Effectiveness of a Culturally Responsive mHealth Gaming Application to Improve Diabetes Health Literacy in India: A Randomized Controlled Trial.

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups ( P = .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group ( P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

Cross Cultural Team Collaboration: Integrating Cultural Humility in mHealth Development and Research.

The World Health Organization called for mobile health initiatives to improve population health outcomes, particularly in limited-resource settings. The aim of our study was to reflect upon approaches embedded in cultural humility and recognize areas where improvement was needed in the social innovation collaborative development of an mHealth app to improve hypertension health literacy in India. A qualitative descriptive case study approach was employed to elicit concepts of cultural humility and areas for improvement derived from communications between project stakeholders. Overarching themes included fostering coalescence and strengthening partnerships in addition to multiple subthemes. Enveloping cultural humility in multidisciplinary, interprofessional and cross-cultural healthcare projects and processes is imperative for the development and implementation of successful culturally congruent health initiatives. Team fostering of coalescence and recognizing challenges and adapting to mitigate challenges can strengthen partnerships, a desired consequence of cultural humility.

Some actions for behavior analyst licensing bodies to consider in response to the COVID-19 pandemic.

The COVID-19 global pandemic has had a significant impact on the practice of applied behavior analysis (ABA). Practitioners and caregivers have had to adapt quickly as physical distancing, stay-at-home orders, and shelter-in-place directives have become commonplace. As the field copes with the changes produced by the COVID-19 outbreak, many behavior analytic practitioners are seeking guidance from regulatory bodies to ensure they are practicing legally and ethically. This article outlines some actions that the regulatory bodies that manage state behavior analyst licensure programs may consider to assist ABA practitioners and consumers during this unprecedented time. Additionally, suggestions are offered as to how state licensing bodies might prepare to support the practice of licensees during future events that present challenges similar to the current pandemic.

Stereotypy in young children with autism and typically developing children.

Although stereotypy is one of the key diagnostic features of autism, few studies have compared stereotypic behavior in children with autism and typically developing children. The present study employed direct observational measurement methods to assess levels of stereotypic behavior in 2-, 3- and 4-year-old children with autism or pervasive developmental disorder - not otherwise specified (PDD-NOS) and age-matched typically developing peers. Thirty children with autism or PDD-NOS and 30 typically developing children participated. Each child's performance of several early learning and play skills was assessed using a direct observational assessment protocol developed for children with autism who were entering early intensive behavioral treatment. Duration of episodes of vocal and motor stereotypy was recorded from a videotaped 10 min portion of that assessment session. Results indicated that the 2-year-old children with autism or PDD-NOS had somewhat higher levels of stereotypic behavior than the typically developing 2-year-olds, while the 3- and 4-year-old children with autism or PDD-NOS displayed substantially higher levels stereotypic behavior than their same-age peers.

Behavioral assessment of joint attention: a methodological report.

This paper describes a highly structured assessment protocol with objective behavioral measures for joint attention responding and initiation. The assessment was given to 26 children diagnosed with autism spectrum disorders and 21 typically developing children, aged two to four years. Interobserver agreement was high for all behavioral measures. Children with autism had relatively minor deficits in joint attention responding and more severe deficits in joint attention initiation, relative to typically developing children. These results replicate those reported in previous research. The protocol can be used reliably to assess behavior indicative of joint attention responding and initiation in typically developing children and children with autism.

Positive behavior support and applied behavior analysis.

This article reviews the origins and characteristics of the positive behavior support (PBS) movement and examines those features in the context of the field of applied behavior analysis (ABA). We raise a number of concerns about PBS as an approach to delivery of behavioral services and its impact on how ABA is viewed by those in human services. We also consider the features of PBS that have facilitated its broad dissemination and how ABA might benefit from emulating certain practices of the PBS movement.

A comparison of intensive behavior analytic and eclectic treatments for young children with autism.

We compared the effects of three treatment approaches on preschool-age children with autism spectrum disorders. Twenty-nine children received intensive behavior analytic intervention (IBT; 1:1 adult:child ratio, 25-40 h per week). A comparison group (n=16) received intensive "eclectic" intervention (a combination of methods, 1:1 or 1:2 ratio, 30 h per week) in public special education classrooms (designated the AP group). A second comparison group (GP) comprised 16 children in non-intensive public early intervention programs (a combination of methods, small groups, 15 h per week). Independent examiners administered standardized tests of cognitive, language, and adaptive skills to children in all three groups at intake and about 14 months after treatment began. The groups were similar on key variables at intake. At follow-up, the IBT group had higher mean standard scores in all skill domains than the AP and GP groups. The differences were statistically significant for all domains except motor skills. There were no statistically significant differences between the mean scores of the AP and GP groups. Learning rates at follow-up were also substantially higher for children in the IBT group than for either of the other two groups. These findings are consistent with other research showing that IBT is considerably more efficacious than "eclectic" intervention.

Evaluating the Quality of Behavior Analytic Practitioner Training Programs.

Dixon and colleagues (2015) asserted that faculty research productivity is a key indicator of the quality of university programs that train future practitioners of behavior analysis. Based on their analysis of publications in select journals, the authors concluded that many faculty in such programs have published little to no research. Some alternative measures of both faculty research productivity and the quality of practitioner training programs are suggested here.

Intensive behavioral treatment for a toddler at high risk for autism.

Intensive, comprehensive treatment using a variety of applied behavior analysis methods was provided to a toddler who was determined to be at high risk for autism at the age of about 1 year. Initially, treatment was delivered in a one-to-one adult-child format in the child's home and other settings, with gradual transitions to group instruction in early intervention and preschool classrooms. Intensive treatment continued for 3 years; by the 4th year, the child was spending most of her time in a regular preschool classroom, with minimal ongoing one-to-one instruction. Direct observational data and results of norm-referenced tests documented large increases in language, social, cognitive, and daily living skills over the course of treatment. After 4 years, the child demonstrated no behavioral or developmental abnormalities, performed above her chronological age level on norm-referenced tests of cognitive and language skills, and was functioning as a typical child in a regular public school kindergarten classroom.

Two methods for teaching simple visual discriminations to learners with severe disabilities.

Simple discriminations are involved in many functional skills; additionally, they are components of conditional discriminations (identity and arbitrary matching-to-sample), which are involved in a wide array of other important performances. Many individuals with severe disabilities have difficulty acquiring simple discriminations with standard training procedures, such as differential reinforcement. Errorless training methods may be more effective with this population. We used multiple-probe designs to compare two potentially errorless procedures for teaching simple discriminations among three pairs of photos of preferred items (S+) and colored rectangles (S-) to three youths with severe disabilities. In Experiment 1, baseline trials conducted with differential reinforcement yielded near-chance performances on all stimulus sets. A progressive delayed prompt training procedure was then implemented, with stimuli presented flat on the tabletop for one participant and at a 45 degrees angle to the tabletop for the other participants. After 120 teaching trials, accuracy remained near chance. Next, a stimulus control shaping procedure was implemented using an adapted Wisconsin General Test Apparatus (WGTA), with stimuli at a 45 degrees angle to the tabletop. Accuracy increased when this procedure was implemented with each stimulus pair in succession. In Experiment 2, for the participant whose stimuli were presented flat on the tabletop during the progressive delayed prompt training procedure, baseline trials were presented on the WGTA as at the end of Experiment 1, with differential reinforcement; accuracy remained high. On probe trials with stimuli placed flat on the tabletop, accuracy decreased to near-chance levels, indicating that the orientation of the stimulus array was a controlling variable.

Comparison of direct observational methods for measuring stereotypic behavior in children with autism spectrum disorders.

We compared partial-interval recording (PIR) and momentary time sampling (MTS) estimates against continuous measures of the actual durations of stereotypic behavior in young children with autism or pervasive developmental disorder-not otherwise specified. Twenty-two videotaped samples of stereotypy were scored using a low-tech duration recording method, and relative durations (i.e., proportions of observation periods consumed by stereotypy) were calculated. Then 10, 20, and 30s MTS and 10s PIR estimates of relative durations were derived from the raw duration data. Across all samples, PIR was found to grossly overestimate the relative duration of stereotypy. Momentary time sampling both over- and under-estimated the relative duration of stereotypy, but with much smaller errors than PIR (Experiment 1). These results were replicated across 27 samples of low, moderate and high levels of stereotypy (Experiment 2).

Comparison of two procedures for teaching dictated-word/symbol relations to learners with autism.

The efficacy of exclusion and delayed-cue procedures for establishing novel dictated-word/symbol relations with 2 boys with autism was compared using computerized match-to-sample procedures. Acquisition of the relations under the two training conditions was compared via an alternating treatments design. The delayed-cue procedure was more efficacious than the exclusion procedure in four of five comparisons across participants.

Comparison of behavior analytic and eclectic early interventions for young children with autism after three years.

In a previous study, we compared the effects of just over one year of intensive behavior analytic intervention (IBT) provided to 29 young children diagnosed with autism with two eclectic (i.e., mixed-method) interventions (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005). One eclectic intervention (autism programming; AP) was designed specifically for children with autism and was intensive in that it was delivered for an average of 25-30 h per week (n = 16). The other eclectic intervention (generic programming; GP) was delivered to 16 children with a variety of diagnoses and needs for an average of 15-17 h per week. This paper reports outcomes for children in all three groups after two additional years of intervention. With few exceptions, the benefits of IBT documented in our first study were sustained throughout Years 2 and 3. At their final assessment, children who received IBT were more than twice as likely to score in the normal range on measures of cognitive, language, and adaptive functioning than were children who received either form of eclectic intervention. Significantly more children in the IBT group than in the other two groups had IQ, language, and adaptive behavior test scores that increased by at least one standard deviation from intake to final assessment. Although the largest improvements for children in the IBT group generally occurred during Year 1, many children in that group whose scores were below the normal range after the first year of intervention attained scores in the normal range of functioning with one or two years of additional intervention. In contrast, children in the two eclectic treatment groups were unlikely to attain scores in the normal range after the first year of intervention, and many of those who had scores in the normal range in the first year fell out of the normal range in subsequent years. There were no consistent differences in outcomes at Years 2 and 3 between the two groups who received eclectic interventions. These results provide further evidence that intensive behavior analytic intervention delivered at an early age is more likely to produce substantial improvements in young children with autism than common eclectic interventions, even when the latter are intensive.

Stimulus equivalence, generalization, and contextual stimulus control in verbal classes.

Stimulus generalization and contextual control affect the development of equivalence classes. Experiment 1 demonstrated primary stimulus generalization from the members of trained equivalence classes. Adults were taught to match six spoken Icelandic nouns and corresponding printed words and pictures to one another in computerized three-choice matching-to-sample tasks. Tests confirmed that six equivalence classes had formed. Without further training, plural forms of the stimuli were presented in tests for all matching performances. All participants demonstrated virtually errorless performances. In Experiment 2, classifications of the nouns used in Experiment 1 were brought under contextual control. Three nouns were feminine and three were masculine. The match-to-sample training taught participants to select a comparison of the same number as the sample (i.e., singular or plural) in the presence of contextual stimulus A regardless of noun gender. Concurrently, in the presence of contextual stimulus B, participants were taught to select a comparison of the same gender as the sample (i.e., feminine or masculine), regardless of number. Generalization was assessed using a card-sorting test. All participants eventually sorted the cards correctly into gender and number stimulus classes. When printed words used in training were replaced by their picture equivalents, participants demonstrated almost errorless performances.

A primer on professional credentialing: introduction to invited commentaries on licensing behavior analysts.

Questions have arisen recently about the relative merits of certification and licensure for protecting practitioners of behavior analysis and consumers of their services. The two approaches to credentialing have short- and long-term implications for practitioners, consumers, and the field. To provide background for the invited commentaries on these issues, we describe similarities and differences in the two types of professional credentials.

Licensing behavior analysts: risks and alternatives.

Under certain conditions, obtaining state laws to license practitioners of behavior analysis might be feasible and could produce benefits for practitioners and consumers. Those conditions are not yet in place in most states, however, and pursuing licensure prematurely carries substantial risks for the entire field. We describe the most serious risks and the conditions that make it more or less likely that licensure initiatives will succeed. Finally, we recommend strategies for securing recognition of practitioners of behavior analysis in laws, regulations, and policies that can minimize risks.