Research in Developmental Disabilities 28 (2007) 353–361
Functional assessment of challenging behavior:
Toward a strategy for applied settings
Johnny L. Matson *, Noha F. Minshawi
Department of Psychology, Louisiana State University, 236 Audubon Hall Baton Rouge,
LA 70803-5501, United States
Received 28 August 2005; received in revised form 1 December 2005; accepted 5 January 2006
Abstract
The development of experimental functional analysis and more recently functional analysis checklists
have become common technologies for evaluating antecedent events and the consequences of problematic
behaviors. Children and developmentally disabled persons across the life span with challenging behaviors
have been the primary focus of this research. The primary purpose of this paper is to present an overview the
developments in this rapidly expanding research literature, particularly as it involves the application of the
functional assessment paradigm in applied settings where resources and time are scarce. Implication of the
functional assessment research for clinical practice are discussed along with strengths and weakness of the
current technology.
# 2006 Elsevier Ltd. All rights reserved.
Keywords: Functional analysis; QABF; Experimental functional analysis
1. Functional assessment of challenging behavior: toward a strategy of application in
applied settings
The purpose of functional assessment in the applied literature has been to identify maintaining
contingencies for aberrant or challenging behavior in the person’s environment (O’Reilly, 1997).
A variety of means for establishing these operations have been described. Most frequently
studied in terms of number of papers have been analogue sessions, where direct observation of
potential maintaining variables systematically manipulated by the experimenter occurs. This
methodology has also been referred to as experimental functional analysis (EFA). A steady
stream of articles have appeared over the past 20 years, refining methods, and describing various
* Corresponding author.
E-mail address: johnmatson@aol.com (J.L. Matson).
0891-4222/$ – see front matter # 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ridd.2006.01.005
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J.L. Matson, N.F. Minshawi / Research in Developmental Disabilities 28 (2007) 353–361
applications of this technology. Length of time of the assessment and other technical constraints
have resulted in abbreviated versions of this technology and have resulted in other researchers
attempting to develop alternative methods of identifying maintaining variables.
More recently, checklists that describe the conditions presented in the experimental functional
analysis literature have emerged. Most notable among these scales are the motivation assessment
scale (MAS) and Questions About Behavior Function (QABF). These scales provide an
additional dimension to the overall literature. The number of studies using these measures,
particularly the QABF, is increasing.
Scatter plots have also been mentioned. The classic paper of Touchette, MacDonald, and
Langer (1985) is the model for application of this technology in many applied settings. However,
while this method has received attention in applied settings, it has been virtually ignored in the
research literature. Therefore, the psychometric properties for accurately establishing
maintaining operations of problem behavior with this approach are unknown. Additionally,
given this paucity of research, scatter plots will not be a focus for this review. There simply is not
a sufficient literature to review.
A fourth method that also has considerable promise is the functional analysis interview
(O’Neill et al., 1997). With this method, the clinician can ask a series of semi-structured
questions with open ended answers as a means of determining environmental events, medical
conditions and other mediating factors that could lead to the person’s challenging behaviors. As
with scatter plots, a research literature has not been established to validate this approach to
functional assessment. Promise exists, however, and hopefully some innovative scholars will
explore the topic in the future. As with scatter plots, though, structured interviews will not be the
focus of this review given the lack of data based studies.
At present then, researchers and practitioners are guided toward EFA and/or checklists as a
means of conducting functional assessments with established psychometric properties. As the
area evolves and efforts to apply these methods in the broad context of school, community living
and institutional settings grow, pragmatic issues of implementation become of greater and greater
concern. The development and application of these two means of functional assessment and their
application in applied settings will be the focus of our review.
2. Experimental functional analysis
The first demonstration of a functional analysis according to Risley (2005) was reported by
Montrose Wolfe and associates (Wolfe, Birnbauer, Lawler, & Williams, 1970; Wolfe,
Birnbauer, Williams, & Lawler, 1965). They treated a severe behavior problem, vomiting, which
the authors demonstrated was maintained by escape (returning her to the dormitory). The focus
on identifying maintaining variables for learning-based treatments has a long history relative to
the application of behavioral methodology in general. However, a focused technology on
functional assessment research did not begin to develop until almost 20 years after this study was
published.
Brian Iwata and his associates have been the primary drivers behind the development of the
EFA technology. While others have published early work on the topic (Carr, 1977; Carr,
Newsom, & Binkoff, 1980), the paper by Iwata, Dorsey, Slifer, Bauman, and Richman (1982)
was the key publication that most authors point to as the seminal early paper on the topic. In this
paper, the authors described the application of operant technology to the environmental events
via in vivo presentation of various antecedent and consequent events. This early paper was based
on nine persons with developmental disabilities and self-injurious behavior. The three conditions
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to which each individual was exposed were play materials (present versus absent), experimental
demands (high versus low) and social attention (absent versus noncontingent versus contingent).
This study was followed by many others. Iwata and associates are to be commended for their
persistence in publishing on the topic. Without their efforts, the functional assessment literature
as we know it would have been unlikely to develop or it would have developed at a much slower
rate.
Hanley, Iwata, and McCord (2003) suggested that functional analysis has become the
hallmark of behavioral assessment. We would not go that far, but certainly it is a topic that has
received a great deal of attention, particularly in the Journal of Applied Behavior Analysis, where
these authors report that 180 of the total 277 studies using this methodology have been published.
The trend in this regard shows no sign of slowing.
With some modifications, most studies have used the EFA procedures described by Iwata et al.
(1982). Assessment sessions are conducted in an analogue setting where the person’s challenging
behavior or behaviors can be directly observed. The person is presented with a control condition,
play condition and two to four experimental conditions consisting of escape (from the presenting
stimuli), being left alone, being given attention for the challenging behavior, and being given a
tangible item when the maladaptive behavior occurs. Often the tangible is a food item. In Derby
et al. (2000), for example, where children with potential multiple functions of their maladaptive
behavior existed, 10 sessions of each condition were conducted. We calculate this as 30–50
sessions per child, a very labor-intensive method.
Using variations of the method described above, many studies with young children have been
conducted (e.g., Broussard & Northup, 1997; Fisher, Adelinis, Thompson, Wordsell, & Zarcone,
1998; Kennedy, 1994; Martin, Gaffan, & Williams, 1999; Thompson, Fisher, Piazza, & Kuhn,
1998). Additional efforts have also been made to expand this technology to other groups. For
example, Carr, Hatfield, Austin, and Bailey (1998) found that attention was a maintaining
variable for the aggression of a 33-year-old female diagnosed with severe mental retardation and
organic psychosis.
These studies typically include two to four participants, rarely more. However, the sheer
number of studies conducted with the EFA technology suggests that many, if not most,
individuals assessed will display some form of maintaining function. Some research has also
been conducted linking intervention to these assessment data. However, this literature is much
more limited than the research on identifying maintaining variables only.
The impracticality of the EFA in most settings, due to the substantial resource and time
allotments needed (Moore et al., 2002), has been tacitly acknowledged by those in the applied
behavior analysis area. This acknowledgement is best exemplified by efforts to develop a ‘‘brief
functional analysis’’ (Northup et al., 1991; Wallace & Knights, 2003). Basically, the major
modification involves shortening session length. For example, Wallace and Knights (2003)
described an extended or standard functional analysis presentation of a condition from 10 to
12 min. Even so, they described 27–34-condition presentation for their participants. We calculate
54–68 ‘‘in session’’ minutes in the brief EFA versus 270 (4.5 h) to 340 (5.7 h) ‘‘in session’’ for the
extended assessment. These calculations do not count set-up time, training of the assessment
personnel, time between conditions, etc., therefore, a conservative estimate is that a brief
assessment may take 2–3 and 6–8 h for a standard assessment to complete, versus 15–20 min for
a checklist. Additionally, the checklist does not require an assessment room, reinforcers (which
many agencies do not have the money to buy) or the same level of staff training.
Other compelling reasons to look for alternatives to the EFA at least for most applied
applications, has led to the development of scaling methods for a functional assessment. Scaling
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has a long established tradition in psychology, and has been used to assess a wide range of areas
from intelligence to psychopathology to social skills (Anastasi & Urbina, 1997).
3. Checklists for functional assessment (CFA)
While the EFA technology has much to recommend it, the labor-intensive nature of the
procedure and the high level of expertise needed to carry out the methods have limited its utility.
As a result, investigators have explored alternative means of acquiring the same type of
information on maintaining variables. The primary rules of operation are that the method must be
fast and require minimal expertise. A method of this sort would be a major success, even if only a
handful of cases could be correctly identified, since such a result would allow for more resource
allocation to more difficult/complex cases with respect to maintaining variables. As noted,
functional analysis interviews and scatter plots have been two methods researchers have
proposed to fill this niche. However, to date research on these methods has not been forthcoming.
The same cannot be said of checklists.
3.1. Motivation assessment scale (MAS)
The MAS (Durand & Crimmins, 1988), has earned the distinction of being the first functional
assessment checklist to appear in the literature. As a result, these authors deserve the credit for
establishing the potential value of this assessment method for identifying maintaining variables
for challenging behaviors. The MAS consisted of questions aimed at determining if attention or
other variables could be identified for challenging behavior.
Reliability studies carried out soon after the development of the MAS proved to be
disappointing (Newton & Sturmey, 1991; Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991).
However, the scale was a very important first step in establishing an alternative to EFAs in clinical
settings.
3.2. Questions about behavior function (QABF)
The MAS was an important new development since it provided the first practical means of
conducting a functional assessment of client problem behavior on a broad scale in applied
settings. However, psychometric problems with reliability surfaced and validity data was not
established. Enter the QABF (Matson & Vollmer, 1995), which included the primary functions
established via the EFA literature but using a format similar to the MAS.
At this writing, the QABF has a substantial data base to support its use in applied settings. This
scale consists of 25 items rated from one to three, occur to does not occur. Five factor analyzed
subscales have been established: escape, attention, nonsocial, tangible and problem behavior
related to pain (Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2000). In Paclawskyj et al.’s
(2000) experiment, 34 persons with severe or profound ID were tested on test–retest reliability
and 57 people were tested for interrater reliability. Pearson product–moment correlations on test–
retest were .795–.990 ( p < .01) for total and subtest scores. Using the same calculation methods,
interrater reliability was also uniformly high. In the second experiment, Paclawskyj et al. (2000)
studied 243 adults with severe or profound ID to test the internal consistency of the subscales.
Coefficient alpha for subscale scores ranged from .9 to .928 and the total score coefficient alpha
was .601. These latter data are good in that subscale internal correlations should be higher than
the total score. If this were not the case, statistically speaking, one would not have subscales.
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Additionally, reliability data has been collected with acceptable test–retest, interrater and internal
reliability (Shogren & Rojahn, 2003).
Nicholson et al. (in press) in the most recently conducted assessment of psychometric properties
of the QABF completed a scale for 118 problem behaviors (mean of 2.95 per individual) across 20
intellectually disabled persons between 10 and 26 years of age and averaging 17.6 years. The
authors concluded that item and subscale interrater reliability were modest but exceeded those of
comparable assessments. They also concluded that interrater agreement was higher for higher rated
behavior and lower for maladaptive (versus disruptive or destructive) behaviors. Their factor
analysis replicated a previous analysis (Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2001).
Internal consistency of the scales was high. In Matson, Bamburg, Cherry, and Paclawskyj (1999)
they generally reported higher reliability than from Nicholson et al. (in press). The authors noted at
this latter study that their raters had less formal training and bachelors level or direct care staff
versus masters level psychologists were employed. This factor may have been a contributor.
However, we suspect that an even bigger issue is that Matson et al. (1999) studied persons with one
problem behavior while Nicholson et al. (in press) studied persons with multiple problem
behaviors. It is likely that this variable might be quite important in any efforts to establish
maintaining operations of a problem behavior. This issue certainly warrants further investigation
regardless of the functional assessment methodology used.
Psychometric properties of the QABF have also been extended to the mentally disabled
population. Singh et al. (in press) tested 135 adults with serious mental illness from three
inpatient psychiatric hospitals. Their factor analysis was identical to the Paclawskyj et al. (2000)
findings. Across the five factors of physical discomfort, social attention, tangible reinforcement,
escape and non-social, interrater reliability ranged from .96 to .98 and Pearson r test–retest
reliability ranged from .86 to .99. Coefficient alpha suggested substantial internal consistency
(.84 to .92) for the target behaviors of aggression and property destruction. The authors also
pointed out that while analogue functional analyses have considerable utility for persons with
developmental disabilities, it would not be possible to use this method for those of normal
intellectual functioning and mental illness on practical grounds.
The validity study that best supports the utility of the QABF in applied settings included a
sample of 398 adults with intellectual disability (Matson et al., 1999). From this sample, 118
individuals evinced self-injury, 83 had aggression and 197 evinced stereotypies. Persons with
more than one of these three challenging behaviors were excluded to ensure a clearer test of
function. The QABF resulted in establishing a function for 83% of the self-injury group, 74% of
persons with aggression and 93% of those in the stereotypy group.
Past two of the study tested 180 people, 60 with each of the three challenging behaviors. Thirty
persons with self-injury, aggression or stereotypy had behavioral treatment based on functions of
the behavior identified with the QABF, while 30 in each challenging behavior group were
prescribed an intervention package of interrupting the aberrant behavior, blocking the behavior,
and redirecting the person to an appropriate task. Treatment was over 6 months, which is
significantly longer than most studies using functional assessment and the persons treated were
adults, in real world settings who evinced these challenging behaviors for many years. Again, this
research differs from many of the functional assessment studies where young children with very
mild problem behaviors are assessed. The result from the study demonstrated significantly
greater effects, with the treatments tailored to the function of the problem behavior versus a
general treatment package. In this respect, the QABF data support validity studies using EFA
procedures. That is, functional assessment is helpful in tailoring more efficient and effective
treatment to client problems.
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Some overlap in EFA and QABF results have been noted, which is good news for the clinician
who is short on time and resources. Paclawskyj et al. (2001) evaluated the convergent validity of
the QABF with EFA and MAS data. They studied 13 adults with profound intellectual disabilities
who evinced self-injury, aggression and stereotypies. The QABF resulted in identification of 16
primary functions for problem behavior, with the challenging behavior of three people having
two primary functions. The EFA which followed parameters established by Iwata et al. (1982)
resulted in 13 primary functions being identified, with two primary functions for 3 of 10 cases.
Overlap of the two methods producing the same function was 56%. However, when the cases
with no identified function by either method were excluded, a 75% overlap in identified functions
was noted.
Hall (in press) assessed four adults with intellectual disability using the QABF and EFA using
the Iwata et al. (1982) methodology. Hall (in press) reported agreement in identify problem
behavior antecedents at 75%, replicating Paclawskyj et al. (2001) data.
More recently, behaviors other than property destruction, aggression, self-injury and
stereotypy have been studied with the QABF. As such, these data follow similar efforts in the
EFA literature where a host of target behaviors have been assessed (e.g., Carr, Sidener, & Sidener,
2005; Girolami & Scotti, 2001; Valdovinos, Roberts, & Kennedy, 2004). For example,
Applegate, Matson, and Cherry (1999) studied 30 people with pica and 18 with rumination.
Nonsocial was the dominant function identified.
Matson et al. (2005) studied 125 intellectually disabled people with pica, rumination, food
stealing, food refusal and mealtime problems (e.g., aggression, self-injury). Escape was most
often associated with food refusal and mealtime problems, pica and rumination were most often
associated with a non-social function, while a tangible function typically motivated food stealing
and food refusal. Food refusal appeared to be due to physical discomfort in most cases.
The QABF, by its nature, is brief and fairly general. This goal is also accomplished by using a
Likert three-point rating scale. As a result, some functions of maladaptive behavior may not be
identified. As a result, Matson et al. (2003) have developed a forced-choice functional analysis
scale, the functional assessment for multiple CausaliTy (FACT), to be used when the QABF does
not yield a clear function. Internal consistency in this initial study was good to excellent and the
factor structure was similar to the QABF. However, additional research on the value of this
measure in identifying function or functions of maladaptive behavior are under way.
3.3. Clash of methodologies
How professionals at this point choose to do a functional assessment appears to have as much
to do with one’s theoretical world view of clinical practice as it does data. Those who espouse a
strong orientation toward applied behavior analysis are likely to rely almost exclusively on EFA
methodology. Checklists are indirect measures of behavior, and are subject to the inaccurate
perceptions of the rater/informant, a valid criticism. Persons with a more ‘‘traditional’’ view of
psychometrics are likely to be concerned, but less concerned than those with a strong applied
behavior analysis perspective relative to this point.
For those who are most interested in applied behavior analysis methodology, there is an
implicit assumption that the EFA methodology is superior to other methods. For example,
checklists are referred to as ‘‘supplemental functional assessments’’ (Hanley et al., 2003). We
would argue that such value laden judgments await further empirical verification. At this point,
the small amount of studies making direct comparisons between EFA and CFA or which test CFA
reliability and validity lead to the opposite conclusion. However, researchers await further
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confirmation of methods for given problems and topographies of behavior to determine what
means are best for a given person’s problems.
The time commitment of the EFA technology is hard to get around. Thus, even the most ardent
EFA proponents have recently been experimenting with ‘‘brief EFA’’ methods (e.g., Wacker,
Berg, & Harding, 2004; Wallace & Knights, 2003). Again, EFA technology may prove to be
superior to CFA methods in some instances once the research is complete. However, the time and
expertise needed by the assessor is hard to overcome.
The EFA has other problems that also warrant attention in the future. For example, the
repeated presentation of maintaining contingencies may identify maintaining variables but it is
also possible that the assessment may strengthen existing maintaining factors and/or introduce
new ones. Second, by the nature of the assessment, the maladaptive behavior is introduced and
then reinforced. This procedure may result in increased rates of the maladaptive behavior for
some period of time following termination of the EFA. As a result, clients and staff in the
immediate proximity of the person being assessed are at some additional risk for personal
harm when aggression, self-injury and noncompliance are evaluated. Third, as Singh et al. (in
press) noted, adults with normal intellectual functioning and possibly some individuals with
ID as well, are likely to ‘‘figure out’’ the parameters of the EFA and refuse to participate.
Fourth, ratings are based on direct observations, but direct observations in a highly contrived
analogue setting. Tasks, the room and the staff who are interacting with the individual are not
typical. Thus, generalizability of the results to real world situations cannot be assumed. Fifth,
very high intensity, low frequency behaviors (e.g., severe aggression) are unlikely to be
evinced during the assessment. If the behavior is elicited it is likely to result in durations far
longer than the brief 2–10 min sessions typically used as assessment conditions. The risk of
harm for client and staff would be considerable. Sixth, while the validity of EFA technology
has to some degree been established in small N studies where identified maintaining functions
have been established, much more needs to be done before EFA can be described as a valid
technology. To our knowledge, no group comparisons of EFA to no functional assessment
studies have been conducted. While a massive study such as the validity paper of Matson et al.
(1999) is unlikely, group data with smaller group sizes would still be a substantial addition to
the literature.
Functional assessment appears to be evolving into two camps, those who prefer EFA and those
who prefer CFA technology. The EFA methods are more likely to find wide acceptance in
smaller, more labor intensive applied settings, such as small university-based inpatient units and
private schools for children with developmental disabilities. CFA methods have become more
popular in developmental centers, group home operations and more recently inpatient psychiatric
hospitals, where fewer resources are available. The field of developmental disabilities is large,
and there appears to be plenty of room for both methodologies. The more immediate issue is to
make practitioners aware of the benefits of functional assessment methods in assessment and
treatment. Much ground has yet to be covered in this regard.
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