-mediated intervention involves
and often predicted aggression. Upon observing these teaching typically developing peers to initiate social
precursor behaviors, staff directed the boy to take contact with and engage a child with ASD in mutu-
time away from his group until he was composed. ally pleasurable social exchanges such as conversa-
Functional communication training also was provided tion and games (Gonzalex-Lopez & Kamps, 1997).
so that he could request a break from instruction. More recently, computerized video modeling has
With the second student, the antecedent procedures become a useful procedure for improving social
were giving him more access to novel activities, skills (LeBlanc et  al., 2003; Simpson, Langone, &
reducing sedentary tasks in favor of more preferred Ayres, 2004). The procedure consists of taping a
interactions with staff, and placing him strategically video sequence of a child with ASD, a peer, or adult
within groups so that he had less proximity to peers. performing specific social skills and then showing
Luiselli et  al. (2000) found that implementing the tape to the child prior to interaction opportuni-
behavior-specific criterion for physical restraint as the ties. These and other procedures provide a rich selec-
first intervention procedure was ineffective. tion for practitioners in building adaptive social
Subsequently, physical restraint decreased and skills.
remained at near-zero frequency when the same crite-
ria were maintained in conjunction with the anteced-
ent intervention procedures. These and similar
procedures should remain a priority when physical Summary
restraint or other restrictive procedures are considered
as behavioral intervention for children with ASD
ABA has been instrumental in assessment and inter-
(Lerman, 2008).
vention for aggression and noncompliance in children
who have ASD. Proper assessment begins by opera-
tionally defining the behaviors to permit reliable mea-
Skill Building Intervention surement before and during intervention. Functional
behavioral assessment (FBA) and functional analysis
Many children with ASD display aggression and non- (FA) should precede intervention in order to isolate
compliance because they are unable to contact posi- controling influences on aggression and noncompli-
tive reinforcement through alternative behaviors. In ance. Social positive reinforcement, social negative
particular, poor social skills contribute greatly to reinforcement, and automatic reinforcement are three
attention maintained and escape motivated problem categories emphasized in FBA and FA. Some of the
behaviors. A child who does not socialize appropri- evidence-based and empirically supported intervention
ately with peers and adults may learn to hit them as a procedures that can be matched to behavior-function
way to elicit attention. Or, being unable to enjoy social include social extinction, differential positive rein-
interactions could result in escape motivated noncom- forcement, FCT, NCR, NCE, instructional fading, and
pliance. A logical approach in such circumstances is modifying verbal directions. Other contributions to
to teach a child the skills needed to initiate and main- effective intervention are studying the role of EOs,
tain social interactions. assessing procedural fidelity, documenting social valid-
Machalicek et al. (2008) outlined five categories ity, monitoring implementation of restrictive methods,
of social skills that have been studied in intervention and teaching social skills.
10  Aggression and Noncompliance 185

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