Resurgence

Resurgence involves three parts of a history

A standard laboratory arrangement has three phases:

1. A target response produces reinforcement.
2. The target response decreases while a different response produces reinforcement.
3. Reinforcement for the alternative response worsens, and the earlier response returns or increases.

Clinical care rarely follows a perfectly controlled sequence. A communication response may initially produce immediate help, a break, attention, or access. Later, partners may respond more slowly, the schedule may be thinned, a device may be unavailable, or the setting may change. The earlier response can recur under those conditions.

The BACB BCBA Test Content Outline, 6th edition covers operant extinction, unwanted effects, generalization, maintenance, relapse, and function-based intervention. It is examination content rather than an individual relapse protocol.

Several forms of relapse look similar

An extinction burst is an early increase when a response first stops producing its maintaining reinforcer. Resurgence follows a history in which a more recent alternative response was reinforced and its reinforcement then worsens.

Renewal is a return associated with a context change after reduction elsewhere. Spontaneous recovery occurs after time passes. Reinstatement follows presentations of the reinforcer outside the prior response-reinforcer relation. Everyday events can include more than one process, and uncontrolled data may support several explanations.

A broad relapse review describes these experimental arrangements and their limits for clinical prediction (Kimball and colleagues). Label the sequence, context, and evidence rather than treating any recurrence as a known mechanism.

Schedule thinning can create a resurgence test

Functional communication training often begins with reliable reinforcement for an accessible message. Schedule thinning later introduces longer waits, periods of unavailability, or greater task requirements. A large or poorly supported change can make the earlier response competitive again.

In one retrospective analysis of FCT schedule thinning for destructive behavior, Briggs and colleagues identified resurgence in 19 of 25 applications, or 76%, and 47 of 111 schedule transitions, or 42%. The applications came from a defined clinical cohort and used the study's resurgence criterion. These rates do not predict other people, responses, settings, or treatments.

An analysis of two case series found larger decreases in alternative-reinforcement availability were associated with larger resurgence (Shahan and Greer). This retrospective association does not establish a universal dose-response rule.

An updated schedule-thinning review summarizes six consecutive controlled case series with 146 applications and reports that resurgence occurred in an average of 73% of applications. The review discusses gradual pacing, reinforcer quality, magnitude, immediacy, competing activities, and other design variables. Its recommendations require case-specific review.

Prepare before reinforcement changes

Define:

• the target and alternative responses
• what counts as a worsening of alternative reinforcement
• the schedule step, setting, and partner involved
• communication and ordinary supports that must remain available
• the person's assent, dissent, comfort, and preferences
• progress, pause, rollback, and stop criteria
• safety, medical, and emergency routes

Measure partner fidelity and system access. A return of the target response may reflect missed reinforcement, broken equipment, absent AAC, an inaccurate schedule signal, a new demand, pain, or another change. Fix implementation and access failures before interpreting the client's behavior.

Practice likely disruptions only when doing so is safe, agreed, and clinically justified. A planned exercise should never manufacture injury risk or remove essential communication. For dangerous responses, even a small increase may trigger an immediate stop.

A fictional resurgence example

Elena is a fictional thirteen-year-old who wants clear updates during delayed community activities. During eight baseline delays, Elena repeats a status question in 7 of 8. Staff answer within ten seconds after 6 of 7 repetitions.

The team teaches an update message through speech or AAC and responds immediately. Across ten treatment delays, Elena uses the message independently in 8 of 10, staff respond on time in 8 of 8, and the prior repeated question occurs in 1 of 10.

A new schedule then asks Elena to wait up to three minutes. Across eight schedule-change delays, staff provide the promised response on time in only 3 of 8. Elena's earlier repeated question occurs in 4 of 8, while the update message occurs in 6 of 8. The sequence meets the team's predeclared resurgence flag: the previously reinforced response increases as reinforcement for the alternative worsens.

The flag supports immediate review rather than proving a single mechanism. Staff timing, schedule length, setting, and activity mix changed together. The team restores reliable updates, adds an honest “still checking” response, and keeps all eight delayed opportunities in the report.

Protect communication, access, and safety

ASHA's AAC practice portal says AAC users should always have access to their tools or devices. Keep a backup communication route, train ordinary partners, and honor recognizable help, stop, pain, and safety messages even when the exact teaching response is absent.

Food, water, bathroom access, mobility, prescribed care, pain care, rest, relationships, and emergency help remain available during schedule changes. Pause nonemergency teaching when assent is withdrawn or distress emerges. A resurgence plan is a prevention and response plan, never permission to wait out danger.

The current BACB Ethics Code applies to BCBA and BCaBA certificants and people who completed an application. It addresses client involvement, consent and assent when applicable, assessment, medical needs, risk, restrictive procedures, data, and continual evaluation.