functional communication training in school setting article

1 page summary of article attached

https://doi

org/10.1177/10983007221126530

Journal of Positive Behavior
Interventions
1 –14
© Hammill Institute on Disabilities 2022
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Literature Review

Over the past several decades, the number of students with
disabilities who are educated in inclusive school settings
alongside their same-age peers without disabilities has
increased, with 64.8% spending 80% or more of their school
day in inclusive settings during the 2018–2019 school year
(U.S. Department of Education, 2021). However, the
subgroup of students with intellectual and developmental
disabilities (IDD; e.g., intellectual disability [ID], autism
spectrum disorder [ASD], multiple disabilities) continues to
spend a majority of their day in separate special education
settings (U.S. Department of Education, 2021). Only 17.3%
of students with ID, 40% of students with ASD, and 14.2%
of students with multiple disabilities were included in inclu-
sive school settings for 80% or more of their school day
during the 2018–2019 school year (U.S. Department of
Education, 2021).

Education received primarily in separate special educa-
tion settings is problematic as students with IDD may ben-
efit from inclusive education in a number of ways,
including more time engaged in academic tasks (e.g.,
Kurth & Mastergeorge, 2012), greater academic achieve-
ment (e.g., Gee et al., 2020), improved communication

skills (e.g., Kleinert et al., 2015), and greater access to
opportunities for interaction with peers and social skills
practice (e.g., Feldman et al., 2016). Likewise, students
with IDD may experience improvements in challenging
behavior when behavioral supports are implemented in
inclusive school settings (Lory et al., 2020; Walker,
Chung, & Bonnet, 2018).

Despite these potential benefits, several barriers to
accessing inclusive school settings for students with IDD
have been identified, including negative adult perceptions
of student competency, district policy, disadvantaged socio-
economic status, and race (Agran et al., 2020; Kurth et al.,
2016). In addition, challenging behavior—a factor most

1126530 PBIXXX10.1177/10983007221126530Journal of Positive Behavior InterventionsMasud et al.
review-article2022

1University of North Carolina at Charlotte, Charlotte, USA
2Kansas University Center on Developmental Disabilities, Lawrence,
USA

Corresponding Author:
Andy B. Masud, Department of Special Education and Child
Development, University of North Carolina at Charlotte, 9201
University City Blvd., Charlotte, NC 28223, USA.
Email: amasud@uncc.edu

Functional Communication Training in
Inclusive School Settings for Students
With Intellectual and Developmental
Disabilities: A Literature Review

Andy B. Masud, MAT1 , Virginia L. Walker, PhD, BCBA-D1 ,
Megan E. Carpenter, PhD, BCBA2, and Ashley Anderson, MEd, NBCT1

Abstract
Functional communication training (FCT) is a well-established, evidence-based practice used to address challenging behavior
among individuals across settings, ages, and disability categories. However, the research is limited on the implementation
of FCT in inclusive school settings for students with intellectual and developmental disabilities. The purpose of this review
was to summarize FCT intervention studies implemented in inclusive K–12 school settings for students with intellectual and
developmental disabilities. We synthesized studies to summarize study characteristics, quality, and intervention effectiveness.
Our findings suggest that FCT was most often implemented as part of a multi-component intervention package and delivered
by educational team members. Furthermore, the quality of most studies was either acceptable or strong. The overall effect
size estimate for primary dependent measures as measured by Tau-U suggested large to very large changes in student
behavior. We present implications for practice specific to educational teams that support the behavioral needs of students
with intellectual and developmental disabilities in inclusive settings and offer avenues for future research.

Keywords
intellectual and developmental disabilities, functional communication training, inclusion, functional behavior assessment

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2 Journal of Positive Behavior Interventions 00(0)

relevant to this study—is often cited as a barrier to inclusive
school settings for this student population (Roberts &
Simpson, 2016; Walker, Loman, et al., 2018). Attitudinal
barriers related to challenging behavior also may play a role
in access to inclusive settings. For example, Bambara et al.
(2009) found that some educational team members may not
view students with disabilities who engage in challenging
behavior as valued members of the school community and
may believe these students are better served in separate spe-
cial education settings. Likewise, Lohrmann and Bambara
(2006) found that some general education teachers reported
that “severe” challenging behavior cannot be addressed
appropriately in the inclusive, general education classroom.
More recently, Jury et al. (2021) found that middle and high
school teachers’ attitudes toward the inclusion of students
with ASD were the most negative when students exhibited
challenging behavior.

The current research base offers compelling evidence
suggesting that challenging behavior can be addressed suc-
cessfully in inclusive school settings for students with IDD
through the implementation of well-established, evidence-
based practices (EBPs), such as a function-based interven-
tions. For example, Walker, Chung, and Bonnet (2018)
conducted a review of studies in which function-based
interventions were delivered in inclusive school settings to
students with disabilities. Results indicated that interven-
tions were largely effective at decreasing challenging
behavior and increasing appropriate behavior and were
viewed as socially valid among educational team members.
In a more recent review, Lory et al. (2020) examined stud-
ies involving a range of interventions, including function-
based interventions, to address challenging behavior
displayed by students with IDD in inclusive school settings.
The authors reported favorable student outcomes, indicat-
ing that behavioral interventions for students with IDD can
be successfully delivered in these setting

Although these reviews provide the field with important
information about a range of behavioral interventions,
including function-based interventions, delivered in inclu-
sive school settings, they did not specifically examine func-
tional communication training (FCT), an EBP for addressing
challenging behavior among individuals with IDD (Gerow
et al., 2018). Functional communication training is a func-
tion-based intervention that relies on differential reinforce-
ment procedures whereby specific desirable behaviors are
reinforced while challenging behavior is placed on extinc-
tion (Cooper et al., 2020). This process is implemented to
teach socially appropriate communicative behavior to
replace challenging behavior (Carr & Durand, 1985). This
replacement behavior, known as a functionally equivalent
communication response (FCR), serves the same function
as challenging behavior as identified through a functional
behavior assessment (FBA). Functional communication
training can be implemented as an intervention in isolation

(i.e., FCT only) or as part of a multi-component interven-
tion package implemented in conjunction with other inter-
ventions (e.g., FCT + self-monitoring, FCT + visual
schedule).

Reviewing the existing research on FCT for students
with IDD, specifically in inclusive school settings, is impor-
tant because FCT is a highly effective intervention, it works
quickly to improve behavior, and it is applicable to all
behavioral functions (Tiger et al., 2008), making it broadly
applicable for students with IDD. Functional communica-
tion training also can be developed and implemented suc-
cessfully in schools by educational team members (i.e.,
teachers, paraprofessionals, related services providers;
Andzik et al., 2016; Walker, Lyon, et al., 2018). As such, it
is important to examine whether FCT is effective across a
range of school settings, particularly in inclusive settings
that offer a host of benefits to students with IDD.
Furthermore, teaching socially appropriate behavior and
developing interventions based on FBA outcomes—two
critical aspects of FCT—are considered high-leverage prac-
tices that are important for effective teaching and student
success in inclusive classrooms (McLeskey et al., 2022).
Finally, information about the specific conditions under
which FCT has been successfully implemented for students
with IDD in inclusive school settings, including the role of
educational teams in planning and implementing FCT,
should be explored to inform implications for planning FCT
interventions and future research initiatives.

Given the benefits of education in inclusive school set-
tings for students with IDD and the importance of imple-
menting EBPs to support the behavioral needs of students in
inclusive school settings, we conducted a systematic litera-
ture review of FCT interventions implemented in inclusive
school settings for students with IDD. Our research ques-
tions were as follows:

Research Question 1: What are the characteristics of
the student participants (e.g., grade level, gender, dis-
ability category), FCT interventions (e.g., prompt and
prompt fading procedures, FCT implementation setting),
and implementer training (e.g., role of trainer, training
dosage) among studies included in the review?
Research Question 2: What is the quality of the studies
included in the review?
Research Question 3: What are the overall effects of
FCT intervention and/or implementer training among
studies included in the review?

Method

The purpose of this systematic literature review was to sum-
marize research studies in which FCT was implemented in
inclusive school settings for students with IDD. Each phase
of the review is described in detail in the following sections.

Masud et al. 3

Figure 1 presents an overview of the literature search and
screening processes.

Literature Search Process

We conducted a literature search in June 2021. First, we
searched four relevant online databases using search terms
related to students with IDD (e.g., intellectual disab*,
severe disab*, extensive support need*, developmental
disab*) and FCT (e.g., functional communication training,
functionally equivalent, mand training). These search terms
are outlined in Supplemental Table 1 available on the
Journal of Positive Behavior Interventions website with the
online version of this article. Our search parameters were
limited to articles in English, including dissertations and
theses to reduce concerns of publication bias (Gage et al.,
2017). We placed no parameters on the year of publication
and applied our search terms to the entire text (i.e., not just
the title or abstract). The online database search yielded a
total of 1,582 potentially relevant references as follows: (a)
PsycINFO (n = 740), (b) ERIC (EBSCO; n = 303), (c)
Medline (ProQuest; n = 401), and (d) ProQuest Dissertations
and Theses Global (n = 138).

Second, we conducted a hand search of 23 relevant journals
with potential content pertaining to behavioral interventions

for individuals with IDD (e.g., American Journal on
Intellectual and Developmental Disabilities, Journal of
Applied Behavior Analysis, Journal of Positive Behavior
Interventions, Journal of Special Education). Using the same
search terms, we used each journal’s online search feature to
identify additional references. In total, the hand search
yielded 951 references. These results are outlined in
Supplemental Table 2 available on the Journal of Positive
Behavior Interventions website with the online version of
this article. Third, we conducted a review of reference lists
from 15 prior systematic literature reviews and meta-analy-
ses related to students with IDD and/or FCT. In total, we
identified 220 additional references to consider for inclusion.
Details of these search results are outlined in Supplemental
Table 3 available on the Journal of Positive Behavior
Interventions website with the online version of this article.
Finally, throughout this process, we contacted 50 authors
who had expertise and a publication history in the area of
FCT to request article recommendations for inclusion in the
review. Sixteen authors responded to our query and recom-
mended 13 articles for consideration. After eliminating dupli-
cates and references not relevant to the purpose of the review
(e.g., studies conducted in non K–12 settings, books and
book chapters), a total of 870 references remained for inclu-
sion consideration.

Figure 1. Summary of the Literature Search and Screening Processes

4 Journal of Positive Behavior Interventions 00(0)

Inclusion Criteria

We applied the following inclusion criteria to the abstract
and, when necessary, the full text of each of the 870 refer-
ences to determine whether they were eligible for inclusion
in the review: (a) the intervention included FCT, (b) the
FCT intervention was implemented in a K–12 inclusive
school setting, and (c) the FCT intervention was imple-
mented with at least one student with IDD. Studies were
included if the intervention involved FCT as the sole inter-
vention or FCT as part of a multi-component intervention
package (e.g., FCT + choice making). Any school setting
where peers without disabilities were present (e.g., general
education classroom, recess, cafeteria, specials) was con-
sidered an inclusive school setting. We excluded studies
when generalization and maintenance data were collected
in an inclusive setting, but the FCT intervention did not take
place in an inclusive setting. We also excluded studies that
did not take place in school settings (e.g., clinics, hospitals,
home). We calculated inter-rater agreement (IRA) across
32.5% of references. The first and second authors coded
50% of the references as primary coders and the third and
fourth authors coded 15% of the references selected at ran-
dom as secondary coders. Agreement was 99.3%. Based on
the application of the inclusion criteria, a total of seven
studies were eligible for inclusion in the review.

Data Analysis

We coded each study at the student participant level, only
including those students who met the previously described
inclusion criteria. In this section, we describe the descrip-
tive coding and intervention effect estimate processes.

Descriptive Coding. The first three authors (i.e., a doctoral
student in special education, an associate professor of spe-
cial education, a postdoctoral researcher in special educa-
tion) each served as primary coder for approximately one
third of the included studies and as secondary coder for
another third. Coders used a coding form developed by the
research team (available upon request) as described in the
following sections. We analyzed descriptive data using
descriptive statistics (i.e., mean and range for open-ended
and percentages for closed-ended categories). In some
cases, we selected multiple responses under a given coding
category, and thus percentages may exceed 100%.

Student Characteristics. The student characteristics cod-
ing categories were as follows: student grade level (i.e.,
Grades K–5, Grades 6–8, Grades 9–12), gender, race and
ethnicity, disability category based on the Individuals with
Disabilities Education Act (2004) eligibility categories,
description of educational placement, communication level
(i.e., pre-linguistic, emerging, multiword), communication

mode prior to FCT (i.e., aided augmentative and alternative
communication [AAC], unaided AAC, speech), and form of
challenging behavior prior to FCT (i.e., destructive, disrup-
tive, distracting).

Functional Communication Training Intervention Characteristics.
The FCT intervention characteristics coding categories
included dependent measures reported (i.e., challenging
behavior, FCR, FCT implementation fidelity, other), form of
challenging behavior, FCR communication mode, research
design, FBA tool (i.e., experimental functional analysis,
descriptive FBA [record review, interview, direct observation,
scale/questionnaire]), function of challenging behavior, estab-
lishing operations (i.e., contrived, natural), FBA assessors and
contributors and those involved in developing the FCT inter-
vention (i.e., experimenter, teacher [special education, general
education], therapist, other), prompt and prompt fading proce-
dures (e.g., most-to-least, time delay), consequences for chal-
lenging behavior (i.e., reinforcement, punishment, extinction),
whether reinforcement schedule thinning procedures were
reported, and whether FCT was part of a multi-component
intervention package or a standalone intervention. In addition,
we coded the following: FCT implementation context (i.e., con-
textualized, decontextualized), a description of the physical set-
ting in and/or routine during which FCT occurred (e.g., general
education math classroom), whether trials were massed or dis-
tributed, dosage (i.e., FCT trials per session, sessions per day or
week, duration of FCT implementation), and the role of those
who implemented FCT (i.e., experimenter, teacher [special
education, general education], paraprofessional, other school
professionals [e.g., therapist, related services providers]).

Functional Communication Training Implementer Training
Characteristics. The FCT implementer training characteris-
tics coding categories included the following: whether FCT
implementers were trained, the role of those who delivered
training to the FCT implementers (i.e., teacher [general edu-
cation, special education], therapist, experimenter including
researcher or graduate assistant), training dosage (i.e., num-
ber of training sessions, duration of training in days, weeks,
or months), training context (i.e., contextualized, decontex-
tualized), and training type (i.e., didactic, experiential).

Study Quality. We coded the following quality indicators:
social validity, dependent measure reliability, implementa-
tion fidelity, generalization data, and maintenance data both
on the FCT intervention and the FCT implementation train-
ing. We also determined whether the included studies met
the What Works Clearinghouse (WWC, 2020) standards for
single-case research, following the guidelines from Maggin
et al. (2013). We first determined whether studies met the
design standards using the following criteria: independent
variable was systematically manipulated, dependent mea-
sures were repeatedly measured over time by more than one

Masud et al. 5

observer, inter-observer agreement was measured across
20% or more of the data points in each condition and met
minimal thresholds (i.e., 80% for percent agreement, 0.60
for kappa), and at least three attempts to demonstrate an
intervention effect at three or more different points in time
were present with a minimum of three data points per con-
dition. For those studies meeting the design standards with
or without reservations, we then determined the overall
strength of the evidence using the following criteria: at least
three points per condition were present (score of “2” = five
or more data points, “1” = three to four data points, “0” =
fewer than three data points), at least three demonstrations
of intervention effect were present (score of “2” = yes, “0”
= no), and the ratio of effects to non effects was acceptable
(score of “2” = no instances of non effects, “1” = ratio is
equal to or less than 3:1, “0” = ratio is greater than 3:1).

Intervention Effect Estimates. Following the visual analysis
guidelines described by Ledford and Gast (2018), the sec-
ond and third authors visually analyzed the graphed data to
determine whether there were no effects, mixed effects, or
positive effects for the primary dependent measures across
studies. To supplement visual analysis, the first and fourth
authors calculated Tau-U (Parker et al., 2011) for the pri-
mary dependent measures across all eligible student partici-
pants and the paraprofessional implementation fidelity
measure for Walker et al. (2021). Tau-U is a nonoverlap
effect size metric that addresses undesirable trends in base-
line conditions and is commonly used to estimate interven-
tion effect for single-case research (Parker et al., 2011).
Tau-U scores can be interpreted as a small (<0.20), moder- ate (0.20–0.60), large (0.60–0.80), or large to very large (>0.80) change (Vannest & Ninci, 2015). We first extracted
the raw data values from participant graphs using WebPlot
Digitizer Version 4.5 (Rohatgi, 2021). Second, we calcu-
lated Tau-U in a free, online calculator (Vannest et al., 2016)
by conducting phase contrasts between baseline and inter-
vention conditions and combining contrasts to produce a
weighted, aggregate Tau-U score for each stud

Inter-Rater Agreement. We calculated IRA for all included
studies. The first three authors each served as primary cod-
ers for one third of the included studies and as secondary
coders for another one third. After independently coding,
the primary and secondary coders met to compare coding
forms and discuss any discrepancies. Upon initial compari-
son, the average IRA was 92.9% (range = 81.3%–100%).
Consensus discussion resulted in 100% agreement across
articles and coders.

Results

In the following sections, we present findings from the
descriptive coding with the student participant treated as the

unit of analysis and intervention effect estimate analyses.
Tables 1 to 3 present data at the study level.

Student Characteristics

Table 1 provides information about student characteristics
for each study. Across the seven included studies, 13 stu-
dents with IDD received FCT within an inclusive school
setting. A majority of students (92%) attended an elemen-
tary school, whereas only one (8%) attended a middle
school at the time of the study. Students were primarily
male (85%); only one female student received FCT (15%).
Student disabilities included ASD (69%), ID (46%), and
speech language impairment (8%). Two students (15%)
were described as White and one was described as Black
(8%). However, for most students, race and ethnicity (77%)
were not reported.

Prior to the FCT intervention, students received special
education services in various inclusive settings. Most stu-
dents (77%) spent a majority of the school day in inclusive
settings, whereas the student in the Walker et al. (2021)
study spent a majority of the day in a self-contained setting;
the extent of inclusion was not reported in the Walker and
Snell (2017) study. Students were eligible for FCT interven-
tion based on their histories of engaging in disruptive
behavior (54%), destructive behavior (46%), and/or dis-
tracting behavior (46%). In over half of the cases (54%),
communication level was not described. Likewise, student
communication mode prior to FCT intervention was not
reported for eight students (62%). For those students whose
communication level was described, five (38%) communi-
cated at an emergent level and one (8%) communicated at
the multi-word level. In terms of communication mode, five
students (38%) communicated with speech, one (8%) used
a non-electronic aided AAC system, and three (23%) used
unaided AAC, including gestures (23%) and sign language
(8%).

Functional Communication Training Intervention
Characteristics

Table 2 provides information about FCT intervention
characteristics for each study. Functional communication
training interventions addressed disruptive (85%), destruc-
tive (62%), and/or distracting (62%) challenging behavior.
For most students (62%), the communication mode of the
FCR was not described; in other cases, students were
taught to use aided AAC (23%), unaided AAC (15%), and
speech (8%). In all but one case, students received FCT as
part of a multi-component intervention package in a range
of inclusive settings. Multi-component interventions
always included antecedent strategies (e.g., embed prefer-
ences, provide choices, use visual schedules) and conse-
quence strategies (e.g., extinction of challenging behavior,

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ab

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00

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es

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7)

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at

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la
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id

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;
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m

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99

6)
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id

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co

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ea

ch
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w

is
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sp
ec

ifi
ed

; C
D

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tt

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1)

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ec

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o

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el

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an

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l (

20
17

)
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as

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of
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en

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sc

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F
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R
, F

C
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pl
em

en
ta

tio
n

fid
el

ity
,

ap
pr

op
ri

at
e

be
ha

vi
or

N
ot

e.
C

B
=

c
ha

lle
ng

in
g

be
ha

vi
or

; F
C

R
=

fu
nc

tio
na

lly
e

qu
iv

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en

t
co

m
m

un
ic

at
io

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re

sp
on

se
; F

C
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=
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; C

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=

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d

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te

rn
at

iv
e

co
m

m
un

ic
at

io
n.

8 Journal of Positive Behavior Interventions 00(0)

reinforcement of appropriate behavior). The FCT inter-
ventions were most often implemented in a contextualized
setting (e.g., within an inclusive classroom during natu-
rally occurring routines; 92%) and, in one case (8%), the
specific context in which FCT was implemented was not
reported. General education teachers (54%), paraprofes-
sionals (54%), and special education teachers (31%) pri-
marily were responsible for FCT implementation, with
one student (8%) receiving FCT from educational team
members whose roles were not specified.

All FCT interventions (and other components of the
multi-component intervention package) were developed
based on FBA outcomes. A descriptive FBA, whether used
alone or in conjunction with a functional analysis, was used
to inform intervention development for all students. Both
interviews (100%) and direct observations (100%) were
conducted for all students, with questionnaires or rating
scales used less often (23%). In two cases (15%), an experi-
mental functional analysis was used to guide the FBA. All
FBAs were conducted by experimenters (100%), with fewer
also conducted by teaching staff not otherwise specified
(15%) or a caregiver (8%). The following educational team
members participated in the FBA process by providing
information through interviews, questionnaires, and/or rat-
ing scales: teachers (69%; 77% not described, 22% special
education, 11% general education), teaching staff not other-
wise specified (62%), paraprofessionals (54%), caregivers
(38%), and other team members (i.e., administrator, student
teacher; 15%). Hypothesized functions resulting from FBA
were as follows: attention (46%), tangible (23%), escape
(15%), and multiple functions (15%); in one case (8%), the
function was unclear. The FCT interventions primarily
were developed by experimenters (46%) and teaching staff
not otherwise specified (38%) and, in one case (8%), a spe-
cial education teacher; FCT developer role could not be
determined for 53% of FCT interventions.

Overall, descriptions of the FCT procedures were lim-
ited. For seven students (54%), FCRs were taught using
natural establishing operations, meaning that implementers
waited for the maintaining reinforcer to become valuable as
opposed to setting up conditions to increase the value of the
reinforcer. However, in nearly half of the cases (46%),
information about whether contrived or natural establishing
operations were used to teach the FCR was not described. In
terms of prompting procedures, students were taught the
FCR through least-to-most prompting (8%), most-to-least
prompting (8%), reminders (8%), and examples and nonex-
amples (8%); in nine cases (69%), the prompting proce-
dures were not reported. For eight students (62%),
challenging behavior was placed on extinction as part of the
FCT intervention, and in only one case (8%), time delay
was used as a delayed reinforcement procedure once the
student acquired the FCR. Functional communication train-
ing dosage also was unclear for most students. The number

of trials per session was not described at all, and the number
of sessions per day or week was described in only four cases
(31%) as either one session per day or one to three sessions
per week. The total duration of the FCT interventions was
described for five students (38%; range = 4–19 weeks).
Finally, a multiple baseline or probe design (62%) or a
reversal/withdrawal design (38%) was used to examine
intervention effectiveness.

Functional Communication Training
Implementer Training Characteristics

In seven cases (54%), FCT implementer training was
reported. Among those who received training, a majority of
implementers were trained by an experimenter (86%), with
fewer trained by their district’s behavior team member
(43%) or a special education teacher (29%). Training took
place in both contextualized (57%) and decontextualized
(57%) scenarios and reflected experiential (100%) and
didactic (57%) training practices. Common practices
included delivering instructions, modeling, rehearsing, and
providing performance feedback to the FCT implementer.
Implementer training lasted between 1 and 3 days depend-
ing on the study with training duration not reported in 43%
of cases. The number of sessions varied between one and
three initial training sessions with follow-up support (e.g.,
weekly coaching) provided in 43% of cases.

Quality Indicators

Both the social validity of the FCT interventions and reli-
ability of student dependent measures were measured and
found acceptable across all but one case; because Walker
et al. (2021) focused on paraprofessional training outcomes,
student dependent measures were not reported.
Implementation fidelity was reported and acceptable across
12 cases (92%). Table 3 provides information specific to
measures of generalization, maintenance, and social valid-
ity for each study. Measures of generalization across set-
tings or behaviors and maintenance for student dependent
measures were reported for four (33%) and six (50%) cases,
respectively. Maintenance probes were collected anywhere
between 1 and 6 weeks post intervention. For those cases in
which implementer training was reported, social validity of
the training procedures and reliability of implementer
dependent measures (i.e., implementation fidelity) were
measured in three cases (75%) and acceptable in each case.
Generalization of implementation fidelity was not mea-
sured, but in one case (25%), maintenance data were col-
lected 1 month post intervention.

Results pertaining to the WWC standards are provided in
Table 3. In terms of the design standards, one study met the
standards without reservations, four met the standards with
reservations, and two did not meet the standards. It should

T
ab

le
3

.
Su

m
m

ar
y

of
S

tu
dy

O
ut

co
m

es
a

nd
Q

ua
lit

St
ud

y
W

W
C

D
S

W
W

C
ES

T
au

-U
p

90
%

C
I

V
is

ua
l a

na
ly

si
s

So
ci

al
v

al
id

ity
o

f
FC

T
G

en
er

al
iz

at
io

n
M

ai
nt

en
an

Bl
ai

r
et

a
l.

(2
00

6)
2

2
0.

98
<

.0
01

[0
.7

5,
1

.0
0]

Po
si

tiv
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(3
/3

)
A

cc
ep

ta
bl

e
re

su
lts

A
cr

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s

se
tt

in
gs

N
ot

r
ep

or
te

d
Bl

ai
r

et
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(2

00
7)

1
1

1.
00

< .0

01
[0

.7
4,

1
.0

0]
Po

si
tiv

e
(1

/1
)

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cc

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su

s
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or

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d

1
pr

ob
e

a
w

ee
k

fo
r

6
w

ee
ks

R
ee

ve
s

et
a

l.
(2

01
3)

0
N

/A
0.

96
<

.0
01

[0
.7

1,
1

.0
0]

Po
si

tiv
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(3
/3

)a
A

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lts

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pr
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os

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3

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et

a
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(2
01

7)
1

1
1.

00
<

.0
01

[0
.6

2,
1

.0
0]

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(3
/3

)
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cc
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lts

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ot

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ep

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d
1

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fo

r
3

w
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d

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ai

r
(1

99
6)

0
N

/A
1.

00
< .0 01 [0 .7

3,
1

.0
0]

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(1
/1

)
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cc
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bl

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lts

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cr

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s

re
sp

on
se

s
N

ot
r

ep
or

te
d

W
al

ke
r

et
a

l.
(2

02
1)

1
1

1.
00

0.
04

[0
.2

3,
1

.0
0]

Po
si

tiv
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(1
/1

)
N

ot
r

ep
or

te
d

N
ot

r
ep

or
te

d
N

/A
W

al
ke

r
an

d
Sn

el
l (

20
17

)
1

1
1.

00
< .0 01

[0
.5

9,
1

.0
0]

Po
si

tiv
e

(3
/3

)
A

cc
ep

ta
bl

e
re

su
lts

N
ot

r
ep

or
te

d
N

ot
r

ep
or

te
d

N
ot

e.
W

W
C

=
W

ha
t

W
or

ks
C

le
ar

in
gh

ou
se

; D

S
=

d
es

ig
n

st
an

da
rd

s;
E

S
=

e
vi

de
nc

e
st

an
da

rd
s;

C
I =

c
on

fid
en

ce
in

te
rv

al
; F

C
T

=
fu

nc
tio

na
l c

om
m

un
ic

at
io

n
tr

ai
ni

ng
; N

/A
=

n
ot

a
pp

lic
ab

le
.

a E
ffe

ct
s

qu
es

tio
na

bl
e

gi
ve

n
th

e
lo

w
n

um
be

r
of

d
at

a
po

in
ts

fo
r

tw
o

of
t

he
t

hr
ee

p
ar

tic
ip

an
ts

10 Journal of Positive Behavior Interventions 00(0)

be noted that, because Reeves et al. (2013) included a rever-
sal design replicated across three participants, and one of
the three replications did not meet standards, we coded the
study as not meeting the standards. Of the five studies that
met the WWC design standards with or without reserva-
tions, four studies demonstrated moderate evidence and one
study demonstrated strong evidence.

Intervention Effects

Visual analysis and Tau-U outcomes are presented in Table
3. Visual analysis indicated that positive effects were dem-
onstrated for primary dependent measures across all eligi-
ble student participants and the paraprofessional participant
for Walker et al. (2021). Likewise, the Tau-U scores for the
primary dependent measures represent a large to very large
change (range = 0.96 – 1.00) in outcomes (Vannest &
Ninci, 2015).

Discussion

The purpose of this systematic literature review was to sum-
marize intervention studies in which FCT was delivered to
address challenging behavior among students with IDD in
inclusive school settings. Despite the evidence base sup-
porting the effectiveness of behavioral interventions deliv-
ered in inclusive settings for students with IDD (Lory et al.,
2020; Walker, Chung, & Bonnet, 2018), the current status
of research on FCT implementation, specifically in inclu-
sive school settings for this population, has not been
explored. Because FCT is an EBP for individuals with IDD
(Gerow et al., 2018) and reflects existing high-leverage
practices for inclusive classrooms (McLeskey et al., 2022),
understanding the conditions under which it has been suc-
cessfully implemented in inclusive school settings has
important implications for intervention planning for stu-
dents with IDD who engage in challenging behavior. This is
particularly important for supporting students whose chal-
lenging behavior may serve as a barrier to placement in
inclusive school settings or that interferes with learning and
social opportunities in these settings (Walker, Loman, et al.,
2018). In this section, we highlight several key findings that
have important implications for future research and
practice.

In our review, we identified seven studies that met the
inclusion criteria. All FCT interventions were implemented
in elementary school settings, with the exception of one
that was implemented in a middle school; this finding may
reflect the barriers to inclusion in secondary settings (e.g.,
Carter & Hughes, 2006) that may lead to fewer inclusive
opportunities for secondary students with IDD. Similar to
previous reviews focused on behavioral interventions in
inclusive school settings (Lory et al., 2020; Walker, Chung,
& Bonnet, 2018), our findings suggest that students with

IDD experienced positive outcomes in response to FCT in
inclusive school settings, with Tau-U effect size estimates
for primary student dependent measures representing large
to very large changes in behavior. Encouragingly, we also
found that most of the reviewed studies were of acceptable
quality based on the WWC analysis. Although these find-
ings are promising, it is important to note that, in all but
one study (Walker et al., 2021), the FCT intervention was
part of a larger, multi-component intervention package that
included other antecedent- and consequence-based strate-
gies in addition to FCT that aligned with the identified
behavioral function(s). This is not surprising, as behavior
intervention plans developed by educational teams typi-
cally have multiple components, including FCT to teach an
FCR (e.g., Goh & Bambara, 2012; Walker, Chung, &
Bonnet, 2018).

We also found that students in our review engaged in a
wide range of challenging behavior topographies in the
inclusive setting, including high-priority destructive behav-
iors (62%) such as aggression toward adults or peers, prop-
erty destruction, and self-injury. However, regardless of the
form of challenging behavior, students demonstrated posi-
tive outcomes. These findings are encouraging, as they indi-
cate that educational team members who support students
with complex behavioral needs in inclusive settings may be
able to implement interventions that produce positive stu-
dent outcomes. Similarly, Lory et al. (2020) reported posi-
tive student outcomes across a range of behavioral
topographies and significantly greater improvements in
behavior among students who engaged in “severe” chal-
lenging behavior in inclusive settings. This contradicts
some teachers’ perceptions that “severe” challenging behav-
ior cannot or should not be addressed in inclusive class-
rooms (Bambara et al., 2009; Lohrmann & Bambara, 2006).
Implementing FCT with or without additional intervention
may reduce the risk of student behavior resulting in removal
from inclusive settings to more restrictive settings, where
most students with IDD spend a majority of their school day
(U.S. Department of Education, 2021).

Also notable is that student participants who used a
range of communication modalities during FCT, including
aided and unaided AAC, experienced positive outcomes.
This finding is particularly noteworthy, as previous
research has indicated that students who use AAC may be
at risk for exclusion from general education settings
(Kleinert et al., 2015) despite mounting evidence that chal-
lenging behavior among students with complex communi-
cation needs can be addressed through communication-based
interventions, like FCT, in inclusive school settings
(Walker, Lyon, et al., 2018).

Across the reviewed studies, educational team mem-
bers who regularly support students with IDD in inclusive
school settings were primarily responsible for FCT imple-
mentation, a finding consistent with previous research on

Masud et al. 11

behavioral interventions in inclusive school settings
(Lloyd et al., 2019; Lory et al., 2020; Walker, Chung, &
Bonnet, 2018). In fact, Lory and colleagues (2020) found
that the role of the interventionist moderated student out-
comes, with behavior change significantly greater when
natural school interventionists (e.g., teachers, paraprofes-
sionals) implemented behavioral interventions in inclu-
sive settings. Together, these findings highlight the
importance of providing general education team members,
particularly general education teachers and paraprofes-
sionals, adequate training to implement function-based
interventions (Samudre et al., 2020; Walker et al., 2021).

Although implementer training was described in several
studies, only one study in the current review experimentally
examined effectiveness of implementer training (Walker
et al., 2021). In this study, special education teachers deliv-
ered an initial training session and follow-up coaching con-
sisting of instructions, models, role-play, and performance
feedback to support paraprofessional-implemented FCT.
Like other research focused on training team members in
function-based intervention (Lloyd et al., 2019; Walker
et al., 2021), results from this particular study suggest that
these training methods can be effective in supporting educa-
tional team members in delivering FCT interventions.

Although the WWC appraisal resulted in positive quality
ratings, our findings suggested limited quality in other
areas. For example, measures of maintenance and general-
ization were limited and only one study reported reinforce-
ment schedule thinning procedures after initial FCT
implementation. This is a critical aspect of FCT implemen-
tation (Hagopian et al., 2011) and especially relevant to the
general education setting where it may not be practical to
reinforce every instance of the FCR. In addition, informa-
tion about whether contrived or natural establishing opera-
tions were used to teach the FCR was often missing.

Limitations and Future Research Directions

Although findings from this review provide important
information about FCT implementation in inclusive settings
for students with IDD, there are a few limitations that must
be considered and addressed through future research. Few
studies met our inclusion criteria and, as noted earlier, only
one study explored the effectiveness of FCT as a standalone
intervention, thus limiting knowledge claims about the
effectiveness of FCT in inclusive settings for this student
population. The small number of studies also limited our
ability to conduct moderator analyses to determine whether
study characteristics moderated participant outcomes. A
final limitation was our inability to extract critical informa-
tion about participant and intervention characteristics across
each student participant. For example, student communica-
tion level, student communication mode, and FCR mode
were not always reported in the included studies. Given that

teaching a communicative response is central to FCT, is it
important to understand these particular characteristics, as
they may moderate the effectiveness of FCT, and this infor-
mation has the potential to inform guidelines for FCT
development and implementation. Clear descriptions of stu-
dent participants and FCT intervention characteristics will
be important to include in future research.

Based on our findings, it is evident that additional
research is needed to examine FCT implementation in inclu-
sive school settings for students with IDD who have varying
characteristics across grade levels. In addition, future
research will need to examine how to adequately train and
support educational team members, including general edu-
cation teachers and paraprofessionals, to implement FCT in
these settings. Finally, there is a need for continued work to
explore how establishing operations are used to teach the
FCR in the inclusive setting and the extent to which behav-
ior change persists after FCT is removed and transfers to
other conditions (e.g., other inclusive school settings).

Implications for Practice

Although there were a limited number of studies that met our
inclusion criteria, the results of this review have potential
implications for practice. As previously noted, our findings
indicate that students with IDD experience positive outcomes
in inclusive settings when educational team members deliver
FCT as part of a multi-component, function-based interven-
tion (e.g., FCT + self-monitoring, FCT + visual schedule,
FCT + choice making). This further supports the evidence
base establishing function-based interventions as highly
effective compared with interventions that are not aligned to
behavioral function (e.g., Goh & Bambara, 2012; Jeong &
Copeland, 2020). Given that challenging behavior may serve
as a significant barrier to academic instruction, social oppor-
tunities, and access to inclusive settings (Roberts & Simpson,
2016; Walker, Loman, et al., 2018), it is critical for educa-
tional teams to prioritize function-based interventions,
including FCT, to promote meaningful access and participa-
tion in these settings.

Another implication relates to how FCT interventions
are developed and implemented specific to the inclusive
context. In all but one study, educators (e.g., paraprofes-
sionals, teachers) implemented FCT in the inclusive setting.
However, fewer educators were involved in conducting the
FBA or developing the intervention plan. It will be neces-
sary for educational teams to ensure that behavioral inter-
ventions are socially valid from the perspectives of multiple
stakeholders (e.g., general education teachers, paraprofes-
sionals, students receiving FCT) and have good contextual
fit for the inclusive setting. Collaborative teaming and
effective training also will be necessary to support effective
FCT intervention development and implementation in the
inclusive setting. Because factors related to the values and

12 Journal of Positive Behavior Interventions 00(0)

abilities of educational team members, classroom needs,
and resources available in the inclusive setting may affect
implementation success (Monzalve & Horner, 2021), edu-
cational team members will need to take these into careful
consideration as they plan FCT interventions. Educational
teams should include those who will directly support stu-
dents (e.g., general education teacher, paraprofessional) and
have expertise in FCT and/or a clear understanding of stu-
dent characteristics (e.g., behavior specialist, school psy-
chologist, special education teacher).

By including all stakeholders, educational teams can
benefit from diverse perspectives and expertise needed to
understand a student’s learning history and FCT goals to
select the appropriate communication mode and instruc-
tional approaches to teach the FCR. The FCR should not
only be more efficient than student challenging behavior
but also align to the student’s communication abilities and
needs (e.g., communication level, communication mode).
As such, educational teams may find it valuable to include
a speech language pathologist who can lend their expertise
in this area. Unfortunately, the specific prompting strategies
used during FCT were not reported in most of the reviewed
studies and thus, we are unable to recommend specific
instructional strategies based on our findings. However,
teams should consider the range of instructional approaches
that have been successfully implemented in previous FCT
research (e.g., system of least prompts, time delay; Tiger
et al., 2008; Walker, Lyon, et al., 2018). Because the pres-
ence of an establishing operation is critical to FCT imple-
mentation, teams will need to determine whether natural
establishing operations (i.e., waiting for the maintaining
reinforcer to be valuable) and/or contrived establishing
operations (i.e., setting up conditions to increase the value
of the reinforcer) is contextually appropriate for the inclu-
sive setting. Although using natural establishing operations
can enhance generalization, education teams may need to
plan for additional opportunities to implement FCT using
contrived establishing operations to increase speed of
acquisition (Tiger et al., 2008). Furthermore, after the edu-
cational team develops the FCT intervention, implementers
unfamiliar with FCT will require training to support their
implementation efforts. Prior research suggests that imple-
menters may require ongoing support before reaching
acceptable levels of implementation (Walker, Lyon, et al.,
2018). Educational teams will need to determine who will
deliver this training and select training approaches (e.g.,
behavioral skills training, coaching with performance feed-
back) that are both effective and contextually appropriate.

Conclusion

Given that students with IDD can benefit from access and
meaningful participation in a range of inclusive school set-
tings, it is important to ensure that EBPs are implemented in

these settings to support students’ behavioral needs. This
review focused on describing the characteristics of studies
involving implementation of FCT, an EBP for individuals
with IDD (Gerow et al., 2018), in inclusive school settings.
Our findings provide preliminary evidence that FCT as part
of a multi-component intervention package can produce pos-
itive student outcomes when implemented by educational
team members in these settings. However, given that few
studies have examined this particular topic and only one
study explored effective training practices for those respon-
sible for FCT implementation in inclusive settings, additional
research is needed to expand the current literature base.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.

Funding

The author(s) received no financial support for the research,
authorship, and/or publication of this article.

ORCID iDs

Andy B. Masud https://orcid.org/0000-0001-8890-0975

Virginia L. Walker https://orcid.org/0000-0003-3248-7290

Supplemental Material

Supplementary material is available on the webpage with the
online version of the article.

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