A Descriptive Review of Telehealth for Individuals With Autism Spectrum Disorder.

Since the early 2000s, telehealth has been used to provide behavior analytic intervention to individuals with autism spectrum disorder (ASD). Evaluating evidence supporting telehealth remains valuable, especially as there has been increased accessibility since the COVID-19 pandemic. Although there is empirical support for telehealth as an effective service-delivery option, important variables (e.g., costs, implementer training) remain unknown. Despite potential roles in telehealth service-delivery models, a careful review of participant prerequisite skills, implementer characteristics (e.g., experience, education), technology variables (e.g., HIPAA compliance), and skill(s) targeted (i.e., mastered or untrained skills) have not been considered. Therefore, we aimed to extend prior telehealth literature reviews by evaluating current research across variables important for telehealth service-delivery involving individuals with ASD. We found thorough descriptions of participants and implementers, implementer training, and social validity evaluations. Limitations of telehealth literature include exclusion of teen and adult participants, limited description of prerequisite skills and evaluations of direct telehealth interventions. Future research areas were identified.

Using computer-based instruction to teach implementation of behavioral skills training.

Behavioral skills training (BST) is considered one of the most effective staff training techniques to implement a wide variety of behavioral technologies; however, research has found a lack of implementation of BST across human service settings due to a shortage of organizational time and resources. The purpose of the present study was first to demonstrate the effectiveness of computer-based instruction (CBI) in teaching BST, and then to demonstrate that the CBI module was effective in training trainers to implement BST with trainees. Results of the present experiment not only demonstrate the effectiveness of CBI in teaching BST, but also demonstrate the generality of the BST to teach behavior therapists.

Using Video Prompting to Teach Leg Shaving to Women with Disabilities.

This was the first study to evaluate procedures for teaching leg shaving to individuals with disabilities. Using a video prompting teaching package in a concurrent multiple baseline design across participants with different diagnoses (i.e., paraplegia, Down Syndrome, and intellectual disability), all participants learned to shave their legs and maintained responding two weeks post-intervention.

Identifying and Training Skill Acquisition Protocol Development: A Preliminary Investigation.

According to the Behavior Analyst Certification Board (BACB), services commonly provided by behavior analysts include writing and revising protocols for teaching new skills. To our knowledge, there are currently no published, peer-reviewed articles or texts focused on developing skill acquisition protocols. The purpose of this study was to develop and evaluate the effectiveness of a computer-based instruction (CBI) tutorial on acquisition of skills related to writing an individualized protocol based on a research article. The tutorial was developed based on a variety of expert samples recruited by the experimenters. Fourteen students enrolled in a university behavior analysis program participated in a matched-subjects group experimental design. The training was separated into three modules on protocol components, identifying important information in a research article, and individualizing the protocol for a learner. Training was self-paced and completed in the absence of a trainer. The training included the following behavioral skills training components: instruction, modeling, individualized pacing, opportunities to actively respond and rehearse skills, and frequent specific feedback. The tutorial resulted in a significant increase in accuracy of protocols during posttest when compared to a textual training manual. This study contributes to the literature by applying CBI training procedures to a complex skill, as well as evaluating training in the absence of a trainer, and provides a technology for clinicians to learn effectively and efficiently to write a technological, individualized, and empirically based protocol.

Evaluating the Effects of Computer-Based Instruction on Trial-Based Functional Analyses Procedures.

Children who engage in problem behavior are often educated in the public schools. A trial-based functional analysis (TBFA) is an experimental functional analysis whereby conditions are embedded into scheduled activities of the school day to identify environmental variables responsible for problem behavior. To be included in this process, it is important that staff are trained effectively and efficiently. Computer-based instruction (CBI) offers several advantages as a staff training tool including less training time, less required supervision, and permits self-paced and individualized training. The efficacy of CBI on procedures of TBFA to practitioners remains unknown. We evaluated the efficacy of CBI teaching procedures of TBFA with 20 practitioners. Results indicate that CBI is an effective and efficient staff training procedure as post-test scores increased following the CBI training across participants with a mean training duration of less than an hour. Three practitioners successfully implemented four conditions of a TBFA with a confederate following CBI training. Following completion of the study, respondents ranked procedures of the CBI as socially valid.

Effects of video modeling on abduction-prevention skills by individuals with autism spectrum disorder.

Deficits in safety skills and communication place individuals with autism spectrum disorder (ASD) at risk of danger. Abduction prevention remains an understudied area. Video modeling has proven to be effective in some research on teaching safety skills to individuals with ASD. Existing research has yet to assess responding to lures from known people. The effects of video modeling on abduction-prevention skills were evaluated using a multiple probe across participants with an embedded adapted alternating treatments design. Using video modeling, we extended research by teaching how to respond to lures from strangers and known individuals by securing a code word. Generalization was programmed for and assessed across multiple lure types, confederates, and locations. Participants demonstrated differentiated responding across lures from strangers and known people and responding generalized to untrained community settings, people, and lures. Three of the 4 participants maintained skills at least 1 week following mastery. Procedures, goals, and outcomes were considered socially valid.

Effects of preliminary class membership on subsequent stimulus equivalence class formation.

The present study examined the effects of including stimuli previously trained as members of functional classes or equivalence classes on subsequent equivalence class formation, and isolated the effects of preliminary training from those of the acquired function stimuli. Fifty-six adults were assigned to 1 of 5 conditions. The control group (CONT) received no preliminary training prior to the terminal phase. Participants in the other 4 groups learned two 3-member functional classes and two 3-member equivalence classes during the preliminary phase. The terminal equivalence phase trained two 5-member classes (A → B → C → D → E) comprising abstract forms; the C stimuli in the terminal phase were (a) from the preliminary functional classes for 1 group (ACQ-F), (b) from the preliminary equivalence classes for the second experimental group (ACQ-E), (c) pictures of everyday objects for the picture control group (PIC), and (d) novel, unfamiliar stimuli for the preliminary training control group (PRE-CONT). Class formation yields were 100% in the PIC condition and 11% in the CONT condition; however, low yields in the PRE-CONT, ACQ-F, and ACQ-E conditions were unexpected, suggesting that procedural variables in preliminary training account for more of the subsequent effects on class formation than the stimulus control properties of the acquired function stimuli.

A Comparison of Video Modeling and Video Prompting by Adolescents with ASD.

Video-based instruction has been effective in teaching a range of skills, including functional living skills, to individuals with autism spectrum disorder. Few studies have compared the efficacy and efficiency across video modality-specifically, comparing video modeling to video prompting. Consequently, practitioners have little empirical guidance when selecting between procedural variations of video-based instruction. Using an adaptive alternating-treatments design with a baseline, we evaluated the comparative effectiveness of point-of-view video modeling and video prompting on the percentage of meal preparation tasks completed correctly and on-task behavior with 4 adolescents with autism spectrum disorder. We found video modeling to be effective and efficient in the acquisition of meal preparation skills across 3 of the 4 participants. Across participants, video prompting resulted in more errors than video modeling did. Skills generalized to an untrained location and were maintained at a 3-week follow-up. Stakeholders reported procedures, goals, and outcomes as socially valid.

Evaluation of Manualized Instruction to Train Staff to Implement a Token Economy.

All components of behavioral skills training may not be necessary to effectively train staff to implement behavior-analytic technologies with children with disabilities. This study evaluated manualized instruction to train inexperienced staff to implement a token economy with a confederate and collect data on learner responding. A nonconcurrent multiple-baseline design across staff trainees was used to evaluate the effectiveness of manualized instruction to increase the staff trainees' accurate implementation of a token economy. Additionally, a modified general case analysis was conducted to identify potential child behaviors. Multiple-exemplar training of these behaviors was presented in random order during sessions. Following the use of the manualized instruction, staff trainees' accurate implementation of a token economy and data collection on confederate responding increased, the skills generalized from a confederate to a child with autism spectrum disorder, and the skills maintained 1 month following training.

The influence of instructive feedback presentation schedule: A replication with children with autism spectrum disorder.

Instructive feedback (IF) is a modification to discrete trial instruction that may increase instructional efficiency for individuals with autism spectrum disorder. Several variations of IF have recently been evaluated in the literature; however, few studies have assessed the effectiveness and efficiency of presenting secondary targets on continuous versus intermittent presentation schedules. The current study evaluated the effectiveness and efficiency of various presentation schedules of secondary targets during discrete trial instruction. Specifically, we replicated and extended Griffen et al. (1998) by comparing a condition in which secondary targets were presented during each trial of a session, a condition in which secondary targets were presented every other trial, and a condition in which secondary targets were presented about every 4 trials. Within-subject replications were included for both participants. One of the intermittent presentation schedules was associated with the most optimal outcomes in all 4 comparisons.

Comparing skill acquisition under varying onsets of differential reinforcement: A preliminary analysis.

The purpose of the current study was to evaluate the effect of implementing differential reinforcement at different times relative to the onset of teaching new skills to learners with autism spectrum disorder. Specifically, we first determined the most efficient differential reinforcement arrangement for each participant. Using the most efficient arrangement, we evaluated if differential reinforcement from the immediate onset, early onset, or late onset is the most efficient for learners to acquire a new skill. Three children diagnosed with autism spectrum disorder who have a history of receiving intervention based on the principles of applied behavior analysis participated in this study. The immediate onset of differential reinforcement resulted in the most efficient instruction in 6 of 7 comparisons. The results are discussed in light of previous studies and suggestions for future research are provided.

Using video modeling to teach play comments to dyads with ASD.

Individuals with autism spectrum disorder (ASD) often display deficits in social and conversational skills. One method used to improve social deficits includes video modeling. When targeting conversational skills, few studies have included individuals with ASD as conversational partners. We evaluated the effects of video modeling on commenting (i.e., scripted statements) during leisure activities with dyads of children with ASD using a multiple-probe-across-activities design. Video modeling alone was found to be effective in increasing scripted statements for 3 of 6 participants. Video modeling, tangible reinforcement, and additional prompts were necessary for the remaining participants. Results maintained 1 and 3 weeks after mastery. Procedures, goals and outcomes were reported as socially valid. Limitations and areas of future research are discussed.

Assessment to identify learner-specific prompt and prompt-fading procedures for children with autism spectrum disorder.

Few studies have evaluated the use of assessment to identify the most efficient instructional practices for individuals with autism spectrum disorder. This is problematic as these individuals often have difficulty acquiring skills, and the procedures that may be efficient with one individual may not be for others. The experimenters conducted instructional assessments to identify the most efficient prompt type (model, partial physical, full physical) and prompt-fading procedure (progressive delay, most-to-least, least-to-most) for teaching auditory-visual conditional discriminations for individuals with autism spectrum disorder. Each assessment was conducted at least twice, and a final generality test combined the most and the least efficient prompt type and prompt-fading procedure for teaching novel auditory-visual conditional discriminations. The results demonstrated learner-specific outcomes for the prompt type assessment, whereas the least-to-most prompt fading procedure was most efficient for all participants.

An examination of preference for augmentative and alternative communication devices with two boys with significant intellectual disabilities.

Selecting an appropriate mode of communication is an important clinical decision when beginning an augmentative and alternative communication (AAC) intervention. In the present study, we investigated whether two boys with significant intellectual disabilities would show a preference for using one of three AAC devices. Initially, the boys were taught to use three AAC devices (i.e., Cyrano Communicator, Mini-MessageMate, and a Picture Communication Board) using a multiple-probe-across-devices design. One participant was successful with only one device, while the other was successful in acquiring basic use of all three devices (i.e., making a request using the device and demonstrating correspondence between the picture icon and item requested). The child who acquired basic use of all three devices participated in the second phase. A choice assessment was conducted using a free-operant paradigm to determine which of the three devices he preferred. In the final phase, the most preferred device was targeted for more specific instruction (i.e., retrieving the device from a distance, turning the device on, approaching a communication partner, getting the communication partner's attention, and using the device to make a request), using a changing criterion design. Results for this participant indicated that he had a clear preference for one device and was able to learn how to use it in a more functional manner. Limitations and suggestions for future research are discussed.

Reinforcer Choice on Skill Acquisition for Children with Autism Spectrum Disorder: a Systematic Replication.

Providing students with autism spectrum disorder (ASD) a choice of putative reinforcers during learning trials may confer advantage during skill acquisition programming. However, such advantage should not be assumed and may not be associated with the most efficient instructional arrangement. In the current study, we taught labels of common object or conditional discriminations to participants with ASD and evaluated efficiency of instruction across child- and experimenter-choice instructional conditions. The results indicated that the most efficient acquisition was observed during the experimenter-choice condition for both participants.

Teaching help-seeking when lost to individuals with autism spectrum disorder.

Deficits in safety skills and communication deficits place individuals with autism spectrum disorder (ASD) at an increased risk of danger. We used a multiple-probe across-participants design to evaluate the effects of video modeling and programming common stimuli to teach low- and high-tech help-seeking responses to children with ASD when lost. Participants acquired answering or making a FaceTime® call and exchanging an identification card in contrived and natural settings. Responses generalized to novel community settings and maintained during a one- and two-week follow-up. Social validity measures showed that the procedures and outcomes of the study were acceptable to indirect and direct consumers, and immediate and extended community members. Implications are that children with ASD can effectively be taught both low- and high-tech help-seeking responses when lost.

Effects of computer-based training on procedural modifications to standard functional analyses.

Few studies have evaluated methods for training decision-making when functional analysis data are undifferentiated. The current study evaluated computer-based training to teach 20 graduate students to arrange functional analysis conditions, analyze functional analysis data, and implement procedural modifications. Participants were exposed to training materials using interactive software during a 1-day session. Following the training, mean scores on the posttest, novel cases probe, and maintenance probe increased for all participants. These results replicate previous findings during a 1-day session and include a measure of participant acceptability of the training. Recommendations for future research on computer-based training and functional analysis are discussed.

The Effects of a Video-Enhanced Schedule on Exercise Behavior.

Research focusing on physical exercise and individuals with autism spectrum disorder (ASD) is limited. Activity- and video-enhanced schedules have successfully increased leisure, academic, social, and daily living skills for individuals with ASD and may be effective in increasing exercise. We evaluated the effects of a video-enhanced schedule presented on an iPad® on exercise behavior with adolescents with ASD using a multiple probe across participants design. Specifically, the effects of a video-enhanced exercise schedule with graduated guidance on independent schedule-following behavior and on-task behavior was evaluated. Participants acquired a video-enhanced exercise schedule and remained on task; we also successfully faded proximity from the participant. The skills generalized to a novel exercise and setting and maintained over time. The procedures were reported to be socially acceptable by stakeholders. Individuals with ASD are more likely to live sedentary lifestyles, have poor diets and sleep, and be overweight. We evaluated the effects of a video-enhanced exercise schedule presented on an iPad® with individuals with ASD on independent schedule following behavior and on-task behavior. We also attempted to fade proximity from an instructor and assessed generalization, maintenance, and social validity. Individuals quickly acquired the exercise schedule and remained on task. Distance from an instructor was increased, skills generalized to novel exercises and locations and maintained over time, and the procedures and outcomes were reported favorable by stakeholders. Practitioners should continue to evaluate the effects of video-enhanced schedules on exercise behavior and determine how to fade the videos.

Using Video Modeling with Voice-over Instruction to Train Public School Staff to Implement a Preference Assessment.

The identification of putative reinforcers is a critical component of programming for individuals with disabilities. A multiple stimulus without replacement preference assessment is one option for identifying putative reinforcers; however, staff must be trained on the steps necessary to conduct the assessment for it to be useful in practice. This study examined the effectiveness of using video modeling with voice-over instruction (VMVO) to train two public school staff to conduct this assessment. Results demonstrate that VMVO was effective in training, producing generalized responding, maintenance, and high social validity ratings.

Establishing Concurrent Mands for Items and Mands for Information about Location in Children with Autism.

This study replicated and extended the methodology used in Howlett et al. (Journal of Applied Behavior Analysis, 44, 943-947 2011) to bring the mands "Where's (item)?" and "I want (item)" under appropriate antecedent control in two boys diagnosed with autism. Trials were alternated in which items were present, missing, and within view (but inaccessible) and missing and out of view. To program for generalization, fifteen items, multiple trainers, and multiple settings were used during teaching. For both participants, manding generalized to novel items, instructors, settings, and situations and maintained after 2 weeks following teaching. Results of the social validity assessment indicated that school staff found the procedures highly acceptable.