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Proceedings of UHCL Student Research Projects 1 (2009) 1 - 7
Functional Analysis and Treatment of Attention-Maintained Elopement in
Children with Autism and Downs Syndrome Using Discriminative Stimuli
Tesa Sansbury, Amber Sanchez, and Pamela Jones
University of Houston-Clear Lake
Abstract
Elopement is a dangerous behavior demonstrated by some individuals with developmental disabilities. Previous studies on
the treatment of elopement have focused on the use of noncontingent reinforcement (NCR), punishment (Kodak, Grow &
Northup, 2004), and functional communication training (FCT) (Piazza et al., 1997; Tarbox Wallace & Williams, 2003).The
examination of the use of discriminative stimuli combined with extinction and response blocking is absent within the
literature. We conducted functional analyses of problem behavior demonstrated by two males, both diagnosed with Autism
and one with a co-morbid Downs Syndrome diagnosis. It was determined that elopement behaviors were sensitive to care
provider reprimands. Subsequent treatments consisted of S-Deltas in the form of unique cards combined with a locked door
and the removal of staff attention. Results indicated that both participants attempted to elope less often in the presence of the
S-Delta. Implications and ideas for further consideration are discussed.
Elopement demonstrated by individuals with disabilities is a
dangerous behavior placing restrictions upon an individual’s
life and reducing one’s autonomy. It is estimated that
approximately 4.9% of individuals out of a population of
30,000 individuals with developmental disabilities engage
in elopement that places their lives at risk (Jacobson, 1982).
In spite of large numbers of individuals demonstrating this
problem, relatively little attention has been given to the
behavior in the research literature.
Recently, studies have examined more effective ways
of determining the function of elopement through the
refinement of functional analysis procedures (Piazza,
Hanley, Bowman, Ruyter, Lindauer, & Saiontz, 1997).
Likewise, the use of punishment in the form of verbal
reprimands paired with discriminative stimuli (i.e.
wristband) has also been demonstrated to completely reduce
eye poking maintained by automatic reinforcement in one
participant (McKenzie, Smith, Simmons, & Soderlund,
2008). Other studies have examined the efficacy of
function-based interventions, such as noncontingent
reinforcement (NCR) and differential reinforcement (e.g.,
Kodak, Grow & Northup, 2004).
For example, in Piazza et al. (1997), the authors
demonstrated the utility of functional analysis procedures
and unique discriminative stimuli (i.e. brightly colored
cards) to signal reinforcement was available for staying in a
designated area. After the function of elopement was
determined for all three participants, the authors taught each
participant to touch a card to receive the reinforcer that had
previously maintained elopement (i.e., attention or delivery
of highly preferred edibles). During treatment, the authors
delivered the reinforcer(s) indicated by the participant when
the card was touched on various schedules resulting in a
decrease in elopement across participants.
In a study conducted by Tarbox, Wallace and Williams
(2003), the experimenters extended the methods of Piazza et
al., (1997) to assess and treat the elopement of three
developmentally disabled individuals using functional
communication training and NCR. Results of the assessment
indicated that elopement was maintained by access to
tangible items (i.e., access to a toy store and delivery of
highly preferred edible items) for two individuals. One
individual’s elopement was maintained by access to adult
attention in the form of reprimand. Upon successful card
exchange demonstrated by the participants, they were given
access to the item, preferred activity, or 30-s of care
provider attention resulting in a reduction in elopement
across all participants.
Although these findings are noteworthy, the studies
contained some limitations. With the exception of one
study, attention was delivered in varying degrees contingent
on the elopement. For instance, physical redirection back to
the designated area was used even when elopement occurred
within a controlled environment (Piazza et al., 1997; Tarbox
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T. Sansbury et al. / Proceedings of UHCL Student Research Projects 1 (2009) 1 – 7
et al., 2003; Kodak et. al., 2004). Severe elopement places
an individual at risk and often cannot be ignored. This may
be problematic when treating elopement that is maintained
by care provider reprimands. Likewise, with the exception
of the study conducted by McKenzie et al., (2008),
generalization of the treatment to other settings was not
included in any of the studies. Although the reduction of the
behavior within the setting wherein it normally occurs is
noteworthy, the inclusion of other settings would be an
important addition to the literature.
Strategies are needed for reducing the likelihood that
elopement will occur outside of the treatment setting where
it is likely to contact maintaining reinforcers (e.g., attention
from others). One possible solution is to establish
discriminative control over the behavior in the treatment
setting and then transfer this control to the generalization
settings. Previous research suggests that the utilization of
discriminative stimuli may be effective in reducing aberrant
responding maintained by adult attention (Cammilleri,
Tiger, & Hanley, 2008; Tiger, Hanley & Heal, 2006). For
example, Cammilleri et al. demonstrated stimulus control
utilizing discriminative stimuli in conjunction with a
multiple-schedule procedure. Three classrooms, each staffed
with two teachers, were examined. The authors established
discriminative stimuli in the form of various colored leis
worn by instructors to signal to children when attention was
and was not available. Results showed a decrease in student
attempts to gain instructor attention across classrooms when
attention was unavailable.
As it may be possible to establish discriminative control
over an individual’s behavior and transfer it to a
generalization setting, the following study sought to
examine the use of a discriminative stimulus to signal that
reinforcement in the form of care provider reprimand or
physical contact was not available (i.e., an S-Delta). It was
hypothesized that elopement attempts would be reduced by
pairing a distinct stimulus with the removal of attention
paired with a locked door. Finally, it was hypothesized that
elopement responses would remain low across
generalization settings once the discriminative stimuli were
introduced into those settings.
Methods
Participants and Settings
Two students were chosen for participation because
their teachers reported that they frequently eloped from
designated multiple areas throughout the day. Informal
observations conducted prior to the study suggested that the
elopement was maintained by attention from teachers in the
form of verbal reprimands, chasing, and/or physical contact
when blocking or redirecting. James was a 7-year-old boy
who had been diagnosed with autism and attention deficit
hyperactivity disorder (ADHD). He had an IQ of 76. He had
been observed to elope at a high rate from multiple areas of
his school building, often placing him at high risk of injury
(i.e., he ran to major highways). Jonathan was a 7-year-old
boy who had been diagnosed with Downs Syndrome,
autism, mental retardation, visual impairment, ADHD, and
sensory integration disorder. He had an IQ of 23. Jonathan
had been observed to attempt to elope at a high rate from the
classroom and on the playground. An interview of the staff
and parents revealed he had also tried to elope from other
doors at his school and at home.
For James, training settings consisted of three sets of
windowed, doubled-doors exits leading to the outside of the
school. Generalization probes were conducted with similar
doors in the cafeteria and gymnasium. A functional analysis
of elopement was not conducted for James (see results and
discussion for further detail).
A functional analysis of Jonathan’s elopement was
conducted in an unfurnished, empty classroom consisting of
one exit. An empty classroom with one door was used
during training sessions. Generalization probes were
conducted at one gated exit on the school playground and
one exit out of the cafeteria doors leading to an interior
hallway.
Response Measurement
Elopement for James was defined as the placement of
the hands on the bar of the door and pressing of the bar.
Interior elopement was measured to determine if the
participant would begin allocating responding to elopement
behavior within the building (i.e., away from care providers)
but not through doors. Interior elopement was defined as
movement out of the 8 ft circumference in front of the door
and attempts to run from staff in the hall.
Jonathan’s elopement was defined as the placement of
his hand on the classroom door handle combined with the
opening (in baseline conditions) or effortful pulling (in Sconditions) of the door Internal elopement was defined as
any movement out of a 15 ft radius from the experimenter.
During baseline and treatment for both participants,
frequency data were collected on elopement using paper and
pencil. These data were expressed as the percentage of
opportunities in which elopement occurred per session.
Each session was comprised of three distinct opportunities
to elope. During baseline sessions, an opportunity was
defined as the removal of staff attention after noncontingent
attention for a designated interval and the initiation of an
interval wherein all problem behavior was ignored with the
exception of elopement. During treatment sessions, an
opportunity was defined as the removal of staff attention
after noncontingent attention for a designated interval and
the initiation of an interval wherein attempts to elope
through S- doors were ignored. Upon conclusion of the full
opportunity interval, the participants were given
noncontingent attention again to reset the next opportunity
to elope. This occurred three times per session.
During the functional analysis of James’s and
Jonathan’s problem behavior, the frequency of problem
behavior or elopement attempts were collected across 10-
3 T. Sansbury et al. / Proceedings of UHCL Student Research Projects 1 (2009) 1 - 7
min sessions, and the response per minute of aberrant
responding was the dependent variable examined.
Interobserver Agreement
Interobserver agreement (IOA) was obtained for a mean
of 52% across all treatment sessions by trained
paraprofessionals or graduate students using pencil and
specially prepared data collection sheets. IOA was collected
for 42% of James’s functional analysis sessions using
Instant Data 1.0 on a laptop and hand-held computer. IOA
was collected on 29% of Jonathan’s functional analysis
sessions using specifically prepared data collection sheets.
Sessions were divided into 10-s consecutive intervals to
compare the two observers’ records and agreement was
determined by examination of the corresponding intervals.
The observers independently recorded their respective
observations but were not be able to see each others’
recordings. For all functional analyses, an exact measure
was calculated as the number of 10-s intervals with
agreement divided by the total number of intervals
multiplied by 100. An agreement consisted of both
observers independently recording the presence or absence
of elopement within a 10-s interval. A disagreement
consisted of only one observer recording the presence of the
behavior. Mean agreements for James’s and Jonathan’s
functional analyses were 93% (range, 83.9%-96.8%) and
98.5%% (range, 96.6%-100%). Mean agreements for
James’ and Jonathan’s treatment sessions were 98% (range,
83%-100%) and 98.8% (range, 0-100%).
Procedure
Functional analysis. A functional analysis of James’s
problem behavior was conducted in his classroom prior to
his inclusion in this study. A functional analysis of
elopement was not conducted due to the large size of the
participant, the severity of the behavior, and available staff
needed to secure his safety during assessment. Prior to his
inclusion in the study, a brief functional analysis of problem
behavior revealed James demonstrated some sensitivity to
attention as a maintaining reinforcer for aberrant
responding. Direct observation of elopement attempts and
subsequent staff interactions led us to believe elopement
was maintained by attention as he was often observed to
turn and laugh to see if staff were chasing him. A
multielement design across conditions was conducted (Iwata
et al., 1982). During the play condition, the participant was
seated on the floor of his workspace with moderately
preferred toys. Noncontingent attention was delivered
approximately every 10-s, and problem behavior produced
no consequences. In the demand condition, low preference
academic tasks were delivered using a three-step prompting
sequence. If the student failed to initiate the task within 5-s,
the paraprofessional serving as the therapist initiated a
gestural model. A full physical prompt was implemented if
the student failed to engage in the desired task. Problem
behavior resulted in removal of task materials and a 30-s
break. During the attention condition, the participant was
seated on the floor with moderately preferred items. The
therapist instructed the participant that she was busy and had
work to do. She then removed attention and began reading a
magazine. Attention in the form of verbal reprimand and
physical redirection back to his designated area from the
paraprofessional was delivered for 30-s contingent upon
demonstration of problem behavior. A tangible condition
was conducted as staff and care providers reported problem
behavior occurred when access to highly preferred toy items
or activities was restricted. During the tangible condition,
the participant was allowed access to a highly preferred
leisure item for 30-s and then the item was removed.
Contingent upon aggression or disruption, the item was redelivered for another 30-s.
A functional analysis of elopement was conducted for
Jonathan by the first two authors to determine if attention
served as the reinforcer maintaining this behavior. All
sessions were 10 min in length and rotated using a
multielement design (Iwata et al, 1982). In the play
condition, the student was seated with the primary
experimenter, and the participant was engaged with
moderately preferred toys. Noncontingent attention was
delivered to the student approximately every 10-s, and
problem behavior was ignored. Attempts to elope from the
room were blocked by the experimenter by turning her back
to the participant and placing her body between the door and
the participant, but no verbal attention was delivered. The
participant was physically guided back to the play area
without verbal attention or eye contact. During the
contingent attention condition, the participant was seated
with the same toys. Problem behavior other than elopement
was ignored. Attention in the form of verbal reprimand,
physical contact, and redirection back to the play area was
delivered for 10-s contingent upon elopement
Baseline. For James, baseline sessions were comprised
of three 30-s opportunities to elope. Prior to initiation of the
session, the participant was directed to an area 6 ft-8 ft
directly in front of a door leading to the outside of the
school building at one of the three training sites. The
experimenter removed attention from the student for 30-s.
All problem behavior was ignored during this interval.
Elopement attempts resulted in 10-s of attention in the form
of a verbal reprimand and physical attention. The primary
experimenter blocked the participant’s path if he attempted
to elope to another area (i.e., hallway), and refrained from
eye contact while redirecting the student back to the radius
until the full interval elapsed. The student was then directed
to the next training area. Three opportunities to elope were
presented to the student at three different exits around the
building per session. If the participant did not attempt to
press the door within an opportunity, no attention was
delivered and staff directed the student to the next training
area.
During baseline sessions Jonathan was seated on the
floor with moderately preferred toy items in front of him.
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T. Sansbury et al. / Proceedings of UHCL Student Research Projects 1 (2009) 1 – 7
After 1 min of play with the primary experimenter, attention
was removed from the participant for up to 6 min. Attempts
to elope resulted in 1 min of verbal reprimand and physical
contact. The student was redirected back to the floor to play,
and the experimenter continued the cycle until three
possible attempts to elope within the specified interval
occurred. If the student did not elope within the 6 min
interval, the experimenter ended the opportunity and
engaged the participant in another 1 min of play. Upon the
conclusion of the interval, attention was again removed and
the next opportunity to elope was initiated.
S-Delta (S-). S-Delta sessions were comprised of three
opportunities to elope per session utilizing the same doors
as in baseline. Sessions were randomly alternated with
baseline conditions once stable responding in baseline
occurred. For training sessions with James, all training
doors were blocked from the outside and a red card was
placed at eye level on the opposite side of the glass. As in
baseline, the experimenter led the student to the training
area in front of the door and removed attention for 30-s.
Attempts to elope through the door were ignored, but the
experimenter pointed to the red card. Other forms of
problem behavior were ignored (i.e., yelling or screaming
did not result in verbal reprimand). Attempts to elope from
the training area to other areas of the school were blocked
by placement of the experimenter’s or paraprofessional’s
body between the participant and the area outlying the
radius. If the participant did not attempt to press the door in
the S-Delta condition, 10-s of attention in the form of praise
and physical contact was delivered, and the student was
verbally redirected to the next site. The process continued
until all three doors had been visited.
During the S-Delta condition for Jonathan, the
experimenter was seated with the participant in the same
location as in baseline and engaged the student with
moderately preferred toys for 1 min at the initiation of the
session. A brightly colored, yellow and fluorescent pink
card was placed at eye level directly under the door handle
of a locked door. After the 1 min play interval elapsed, the
experimenter removed attention for up to 6 min. Attempts to
elope did not result in the delivery of attention, verbal
reprimand or physical contact and the experimenter pointed
to the brightly colored stimuli. If the student did not elope
within the interval, the experimenter re-initiated a play
interval and removed attention again. This occurred until
three opportunities to elope had been completed.
Mass Trial Sessions. The training procedures were
altered for Jonathan when he seemed to have trouble
acquiring the discrimination. Single trials under the baseline
and S-Delta conditions were rapidly but randomly alternated
within a multielement design. The number of trials
conducted during each session varied depending upon the
availability of the participant on a given day. Each
opportunity began with a 1 min interval of play followed by
the removal of attention and the initiation of a 6 min
interval. During a baseline opportunity, an elopement
attempt resulted in 1 min of verbal reprimand, physical
redirection and direction back to the play area. During an S
– opportunity, elopement attempts did not result in attention
and the re-initiation of the 1 min play interval occurred after
the full 6 min interval had elapsed.
Generalization. Generalization probes were conducted
for each participant in settings where staff had reported
previous attempts to elope. These probes were conducted
prior to and following training. James’s generalization
probes were conducted in the cafeteria and in the school
gymnasium. The student was led to each of the exits and the
session was run as in baseline. Jonathan’s generalization
probes were held on the playground and in the cafeteria. The
primary experimenter led the participant to an area
approximately 8 ft from a playground exit. The primary
investigator initiated a 1 min interval of play using the same
leisure items used in baseline and S- conditions with the
participant and then removed attention as in baseline
sessions. If the participant attempted to open the door the
experimenter delivered a verbal reprimand and physical
contact and redirected the participant back to the play area.
This cycle was repeated until three opportunities to elope
had been presented.
Upon separation in the data path between S- and
baseline conditions, additional generalization probes were
conducted. Participants were placed in their relative areas
and S- conditions were conducted with blocked doors. Upon
3 consecutive sessions wherein the student did not attempt
to elope, the doors were then unblocked and the stimuli left
in place. The stimuli were faded by ¼ for each 5 sessions
that were conducted in the absence of elopement.
Experimental Design. The effects of discrimination
training were evaluated in a combined multielement and
multiple baseline design.
Results
Figure 1 displays the functional analysis results for
James. It may be noted that the response per minute of
problem behavior was sensitive to escape from task
demands, attention and access to tangible items (attention;
M = .93; escape; M = .86; tangible delivery; M = 1.2).
Because of the severity of aggression demonstrated by the
participant, the analysis was terminated prematurely.
Informal observations of actual elopement attempts and staff
availability led to the decisions not to conduct a functional
analysis of elopement. However, because aberrant
responding in the initial analysis seemed to be somewhat
sensitive to attention and direct observation of numerous
elopement attempts yielded the conclusion that attention
was the maintaining reinforcer for the response, a treatment
designed around this function was implemented. Functional
analysis results for Jonathan (see bottom panel, Figure 1)
indicate a sensitivity to care provider reprimand delivered
contingent upon elopement (contingent attention; M = 2.2;
control; M =.06).
5 T. Sansbury et al. / Proceedings of UHCL Student Research Projects 1 (2009) 1 - 7
2.5
Response per Minute
2
Play
1.5
Attention
Demand
1
Tangible
0.5
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Session
Elopement per Minute
0.8
0.7
0.6
0.5
Play
0.4
Contingent Attention
0.3
0.2
0.1
0
1
2
3
4
5
6
7
Session
Figure 1. Functional analysis results for James (top panel) and Jonathan (bottom panel).
Figure 2 displays the percentage of opportunities James
tried to elope during sessions. Baseline responding
maintained at a relatively high percentage of opportunities
across sessions (M = 87%) relative to S – sessions (M =
26%). Across conditions, elopement eventually reduced
across settings and therapists to 0 attempts once the Scondition was introduced. Likewise, for Jonathan,
elopement maintained during baseline sessions (M = 98%)
while decreasing during the S- sessions (M = 31%).
Elopement attempts during the S- condition were
completely eliminated once mass trials were initiated.
Generalization to the playground and cafeteria settings were
not accomplished within the first presentation of the card
but stimulus control over elopement behavior was obtained
within three training sessions.
Discussion
The results suggest elopement attempts significantly
decreased across participants and settings in the presence of
the S-Delta. There are numerous implications of the results
of this study. As the literature examining methods for the
reduction of elopement have consisted of punishment or
reinforcement, a method utilizing discriminative stimuli
may be more easily applied by classroom staff and care
providers once initial training has been completed. If the
simple placement of a unique card on various doors of a
participant’s environment reduced elopement attempts, staff
and care providers may find this to be a more desirable
alternative to having to implement a dense reinforcement
schedule or the use of punishment as seen in previous
research. Generalization to other areas of the student’s
surroundings may also be accomplished more easily by staff
members once initial training has been conducted. Likewise,
if desirable results utilizing a discriminative stimulus are
obtained, favorable results may be obtained across care
providers as the card would serve to control student
behavior and not the integrity with which staff implement a
reinforcement or punishment contingency as seen in
previous research.
It is hypothesized James demonstrated an overall
extinction effect of elopement across baseline and S-Delta
conditions. During the course of treatment, staff reported
James continued to elope out of session (i.e. on the
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T. Sansbury et al. / Proceedings of UHCL Student Research Projects 1 (2009) 1 – 7
Mass T rial
S-Delta T raining
100
90
80
70
60
50
40
30
20
10
0
Baseline
S Delta
Cafeteria
Playgrd
Playgrd S- Training
Baseline
113
Session
Sdelta + Ext
106
99
92
85
78
71
64
57
50
43
36
29
15
8
Cafeteria S-
1
Percent
Baseline
22
Baseline
100
baseline
Percent
80
Sdelta
60
Elopement out of
other area
P.E.
40
20
Cafeteria
Session
57
2.
49
45
41
37
33
29
25
21
17
13
9
5
1
0
Para Baseline
Para Cafeteria
Figure 2. Percentage of opportunities eloped per session for James (top panel) and Jonathan (bottom panel).
playground) even though he no longer attempted within
session. This reduction in attempts with sessions across
treatment settings could be attributed to the participant’s
higher level of cognitive functioning relative to the other
participant. It is hypothesized James simply learned that if
he waited long enough, a situation would arise out of
training sessions wherein he could run and gain high quality
attention from care providers due to the nature of the setting
(i.e., recess) as care providers reported attempts to run out of
session even though an overall reduction of elopement
within session occurred. It is also hypothesized that
attention delivered contingent upon elopement behaviors in
baseline sessions for James was less desirable than the invivo attention delivered when the participant actually eloped
out of session. Successful elopement attempts outside of
sessions generally produced long periods of attention as
staff redirected the student back to the school building. This
could explain why elopement may have extinguished during
sessions but maintained outside of treatment sessions.
A more parsimonious explanation for the decrease in
elopement across conditions demonstrated by James may be
because the response never came under the control of the SDelta stimuli and that he failed to discriminate between the
two conditions. However, during treatment sessions James
would frequently ask the experimenters to remove the cards
so he could leave the building when his father came to pick
him up from school. Likewise, when he observed baseline
doors, he would tell experimenters and school staff not to
put the card in place so he could leave or so that his parents
could enter the building. This would suggest James did
acquire the discrimination between conditions but that
differential responding was not captured within treatment
sessions.
Jonathan took much longer to discriminate between
baseline and S-Delta conditions than James. During baseline
and S-Delta training sessions, every attempt was made to
block the light switches next to the training door. If the
participant was able to tear off the heavy tape restricting
access to the switches, the experimenter would physically
block the participant from reaching the lights by placing her
hand over the light switch plate and turning her face from
Jonathan. It is possible that this served as a form of attention
and increased the duration of training making discrimination
between conditions more difficult. Once light switch play
was no longer blocked, a rapid discrimination between
conditions was obtained. These events may be important to
7 T. Sansbury et al. / Proceedings of UHCL Student Research Projects 1 (2009) 1 - 7
control in future training sessions wherein it may be
necessary to examine all methods of possible attention that
may hinder discrimination between conditions for
participants. As in this case, even a small amount of
attention may have dramatically increased the duration of
training.
One limitation of the study is that although a functional
analysis of problem behavior was conducted for James, no
functional analysis of elopement behavior was conducted.
Although his aberrant behavior was shown to be sensitive to
attention, it is possible elopement was maintained by
another consequence. Due to the severity of the individual’s
elopement at the time of the study, an actual functional
analysis of elopement was not considered feasible.
Likewise, as elopement can be an extremely dangerous
behavior, it is possible students may successfully elope from
the training setting before staff are able to block, placing
participants at risk for injury during training sessions.
Although an overall reduction in elopement attempts
occurred when S-Delta stimuli were added to conditions, the
treatment did not address elopement in areas where the
response cannot be blocked or ignored (i.e., mall). Further
research should examine safer treatment options for the
reduction of elopement behavior through the use of
discriminative stimuli to reduce elopement attempts in an
effort to keep individuals close to care providers. Although
no reliable data were collected on elopement attempts out of
session, further research should examine ways to effectively
reduce elopement attempts demonstrated by participants
outside of sessions during treatment as this places
individuals at increased risk.
The results of the present study suggest the use of SDelta stimuli indicating the maintaining reinforcer is not
available for elopement attempts maintained by attention
may offer a practical and way to reduce elopement.
However, given the limitations mentioned, further study
should be conducted to increase the autonomy and safety of
these individuals. As elopement is a dangerous behavior
resulting in risk to student safety, the expansion of the
literature on ways to reduce this type of aberrant responding
would be beneficial.
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