Resolving Barriers to Continence for Children with Disabilities: Steps Toward Evidence-Based Practice.

Behavior-analytic toilet training (BATT) methods to support urine continence have been reviewed and replicated in numerous studies. Despite empirical validations of BATT, children with disabilities may not experience successful toilet training nor access the associated health and social benefits of urinary continence. It is possible these outcomes are partially due to practical barriers that arise throughout urine training. In practice, barriers may interfere with toilet training to the extent that training is postponed or discontinued, resulting in long-term incontinence and other related problems. Examples of barriers include problem behavior, excessive urine retention, recurrent accidents, and excessive or insufficient independent self-initiations to toilet. Researchers have sometimes described strategies to address these types of barriers. However, practitioners may not be aware of these strategies because they are secondary to the purpose of an investigation and may only apply to a subset of participants. The purpose of this review article is to synthesize the collection of barrier solutions described in published research on urine training for children with developmental disabilities. Results may assist practitioners in modifying BATT according to an evidence-based practice framework until their clients overcome barriers to achieve urine continence.

Assessment and Treatment of Prosody Behavior in Individuals with Level 1 Autism: A Review and Call for Research.

Differences in prosody behavior between individuals with autism spectrum disorder (ASD) and their typically developing peers have been considered a central feature of ASD since the earliest clinical descriptions of the disorder (e.g., Kanner, 1943/1973). Prosody includes pitch and volume among other dimensions of vocal-verbal behavior that discriminate responses of the listener; thus, people with ASD whose prosody has confusing or off-putting effects may have fewer social opportunities at work, at school, or in the community. The purpose of this review is to examine the state of the literature intervening on prosody with individuals with ASD and to provide recommendations for researchers who are interested in contributing to the scientific understanding of prosody.

Efficacy and social validity of procedures for improving conversational skills of college students with autism.

Better conversational skills correspond to a higher quality of life for adults diagnosed with autism spectrum disorder (ASD). In this study, we taught vocal-verbal responses discriminated by compound arrangements of concealed conversation partner mands to two college students with ASD. Participants learned to engage in self-questioning about their conversation partner's behavior and to reinforce three concealed mands for termination of an aversive conversation scenario. We assessed generalization to conversation probes with trained confederates and to interactions with untrained conversational partners (e.g., peers, professors). Finally, we collected peer ratings of the social validity of changes in conversational behavior as well as participants' ratings of study goals, procedures, and outcomes.

Durability, negative impact, and neuropsychological predictors of tic suppression in children with chronic tic disorder.

Chronic tic disorders are characterized by involuntary motor and vocal tics, which are influenced by contextual factors. Recent research has shown that (a) children can suppress tics for brief periods of time, (b) suppression is enhanced when programmed reinforcement is provided for tic-free intervals, and (c) short periods of suppression do not result in a paradoxical "rebound" in tic frequency when active suppression has ceased. The current study extended existing research in three important ways. First, we examined whether tic suppression ability decreased as suppression duration increased from 5 to 25 to 40 min. Second, we examined post-suppression tic frequency to test whether longer periods of suppression were more likely to be associated with a rebound effect. Finally, we explored neuropsychological predictors of tic suppression. Thirteen children with Tourette syndrome or a chronic tic disorder completed the study. Results showed that (a) tic suppression was sustained for all of the suppression durations, (b) rebound effects were not observed following any of the suppression durations, and (c) ability to suppress was correlated with omission, but not commission errors on a continuous performance task. Implications of these findings are discussed.

Behavioral contributions to teaching of psychology: an annotated bibliography.

An annotated bibliography that summarizes behavioral contributions to the journal Teaching of Psychology from 1974 to 2006 is provided. A total of 116 articles of potential utility to college-level instructors of behavior analysis and related areas were identified, annotated, and organized into nine categories for ease of accessibility.

Effects of programmed teaching errors on acquisition and durability of self-care skills.

This investigation sheds light on necessary and sufficient conditions to establish self-care behavior chains among people with developmental disabilities. First, a descriptive assessment (DA) identified the types of teaching errors that occurred during self-care instruction. Second, the relative effects of three teaching errors observed during the DA were evaluated across two behavior chains for three participants. Third, the effects of individual teaching errors were studied with a third behavior chain per participant. Teaching errors included prompting steps out of order, delivering the reinforcer at times other than immediately following correct completion of the training step, and failing to prompt completion of all steps within a teaching trial. All teaching errors included in the evaluation interfered with skill acquisition and disrupted performance of mastered skills. Results are discussed in terms of future research on the components of efficacious treatment packages for disseminating effective practices.

Teaching multiply controlled intraverbals to children and adolescents with autism spectrum disorders.

Reciprocal conversations, instructional activities, and other social interactions are replete with multiply controlled intraverbals, examples of which have been conceptualized in terms of conditional discriminations. Although the acquisition of conditional discriminations has been examined extensively in the behavior-analytic literature, little research has evaluated procedures to establish multiply controlled intraverbals. Thus, the purpose of this investigation was to evaluate the effects of procedures based on conditional discrimination training on the acquisition of multiply controlled intraverbals with 7 participants who had been diagnosed with autism spectrum disorders. We evaluated the effects of prompt delay with error correction, a differential observing response (DOR), and a DOR plus blocked trials on the acquisition of intraverbals using a multiple baseline design. Accuracy of intraverbal performance increased for at least 1 set of stimuli for all participants under prompt delay with error correction conditions; however, 4 participants required additional teaching (i.e., DOR, modified DOR, modified prompt delay with error correction). Based on these findings, when prompt delay with error correction is not sufficient to establish multiply controlled intraverbals, prompted DORs may be an effective alternative.

Effects of a differential observing response on intraverbal performance of preschool children: a preliminary investigation.

Axe (2008) speculated that some instances of intraverbal responding might be associated with limited or delayed acquisition because they require discrimination of multiple components of verbal stimuli. Past studies suggest that acquisition of responses under control of complex, multicomponent antecedent stimuli (e.g., conditional or compound stimulus control) can be facilitated with the introduction of a differential observing response (DOR; Dube & McIlvane, 1999; Gutowski, Geren, Stromer, & Mackay, 1995). The purpose of the current study was to evaluate the effects of a DOR (i.e., repeating the question) on intraverbal responding with six neurotypical preschool children. Findings included that (a) accuracy of intraverbal performance increased when the experimenter prompted a DOR; (b) 1 of 6 participants overtly emitted the DOR for a second relation in the absence of prompts, which was correlated with increased accuracy; and (c) following mastery, response accuracy was variable for 3 participants. Based on these findings, prompted DORs may offer an effective, if temporary, aid to intraverbal instruction for neurotypical preschool children.

Assessing preferences of individuals with developmental disabilities: a survey of current practices.

Although professionals working with individuals with developmental disabilities have much to gain from using systematic methods of reinforcer identification, practitioner knowledge and use of stimulus preference assessments (SPA) has rarely been examined. The purpose of this survey was to assess awareness and implementation of SPAs among professionals who serve people with developmental disabilities within and outside the field of applied behavior analysis. A total of 406 individuals responded to the survey; 246 respondents were recruited via direct email, and 160 respondents were recruited from Internet postings. Fewer than 60% of respondents across all disciplines (i.e., applied behavior analysis, psychology, and special education) reported knowledge of the term stimulus preference assessment. While nearly 90% of behavior analysts reported using at least one direct method of SPA (i.e., an assessment involving direct observation and measurement of behavior), many reported personal lack of knowledge (18.6%) and lack of time (81.4%) as barriers to conducting these assessments on a regular basis. Survey results are discussed in terms of (1) the need for greater awareness and acceptance of reinforcer identification methods among behavior analysts, educators, and other service providers and (2) barrier-specific solutions to potentially increase the regularity of SPA usage in the education and treatment of individuals with developmental disabilities.

Evaluation of a self-instruction package for conducting stimulus preference assessments.

Research suggests that inexperienced individuals cannot accurately implement stimulus preference assessments given written instructions alone. Training that includes written instructions supplemented with feedback from a professional with expertise in conducting preference assessments has proven effective; unfortunately, expert-facilitated direct training may not be widely available. In the current study, we used multiple baseline designs to evaluate the efficacy of an antecedent-only self-instructional package to train staff members to implement two methods of stimulus preference assessments. Accuracy was low when participants had access to written instructions alone. When access to enhanced written instructions was provided (i.e., technical jargon was minimized; instructions included pictures, diagrams, and step-by-step examples), inexperienced staff accurately implemented the assessments. Results are discussed in terms of opportunities to disseminate behavior-analytic technologies through self-instruction and print resources.

Description of a practitioner model for identifying preferred stimuli with individuals with autism spectrum disorders.

The rich technology of stimulus preference assessment (SPA) is a product of 40 years of experimental research. Basic principles of reinforcement and a modest empirical literature suggest that high-preference stimuli identified via SPA may enhance treatment efficacy and decrease problem behavior more effectively than less-preferred stimuli. SPAs can be conducted using one of several methods associated with different time requirements and outcomes. Despite the broad applicability of preference assessments, we are unaware of widely available practitioner guidelines that prescribe when to use SPAs, how to select and modify specific SPA procedures, and how to supplement SPAs with other procedures for maximizing performance. The purpose of the current article is to describe a model for practitioners to select and conduct preference assessments based on practical considerations and research findings. Data are also reported from the application of the proposed model to preference assessments for 20 individuals diagnosed with autism spectrum disorders.

Evaluation of single and mixed verbal operant arrangements for teaching mands and tacts.

The purpose of this series of experiments was to evaluate the effects of mixed mand-tact arrangements on the acquisition of mands and tacts in preschool-aged children. In Experiment 1, the effects of three training arrangements (mand-only training, tact-only training, and mand-tact training) were investigated with 3 typically developing children. Rates of acquisition in single (mand-only and tact-only) versus mixed (mand-tact) presentation were comparable, in contrast to earlier investigations. Experiment 2 attempted to clarify the equivocal findings of Experiment 1 by directly replicating the Carroll and Hesse (1987) investigation with 2 typically developing children. Results again demonstrated no clear benefit of mixed verbal operant training on tact acquisition. In Experiment 3, these same arrangements were evaluated with a boy with autism and included assessments to determine that a relevant establishing operation was in effect prior to each mand training session. Experiment 3 again failed to demonstrate the facilitative effects of mand-tact training on the acquisition of mands or tacts. Taken together, the data from these three experiments fail to support the improved efficiency of mand-tact training suggested by prior studies. Findings are discussed in the context of future research investigating mixed verbal operant arrangements.

The effects of differential reinforcement of unprompted responding on the skill acquisition of children with autism.

The recommendation to reserve the most potent reinforcers for unprompted responses during acquisition programming has little published empirical support for its purported benefits (e.g., rapid acquisition, decreased errors, and decreased prompt dependence). The purpose of the current investigation was to compare the delivery of high-quality reinforcers exclusively following unprompted responses (differential reinforcement) with the delivery of high-quality reinforcers following both prompted and unprompted responses (nondifferential reinforcement) on the skill acquisition of 2 children with autism. Results indicated that both were effective teaching procedures, although the differential reinforcement procedure was more reliable in producing skill acquisition. These preliminary findings suggest that the differential reinforcement of unprompted responses may be the most appropriate default approach to teaching children with autism.