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Parent Implementation of Function-Based Intervention to Reduce Children's Challenging Behavior: A

Literature Review
Angel Fettig and Erin E. Barton
Topics in Early Childhood Special Education published online 23 December 2013
DOI: 10.1177/0271121413513037

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513037
research-article2013
TECXXX10.1177/0271121413513037Topics in Early Childhood Special EducationFettig and Barton

Article
Topics in Early Childhood Special Education

Parent Implementation of Function-

XX(X) 1­–13
© Hammill Institute on Disabilities 2013
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DOI: 10.1177/0271121413513037

Challenging Behavior: A Literature tecse.sagepub.com

Review

Angel Fettig, PhD1 and Erin E. Barton, PhD2

Abstract
The purpose of this literature review was to analyze the research on parent-implemented functional assessment (FA)-
based interventions for reducing children’s challenging behaviors. Thirteen studies met the review inclusion criteria. These
studies were analyzed across independent variables, types of parent coaching and support provided, measurement of
implementation and intervention fidelity, child dependent variables, social validity, and study rigor. Overall, the evidence
provide some support that parents can be trained to implement FA-based interventions with follow-up coaching and support,
and these interventions reduce children’s challenging behaviors and increase children’s use of appropriate behaviors.
However, inadequacies in study rigor and reporting of the implementation and intervention fidelity limit interpretations.
Implications for practice and future research are discussed.

Keywords
collaboration, families, challenging behaviors, intervention strategies

Positive behavior support (PBS) is a tiered, prevention
approach to challenging behavior that provides assessment
driven, comprehensive support focusing on re-designing
environments to reduce challenging behaviors and increase
pro-social behaviors (Powell, Dunlap, & Fox, 2006). The
efficacy of PBS has been well documented across children
with and without disabilities, very young children, and
organizations (Dunlap & Fox, 2011). A central feature of
PBS is the focus on functional assessment-based (FA-based)
interventions. FA-based interventions use functional behav-
ioral assessments (FBAs) to systematically gather informa-
tion to identify why a child might be demonstrating a
challenging behavior and the environmental conditions
under which challenging behaviors are likely to occur.
Considerable evidence supports the use of FBAs and subse-
quent PBS plans with young children across early child-
hood settings (Dunlap & Fox, 2011). Studies that compared
FA-based interventions with non-function-based interven-
tions have noted distinct benefits from FA-based interven-
tions (Ingram, Lewis-Palmer, & Sugai, 2005).
Several reviews have identified the efficacy (Conroy,
Dunlap, Clarke, & Alter, 2005; Dunlap & Fox, 2011) and
key intervention features of FA-based interventions in early
childhood (Wood, Blair, & Ferro, 2009). Although this
research has largely focused on practitioner implementation
in school and clinic settings, individual studies have exam-
ined parent implementation of FA-based interventions for
young children with challenging behaviors and the results
are promising (Dunlap, Ester, Langhans, & Fox, 2006).
However, no reviews to date have specifically examined
implementation or intervention fidelity features of parent-
implemented FA-based interventions.
When identifying evidence-based practices, the family
coaching practices are likely as essential in the process as
the FA-based intervention practices. Thus, the description
and fidelity of the FA-based intervention practices and the
family coaching practices are fundamental features of this
research. In fact, Fixsen, Naoom, Blase, Friedman, and
Wallace (2005) argued that factors affecting implementa-
tion are as important as the effectiveness of the interven-
tion. This approach to implementation is changing how we
address the gap between science and practice and stresses
the imperative function of fidelity. For FA-based parent
interventions, this highlights the importance of under-
standing and identifying features of effective family
coaching.
1
University of Massachusetts Boston, USA
2
Vanderbilt University, Nashville, TN, USA
Corresponding Author:
Angel Fettig, Department of Curriculum and Instruction, University of
Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125,
USA.
Email: angel.fettig@umb.edu

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2 Topics in Early Childhood Special Education XX(X)
In general, the focus of family coaching is to build the
family’s capacity to support their child’s learning and
development. A developing literature exists examining the
role of parents and family-focused strategies for promoting
learning and development in young children (Powell &
Dunlap, 2010; Trivette, Dunst, & Hamby, 2010). Several
family coaching practices have emerged from this litera-
ture; these practices are based on principles of adult learn-
ing and guided by principles of family-centered practices
(Sandall, Hemmeter, Smith, & McLean, 2005). For exam-
ple, Powell and Dunlap (2010) reviewed interventions
focused on enhancing parental interactions and caregiving
skills with their infants and toddlers. They identified several
common characteristics of coaching across these interven-
tions (e.g., multiple opportunities for practice with feed-
back, homework and follow-up activities, and the use of
live or video modeling). Similarly, Rush and Shelden
(2005) proposed the following five characteristics of family
coaching based on a synthesis of research on coaching prac-
tices: joint planning, observations, action, reflection, and
feedback. While these reviews highlighted important char-
acteristics that support parent implementation of interven-
tions with young children, neither specifically examined the
parent support features in the parent-implemented FA-based
interventions literature. A discrete list of coaching practices
has emerged from the early childhood parent coaching lit-
erature (McWilliam, 2010; Powell & Dunlap, 2010; Rush
& Shelden, 2011); however, no peer-reviewed syntheses of
the parent training research to date have specifically exam-
ined parent coaching practices (Barton & Fettig, 2013;
Roberts & Kaiser, 2011). Thus, the evidence for parent
coaching practices remains untested and systematic reviews
are warranted.
In the literature on parent implementation of FA-based
interventions, implementation fidelity refers to the proce-
dures used to support parent implementation of FA-based
intervention; intervention fidelity refers to the use of the
individualized practices outlined in the PBS plan (Dunst,
Trivette, & Hamby, 2008; Dunst, Trivette, McInerney, et
al., 2008). For example, implementation fidelity refers to
the implementation of specific training and coaching prac-
tices used (e.g., modeling, role-play, feedback) to support
the parents’ use of the FA-based intervention practices in
the PBS plan. Intervention fidelity refers to the parents’ use
of the practices in the PBS plan (e.g., redirection, specific
praise, transition warnings). The emerging body of imple-
mentation science literature stresses that high-fidelity
implementation of effective training practices (implementa-
tion fidelity) yields high-fidelity implementation of evi-
dence-based practices (intervention fidelity), which results
in positive child outcomes. In fact, research has shown that
implementation that does not meet known fidelity thresh-
olds often yields ineffective outcomes (Strain & Bovey,
2011; Vernez, Karam, Mariano, & DeMartini, 2006). Thus,
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an analysis of the research on the effectiveness of parent-
implemented FA-based interventions should include an
analysis of child outcomes, parent-intervention fidelity, and
the practices used to support parent high-fidelity
implementation.
Not surprisingly, most of the studies examining FA-based
parent interventions used single-case research designs
(SCRD). The What Works Clearinghouse (WWC; T. R.
Kratochwill et al., 2010) recently published SCRD stan-
dards to analyze study rigor and to guide the identification
of evidence-based practices. Studies are evaluated on the
strength of the research design (i.e., internal validity) and
the strength of evidence (i.e., visual analysis). Each study
that meets design standards (or meets with reservations)
should then be visually analyzed for strength of evidence.
Recently, the standards have been applied to published
reviews of token economies and group-based contingencies
(Maggin, Chafouleas, Mosely, & Johnson, 2011; Maggin,
Johnson, Chafouleas, Ruberto, & Berggren, 2012).
Applying these standards to the FA-based parent interven-
tions can identify the methodological strengths (i.e., experi-
mental rigor) and weaknesses of this literature.
As described previously, although several empirical
investigations of FA-based parent interventions have been
conducted, no reviews have systematically examined or
identified common, effective coaching practices. Such a
review is warranted to identify key features for supporting
intervention and implementation fidelity. The purpose of
this synthesis was to identify implementation features (i.e.,
family coaching practices), summarize intervention fea-
tures (e.g., components of the behavior support plans), eval-
uate the measurement of these features (i.e., implementation
and intervention fidelity), and analyze the experimental
rigor within the research on FA-based parent interventions
to ascertain implications for practice and future research.
Method
FA-based parent-intervention studies were identified
through four steps. First, PsychINFO and ERIC databases
were searched using the terms functional assessment and
challenging behaviors. Limits were set for peer-reviewed
journal articles, those written in English and those reporting
studies involving human participants. Second, the same
databases were searched using the terms functional assess-
ment and parent training and then functional assessment
and parent intervention. Third, the same databases were
searched using the terms functional communication train-
ing and parent training and then functional communication
training and parent intervention. Fourth, ancestral searches
were conducted using the identified studies. Studies were
included if they (a) had a FA component, (b) focused on
FA-based parent interventions to reduce challenging behav-
iors, (c) included and reported direct observations of child
Fettig and Barton 3
behaviors as part of the dependent variable, (d) had parents
as the primary participants, (e) had children aged 8 years or
younger with or without disabilities and with challenging
behaviors as a secondary participant, and (f) used an experi-
mental design. The search results yielded 13 studies. One
study (Lucyshyn, Albin, & Nixon, 1997) was identified
during the search process; however, it was excluded from
the review because the data were duplicated in a follow-up
publication (Lucyshyn et al., 2007).
Coding Procedures and Component Definitions
The authors developed operationalized definitions for each
variable and used a data extraction spreadsheet to indepen-
dently extract and record information from the 13 studies.
The following variables were defined and coded across all
13 studies: the participant characteristics, intervention set-
tings, independent variables, pre-intervention training and
post-training support, child dependent variables, outcome
measurement, measurement of implementation and inter-
vention fidelity, research design, evidence of functional
relation (Gast, 2010; Horner et al., 2005; Kazdin, 2010),
and overall outcomes. Also, the WWC SCRD standards
were applied to all studies (T. R. Kratochwill et al., 2010).
The first author reviewed both spreadsheets for agreement.
Disagreements were discussed, and the authors reached a
consensus on how disagreements should be coded.
However, such discussions only occurred twice: (a) to clar-
ify definitions of family coaching practices and (b) to
resolve a disagreement on determining the evidence of
experimental control of one study. The overall agreement
between the two authors was calculated by dividing the
number of agreements by the number of agreements plus
disagreements; the overall agreement was more than 95%
across studies and variables.
Description of variables.  Participant characteristics were sep-
arated into child participants and parent participants. For
child participants, number of participants in each study, age
(in months), gender, and diagnoses were coded. Parent edu-
cation level was the only parent demographic variable
coded. Intervention settings were coded to indicate the tar-
geted setting of the behavior intervention for each study.
The settings were coded as play/non-specified time, meal/
snack time, bedtime, transition time, toileting routine, and
community setting. Independent variables consisted of cod-
ing PBS plan components and duration of the intervention.
Prevention strategies, replacement behaviors, and new
responses to behaviors (Lucyshyn, Kayser, Irvin, & Blum-
berg, 2002) were identified. Prevention strategies were
those in which antecedent conditions were changed (e.g.,
providing transition warnings, use of visual supports, and
stating behavior expectations). Replacement behaviors
were skills identified as functionally equivalent to the target
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behavior. New responses to behaviors included reinforce-
ment of the child’s use of newly learned skills and responses
to occurrences of the challenging behaviors. The duration
of the intervention was coded to reflect the length of time
from the beginning to the end of the intervention. Pre-inter-
vention training (parents training on the use of FA-based
intervention) and post-training support (parents implemen-
tation of the FA-based intervention in target routines) were
coded across 10 categories: (a) routines-based, (b), inter-
vention self-monitoring, (c), collaborative progress moni-
toring, (d) modeling, (e) role-play, (f) practice and support
for trying new skills, (g) guided self-reflection, (h) collab-
orative problem solving, (i) performance-based feedback,
and (j) building motivation for practice between training
sessions (i.e., including between-session homework or
other between-session follow-up or support). Studies that
used strategies outside of these categories also were noted.
As described previously, this discrete list of coaching prac-
tices was compiled based on a recent review of the parent
coaching literature (McWilliam, 2010; Powell & Dunlap,
2010; Rush & Shelden, 2011); however, this did not include
peer-reviewed syntheses of the literature, because none
exists.
Child dependent variables were coded to reflect whether
challenging behaviors and appropriate behaviors were mea-
sured, and the metric and the measurement system for the
behavior measures were documented. The presence or
absence of four other outcome characteristics was also
recorded: generalization, maintenance, contextual fit of PBS
plan, and social validity. The authors recorded whether gen-
eralization and maintenance of the parents’ use of the
FA-based intervention were measured in settings beyond the
target setting and time period, whether the contextual fit of
the PBS plan was considered (i.e., whether the values,
resources, and needs of the family were used to develop the
PBS plan), and whether social validity measures were used.
Implementation fidelity was coded to reflect whether coach-
ing and training implementation were measured. The mea-
surement of intervention fidelity (i.e., parent implementation
of the PBS plan) and the measurement system used were
documented. All studies were coded for the research design
used, and the presence of a functional relation was measured
using visual analysis of the following five data characteris-
tics: (a) a stable baseline, (b) overlap, (c) the immediacy at
the point of phase change, (d) the consistency of the treat-
ment effects, and (e) at least three attempts at demonstrating
treatment effects (Gast, 2010; Horner et al., 2005; Kazdin,
2010). The previously described data features were assessed
individually and collectively at the study level to determine
whether each study established experimental control and
demonstrated a functional relation.
WWC SCRD standards. The WWC SCRD standards were
applied to all studies. Six design standards (T. R. Kratochwill
4 Topics in Early Childhood Special Education XX(X)
et al., 2010) were used to evaluate each study: systematic
manipulation of independent variable, dependent variable
measured repeatedly, interobserver agreement (IOA) reported
for more than 20% of the data and at more than 80% the
agreement, at least three attempts at demonstrating a treat-
ment effect, and at least three data points per phase. These
were analyzed using criteria designed and used in previous
behavioral research (e.g., Maggin & Chafouleas, 2011; Mag-
gin et al., 2011; Maggin et al., 2012). The initial four criteria
were scored using a dichotomous scale (i.e., present, not pres-
ent) at the study level and the final two design standards were
coded at the case level using a dichotomous scale for the fifth
standard and trichotomous scale for the sixth. The individual
studies were ultimately classified as (a) Meets Standards if
they provided five or more data points per condition and met
all other design standard criteria, (b) Meets Standards With
Reservations if there were three or four data points per condi-
tion and met all other criteria, and (c) Does Not Meet Stan-
dards if there were fewer than three data points per condition
or if the case failed to meet any criteria. The strength (i.e.,
strong or moderate) of the evidence was analyzed for the
studies meeting standards or meeting standards with reserva-
tions using the WWC’s pre-determined criteria (e.g., Maggin
& Chafouleas, 2011). Finally, the “5-3-20” guidelines pro-
posed by the WWC were used to determine whether FA-
based parent interventions were evidence-based (T. T.
Kratochwill et al., 2013). These criteria include (a) a mini-
mum of five SCRD studies that met standards or standards
with reservations, (b) studies conducted across a minimum of
three independent research groups, and (c) a minimum of 20
individual demonstrations of an effect (e.g., children, fami-
lies, settings, behaviors etc.).
Results
The 13 identified studies were published between 1997 and
2009. The following variables are summarized and
described in the next sections: participant characteristics;
intervention settings; independent variables; collaboration
with parents; training and support; implementation and
intervention fidelity; generalization, maintenance, contex-
tual fit, and social validity of the intervention; dependent
variables; and evidence of experimental control. Finally,
the application of the WWC standards to the studies is
described.
Participant Characteristics
Based on the selection criteria for this review, the partici-
pants were children who demonstrated challenging behav-
iors (N = 32); participant characteristics are shown in
Table 1. Ten studies included children with identified dis-
abilities. Fifty-nine percent (n = 19) of the children included
across the studies were diagnosed with autism spectrum
disorders, 19% with language delays (n = 6), 16% with
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developmental delays (n = 5), and 6% with a genetic disor-
der (n = 2). Twenty-five percent (n = 8) of the participants
did not have identified delays or diagnosis. The youngest
child was 24 months (Marcus, Swanson, & Vollmer, 2001)
and the oldest child was 8 years (Vaughn, Clarke, & Dunlap,
1997). Thirty-one percent (n = 4) of the 13 studies reported
parents’ level of education. Sixty-six percent (n = 21) of the
child participants were male.
Intervention Settings
All 13 studies focused on daily routines in the home; 4 stud-
ies also targeted routines in the community setting. One
study (Marcus et al., 2001) conducted the parent training for
one parent–child dyad in the classroom, but the intervention
focused on a home routine (see Table 2).
Independent Variables
As part of the inclusion criteria, all 13 studies used FA-based
strategies to create PBS plans and trained parents in imple-
menting the plan. Four of the 13 studies created PBS plans
that included all three components (i.e., prevention strate-
gies, teaching replacement skills, and new responses to
challenging behaviors). Nine studies incorporated function-
based strategies (FB strategies) that included two of the
three components. Three studies used functional communi-
cation training. Only 5 of the 13 studies reported the dura-
tion of the intervention. Two studies lasted 12 to 14 months,
one lasted 23 weeks (Lucyshyn et al., 2007), one lasted 7
weeks (Marcus et al., 2001), and one conducted observa-
tions twice per week but did not report the duration of the
intervention (Vaughn et al., 1997).
Collaboration With Parents
Collaboration with parents in administering a FBA, creat-
ing the PBS plan, and implementing the plan is essential.
While all studies reported parent collaboration in conduct-
ing a FBA, the extent of collaboration described varied
across studies. For example, Dunlap, Ester, et al. (2006)
described collaborating with parents to conduct a FBA,
select a routine that was of the greatest concern, and iden-
tify the functions of the challenging behaviors. Vaughn et al.
(1997) indicated that the parent selected the intervention
but did not describe collaboration beyond this. Only five
studies reported the involvement of parents in developing
the PBS plan (Duda, Clarke, Fox, & Dunlap, 2008; Dunlap
& Fox, 1999; Fettig & Ostrosky, 2011; Koegel, Stiebel, &
Koegel 1998; Vaughn, Wilson, & Dunlap, 2002).
Training and Support
Pre-intervention training. Several evidence-based family
coaching strategies were used across these studies during
Fettig and Barton 5

Table 1.  Participant Characteristics.

Child participants
Parent education
Study No. Reference n Age (months) Gender Diagnosis level
 1 Duda, Clarke, Fox, and Dunlap 3 34–60 One female, two males None College graduate
(2008)
 2 Dunlap and Fox (1999) 6 29–44 One female, five males Pervasive Developmental Some high school
Disorder to college
graduate
 3 Dunlap, Ester, Langhans, and Fox 2 30–33 Two females Exp. Language Delay NR
(2006)
 4 Fettig and Ostrosky (2011) 2 41–52 One female, one male None BA; PhD
 5 Frea and Hepburn (1999) 2 48 Two males Autism NR
 6 Galensky, Miltenberger, Stricker, 3 34–83 Two females, one male None NR
and Garlinghouse (2001)
 7 Harding, Wacker, Berg, Lee, and 1 30 One male Developmental Delay and NR
Dolezal (2009) Peter’s Anomaly
 8 Koegel, Stiebel, and Koegel 3 49–70 One female, two males Autism and Developmental NR
(1998) Delay
 9 Lucyshyn et al. (2007) 1 60 One female Autism and Moderate to NR
Severe ID
10 Marcus, Swanson, and Vollmer 4 24–60 One female, three Developmental and Speech NR
(2001) males Delays
11 Moes and Frea (2002) 3 39–43 One female, two males Autism NR
12 Vaughn, Clarke, and Dunlap 1 96 One male Agenesis of Corpus NR
(1997) Callosum
13 Vaughn, Wilson, and Dunlap 1 84 One male Autism, Severe ID Some college
(2002)

Note. Exp. = Expressive; NR = not reported; ID = intellectual disabilities.

pre-intervention training (see Table 3). All studies reported
the strategies or components of the parent training. The
coaching strategies ranged from discussions of examples of
specific strategies to intensive practice using modeling and
performance-based feedback. All 13 studies used daily rou-
tines as the context for training. Other frequently used strat-
egies included modeling (n = 7), practice and support for
trying new skills (n = 6), and building motivation for prac-
tice (n = 5). All but two studies used more than one strategy
to deliver pre-intervention training. For example, Frea and
Hepburn (1999) used a manualized training that included
discussions of (a) the communicative nature of problem
behavior, (b) functions of behavior, (c) how to record
behavior, (d) how to determine the function of the behavior,
and (e) the importance of choosing a new functionally
equivalent behavior. They used a checklist to record infor-
mation about challenging behavior and guide discussions.
Lucyshyn et al. (2007) included a written PBS plan, rou-
tine-specific implementation checklists, modeling, behav-
ioral rehearsal (i.e., practice), and problem-solving
discussions as part of their training and support activities.
Koegel et al. (1998) and Vaughn et al. (2002) did not report
the specific strategies used during parent training.
Post-training support.  Eleven of the 13 studies reported the
use of coaching and support strategies after the initial
training to assist parents in implementing the FA-based
interventions. All of these 11 studies used daily routines as
the context for the intervention, which indicated that sup-
port was provided directly to the routine. Performance-
based feedback was the second most commonly used
practice (n = 6), followed by modeling (n = 4), and practice
and support to try new skills (n = 4). Most (n = 9) studies
used a combination of strategies during post-training sup-
port. For example, Dunlap and Fox (1999) used modeling,
collaborative progress monitoring, and performance-based
feedback. Fettig and Ostrosky (2011) used modeling, prac-
tice, guided self-reflection, performance-based feedback,
and built motivation for between-session practice.
Implementation and Intervention Fidelity
As previously described, implementation fidelity refers to
the procedures used to support parent implementation;
intervention fidelity refers to the parents’ use of the
FA-based strategies. Although all 13 studies used parent
training and coaching, only 2 studies (Dunlap, Ester, et al.,
2006; Fettig & Ostrosky, 2011) measured and reported
implementation fidelity. Also, none of the 13 studies
reported the education and training of the trainer. Six of the
13 studies reported the intervention fidelity of the parent-
implemented FA-based intervention (see Table 2). For

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6 Topics in Early Childhood Special Education XX(X)

Table 2.  Intervention Characteristics.

Behavior support plan component
Intervention setting Intervention fidelity (parent)
Prevention Replacement New responses
Study P M B T Tt Cm NS strategies behaviors to behaviors Duration Strategies measured Measurement system

Duda, Clarke, Fox, and X X X X NR Steps in the BSP % of steps

Dunlap (2008)
Dunlap and Fox (1999) X X X X NR NR NR
Dunlap, Ester, Langhans, and X X X (FCT) X NR Attention to CB, % of intervals of
Fox (2006) Prompt RB, strategy used, partial
Reinforce RB interval
Fettig and Ostrosky (2011) X X X NR Strategies used % of strategies
Frea and Hepburn (1999) X X NR NR NR
Galensky, Miltenberger, X X NR Attention, Ignoring, Contingent to behavior;
Stricker, and Garlinghouse Redirection, % of intervals, partial
(2001) Differential interval
reinforcement
Harding, Wacker, Berg, Lee, X X X (FCT) X 14 months NR NR
and Dolezal (2009)
Koegel, Stiebel, and Koegel X X X X X NR NR NR
(1998)
Lucyshyn et al. (2007) X X X X X X 23 weeks NR NR
Marcus, Swanson, and X X 7 weeks Correct antecedent; % of contingent delivery
Vollmer (2001) correct response of correct responses
to CB; correct
response to AB
Moes and Frea (2002) X X X X X (FCT) 1 year NR NR
Vaughn, Clarke, and Dunlap X X X X Two times NR NR
(1997) per
week
Vaughn, Wilson, and Dunlap X X X NR Mother’s positive % of intervals of
(2002) behavior and occurrence
affection

Note. P = play/non-specified time; M = meal/snack time; B = bedtime; T = transition time; Tt = toileting routine; Cm = community; NS = not specified; X = measured; NR =
not reported; BSP = behavior support plan; FCT = functional communication training; CB = challenging behaviors; RB = replacement behavior; AB = appropriate behavior.

example, Dunlap, Ester, et al. (2006) used 10-s intervals to
measure the mother’s use of the FB strategies in the plan
and calculated the percentage of intervals of intervention
fidelity. Duda et al. (2008) and Fettig and Ostrosky (2011)
calculated the percentage of strategies implemented during
each routine.
Generalization, Maintenance, Contextual Fit,
and Social Validity
None of the 13 studies measured generalization, and only
2 studies measured maintenance of parent-intervention
implementation. Contextual fit was measured in 3 of the
13 studies using a parent-completed goodness of fit mea-
sure (Dunlap, Ester, et al., 2006). Two additional studies
discussed contextual fit but did not report measures. Five
of the 13 studies used a parent-completed rating scale or
questionnaire to measure social validity. These rating
scales and questionnaires were designed to ask parents
about the goals, outcomes, and procedures of the interven-
tion. Two studies (Duda et al., 2008; Dunlap, Ester, et al.,
2006) measured social validity by having non-intervention
parents rate the child behavior, parent behavior, and inter-
vention procedures. One study (Fettig & Ostrosky, 2011)
conducted an interview with parents to measure social
validity (see Table 4).
Child Dependent Variables
The primary child dependent variables in all 13 studies
were challenging behaviors, and, across studies, these were
individually operationalized and measured for each child
(see Table 4). For example, the challenging behaviors for
the six child participants in Dunlap and Fox’s (1999) study
varied from hand gazing, hyperventilating, and wandering
for one child to prolonged tantrums and destroying objects
for another. For the Galensky, Miltenberger, Stricker, and
Garlinghouse (2001) study, challenging behaviors included
expulsion of non-preferred foods, play, elopement, and tan-
trums during mealtimes. Ten studies also reported and mea-
sured child appropriate/replacement behaviors. For
example, Duda et al. (2008) examined child level of engage-
ment pre- and post-intervention, and Lucyshyn et al. (2007)
measured latency of task completion. Eleven of the 13 stud-
ies used partial interval recording to measure the estimated
duration of child behaviors. Three studies used event and
duration sampling to measure rate or duration of target
behaviors.

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Fettig and Barton 7

Table 3.  Implementation Characteristics Across Studies.

Post-training support (during

Family coaching practices
Routines-based
Intervention self-monitoring
Collaborative progress
monitoring
Modeling (live and video)
Role-play
Practice and support for trying Providing opportunities for parent
new skills
Guided self-reflection
Collaborative problem solving Working with parents to solve issues
Performance-based feedback
Building motivation for practice Collaborating with parents to plan
between training sessions
Other
Measured implementation
fidelity
Description Pre-intervention training intervention)a
Teaching parents to embed learning 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 1, 2, 3, 4, 6, 7, 8, 10, 11, 12, 13
into the family’s daily routines 11, 12, 13b
Supporting parents in monitoring their 9  
own implementation of the FA-based
plan
Working with parents to create 2
a schedule for monitoring child
progress
Demonstrating practices 1, 2, 3, 7, 9, 10, 11 1, 2, 4, 10
Practicing implementing the strategies 10 10
with the trainer and the parent
3, 6, 9, 10, 11, 12 4, 6, 10, 12
practice of new FA-based intervention
skills during routines
Supporting parents in self-reflection of 1, 4
their implementation of the FA-based
intervention
4, 9 11
with the FA-based plan
Providing parents immediate and 6, 10, 11 1, 2, 4, 6, 7, 10
specific feedback regarding their
implementation
2, 3, 4, 7, 11 3, 4, 11
implementation for the time in
between training/coaching sessions.
5: Manual; 7: Written 1: Pre-session reminders
instructions
3, 4 3

Note. Family coaching practices described by McWilliam (2010), Powell and Dunlap (2010), and Rush and Shelden (2011). FA-based = functional
assessment-based.
a
All studies except No. 5 (Frea & Hepburn, 1999) and No. 9 (Lucyshyn et al., 2007) included follow-up support. bStudy numbers are identified in Table 1.

Generalization and maintenance of child behaviors. General-
ization and maintenance of child behaviors were measured
in 2 and 5 of the 13 studies, respectively. For example,
Lucyshyn et al. (2007) measured the generalization of the
child’s behavior changes to untrained settings. They also
measured maintenance of child behaviors 6, 18, 36, 67, and
86 months post-intervention. Fettig and Ostrosky (2011)
and Duda et al. (2008) measured child behaviors 1 month
and 4 months after the intervention ended, respectively.
Evidence of Experimental Control
All 13 studies used SCRD methodology to examine the
relation between FA-based parent intervention and child
behaviors; one study used a reversal design (Harding,
Wacker, Berg, Lee, & Dolezal, 2009), and 12 used multiple
baseline designs. Of the 12 studies that used multiple base-
line designs, 7 examined changes across participants, 4
investigated across routines, and 2 investigated across set-
tings (e.g., Dunlap & Fox, 1999). The authors used visual
analysis to determine whether experimental control was
established and whether there was a functional relation
between the FA-based parent intervention and child behav-
iors using five data characteristics (see Table 5).
Seven of the 13 studies had stable baselines. The base-
line data in these 7 studies demonstrated stable and high
levels of challenging behavior for all children. One study
(Dunlap, Ester, et al., 2006) had stable baselines for five of
the six targeted routines. Seven of the 13 studies had fewer
than 10% overlapping data across conditions for all partici-
pants and behaviors. One study (Dunlap, Ester, et al., 2006)
met this criterion for five of the six targeted routines. Ten
studies documented an immediate effect; 1 study docu-
mented an immediate effect for one of the two participants
(Frea & Hepburn, 1999). Ten studies demonstrated consis-
tent changes within and across conditions.

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8 Topics in Early Childhood Special Education XX(X)

Table 4.  Child Dependent Variables and Generalization, Maintenance, Contextual Fit, and Social Validity of PBS Plan Across Studies.
Child dependent variable PBS plan

Challenging Appropriate Metric and measurement

Study behaviors behaviors system Generalizationa Maintenancea Contextual fit Social validity
b b
Duda, Clarke, Fox, and Dunlap (2008) X X % intervals, partial interval x X
Dunlap and Fox (1999) X % intervals, partial interval x  
Dunlap, Ester, Langhans, and Fox (2006) X X % intervals, partial interval X X
Fettig and Ostrosky (2011) Xb % intervals, partial interval X X
Frea and Hepburn (1999) X X Rate, event recording  
Galensky, Miltenberger, Stricker, and X X % intervals, partial interval X
Garlinghouse (2001)
Harding, Wacker, Berg, Lee, and Dolezal X X % intervals, partial interval X
(2009)
Koegel, Stiebel, and Koegel (1998) X % intervals, partial interval X
Lucyshyn et al. (2007) Xb,c Xb,c Rate and latency, event X X
and duration sampling
Marcus, Swanson, and Vollmer (2001) Xb Xb Rate, event sampling; % X  
intervals, partial interval
Moes and Frea (2002) Xb,c Xb,c % intervals, partial interval X X
Vaughn, Clarke, and Dunlap (1997) X X % intervals, partial interval  
Vaughn, Wilson, and Dunlap (2002) Xb Xb % intervals, partial interval  

Note. PBS = positive behavior support; X = measured; x = discussed but not measured.
a
Refers to generalization and maintenance of parent implementation of the PBS plan. bStudy also measured maintenance of these behaviors. cStudy also measured generalization
of these behaviors.

Table 5.  Evidence of Experimental Control by Study (Gast, 2010; Horner et al., 2005; Kazdin, 2010).
Stable Overlapping Immediacy Consistency Attempts at three Functional
Study Design baseline data of change of change treatment effects relation

Duda, Clarke, Fox, and Dunlap (2008) MB × Routines X — X X X X

Dunlap and Fox (1999) MB × Settings MB × X — X X — —
Part.
Dunlap, Ester, Langhans, and Fox (2006) MB × Routines 5/6 routines 5/6 routines X X X X
Fettig and Ostrosky (2011) MB × Part. X — X X — —
Frea and Hepburn (1999) MB × Part. X — 1/2 part. X — —
Galensky, Miltenberger, Stricker, and Garlinghouse MB × Part. — X — — — —
(2001)
Harding, Wacker, Berg, Lee, and Dolezal (2009) Reversal design — X — X X X
Koegel, Stiebel, and Koegel (1998) MB × Part. — 2/3 part. — X X —
Lucyshyn et al. (2007) MB × Settings — X X X X X
Marcus, Swanson, and Vollmer (2001) MB × Participants — X X — X —
Moes and Frea (2002) MB × Part. X X X X X X
Vaughn, Clarke, and Dunlap (1997) MB × Routines X X X X — —
Vaughn, Wilson, and Dunlap (2002) MB × Subroutines X — X — X —

Note. MB = multiple baseline design; X = evidence present; — = evidence not present; Part. = Participant.

Functional relation.  Eight of the 13 studies attempted at
least three demonstrations of a treatment effect. Five of
these 8 studies demonstrated clear evidence of a func-
tional relation between at least one behavior and the inter-
vention. For example, Duda et al. (2008) demonstrated
discontinuity of behavior from the end of baseline to the
beginning of the next phase (no overlap), systematic and
immediate decrease in children’s challenging behavior
from baseline to intervention phase (trend and immedi-
acy), and consistent data patterns across similar phases
(consistency). Three of the 8 studies did not demonstrate
a functional relation.
Application of the WWC Single-Subject Design
Standards
The WWC standards were applied to all 13 studies (see
Table 6). All 13 studies systematically manipulated the
independent variables and repeatedly measured dependent
variables. All but 1 study met minimum standards for IOA;
Marcus et al. (2001) did not report IOA for all conditions or
on at least 20% of the sessions for each condition. Eight of
the 13 studies had three attempts in demonstrating a treat-
ment effect. Four studies had five or more data points per
phase, 8 had at least three data points per phase, and 1 had

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Fettig and Barton 9

Table 6.  Application of WWC Single-Subject Design Standards.

Three attempts in Fewest number WWC
Systematically DV measured IOA reported Reported demonstrating a of data points WWC final strength of
Study manipulated IV repeatedly for ≥20% IOA at ≥80% treatment effect per phase rating relation

Duda, Clarke, Fox, and Dunlap X X X X X 3 M w/R Moderate

(2008)a,b
Dunlap and Fox (1999) X X X X — 3 Does not No evidence
Dunlap, Ester, Langhans, and X X X X X 3 M w/R Moderate
Fox (2006)a,b
Fettig and Ostrosky (2011) X X X X — 5 Does not No evidence
Frea and Hepburn (1999) X X X X — 3 Does not No evidence
Galensky, Miltenberger, Stricker, X X X X — 6 Does not No evidence
and Garlinghouse (2001)
Harding, Wacker, Berg, Lee, and X X X X X 3 M w/R Moderate
Dolezal (2009)a,b
Koegel, Stiebel, and Koegel X X X X X 5 Meets No evidence
(1998)
Lucyshyn et al. (2007)a,b X X X X X 5 Meets Strong
Marcus, Swanson, and Vollmer X X — X X 3 Does not No evidence
(2001)
Moes and Frea (2002)a X X X X X 2 Does not No evidence
Vaughn, Clarke, and Dunlap X X X X — 3 Does not No evidence
(1997)
Vaughn, Wilson, and Dunlap X X X X X 3 M w/R No evidence
(2002)

Note. WWC = What Works Clearinghouse; DV = dependent variable; IOA = interobserver agreement; X = evidence present; M w/R = meets with reservations; — =
evidence not present.
a
These studies were determined to demonstrate a functional relation using Gast (2010), Horner et al. (2005), and Kazdin (2010; see Table 5). bThese studies met WWC
standards, provided moderate or strong evidence based on the WWC standards, and were determined to demonstrate a functional relation using Gast (2010), Horner et al.
(2005), and Kazdin (2010).

at least one phase that presented less than three data points.
Two studies (Koegel et al., 1998; Lucyshyn et al., 2007)
were classified as meets standards. Lucyshyn et al. (2007)
also provided strong evidence for a treatment effect.
However, Koegel et al. (1998) demonstrated a treatment
effect for two of the three participants, thus, providing no
evidence of an overall treatment effect. Four of the 13 stud-
ies were classified as meets standards with reservations due
to having fewer than five but more than three data points per
condition and meeting all remaining criteria. Of these 4
studies, 3 provided moderate evidence of a treatment effect
and 1 provided no evidence of a treatment effect (Vaughn
et al., 2002). The remaining 7 studies were classified as
does not meet standards due to not meeting at least one of
the six standard criteria, thus did not provide evidence of a
treatment effect. The results from the application of the
WWC standards were mostly supported by the authors’
visual analyses (Gast, 2010; Kazdin, 2010); 12 of the 13
studies were rated consistently across these two sets of anal-
yses. Moes and Frea (2002) demonstrated a functional rela-
tion but did not meet WWC standards due to having fewer
than three data points in at least one condition.
Overall Outcomes
All 13 studies indicated that FA-based parent interven-
tions were effective at decreasing challenging behaviors.
However, only 4 of the 13 studies met WWC design
standards and provided evidence of a treatment effect.
Nine of the 13 studies either did not meet WWC standards
or demonstrate a treatment effect, which limits interpreta-
tions of the results. Only 3 studies met the WWC design
standards with or without reservation and demonstrated a
treatment effect. Thus, FA-based parent interventions
are not yet considered an evidence-based practice accord-
ing to the 5-3-20 guidelines proposed by the WWC
(T. T. Kratochwill et al., 2013).
Discussion
State of Literature
Although multiple reviews of FA-based interventions for
young children with challenging behaviors have been con-
ducted (Carr et al., 2002; Conroy et al., 2005), none has
examined implementation features across the FA-based
parent interventions. This review is timely given the
increased focus on implementation and emerging literature
on effective family coaching practices (Fixsen et al., 2005;
Kaminski, Valle, Filene, & Boyle, 2008; Powell & Dunlap,
2010). While the review provided some evidence support-
ing the use of FA-based parent intervention in reducing
children’s challenging behaviors, several gaps in the litera-
ture were identified. Furthermore, the implementation
practices used to train parents varied across studies. Only
two studies measured implementation fidelity and few

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10 Topics in Early Childhood Special Education XX(X)
measured parent-intervention fidelity. In general, studies
provided limited demographic information for the parents
and children, which reduced the generalizability of this lit-
erature. Only four studies provided evidence of a treatment
effect. These limitations impede interpretations of the
results. This review highlights the need for additional, rig-
orous studies that examine effectiveness of FA-based
parent interventions and systematic analyses of parent
coaching practices. There are at least five major contribu-
tions from this literature and each will be described in the
subsequent section.
Family Coaching Practices
Although the studies in this review varied in their descrip-
tion of implementation fidelity, there are some notable con-
sistencies. All studies reported focusing on the family’s
daily routines during the initial training on the FA-based
intervention, and most used routines to guide follow-up
support. This focus on routines aligns with family-centered
approaches to early intervention, which support the integra-
tion of the intervention into natural activities to teach func-
tional, meaningful skills for children (McWilliam, 2010;
Sandall et al., 2005). Also, the FA-based parent programs
often used a combination of modeling, supportive practice,
or performance-based feedback. This aligns with the
research on coaching early childhood professionals (Barton,
Kinder, Casey, & Artman, 2011; Fox, Hemmeter, Snyder,
Binder, & Clarke, 2011).
In addition, most of the studies (i.e., 11 of 13) provided
some form of follow-up coaching and support to aid parents
in the implementation of the intervention strategies. This
suggests that the use of follow-up coaching is an important
implementation feature in parent training, which is sup-
ported by the literature. Research consistently shows that
training without follow-up coaching and support is largely
ineffective. In fact, follow-up coaching focused on practice
and support is related to higher rates of fidelity and
improved outcomes for children (Kaminski et al., 2008;
McMahon & Forehand, 2003; Sexton et al., 1996; Strain &
Bovey, 2011). A meta-analysis conducted by Kaminski and
colleagues (2008) revealed that parent training programs
that included coaching produced higher levels of positive
parenting behaviors and lower levels of child externalizing
problems than programs without those components. For
example, Marchant and Young (2001) found that parent
coaching is a key component in supporting parents in imple-
menting positive parenting strategies. They used in-home
coaching to teach four parents positive parenting practices
and found that parents increased and maintained use of the
practices and learned to self-monitor their use of the prac-
tices. Child compliance improved with parents’ high-fidelity
use of the practices. The findings from this review align
with both the early childhood professional development and
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parent-intervention research and suggest that follow-up
coaching might be an essential aspect of parent-imple-
mented FA-based interventions.
Intervention and Implementation Fidelity
Assessing fidelity is important for establishing experi-
mental control and identifying the intensity and type of
treatment needed to produce the desired behavior change.
This literature underreported intervention and implemen-
tation fidelity and intervention duration. This severely
limits this literature, because higher rates of fidelity are
associated with improved child outcomes. For example,
Strain and Bovey (2011) found that the fidelity with which
teachers implemented a comprehensive program for chil-
dren with autism predicted child outcomes (intervention
fidelity). That is, children in classrooms with high-fidelity
implementation performed better on measures of cogni-
tion, language, social, problem behaviors, and autism
symptomatology than children in classrooms with moder-
ate- or low-fidelity implementation. In addition, the lack
of functional relation observed in several studies in this
review could be due to parents’ inconsistent or infrequent
use of the FA-based practices. If researchers found parents
were not implementing FB-based practices with fidelity, it
might be necessary to revise the coaching practices or the
PBS plan. This level of intervention fidelity measurement
and plan refinement was not mentioned in any of the stud-
ies, yet might be critical for improving and sustaining
child outcomes.
The intervention duration, coaches training, and imple-
mentation fidelity (i.e., the strategies used to support par-
ents) also are essential components and will impact parent
use of the intervention. These were grossly underreported in
this literature. In fact, a major limitation of this review is the
lack of measurement of implementation fidelity. Measuring
implementation fidelity is essential for identifying effective
practices for coaching parents, which will have a direct
impact on establishing effective FA-based parent interven-
tions. Future research on FA-based interventions should
measure implementation fidelity and examine the essential
components for coaching parents. This includes examining
the duration, types of support, and coaching practices
required to produce high levels of parent implementation of
the FB strategies. Also, future research should examine
strategies for fading coaching and supports. The fading of
supports was not discussed or reported in any of the 13
studies.
Collaboration With Parents and Contextual Fit
Collaboration with parents and contextual fit is an essential
and a critical feature of this literature. However, the col-
laboration with parents was inadequately described across
Fettig and Barton 11
the studies; only five studies involved parents in designing
the PBS plan and three studies measured the contextual fit
of the FA-based practices. The contextual fit of a PBS plan
is essential because it measures the efficacy and accept-
ability of the FA-based intervention for the individual fam-
ily. A PBS plan must reflect the family’s goals and
strengths, consider the family’s resources and social sup-
ports, and improve the family’s quality of life (Albin,
Lucyshyn, Horner, & Flannery, 1996). FA-based interven-
tion studies should consider collaboration with parents in
administering a FBA, creating a behavior support plan, and
implementing the plan to increase the likelihood of a con-
textual fit (Dunlap, Strain, et al., 2006; Neisworth &
Bagnato, 2005). Contextual fit also increases the likelihood
of long-term benefits for the families (Lucyshyn, Horner,
Dunlap, Albin, & Ben, 2002). The collaboration process
should be described and systematically measured in future
research.
Generalization of Behavior Changes
This review provides limited support for the generalization
of parent and child behaviors (Dunlap, Fox, Vaughn, Bucy,
& Clarke, 1997). While child challenging behaviors and
appropriate replacement behaviors were examined in 10 of
the 13 studies, the generalization of child behaviors was
only measured in 2 studies and no studies measured the
generalization of parent implementation. The goal of teach-
ing children appropriate behaviors should include general-
ization across settings, people, and materials. Furthermore,
the generalization of the parent behavior might be neces-
sary for consistently supporting the child’s use of appropri-
ate behaviors and preventing challenging behaviors. The
maintenance of parent and child behaviors was also inade-
quately addressed. Lucyshyn et al. (2007) provided an
excellent example of measuring maintenance by examining
changes in child behaviors in a follow-up study 10 years
after the initial study. Future studies should examine both
generalization and maintenance of child behaviors and par-
ent implementation.
Study Quality and Rigor
SCRD is an appropriate methodology to differentiate treat-
ment effects from other factors that might impact behavior
change. However, the rigor of the reviewed studies is com-
promised due to unstable baselines, overlapping data, and
intrastudy replication. In fact, only two studies met WWC
standards and four studies met with reservations. Of these
six studies, only four demonstrated a treatment effect. This
limits interpretation on the effectiveness of FA-based par-
ent interventions. Future studies should be rigorously
designed and conducted in consideration of the WWC
standards.
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Implications for Practice
This literature review resulted in the following suggestions
concerning FA-based parent interventions. First, develop-
ing interventions based on FBAs were effective in reduc-
ing children’s challenging behaviors. This body of literature
supports and extends previous research by suggesting that
parent-implemented FA-based interventions can decrease
child challenging behavior (Fox, Dunlap, Hemmeter,
Joseph, & Strain, 2003; Ingram et al., 2005). Second, con-
sistent with the findings in the meta-analysis conducted by
Kaminski and colleagues (2008), effective coaching and
support strategies might be necessary to ensure high-fidel-
ity parent implementation of FA-based interventions.
Follow-up coaching and support within the context of daily
routines, using modeling, performance-based feedback,
and ongoing progress monitoring might be essential com-
ponents of parent interventions as they were used through-
out this literature. The implementation features (parent
coaching) should be carefully planned, systematically
implemented, and monitored throughout the process.
Limitations
There are two limitations of this literature review that is
worth noting. First, applying contemporary research criteria
to studies published well before the recommended guide-
lines were established is bound to indicate weakness. Thus,
the use of the WWC standards should not discount the
strengths in the FA-based parent-intervention literature.
Second, unreported information in a publication does not
indicate that the specific variable (e.g., implementation
fidelity, trainer education) was not noted and measured.
Journal editing and space limitations might lead to authors
omitting study information that is of importance to this
review.
Conclusion
Challenging behaviors are a major impediment to family
quality of life. In this review, the authors examined
FA-based parent interventions and identified several limita-
tions. While most studies incorporated family-centered
practices and adult learning strategies to support parents,
the limitations with study quality and lack of fidelity high-
light a dire need for rigorous research. In fact, only 4 of the
13 studies met WWC standards and demonstrated a treat-
ment effect and only 2 of the 13 studies measured imple-
mentation fidelity; FA-based parent intervention could not
be considered as an evidence-based practice. Future
research should include rigorous studies of the most effi-
cient and effective components of coaching for supporting
parents’ high-fidelity use of FA-based interventions. Then,
policies and systems should be developed to ensure that
12 Topics in Early Childhood Special Education XX(X)
parents of young children with challenging behaviors have
access to evidence-based support for high-fidelity imple-
mentation of FA-based interventions.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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