Augmentative and Alternative Communication

ISSN: 0743-4618 (Print) 1477-3848 (Online) Journal homepage: http://www.tandfonline.com/loi/iaac20

Supporting individuals with challenging behavior

through functional communication training and
AAC: research review

Pat Mirenda

To cite this article: Pat Mirenda (1997) Supporting individuals with challenging behavior
through functional communication training and AAC: research review, Augmentative and
Alternative Communication, 13:4, 207-225, DOI: 10.1080/07434619712331278048

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Published online: 12 Jul 2009.

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 0743-4618/97/1304-0207 $3.00/0; Volume 13, December 1997
AAC Augmentative and Alternative Communication
Copyright © 1997 by ISAAC

Supporting Individuals with Challenging Behavior

through Functional Communication Training and
AAC: Research Review
Pat Mirenda
Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada

The term “functional communication training” (FCT) has been used over the past decade to
refer to a set of procedures designed to reduce challenging behavior by teaching functionally
equivalent communication skills. Functional communication training requires a thorough
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assessment to identify the function (or “message”) of the behavior of concern and systematic
instruction related to the new communicative behaviors. The growing body of empirical litera-
ture demonstrating the efficacy and mechanisms of this procedure has included a number of
examples in which augmentative and alternative communication (AAC) techniques were used
during intervention. The purpose of this review is to summarize the extant FCT/AAC research
in an accessible format and to identify areas for future research in this area.

KEY WORDS: behavior problems, functional communication, severe disabilities, training

Since 1985, numerous studies have examined var-
ious aspects of an intervention strategy used to sup-
port individuals with challenging behavior (i.e., behav-
ior problems) that has become known as “functional
communication training” (FCT). FCT involves “both
the assessment of the function of the problem behav-
ior and the teaching of a more appropriate form that
serves the same function…” (Durand, 1990, p. 23). For
example, Carr and Durand (1985) used this approach
with four children with developmental disabilities who
engaged in a variety of aggressive, self-destructive,
and disruptive behaviors. The authors first conducted
systematic assessments to determine the functional
motivation of the behaviors for each child. In three
cases, challenging behaviors occurred primarily when
the children were presented with difficult tasks, sug-
gesting that the behaviors were escape motivated.
For one of these three children, as well as for the
fourth child, the behaviors occurred when the children
were provided with low levels of adult attention, sug-
gesting that, in these cases, the behaviors also served
an attention-getting function. The children were taught
two verbal communicative phrases: (a) “Am I doing
good work?,” a phrase designed to elicit adult atten-
tion, and (b) “I don’t understand,” a phrase designed
to elicit adult assistance during difficult tasks. For all
four children, there was an immediate and substantial
reduction in the frequency of the target behaviors only
after they learned the communicative phrase that was
relevant to the specific function of their behavior. As
the authors noted in their discussion of the results, “It
is likely that we will never be able to demonstrate def-
initely that a particular child intended to ask for assis-
tance or attention by means of his or her misbehav-
ior. Nonetheless, we may find it helpful to view
misbehavior as if it were a form of nonverbal commu-
nication, specifically, a request for certain behaviors
on the part of others” (p. 125).
Many FCT studies have involved child or adult par-
ticipants for whom speech was the primary mode of
communication (e.g., Durand & Carr, 1987, 1991,
1992). However, an increasing body of research has
applied FCT to individuals who use some form of aug-
mentative or alternative communication (AAC). These
studies were identified through a computer literature
search using the terms “functional communication
training” and “functional equivalence,” as well as
through examination of all issues from 1985–1996 of
the Journal of Applied Behavior Analysis, The Journal
of the Association for Persons with Severe Handi-
caps, and Augmentative and Alternative Communica-
tion. Whenever a relevant article was found, its refer-
ence list was examined to identify new studies not
already included in the corpus. Studies that did not
specifically focus on behavioral support or that did
not specifically identify “functional communication
training” as an intervention strategy were not included.
A total of 21 studies that employed FCT/AAC with one
or more participants were identified in this manner.
The purpose of this review is to summarize the extant

207
 208
FCT/AAC research in an accessible format and to
identify areas for future research.
TARGET SUBJECTS AND BEHAVIORS
The 21 studies reviewed included FCT/AAC inter-
ventions for a total of 52 participants. A few of these
studies also included participants with whom verbal
FCT was used (e.g., Northup et al., 1991; Peck et al.,
1996); however, those participants were not included
in this review. Table 1 summarizes the most relevant
participant characteristics.
The 52 participants included 30 males and 22
females ranging in age from 1.3 to 36 years, with a
mean age of 13.8. All had one or more developmen-
tal disabilities. Forty-one participants (79%) were con-
sidered to have severe and/or profound mental hand-
icaps. Eight participants had autism, six were
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moderately mentally handicapped, and three had
Down syndrome. Sensory impairments (vision and/or
hearing) were evident in 11 participants, one or more
physical disabilities (e.g., cerebral palsy, heart anom-
alies) were present in 12, and seizure disorders were
present in 5 participants. Of the 52 participants, half
had no speech and no formal communication system
prior to the study in which they participated. Thirteen
participants used limited gestures, manual signs,
and/or simple graphic symbols to communicate. Four-
teen participants had some functional speech, but it
was considered insufficient to meet their ongoing daily
communication needs.
Many participants exhibited more than one type of
challenging behavior. Over half (56%) engaged in self-
injurious behavior (SIB) of varying topographies. Much
of the SIB was considered to be dangerous or even life
threatening, and a few participants spent hours each
day in restraints to prevent injury (e.g., “Mike” in
Northup et al., 1994). Similarly, 42% of the participants
engaged in aggression against other people (hitting,
scratching, etc.). Other behaviors of concern included
tantrums, off-task or “silly” behavior, pulling on the lines
of feeding tubes or other life support equipment, non-
compliance, screaming, yelling, property destruction,
and self-stimulatory behavior (e.g., repetitive rocking).
ASSESSMENT
Assessment Strategies
There is no doubt that a successful FCT/AAC inter-
vention must begin with an accurate assessment of
the function of the challenging behavior. Without this,
it is simply impossible to determine which message(s)
to teach as alternatives to the behavior. The result can
be that, even though communication is increased
through instruction of a new communicative form, the
behavior problem is unchanged because of a “mis-
match” between the new form and the old behavior.
This unfortunate outcome can be avoided through the
Mirenda
use of one or more of the assessment procedures
from the studies reviewed for this article; these are
summarized in Table 2.
The most common assessment strategy (used with
32 of the 52 participants) was some form of interview
used in the initial phase of assessment to gather infor-
mation from caregivers about the conditions in which
the problem behavior was most likely to occur. Sec-
ond in prevalence was a functional analysis (also
referred to as an “analogue assessment”), which was
used with 29 of the participants. The third most com-
mon strategy was the Motivation Assessment Scale
(Durand and Crimmins, 1992), which was used to
assess 10 participants. Other assessment strategies
included observations, A-B-C charts, scatter plots,
and descriptive analyses. These assessment strate-
gies will be described in the sections that follow.
Interview
The purpose of an assessment interview is to assist
in identification of the function(s) of the problem
behavior. Such interviews can be conducted either
informally (e.g., Carr et al., 1994) or in a more struc-
tured fashion (e.g., Iwata, Wong, Riordan, & Lau,
1982; Willis, LaVigna, & Donnellan, 1989). The most
often-cited structured interview used in the studies
reviewed was the Functional Analysis Interview
(O’Neill, Horner, Albin, Storey, & Sprague, 1990),
which is designed to gather information in three main
areas: (a) a description of the behavior(s) of concern;
(b) identification of physical and environmental factors
that predict the behavior(s); and (c) identification of
the potential functions of the behavior(s). In all cases,
the interview was used as one component of a multi-
element assessment package. Although interviews
are widely used during assessment prior to FCT, no
reliability or validity data are available for their use.
Functional Analysis
This assessment procedure involves exposing the
individual of concern to a series of situations (called
“analogue conditions”) that simulate naturally occur-
ring environmental events that might be related to the
challenging behavior (Iwata, Dorsey, Slifer, Bauman,
& Richman, 1982). The presence of the behavior is
taken as an indication that the associated condition is
relevant to the function of the behavior. In a typical
functional analysis, the individual of concern is
exposed to two or more assessment conditions over a
period of several days. For example, in the “tangibles”
condition, preferred items (e.g., toys, food) are placed
out of reach but within sight of the individual. Each
time the target behavior occurs, the item is provided
briefly (e.g., for 30–60 seconds) and then removed.
The occurrence of the behavior during this condition is
an indication that the behavior functions as a request
for the preferred item (i.e., positive reinforcement).
 Functional Communication Training and AAC 209

TABLE 1: Participant Description

FCT Preintervention Target Behavior

Participant Expressive Treated with
Study Name Age Disability Communication Mode FCT

Bird et al., 1989 Greg 27 Autism, profound Approx. 15 one-word utterances, SIB (multiple topographies)
MR, and self-inflicted semi-intelligible, rarely
blindness from SIB spontaneous
Jim 36 Autism and profound MR Nonverbal; two manual signs, Aggression and SIB
rarely spontaneous (multiple topographies)
Campbell & Don 8 Autism No formal system Crying, screaming,
Lutzker, 1993 property destruction
Day, Rea, Schussler, Mary 15 Severe MR Few manual signs, one-word SIB
Larsen, & Johnson, verbal labels
1988
Day et al., 1994 Brandi 9 Autism Nonverbal; simple gestures SIB (biting, hitting, pinching)
Dawn 34 Severe MR, seizure Same as above SIB (head hitting)
disorder
Jamie 18 Severe MR, hyperactivity, Same as above Aggression (grabbing
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mild spastic quadriplegia and biting)

Durand, 1993 Michelle 5 Moderate MR and Nonverbal; inconsistent head nods Aggression (crying, hair
cerebral palsy and pointing pulling)
Peter 15 Severe MR and Nonverbal; no formal system SIB (head hitting, face
cerebral palsy slapping)
Joshua 3 Severe MR Nonverbal; no formal system Tantrums (crying,
screaming, aggression)
Durand & Kishi, 1987 Tina 20 Profound MR, dual Nonverbal; no formal system Aggression (scratching,
sensory impairments pinching)
John 20 Severe MR, dual Same as above Aggression (hitting,
sensory impairments throwing objects)
Lew 21 Profound MR, dual Same as above SIB (hand biting, face
sensory impairments slapping)
Jim 21 Severe MR, dual sensory Same as above SIB (head banging, hand
impairments biting)
Kim 21 Same as above Same as above SIB (slapping) and
aggression (head butting)
Fisher et al., 1993 Bob Child Profound MR No formal system; reach for SIB (multiple) and other
preferred objects destructive behaviors
Art Same Same as above No formal system Same as above
as above
Jan Same Same as above No formal system; reach for Same as above
as above preferred objects
Abe Same Same as above No formal system Same as above
as above
Gerra et al., 1995 Sara 8 Blindness and severe MR Approx. 30 words, mostly echolalic SIB (multiple topographies)
Horner and Budd, 1985 Male 11 Autism, moderate MR Limited expressive language Grabbing, yelling
and manual signs
Horner & Day (1991) Paul 12 Severe MR, severe hearing Approx. 20 manual signs SIB (head hitting),
impairment, hemiparesis, aggression (kicking, hitting,
cerebral dysgenesis scratching)
Peter 14 Profound MR with autistic Nonverbal; no formal system SIB (face hitting)
tendencies
Mary 27 Autism, severe MR Single spoken words SIB (head hitting)
Horner et al., 1990 David 14 Moderate MR, No formal system Aggression, property
seizure disorder destruction
Hunt, Alwell, & Paula 16 Severe MR Speech limited to single words Variety of “silly” behaviors
Goetz, 1988 and echolalic phrases directed toward peers
Peter 16 Same as above Same as above Same as above
Mary 14 Same as above Same as above Same as above

MR = mental retardation; SIB = self-injurious behavior; MLU = mean length of utterance; PKU = phenylketonuria.

(continued)
 210 Mirenda

TABLE 1: (continued) Participant Description

FCT Preintervention Target Behavior
Participant Expressive Treated with
Study Name Age Disability Communication Mode FCT

Hunt et al., 1990 Matt 18 Down syndrome Limited speech with moderate to Variety of disruptive and
severe articulation deficit and aggressive behaviors
MLU = 4 directed toward peers
Katie 18 Same as above Limited speech with severe Same as above
articulation deficit and MLU = 2
Ty 17 Severe MR, Speech with moderate articulation Same as above
seizure disorder deficit and MLU = 6
Lalli et al., 1993 Al 10 Severe-profound MR and No speech; pointed to “yes” and SIB (head banging)
cerebral palsy “no” card in a picture book
Bob 10 Down syndrome No speech, signed for “toilet” Aggression
Mary 14 Severe-profound MR and No formal system SIB (hand scratching)
cerebral palsy
Lalli et al., 1995 Joe 10 Moderate MR Verbal utterances SIB (head and mouth
banging)
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Kim 13 Moderate MR, autism Speech 1 gestures Aggression

Northup et al., 1991 Curtis 24 Severe-profound MR, Nonverbal, no formal system Aggression (multiple
legal blindness topographies)
Heidi 21 Severe-profound MR Same as above SIB and aggression
(multiple topographies)
Northup et al., 1994 Mike 5 Severe-profound MR Nonverbal, no formal system SIB (head banging, head
and seizures hitting)
Rebecca 6 Severe-profound MR, Manual signs (unspecified) SIB (head banging, face
Goltz syndrome, vision slapping)
impairment, incomplete
palate and right leg
Heidi 11 Severe-profound MR Single-word utterances Aggression (hair pulling,
hitting, grabbing)
Jane 8 Severe-profound MR, Nonverbal, no formal system SIB (hand mouthing with
blind, nonambulatory tissue breakdown)
Peck et al., 1996 Alexander 22 mo Short-bowel syndrome, Crying, laughing, some babbling, Pulling and chewing on
severe developmental delay no formal system feeding tube and IV lines,
aggression
Cassandra 16 mo Multiple heart and lung Crying, no formal system Pulling on feeding tube and
anomalies, severe cardiac monitor lines, crying,
developmental delay SIB (hair pulling)
Maxwell 4 Severe MR Manual signs and speech for SIB (head hitting, head
“done” and “please” banging), aggression, other
disruptive behaviors
Kevin 2 Failure to thrive Vocalizations, some word Severe noncompliance and
approximations aggression
Sigafoos & Meikle, Dale 8 Autism, moderate- No speech; manual sign “eat,” few Aggression, SIB, property
1996 severe MR black-and-white line drawing destruction, screaming,
symbols crying
Steege et al., 1990 Ann 5 Profound MR, Nonverbal; no formal system SIB (biting)
nonambulatory
Dennis 6 Same as above Same as above Same as above
Wacker et al., 1990 Bobby 7 Autism, profound MR, Nonverbal; no formal system SIB (hand biting), tantrums,
seizure disorder noncompliance, self-
stimulatory behavior
Barb 30 Untreated PKU and Same as above Self-stimulatory behavior
profound MR (rocking and others)
Jim 9 Severe-profound MR Same as above Aggression (slapping, biting)

MR = mental retardation; SIB = self-injurious behavior; MLU = mean length of utterance; PKU = phenylketonuria.
 Functional Communication Training and AAC 211

TABLE 2: Assessment Descriptions

Assessment Method Functional Motivation

Study Participant and Setting of Behavior

Bird et al., 1989 Greg Observation and MAS; day Escape from task demands
program classroom
Jim Same as above Escape from task, tangibles
Campbell & Lutzker, 1993 Don A-B-C chart; home and community Tangibles, escape from demands
Day et al., 1988 Mary Functional analysis; school Tangibles, escape
Day et al., 1994 Brandi Interview (FAI), functional analysis; Escape from difficult task and
home tangibles
Dawn Same as above Same as above
Jamie Same as above Same as above
Durand, 1993 Michelle MAS; staff training workshop Attention, escape from 1:1 tasks
Peter Same as above Escape from 1:1 tasks
Joshua Same as above Tangibles during meals
Durand & Kishi, 1987 Tina Interview, MAS; community day program Escape from task demands
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John Interview, MAS; institution school Same as above

Lew Same as above Tangibles (toys, food)
Jim Interview, MAS; group home Same as above
Kim Same as above Attention
Fisher et al., 1993 Bob Observation, functional analysis; Escape from nonpreferred tasks
in-patient hospital unit
Art Same as above Same as above
Jan Same as above Tangibles
Abe Same as above Same as above
Gerra et al., 1995 Sara Interview, observation; special Tangibles
education classroom
Horner & Budd, 1985 Male Observation of antecedents and Tangibles
consequences; special education
classroom
Horner & Day, 1991 Paul Interview (FAI), functional analysis; Escape from difficult tasks
group home
Peter Same as above Same as above
Mary Same as above Same as above
Horner et al., 1990 David Interview (FAI), functional analysis; Escape from difficult task
special education classroom
Hunt et al., 1988 Paula Interviews, observations, analysis of Attention/social interaction from peers
consequences; regular and special
education classrooms and
community sites
Peter Same as above Same as above
Mary Same as above Same as above
Hunt et al., 1990 Matt Observation of antecedents and Attention/social interaction from peers
consequences; regular and special
education settings in high school,
community sites
Katie Same as above Same as above
Ty Same as above Same as above
Lalli et al., 1993 Al Interview, scatter plot, observation of Escape from task demands
antecedents and consequences, (transition) and attention
descriptive analysis; special
education classrooms
Bob Same as above Attention
Mary Same as above Attention

MAS = Motivation Assessment Scale (Durand & Crimmins, 1992); FAI = Functional Analysis Interview (O’Neill et al., 1990).
(continued)
 212 Mirenda

TABLE 2: (continued) Assessment Descriptions

Assessment Method Functional Motivation

Study Participant and Setting of Behavior

Lalli et al., 1995 Joe Interviews, observations, Escape from tasks

functional analysis; in-patient
hospital setting
Kim Same as above Same as above
Northup et al., 1991 Curtis Interviews, questionnaire, functional Escape from difficult tasks
analysis; out-patient hospital clinic
Heidi Same as above Tangibles
Northup et al., 1994 Mike Interview, observations, record Escape from difficult tasks
review, functional analysis;
special education classroom
Rebecca Same as above Escape from difficult tasks and attention
Heidi Same as above Escape from difficult tasks
Jane Same as above Attention
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Peck et al., 1996 Alexander Interview, antecedent assessment, Attention

functional analysis; in-patient
hospital setting
Cassandra Interview, antecedent assessment; Same as above
in-patient hospital setting
Maxwell Interview, antecedent assessment; Escape from task demands
integrated preschool
Kevin Interview, antecedent assessment, Same as above
functional analysis; in-patient
hospital setting
Sigafoos and Meikle, 1996 Dale Functional analysis; special Attention and tangibles
education classroom
Steege et al., 1990 Ann Interview, functional analysis; Escape from unpleasant tasks
in-patient hospital setting (grooming)
Dennis Same as above Same as above
Wacker et al., 1990 Bobby Functional analysis; Tangibles
in-patient hospital setting
Barb Same as above Sensory
Jim Same as above Escape from unpleasant task

MAS = Motivation Assessment Scale (Durand & Crimmins, 1992); FAI = Functional Analysis Interview (O’Neill et al., 1990).

In the “attention” condition, the individual is given
access to a preferred activity (e.g., a toy) and is pro-
vided with attention each time the target behavior
occurs (e.g., the assessor might say, “Don’t do that”).
Behaviors that occur during this condition have an
attention-getting function (i.e., positive reinforcement).
In the “escape” condition, the individual is given a dif-
ficult task to complete and, each time the target
behavior occurs, both attention and the task are
removed. In this case, the occurrence of behavior
suggests that the function is to escape from tasks or
associated demands (i.e., negative reinforcement).
Finally, in the “alone” condition, no demands are
made and the individual is provided with no toys and
no attention. Behaviors that occur during this condi-
tion are likely to be sensory motivated, since no envi-
ronmental consequences are provided. Variations of
these four conditions might also be used to test spe-
cific alternative hypotheses regarding the function of
the behavior. For example, Horner and Day (1991)
used a variation of the escape condition with a par-
ticipant named “Peter” (see Tables 1 and 2). They
presented Peter with a difficult task and provided
assistance each time he engaged in SIB (the target
behavior). Because his behavior increased in this con-
dition, it was assessed as being motivated by a
request for assistance.
Several authors have demonstrated that brief forms
of functional analysis can be used effectively and
accurately in out-patient clinic or classroom settings in
which the time available for assessment may be lim-
ited. For example, Northup et al. (1991) created ana-
logue conditions that were 10 minutes in duration and
rapidly alternated them to produce differing frequen-
cies of the behavior. These researchers were able to
complete clinic out-patient assessments within 90
 Functional Communication Training and AAC
minutes using this strategy and went on to design
successful FCT/AAC interventions based on the out-
comes. Similarly, Northup et al. (1994) combined
teacher interviews, classroom observations, and func-
tional analyses to analyze the behaviors of four par-
ticipants with whom FCT/AAC was later employed in
a school setting. These studies and others support the
use of an abbreviated functional analysis in applied
settings in order to plan communication interventions
for individuals with severe challenging behavior
(Cooper & Harding, 1993).
Motivation Assessment Scale (MAS)
The MAS is a 16-item questionnaire that can be used
to assess the functions or motivations of behavior prob-
lems. The 16 items are organized into the four func-
tional categories described previously for the functional
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analysis, namely, tangibles, attention, escape, and
sensory. The MAS asks questions about the likelihood
of a problem behavior occurring in a variety of condi-
tions. Each question is rated on a 0 to 6 scale, where
0 = never, 3 = half the time, and 6 = always. Examples
of questions related to each of the categories include:
• Tangible function: “Does the behavior occur when
you take away a favorite toy, food, or activity?”
• Attention function: “Does the behavior seem to
occur in response to your talking to other persons
in the room?”
• Escape function: “Does the behavior occur follow-
ing a request to perform a difficult task?”
• Sensory function: “Would the behavior occur
repeatedly, in the same way, for very long periods
of time if no one was around (e.g., rocking back
and forth for over an hour)?”
As should be evident from these examples, the
MAS is, in effect, an interview form of the functional
analysis described previously. In the end, the scores
for the four questions related to each category are
tallied and ranked in order of magnitude. The highest
scoring category is considered to be the primary func-
tion of the behavior. When two or more categories
are given high scores, the behavior may have multi-
ple motivations. For example, a behavior might be
used by an individual to both get attention and to
escape from a difficult task.
A number of studies have investigated the reliabil-
ity and validity of the MAS, with somewhat mixed
results. The original study by Durand and Crimmins
(1988) indicated excellent inter-rater reliability (i.e.,
Pearson correlation coefficients ranged from .80–.95)
and test–retest reliability (Pearson r = .89–.98.). This
study also compared teachers’ ratings on the MAS
with functional analysis outcomes for eight individuals
with SIB, with identical conclusions for all participants.
Similar positive outcomes were reported by Crawford,
Brockel, Schauss, and Miltenberger (1992), who com-
213
pared the MAS with both functional analysis and an A-
B-C chart approach to assessment. In addition, evi-
dence for the validity of the factor structure (i.e., the
four motivational categories) of the MAS was provided
by Bihm, Kienlen, Ness, and Poindexter (1991) on a
sample of 118 persons with severe or profound devel-
opmental disabilities. However, other studies have
questioned the inter-rater reliability (Sigafoos & Kerr,
1994; Zarcone, Rodgers, Iwata, Rourke, & Dorsey,
1991) and factor structure of the instrument (Singh &
Donatelli, 1993). Given these discrepant results, the
MAS is best used as one component of a multiele-
ment assessment battery to assess the function(s) of
behavior across a variety of settings (Kearney, 1994).
Observations and A-B-C Charting
Nine of the 20 studies reviewed reported the use of
systematic observations or A-B-C charting as one
component of behavioral assessment. In fact, obser-
vation is also implicit in the functional analysis when
the individual is exposed to the analogue conditions.
Usually, observations are recorded via anecdotal
records that describe the antecedents (A), behaviors
(B), and/or consequences (C) that occurred during
each behavioral episode. Alternatively, these three
components can be recorded on a three-column form
(called an A-B-C chart), rather than narratively. From
these descriptive analyses, hypotheses are formed
regarding the functional motivation of the behavior
(see Donnellan, Mirenda, Mesaros, & Fassbender,
1984). For example, it might be observed that a stu-
dent tantrums (behavior) whenever she is asked to
stop a preferred activity (antecedent), and that the
usual response of the teacher is to allow continued
access to the activity for a period of time (conse-
quence). If this pattern were observed repeatedly over
several days, it would suggest that the behavior is tan-
gibly motivated (i.e., the student engages in the behav-
ior to gain access to the preferred activity). In order for
observational assessment to be accurate and useful,
it should be conducted over several days in a variety
of contexts and situations. Because no reliable and
valid protocols for completing observational assess-
ments or A-B-C charts have been developed to date,
these assessment techniques are usually used in con-
junction with other assessment approaches.
Other Assessment Strategies
Additional assessment strategies reported in the 21
studies reviewed were a written questionnaire, record
review, and scatter plot analysis (Touchette, Mac-
Donald, & Langer, 1985). The latter strategy requires
an observer to record zero, low-, and high-frequency
occurrences of the problem behavior on a grid in
which the columns represent successive days and the
rows represent time segments (e.g., hours, half hours,
etc.). Visual inspection is then used to identify the
 214 Mirenda
time segments (and, by association, the activities that
occurred during those segments) characterized by
high-frequency occurrences of the target behavior.
Other assessment strategies that were not used in
the studies reviewed but that might be useful include
the index card observation and recording format
described by Carr et al. (1994) and the assessment
process described by Meyer and Evans (1989). None
of these techniques are supported with data regard-
ing their reliability or validity.
Assessment Settings
For 67% of the participants, assessment was con-
ducted in one or more regular education, special edu-
cation, day program, group home, or family home set-
tings. The remaining 17 assessments were conducted
in out-patient or in-patient hospital settings, so that the
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experimenters could control extraneous variables that
might have affected the outcomes of the research.
The variety of natural settings in which FCT/AAC
assessments have occurred is encouraging, in that
they represent a broad array of the types of environ-
ments in which individuals with developmental dis-
abilities typically live, work, learn, and play. This sug-
gests that the assessment strategies summarized
here are potentially usable across a wide variety of
environments.
Functional Motivation of Behavior
The results of the assessment processes employed
across the 52 participants are summarized in Table 2.
For 10 of the 52 participants (19%), two functions of
behavior were identified. The most common function
of behavior was escape, which occurred for 29 par-
ticipants (56%). The activities from which participants
were motivated to escape included those that were
apparently difficult, nonpreferred, or perceived as
unpleasant (e.g., grooming activities). For these 29
participants, the “message” of their behavior was per-
ceived to be “I don’t want to ______.” Equal numbers
of participants engaged in behavior that was attention
motivated and/or tangibly motivated (16 participants
or 31% each). These participants used their behavior
to communicate “Pay attention to me” (attention) and
“I want ______” messages (tangibles), respectively.
Finally, one of the FCT/AAC participants in the stud-
ies reviewed engaged in behavior that was primarily
sensory motivated (“Barb” in Wacker et al., 1990).
Examination of Tables 1 and 2 together suggest
that the behavior-function relationships across partic-
ipants were quite varied. For example, consider the
patterns of the two most frequently occurring behav-
iors, SIB and aggression. Of the 29 participants who
engaged in SIB, 17 (58%) used this behavior to
escape from tasks, 11 (38%) used it to gain access to
preferred tangibles, and 7 (24%) used it to get atten-
tion (percentages total >100% because some SIB was
multiply motivated). Of the 16 instances of aggressive
behavior, 13 (81%) were escape motivated, 8 (50%)
were attention motivated, and 5 (31%) were tangibly
motivated (percentages total >100% because some
aggression was multiply motivated). Thus, it is clear
that no single behavior was used for a single function
across individuals, nor vice versa. This provides fur-
ther support for the use of comprehensive behavior
assessments that are individualized in nature.
INTERVENTION STRATEGIES
AAC Techniques
A variety of AAC techniques were employed across
the 52 individuals included in the review sample. Table
3 summarizes the AAC techniques used, the function-
ally equivalent messages taught, the responses to the
messages, and the outcomes of the intervention for
each of these individuals.
Ten individuals (19%) were taught to use more than
one AAC technique during intervention. The vast
majority of the participants (92%) were taught to use
communication techniques that were either no- or low-
technology in nature. The most commonly used tech-
nique was manual signing, which was used with 19
(37%) of the individuals involved. Gestures or com-
munication books were each taught to eight partici-
pants (15%). Microswitches with single-message
tapes, tangible symbols, and cards with printed words
were each used with six individuals (12%). Other AAC
techniques included voice output communication aids
(three participants), line drawings or photographs (two
participants), a simple attention-getting device (a ball
with a bell in it, one participant), and a Canon Com-
municator M™ (one participant). With few exceptions
(e.g., Durand, 1993), little or no information was pro-
vided regarding how and why a particular AAC tech-
nique was selected. It is likely that manual signing
and gestures were the most commonly used tech-
niques (one or both were used with 50% of the par-
ticipants) because most of the participants were
ambulatory and these techniques are imminently
portable. Tangible symbols were used exclusively with
participants who were blind or dual sensory impaired,
although not all participants with these disabilities
were provided with tangible symbols. Communication
books were used with all six participants for whom
social interaction with peers was a primary motivator
of behavior. In many of the remaining cases, it
appeared that AAC technique selection was quite
arbitrary, or was determined by equipment availabil-
ity rather than participant need. Durand (1990) and
Carr et al. (1994) provided discussions of systematic
decision making in this regard.
Communication Messages and Responses
In all of the studies reviewed, the messages taught
and the responses to those messages were directly
related to the assessed function of the challenging
 Functional Communication Training and AAC 215

TABLE 3: Intervention Strategies

AAC Technique Response to

Study Participant Used Message Taught Message Outcome

Bird et al., 1989 Greg Tangible symbol “Break” message assigned Brief break from task, ISR to near-zero;
to token access to self-restraint 20-wk FU
and preferred reinforcers
Jim Manual sign “Break,” “work,” “eat,” Brief break from task or ISR to <5/wk; 1-yr FU
“music,” “bathroom” access to requested
item/activity
Campbell & Don Manual sign 1 gesture “Please” 1 point to item; Access to requested item ISR to near-0; no FU
Lutzker, 1993 “Please eat;” “Please drink”
Day et al., 1988 Mary Gesture (hand clap) + Tangibles: “Pay attention Tangibles: access to ISR from a mean SIB
speech to me” (message assigned requested item; escape: rate of 53/day to a mean
to hand clap) 1 manual sign brief break from task of 6/day over a 2-mo FU
or speech for desired item;
escape: “no” (verbal)
Day et al., 1994 Brandi Manual sign 1 speech Tangibles: “want” sign 1 Tangibles: praise, access ISR once behavior
point; escape: “Go” (speech) to preferred items; escape: related to the function
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brief break from task was taught; 1-yr

anecdotal FU
Dawn Manual sign and card Tangibles: “want” sign; Same as above Same as above
with printed word escape: card with “help”
on it
Jamie Same as above Tangibles: “want” sign; Same as above Same as above,
escape: card with “break” even after task
on it demands increased
Durand, 1993 Michelle Wolf™ and head “I want to be with the group” End of 1:1 task and ISR to 89% of
pointer access to group activity baseline
Peter Introtalker™ “I want a break” Brief break from task ISR to 78% of baseline
Joshua Wolf™ “I want more” More food, drink items ISR to 95% of baseline
Durand & Tina Tangible symbol “I want a break” written Brief break from ISR to 8% of baseline
Kishi, 1987 on token task at 1-mo FU
John Same as above Same as above Same as above ISR to zero at 1-mo FU
Lew Same as above Request function assigned Access to favorite NR; staff did not
to symbol tangibles implement program
Jim Gesture (raised hand) Request function assigned Access to favorite ISR to near-zero at
to raised hand tangibles 9-mo FU
Kim Same as above Initial meaning assigned to Attention from staff NR at 1-mo FU; GR to
gesture: “Come spend some 10% of baseline at 9-mo
time with me,” later: FU after second message
“Can I help you?” assigned to gesture
Fisher et al., 1993 Bob Manual signs “Go” Brief break from task NR, even with FCT 1
punishment
Art Same as above “Go” Same as above ISR only when FCT 1
punishment was used
Jan Same as above “More” Access to preferred toys Same as above, but
poor generalization
across settings
Abe Same as above “More” Same as above NR, even with FCT 1
punishment
Gerra et al., 1995 Sara Communication board Choices: lie on the mat, get Access to requested activity GR of behavior over 114
with 7 tangible symbols a hug, eat peanut butter days; anecdotal FU
(objects, textured with a cracker, drink juice,
materials) for preferred eat cereal, listen to music,
activities and bounce on a large
rubber ball
Horner & Male Manual signs “juice,” “timer,” “choose,” Access to requested item ISR once instruction
Budd, 1985 “bottle,” “folder” occurred in natural
setting (classroom)

ISR = immediate substantial reduction; FU = follow-up; NR = no reduction; GR = gradual reduction.

(continued)
 216 Mirenda

TABLE 3: (continued) Intervention Strategies

AAC Technique Response to
Study Participant Used Message Taught Message Outcome

Horner & Paul Manual signs Sentence (“I want to go, Brief break from task ISR to near-zero only
Day, 1991 please”) and single word after single word was
(“break”) taught
Peter Same as above “Help” Task assistance provided ISR to near-zero
on an FR3 and FR1 only during FR1
schedule schedule
Mary Card with printed word “BREAK” Brief break from task ISR only when break was
immediately or after immediate
20-sec delay
Horner David Canon “Help, please” (letter-by- Assistance with task from NR when letter-by-letter
et al., 1990 Communicator M™ letter spelling vs. single- teacher (reduced task spelling required; ISR to
with alphabet letter message key) difficulty) near-zero with single
keys and single- message key
message key
Hunt et al., 1988 Paula Conversation book with Books used to establish Social interaction during ISR to near-zero after
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colored photographs and maintain topics during conversational interactions conversation training with
and line drawings conversation with peers book
Peter Same as above 1 Same as above Same as above Same as above
written phrases
and labels
Mary Same as Paula above Same as above Same as above ISR to zero after
conversation training
Hunt et al., 1990 Matt Conversation book Books used to establish and Social interaction during ISR to near-zero in
with colored maintain topics during conversational interactions untrained settings
photographs, line conversation with peers
drawings, written
words, and phrases
Katie Same as above Same as above ISR to zero in untrained
settings
Ty Same as above Same as above ISR to near-zero in
untrained settings
Lalli et al., 1993 Al Photographs in a Request/choice re: photo Praise and access to ISR to zero; 4-wk FU
picture booklet touched chosen object/activity
Bob Gesture (hand/arm “Hello, pay attention to Brief 1:1 attention Same as above
wave) and tangible me” (meaning assigned from teacher
symbol (toy) to gesture 1 toy)
Mary Gesture (tap on Same as above Same as above ISR to near-zero;
teacher’s arm) 4-wk FU
Lalli et al., 1995 Joe Card with printed word “BREAK” Brief removal of task GR to zero even after
task demands increased
Kim Gesture (head shake) “No” Same as above ISR to near-zero even
after task demands
increased
Northup et al., 1991 Curtis Manual sign “Please” Brief removal of task ISR to near-zero even
after task demands
increased
Heidi Same as above “Please” Access to preferred items ISR to zero
Northup Mike Microswitch positioned “I’d like a break now, Brief break from task, ISR To near zero;
et al., 1994 on shirt, attached to a please” (taped message) access to pillow and music 17-mo FU
tape recorder with faded later to “Please”
single-message tape, (manual sign)
and manual sign
Rebecca Manual signs “No,” “help,” “more” “No” = brief break from task; GR to near-zero after 9
“help” or “more” = assistance mo; 17-mo FU
or continued attention
Heidi Same as above “Please” Brief break from task ISR but not to acceptable
levels for teacher;
intervention terminated

ISR = immediate substantial reduction; FU = follow-up; NR = no reduction; GR = gradual reduction.

(continued)
 Functional Communication Training and AAC 217

TABLE 3: (continued) Intervention Strategies

AAC Technique Response to
Study Participant Used Message Taught Message Outcome

Jane Microswitch and tape “Please come here” Brief teacher attention ISR to near-zero,
recorder with single- 17-mo FU
message tape
Peck et al., 1996 Alex Microswitch with “Somebody come here, Brief attention from adult ISR to near-zero,
pretaped message please” 6-mo FU
Cass Ball with bell “Come here” (meaning Brief attention from adult ISR to zero; 2-mo FU
assigned to sound of bell)
Maxwell Manual sign and “Done” Brief break from task ISR to near-zero; no FU
card with printed word
Kevin Speech or card with “Play” Brief break from task GR to low levels over
printed word 6-mo FU
Sigafoos & Dale Gesture (tap adult’s “Pay attention to me” Gesture = brief 1:1 ISR to near-zero;
Meikle, 1996 hand) and three black- (meaning assigned to attention from teacher; 3-mo FU
and-white line drawings gesture); “food,” “drink,” point to line drawing =
“toy” (line drawings) provision of requested item
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Steege Ann Microswitch device “Stop!” Brief break from undesired ISR to near-zero;
et al., 1990 with single prerecorded activity behavior returned at
message 1-yr FU because
intervention not
implemented at home
Dennis Same as above Same as above Same as above ISR to zero; rare SIB at
6-mo FU
Wacker Bobby Gesture (touch to Request function Access to favorite yellow ISR to zero with
et al., 1990 chin with finger) assigned to gesture bowl FCT 1 time-out package
Barb Microswitch and tape “I’m tired of rocking; Access to preferred ISR to near-zero
recorder with single somebody give me activities (rocking chair
taped message something to do” and exercise bike)
Jim Manual sign “Please,” “eat” “Please” = brief break ISR to near-zero with
from task; “eat” = FCT 1 graduated
brief break 1 cracker guidance

ISR = immediate substantial reduction; FU = follow-up; NR = no reduction; GR = gradual reduction.

behavior. As noted previously, this is perhaps the
most critical component for an FCT/AAC intervention
to be successful and has been referred to as
“response match” (Durand, Berotti, & Weiner, 1993).
The new communicative behavior must serve the
same function as the challenging behavior in order for
the latter to be reduced. Day, Horner, and O’Neill
(1994) demonstrated this with three individuals
(“Brandi,” “Dawn,” and “Jamie”) who used a variety of
behaviors for two functions: to escape from tasks and
to obtain desired tangibles. After each individual was
taught a functionally equivalent communication mode
for one function, levels of problem behavior
decreased for that function but not for the other. Only
after separate communication forms were taught for
both functions was problem behavior reduced to
acceptable levels. This study provided the first empir-
ical evidence of the importance of response matching
for FCT/AAC applications.
It is interesting to note that, in the studies reviewed,
there was considerable variation regarding the spe-
cific messages taught within functional categories,
depending on the specific contexts in which the chal-
lenging behaviors occurred. For example, 29 of the
participants displayed escape-motivated behavior,
and nine different basic messages were taught as
communicative alternatives: “break,” “go,” “no,”
“done,” “stop,” “please,” “help,” “play,” and choice. In
some cases, the polite (e.g., “Help, please”) and/or
sentence forms (e.g., “I want a break”) of these mes-
sages were used. The first five of these messages are
clearly related to the escape function of behavior, in
that they all signal the need for a pause during a task.
Subjects who produced these five messages were all
provided with a brief (usually, 30–90 seconds) break
from the task at hand. The “help” message was used
in situations where the assessment indicated the
behavior to be a request for assistance more than a
request for a break per se, and assistance was pro-
vided in response. Finally, the “please,” “play,” and
choice messages for escape-motivated behaviors
were used in situations where the assessment indi-
cated a need to “kill two birds with one stone” because
of multiply motivated behaviors. For example, the
choice message was taught to “Al,” a 10-year-old boy
with severe handicaps who engaged in SIB during
transitions between classes at school (Lalli, Browder,
Mace, & Brown, 1993). Assessment indicated that the
 218 Mirenda
behavior was Al’s attempt to escape from the transi-
tion, apparently because he was unsure about the
activity to follow, while also getting attention from the
teacher. He was taught to choose his next scheduled
activity by pointing to a photograph in a communica-
tion book at the beginning of the transition period and
was then praised and provided with this activity if he
completed the transition without engaging in SIB.
Thus, the choice message alleviated his uncertainty
about the next activity and, presumably, reduced his
motivation to escape while also providing him with
attention for appropriate behavior. Teaching a request
or choice-making alternative for escape-motivated
behavior may have the added advantage of increased
social acceptability for caregivers, in that the individ-
ual is making a “request to” rather than a “request
from” a task (O’Neill & Reichle, 1993).
Sixteen participants engaged in attention-motivated
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behavior and were taught a variety of alternatives
designed to elicit attention. These included the basic,
polite, or sentence forms of “pay attention to me,”
“come here,” and “more,” in addition to “I want to be
with the group” and the use of communication books
during conversational interactions with peers. Either
brief or extended attention/social interaction was pro-
vided in all cases, depending on the context. Again,
the specific message appeared to depend on the con-
text in which the behavior occurred. An additional 16
participants were taught FCT/AAC alternatives to tan-
gible-motivated behavior. In some of these cases, a
generic message (e.g., “want,” “please,” “more,” and “I
want something to do”) was taught, and caregivers
were told which preferred tangible item to provide in
response (e.g., “Heidi” in Northup et al., 1991). In other
cases, the response to the generic message was
access to a variety of preferred items or activities from
which the individual was allowed to make a selection
(see Day et al., 1994). Still other studies involved
teaching the use of specific vocabulary items corre-
sponding to preferred items (Horner & Budd, 1985) or
of multiple-message communication choice displays
(e.g., Gerra, Dorfman, Plaue, Schlackman, & Work-
man, 1995; Sigafoos & Meikle, 1996). In all cases, the
response was access to one or more preferred items
or activities. Finally, one participant who engaged in
sensory-motivated behavior (self-stimulatory rocking)
was taught to ask for preferred activities using a sin-
gle-message tape and a microswitch. This successful
intervention was apparently designed to reduce the
sensory “boredom” that caused her to engage in self-
stimulatory behavior during “down time,” although this
was not stated explicitly (Wacker et al., 1990).
Principles of Response Mastery
Many of the published FCT/AAC studies were
designed to replicate the efficacy of the original Carr
and Durand (1985) study with individuals who had
specific disabilities or who required AAC. As such,
they provide a valuable and broad-based empirical
foundation for the use of this approach. Other studies
focused on specific aspects of the technique and
sought to explore these within an experimental para-
digm. From these studies, we can understand the
principles of response mastery that are critical to suc-
cess. Durand et al. (1993) described response mas-
tery as “the ability of the trained communicative
response or responses to successfully and efficiently
produce the desired outcome” (p. 324). Durand et al.
(1993) described four main components of response
mastery: response success, response efficiency,
response acceptability, and response recognizability.
In the sections that follow, these four principles and
selected examples to illustrate them from the studies
reviewed will be presented in summary form.
Response Success
This principle states that an alternative communi-
cation behavior must be successful in obtaining the
desired response in order for a reduction in challeng-
ing behavior to occur. If the individual uses his or her
new communication behavior in place of challenging
behavior and no one “listens,” the challenging behav-
ior will not be reduced. This principle was illustrated
in many of the studies in which FCT/AAC had no long-
term effect for one or more participants (e.g., Durand
& Kishi, 1987; Northup et al., 1994; Steege et al.,
1990). In each of these cases, caregivers were unable
or unwilling to respond to the new communication
behavior in accordance with its function. The result
was that the FCT/AAC intervention had either no
impact on the challenging behavior or had an imme-
diate impact but had returned by follow-up. This may
be directly related to the degree of control or choice
that is generally available to the individuals involved
(see Carr et al. [1994] and Durand et al. [1993] for
extensive discussions of this concern). The fact is that
FCT/AAC interventions shift control from caregivers to
the individuals they support as the latter learn to ask
for preferred items, attention, breaks from work, and
so forth. Although this issue requires further empirical
attention, it would appear that, in settings in which
caregivers are reluctant to share control or in which
choice making is discouraged, FCT/AAC interventions
are likely to be less successful (Durand et al., 1993).
Response Efficiency
This issue has also been deemed the “principle of
response effectiveness” (Beukelman & Mirenda,
1992; Mirenda, 1995, 1996). People communicate in
the most efficient and effective manner available to
them at any given point in time. This means that an
alternative communication behavior must be at least
as easy to produce and at least as effective as is the
behavior it is meant to replace. Several studies have
explored one or more dimensions of this complex
 Functional Communication Training and AAC
issue. The first component of efficiency is physical
effort. In a study by Horner, Sprague, O’Brien, and
Heathfield (1990), “David,” an adolescent whose
behaviors included escape-motivated aggression,
property destruction, and yelling, was taught two
methods for producing a message to elicit assistance,
using a Canon Communicator M.™ The first method
involved having him type the message “Help, please”
using letter-by-letter spelling. The second required
him to simply push a single key on the Canon™ to
produce the preprogrammed message “Help, please.”
In both cases, the response was to provide him with
assistance for a difficult task. David continued to
engage in challenging behaviors even after he was
taught to type the message in a letter-by-letter fash-
ion, but the behaviors were reduced to zero once he
was provided with the preprogrammed alternative.
This effect was replicated in a second study (Horner
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and Day, 1991) with “Paul,” a child who was taught to
produce a manually signed sentence (“I want to go,
please”) versus a single word (“break”) for escape-
motivated behavior. These examples illustrate the
importance of selecting FCT/AAC behaviors that
require less physical effort than do the challenging
behaviors they are meant to replace. For Paul and
David, the single-message and single-sign options
worked to reduce their behaviors because they were
easier to produce than the alternatives.
A second dimension of response efficiency involves
the density or schedule of reinforcement. Horner and
Day (1991) illustrated this through “Peter,” an adoles-
cent who engaged in escape-motivated SIB. Like
David in the above example, he was taught to sign
“help” during difficult tasks to receive assistance.
Sometimes, Peter received assistance only after he
signed “help” three times (FR3 schedule of reinforce-
ment). At other times, he received assistance each
time he signed “help” (FR1 schedule). Not surprisingly,
a reduction in challenging behavior occurred only dur-
ing the FR1 condition. During the other condition,
Peter initially signed “help” quite frequently, and there
was an initial reduction in his behavior. However, he
seemed to realize quite quickly that signing three times
actually required more effort than did SIB, and he
stopped signing after a few attempts.
Related to the schedule of reinforcement is the third
aspect of efficiency, duration of reinforcement . A
recent study by Peck et al. (1996) demonstrated that
one way of maximizing the likelihood that a learner will
use a new FCT/AAC behavior instead of an old chal-
lenging behavior is to make the former more “worth-
while” than the latter, at least during initial instruction.
In the Peck et al. study, the quality and/or amount of
reinforcement was manipulated to demonstrate that a
learner is likely to engage in whichever behavior
(FCT/AAC or challenging) will result in more or better
results. Thus, it is important to ensure that the amount
and quality of reinforcement must be at least as great
for the FCT/AAC behavior as it is/was for the chal-
219
lenging behavior. For example, if a child receives an
entire cookie each time he or she tantrums, but only
receives a piece of cookie when he asks for it using
the new FCT/AAC behavior, it is unlikely that the new
behavior will replace the old over the long term.
A final consideration related to response efficiency
is the delay between the FCT/AAC behavior and the
response to it. Horner and Day (1991) provided evi-
dence of the impact of delay in a study involving
“Mary,” an adult with autism who engaged in escape-
motivated aggression. She was taught to hand an
index card with the word “BREAK” on it to a teacher
during difficult tasks. In one condition, she received a
brief break after a 1-second delay, while in the con-
trasting condition the teacher gave her a break after a
20-second delay. As predicted, Mary asked for breaks
frequently and her aggression decreased dramatically
during the 1-second delay condition, but she reverted
to aggression and stopped asking for breaks when the
20-second delay condition was initiated. In this case,
the physical effort required of Mary was identical
regardless of the delay. Nevertheless, the 20-second
delay caused her challenging behavior to be more effi-
cient than the FCT/AAC behavior, with the logical out-
come. In combination, the schedule of reinforcement
and the delay examples provide evidence that, at least
during the initial learning phase of intervention, the
response requested through FCT/AAC be provided
each time and immediately in order for the intervention
to be successful.
It is important to note that the issue of delay is one
that can and must be dealt with over time, especially
for learners whose behavior is escape motivated. Oth-
erwise, once the FCT/AAC escape behavior that
results in a break from the task has been learned, the
individual may use it continuously, thus avoiding all
work. If this problem occurs, increasing delays or task
demands can be systematically inserted between the
communication behavior and the response. For exam-
ple, Lalli, Casey, and Kates (1995) taught “Joe” and
“Kim” to complete increasing numbers of steps in a
16-step task prior to getting the break they requested.
The frequency of their SIB remained at near-zero as
the task demands were gradually increased. Other
researchers have also taught participants with escape-
motivated behavior to tolerate increased task demands
over time (e.g., Bird, Dores, Moniz, & Robinson, 1989;
Day et al., 1994; Fisher et al., 1993; Northup et al.,
1991). The key to success in this regard appears to be
to increase task demands systematically only after the
new FCT/AAC behavior has been well learned.
Response Acceptability
Another aspect of response mastery involves the
acceptability of the FCT/AAC behavior to others, since
this is likely to affect whether or not they respond to it.
Clearly, if the new behavior does not receive the
desired response, the old, challenging behavior that
 220
does receive the response will persist. One research
study has provided evidence of this aspect to date.
Durand and Kishi (1987) described an intervention for
“Kim,” a woman with dual sensory impairments and
severe handicaps whose behaviors included SIB and
aggression, both of which were attention motivated.
They taught her to “sign for adult attention” (p. 6) but
their report provided no details about either the specific
sign or the message. In a later article, Durand et al.
(1993) provided additional details, noting that Kim had
been taught to raise her hand for attention and that
staff had been told that her raised hand meant “Come
spend some time with me.” Despite the fact that Kim
learned to raise her hand, the intervention was unsuc-
cessful because, staff argued, they “were very busy
and did not have time to respond each time she raised
her hand” (Durand et al., 1993, p. 327). Subsequently,
the message assigned to the raised hand was
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changed to “Can I help you?” and resulted in a rather
dramatic decrease in Kim’s challenging behavior (see
Durand & Kishi, 1987). The second message was
more acceptable to staff in that they could now pay
attention to her while still engaging in the chores with
which they were occupied. This is a familiar issue to
many in the AAC community who have had the expe-
rience of providing a child with a negative message on
a communication display (e.g., “Leave me alone” or
“#$&*!@”), only to have the child ignored or even pun-
ished for using the message because of its content!
Similarly, Kim’s example illustrates the need for care-
ful selection of the FCT message in terms of its accept-
ability to others in the prevailing environment in order
for the intervention to be successful.
Response Recognizability
Basically, this principle says that if the new com-
municative behavior is not easily recognized by those
who should respond to it, the desired response will not
occur and the challenging behavior will not be
reduced. In AAC terms, this principle is related to the
degree of iconicity of a symbol or message. At one
end of the iconicity continuum are transparent sym-
bols or messages, the meanings of which are highly
“guessable.” At the other end are opaque symbols or
messages whose relationships to their referents are
not obvious and may be quite arbitrary. In the middle
of the iconicity continuum are translucent symbols or
messages, which are not readily guessable without
additional information (Beukelman & Mirenda, 1992;
Reichle, York, & Sigafoos, 1991). A study by Durand
and Carr (1991) illustrated the importance of mes-
sage iconicity through a child with autism named
“Hal,” who exhibited violent tantrums that were
escape motivated. Because he could speak, he was
taught to say “I don’t understand” in order to elicit
assistance from the teacher during difficult tasks at
school, thereby removing his need to escape. The
intervention was successful in dramatically reducing
Mirenda
his behavior over a 2-year period. However, Hal’s
behavior returned during the third year because his
new teacher did not understand what he was saying
and thus did not provide assistance when he asked for
it. A brief intervention to improve his articulation skills
again resulted in a dramatic reduction in the chal-
lenging behavior, which was maintained 1 year later.
Although this FCT study did not involve AAC, it is one
of the few published reports that illustrates the impor-
tance of response recognizability.
Several of the studies reviewed appeared to incor-
porate this principle into the selection of an FCT/AAC
technique, symbol, and/or message, while others did
not. One report included the use of voice output com-
munication devices for three participants. Most of the
studies produced by researchers from the University
of Iowa incorporated single-message tapes activated
by microswitches as AAC techniques for one or more
of the participants. All of these examples ensured
response recognizability through the use of specific
spoken messages. Other studies used printed output
from a Canon Communicator M,™ printed captions
under photographs, or printed words on cards or
tokens to ensure recognizability. Finally, a few stud-
ies used photographic or line drawing symbols to rep-
resent messages. Presumably, these picture symbols
were either quite transparent or were accompanied by
written labels to ensure intelligibility, although this was
not always stated explicitly.
Other studies used unaided techniques such as man-
ual signs, tangible symbols, gestures, or attention-get-
ting devices, all of which ran the risk of being misun-
derstood by unfamiliar respondents. Perhaps most
problematic with regard to iconicity were those inter-
ventions in which gestures or manual signs were
assigned idiosyncratic meanings, depending on the
function of the behavior to which they were related.
These included arbitrary tangible symbols or gestures
that meant “I want,” a raised hand that meant “Come
spend some time with me,” opaque tangible symbols for
specific preferred activities, various gestures (e.g., a
hand clap) that meant “Pay attention to me,” a ball with
a bell in it that was meant to signal “Come here,” and
the manual sign “please” to ask for a break from a task.
All of these are quite low in terms of response recog-
nizability, especially to unfamiliar caregivers, and their
effectiveness might be expected to erode over time.
Unfortunately, no studies have investigated the issue of
response recognizability specifically for FCT/AAC inter-
ventions, so empirical support for the use of specific
communication techniques in this regard is not avail-
able. It stands to reason, though, that the more trans-
parent the symbol or message, the more successful a
FCT/AAC intervention will be over the long term.
INSTRUCTIONAL TECHNIQUES
The term “instructional techniques” is used here to
refer to the (a) strategies used to teach new commu-
 Functional Communication Training and AAC
nicative behaviors, (b) consequences applied to chal-
lenging behaviors if they occur, and (c) teaching
schedules and settings used for instruction. A wide
variety of instructional techniques were used in the
FCT/AAC studies reviewed. These were largely
dependent on the focus of a particular study. For
example, some studies were designed to compare
the relative efficacy of two types of consequences
(Fisher et al., 1993; Wacker et al., 1990) or of con-
ducting intervention in two types of settings (Horner &
Budd, 1985). Others were designed to examine FCT
as one component of a multielement treatment pack-
age (Peck et al., 1996; Sigafoos & Meikle, 1996). Still
others were less formal case studies (Campbell &
Lutzker, 1993; Gerra et al., 1995). These wide varia-
tions in purpose made it difficult to analyze the instruc-
tional techniques used since the techniques them-
selves were often experimental in nature. However, a
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general summary will be provided in the sections that
follow.
Teaching Strategies
In all cases, systematic teaching strategies such
as prompting and fading were used to teach new
communicative behaviors. Prompts were most often
presented in a “least-to-most” intrusive order, with
verbal prompts used initially to generate the desired
behavior, followed by more intrusive prompts as
needed (e.g., gestural, modeling, partial physical,
and/or hand-over-hand prompts; see Snell, 1987). In
a few cases, an errorless learning or “most-to-least”
prompt hierarchy was used, starting with full physical
prompts and decreasing the amount of assistance
over time as the learner began to produce the desired
communicative response (e.g., Bird et al., 1989;
Fisher et al., 1993; Sigafoos & Meikle, 1996). Prompts
were usually faded by gradually decreasing the
amount of assistance provided or, in a few cases, by
the use of a time delay procedure (e.g., Bird et al.,
1989; Horner et al., 1990). Time delay involves paus-
ing for gradually increasing increments of time before
prompting to give the learner opportunities to produce
the behavior without assistance (Snell, 1987). Read-
ers are referred to Durand (1990) for a more complete
discussion of the prompt fading steps typically used
in FCT.
Consequences
As noted previously, the consequence for the
desired communicative behavior in FCT is always the
provision of the requested item or activity (i.e., tangi-
ble item, attention, or brief break, assistance, etc.). In
addition, the studies reviewed used a variety of con-
sequences in response to challenging behaviors that
occurred during instruction. The most common con-
sequences were extinction (i.e., ignoring the behavior
and continuing with the task at hand) and physical
221
redirection or response blocking (especially of SIB
and aggression), as recommended by Durand (1990).
Other consequences included guided compliance
(i.e., hand-over-hand assistance to complete a task),
brief time-out (e.g., 30–60 seconds), withholding
desired reinforcers, and mild verbal reprimands. Gen-
erally, it is recommended that the least intrusive and
most neutral response that ensures the safety of the
individual and those around him or her should be used
in response to challenging behaviors that may occur
during and after intervention (Durand et al., 1993).
However, the results of a few studies suggest that
some individuals may require mild forms of negative
consequences, at least initially (e.g., Fisher et al.,
1993; Wacker et al., 1990).
Settings and Schedule
Early in the development of FCT as a behavioral
intervention, Horner and Budd (1985) established the
importance of teaching the new communicative
behavior in the natural settings in which it will be used.
All of the studies reviewed incorporated this principle
into at least part of the FCT/AAC instruction that was
provided. In most cases, intervention was conducted
in the individual’s home, classroom, day activity cen-
ter, and so forth. When initial instruction occurred in a
controlled setting such as a hospital clinic, later
instruction almost always occurred in natural envi-
ronments during the generalization and/or follow-up
phases. It is unlikely that generalization will occur
unless natural setting instruction is included at some
point in the training process.
With regard to the schedule of instruction, instruc-
tion should be implemented throughout the day,
whenever naturally occurring, relevant communica-
tion opportunities present themselves (Carr et al.,
1994; Durand, 1990). This “distributed practice”
approach has been found to result in the best overall
generalization across settings and people (Snell,
1987). On the other hand, distributed practice may
result in a slower rate of initial acquisition if naturally
occurring opportunities for instruction occur sporadi-
cally, and may be logistically complicated. The alter-
native used in almost all of the research studies to
date was a “massed trial” approach (Snell, 1987). This
involves a 10- to 30-minute teaching session during
which the individual is exposed to one or more of the
situations that were shown during assessment to elicit
the behavior (e.g., difficult tasks or no-attention situ-
ations). Then, prior to the occurrence of any chal-
lenging behavior, the selected instructional tech-
niques are used to teach the new communicative
behavior, and the desired response is provided. A
series of trials can be set up in this manner within a
short period of time to provide concentrated instruc-
tion. Of course, instructional trials will have to be inter-
spersed throughout the day, once initial learning has
occurred. However, the “massed trial” approach may
 222 Mirenda
have the advantages of more rapid acquisition and
fewer logistical demands in the early phases of
instruction.
OUTCOMES
Short-term Impact
As summarized in Table 3, the FCT/AAC interven-
tion resulted in an immediate and substantial reduc-
tion in the frequency of the target behavior for 44 of
the 52 participants (85%). For four participants, there
was a gradual reduction in challenging behavior and,
for another four participants, the intervention had no
immediate impact. Two of the latter four participants
were “Lew” and “Kim” from the report by Durand and
Kishi (1987); their stories provide clear examples of
the negative impact of ineffective implementation by
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staff. The other two “failure” participants were “Bob”
and “Abe” in the Fisher et al. (1993) report. These
authors were unable to explain the intervention failure
but offered several hypotheses as to why this might
have occurred. Despite these exceptions, it is clear
that FCT/AAC is a promising practice for the reduction
of severe behavior problems, at least on a short-term
basis.
Generalization
Once a new FCT/AAC behavior has been taught, it
is important to assess its impact and, if needed, imple-
ment additional intervention procedures to ensure that
the learner can use it across novel (i.e., untrained)
settings, people, and situations. Unfortunately, such
generalization measures were evident for fewer than
25% of the participants in the studies reviewed. In a
few studies, systematic data were provided with
regard to generalization across instructors (Bird et al.,
1989), communication partners (Hunt, Alwell, Goetz,
& Sailor, 1990), and settings (Horner & Budd, 1985).
In the remaining studies that explored this issue,
anecdotal information about successful generaliza-
tion was evident (Campbell & Lutzker, 1993; Gerra et
al., 1995; Hunt et al., 1988; Steege et al., 1990). The
absence of specific generalization data in most of the
research reviewed probably reflects the fact that the
purpose of many of these studies was to explore a
specific aspect of the FCT intervention in a scientifi-
cally rigorous fashion, rather than to provide accounts
of successful long-term interventions.
Follow-up and Maintenance
Either anecdotal or empirical follow-up information
about the long-term impact of FCT/AAC interventions
was provided for 24 of the 52 participants (46%)
across 10 of the 21 studies reviewed (48%). Follow-up
periods ranged from 1 to 17 months, with an average
of 8 months. For all but two of the participants (“Heidi”
in Northup et al. [1994] and “Ann” in Steege et al.
[1990]), follow-up data were positive in that the new
FCT/AAC behaviors continued to be used and the fre-
quencies of the challenging behaviors remained low.
Implicit in these successful follow-up data are positive
generalization data as well, since the follow-up data all
reflect the participants’ use of FCT/AAC behaviors in
untrained settings. In addition, one participant (“Kim”
from Durand & Kishi [1987]) had acquired a new
FCT/AAC behavior at follow-up, despite the fact that
she was one of the short-term intervention “failures.”
This occurred because the message assigned to her
FCT/AAC behavior was changed over time to make it
more acceptable to staff (see discussion under “Prin-
ciples of Response Mastery”).
Overall, the research reviewed suggests that both
generalization and maintenance of new communica-
tive behaviors can be enhanced by use of the follow-
ing practices: (a) natural settings for instruction, (b)
distributed practice trials, and (c) selection of
FCT/AAC behaviors that are efficient, acceptable, and
recognizable by others. On the other hand, FCT/AAC
interventions are less likely to be successful over time
in environments that (a) are homogeneous (e.g.,
classrooms specifically for students with challenging
behaviors), (b) de-emphasize the importance of
choice and control in the lives of the people sup-
ported, and (c) do not work within a collaborative (i.e.,
team) model of intervention (Carr et al., 1994; Durand,
1990). Intervention in homogeneous settings presents
formidable barriers in terms of staff intervention time,
the demands made of staff, and the quality of appro-
priate communication and behavior models available.
Lack of an atmosphere in which genuine and regular
opportunities for control and choice making occur
often means that, once FCT/AAC behaviors are
taught, staff are unwilling to respond to them because
they are inconvenient or require a “giving up” of staff
control. And, without proper supports and teamwork,
FCT/AAC interventions will probably fail to generalize
across either personnel or environments.
FUTURE RESEARCH
This final section will offer suggestions for future
research on FCT/AAC in a variety of areas, based on
the research review.
Subjects and Behaviors
The combination of FCT and AAC has been applied
exclusively to individuals with developmental disabil-
ities to date. However, it seems logical to assume that
this strategy might also be useful with other individu-
als who have both limited speech and either chronic
or acute behavior problems. Such individuals might
include adults with degenerative illnesses such as
Alzheimer’s and Huntington’s disease. They might
also include individuals with traumatic brain injury,
 Functional Communication Training and AAC
stroke, or spinal cord injury during the early stages of
recovery. In addition, there is no reason to assume
that the challenging behaviors with which FCT can be
used are limited to those in the studies reviewed. In
particular, extension of this work to sensory-motivated
behaviors would appear to merit additional attention,
since intervention with the one participant who
demonstrated this type of behavior was successful, at
least in the short term.
Assessment
Future research in this area should aim to further
refine existing assessment procedures toward
increasing efficiency and simplicity in a variety of set-
tings (e.g., rehabilitation facilities, general education
classrooms). In addition, there is no doubt that an
increasing array of professionals are being asked to
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provide FCT instruction both to individuals who can
speak and to those who use AAC. Research is
needed to identify how to best provide instruction
regarding behavioral assessment to speech-language
pathologists, teachers, parents, group home staff, and
others who might be involved in this process (see
Berg and Sasso, 1993).
Intervention
A number of questions remain in the area of
FCT/AAC instruction. Among them are those related
to response recognizability, which, as noted previ-
ously, is directly related to the issue of symbol and
message iconicity. Research regarding systematic
procedures for selecting FCT/AAC techniques that
are maximally transparent is sorely needed, as is
research investigating the relative impact of teaching
generic (e.g., “want”) messages versus specific (e.g.,
“cookie,” “juice”) messages for FCT. What are the
cost/benefit considerations of generic versus specific
messages with regard to rapidity of acquisition, care-
giver responsiveness, generalization across settings,
and long-term maintenance? In addition, future
research is needed regarding identification of the opti-
mal techniques for instruction and for responding to
challenging behavior that occurs during instruction.
Perhaps most important of all, investigations regard-
ing strategies for changing staff attitudes and practices
to promote successful, functional communication in
school and community settings is of paramount impor-
tance. Work has begun in this area, and readers are
referred to the discussion by Anderson, Albin, Mesaros,
Dunlap, and Morelli-Robbins (1993) in this regard. In
addition, research is needed to address questions such
as the following: What are the variables that prevent
some staff from creating more appropriate and mean-
ingful communication opportunities for the people they
support? What types of interventions are most effective
in assisting them to share control and approach chal-
lenging behavior from a proactive rather than a reactive
223
perspective? How can training in FCT/AAC be deliv-
ered most effectively to staff who may have little or no
background in AAC or behavior analysis? Answers to
these and other intervention questions are of critical
importance if FCT/AAC interventions are to gain wide-
spread acceptance and use.
Outcomes
Clearly, longitudinal studies that document general-
ization and long-term maintenance would provide
additional information regarding the impact of
FCT/AAC. In addition, interventions in which parents,
teachers, and other supporters are trained to provide
intervention during both the initial and follow-up stages
are needed in order to refine existing procedures so
that they are maximally usable in natural settings.
Finally, as noted by Meyer and Evans (1993), it is crit-
ical to develop outcome measures that go beyond the
traditional “did the behavior decrease after interven-
tion?” measures. Such measures might include, for
example, those related to (a) positive collateral effects
(e.g., increased peer interactions or access to pre-
ferred activities; see Malette et al., 1992), (b) less
restrictive placements and greater participation in inte-
grated activities (e.g., Campbell & Lutzker, 1993), (c)
participant quality-of-life measures (e.g., positive affect;
see Durand, 1993), and (d) perceptions of improve-
ment by family members, classmates, and so forth.
SUMMARY
This research review has summarized and analyzed
the extant literature on FCT/AAC interventions across
a variety of dimensions. It is interesting to note that, at
the present time, this research is driven by the field of
applied behavior analysis, as reflected in the fact that
half of the studies reviewed were published in the pre-
mier journal in that field (Journal of Applied Behavior
Analysis). The remaining studies appeared in education
or disability-specific journals, and only one (Durand,
1993) was published in a communication journal (Aug-
mentative and Alternative Communication). This prob-
ably reflects both the novelty of FCT relative to other
types of communication interventions and the fact that
information about the relationship between challenging
behavior and communication has only recently been
available in written forms that communication special-
ists are likely to access (e.g., Beukelman & Mirenda,
1992; Durand & Berotti, 1991; Reichle & Wacker, 1993;
Reichle et al., 1991). Nonetheless, it is clear from this
review that FCT/AAC interventions should be among
the first interventions considered for many individuals
who engage in severe behavior problems. Speech-lan-
guage pathologists, teachers, and other communica-
tion specialists must familiarize themselves with the
assessment and intervention components of this tech-
nique that are most likely to result in positive outcomes.
FCT/AAC interventions represent the actualization of
 224 Mirenda
the belief that “communication and behavior are insep-
arable” and, as such, they deserve the careful attention
of both AAC researchers and practitioners.
Address reprint requests to: Pat Mirenda, Faculty
of Education, University of British Columbia, Vancou-
ver, British Columbia V6T 1Z4, Canada.
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OUTSTANDING AAC ARTICLES FOR 1996

The outstanding articles for 1996 have been selected by a vote of the associate editors. The student research award was
won by Kate Franklin, Pat Mirenda, and Gail Phillips for their article “Comparisons of Five Symbol Assessment Protocols
with Nondisabled Preschoolers with Severe Intellectual Disabilities.” This research was completed when Kate Franklin and
Gail Phillips were students of Dr. Mirenda. The recipients of the professional research award were Heidi Horstmann Koester
and Simon P. Levine for their article “Effect of a Word Prediction Feature on User Performance.” On behalf of ISAAC, I
wish to thank and congratulate the recipients. They will be honored at the ISAAC conference in Dublin, Ireland; however,
their awards have already been sent to them.

WORDS+/ISAAC OUTSTANDING CONSUMER LECTURE AWARD

The Words+/ISAAC Outstanding Consumer Lecture Award is presented at each International Conference. The award is
$2,000 (US), which is intended to defray expenses for the selected consumer to attend the conference and deliver the lec-
ture using their AAC device at an unopposed, feature presentation. ISAAC membership is required. The lecture can be about
any subject that the applicant would like to present to an international audience of consumers, clinicians, educators, and
researchers in AAC (but preferably not “How my life is better because of AAC”). Applications must include (1) a 500- to 1000-
word detailed description of the proposed lecture, (2) pertinent background information, (3) no more than two letters of rec-
ommendation, and (4) an agreement to attend the conference and present the lecture in person using the applicant’s AAC
device. Send applications to Words+/ISAAC Outstanding Consumer Lecture Award c/o ISAAC Secretariat. Applications must
be postmarked no later than January 31, 1998.

WORDS+/ISAAC CONSUMER SCHOLARSHIP AWARD

The Words+/ISAAC Consumer Scholarship Award is presented at each International Conference. The award is $2,000
(US) per year for 2 years ($4,000 total), which must be used for postsecondary education or training. Applicants must be
AAC device users who are ISAAC members. Applications must include (1) a 300- to 500-word essay focusing on the appli-
cant’s educational plans and a two-year time line, (2) the name of the institution that the applicant will attend, (3) the cost
of attending the institution, and (4) no more than two letters of recommendation. Send applications to Words+/ISAAC Con-
sumer Scholarship Award c/o ISAAC Secretariat. Applications must be postmarked no later than January 31, 1998.