Use of Augmentative and Alternative Communication by Individuals with Rett Syndrome Part 1: Page-Linking.

Although the last decade has welcomed evidence that individuals with Rett syndrome (RTT) can communicate using alternative and augmentative communication (AAC), less is known about effective procedures for teaching various component skills required for expressive communication of individuals with complex communication needs. The purpose of the current study was to evaluate the effects of systematic individualized instruction procedures on the page-linking skills of individuals with RTT. A nonconcurrent multiple baseline design across participants was used to evaluate independent and accurate responding utilizing both a high-tech and low-tech AAC device for three participants. All sessions were conducted in the participants' homes by their parents with remote coaching from a researcher via telehealth. Results indicated that for all three participants, individualized procedures that included behavior chaining, differential reinforcement, and delayed prompting were effective for teaching page-linking in both a high-tech and a low-tech AAC device. Directions for future research and practice are discussed.

Mand Modality Preference Assessments among High- and Low-Tech Options for Individuals with Intellectual and Developmental Disabilities: A Systematic Review.

The extant literature demonstrates that individuals with intellectual and developmental disabilities (IDD) exhibit preferences among communication modalities when multiple modalities are available and produce reinforcement on identical reinforcement schedules. High- and low-tech communication options, such as voice output devices and picture cards, are commonly recommended for individuals with limited vocal communication skills. In this study, we conducted a systematic literature review of research studies that implemented mand modality preference assessments (MMPAs) that included both a high- and low-tech communication option with individuals with IDD. We identified 27 studies meeting our inclusion criteria and summarized the participant demographics, MMPA design and procedural variations, and MMPA outcomes. The results suggested that high-tech communication options were generally more preferred over low-tech options. However, there was a high degree of variability in how the studies were conducted and conclusions were reached. We discuss some of the current research gaps and the implications for clinical practice.

Teaching Requesting to Individuals with Rett Syndrome Using Alternative Augmentative Communication (AAC) Through Caregiver Coaching via Telehealth.

Rett syndrome is a severe neurodevelopmental disorder that results in both motor and language skill regression with a wide range of severity in symptom presentation. Communication intervention may be particularly challenging for this population due to the decline in speech, motor skills, and motor planning difficulties that characterize the disorder (Townend et al., 2020), often resulting in the need for augmentative and alternative communication (AAC) technology. Very limited research has evaluated communication interventions for individuals with Rett syndrome and even fewer have targeted expressive communication, an important skill required for improved autonomy and quality of life (Sigafoos et al., 2009; Townend et al., 2020). The current study sought to systematically replicate the Simacek et al. (2017) mand training procedures to teach three girls with Rett Syndrome to use AAC to make requests through caregiver coaching by researchers via telehealth. Results suggest that mand training was successful in increasing AAC use for all three participants. Barriers to intervention for this population and implications of results for future research and clinical practice are discussed.

Use of Augmentative and Alternative Communication by Individuals with Rett Syndrome Part 2: High-Tech and Low-Tech Modalities.

The vast majority of individuals with Rett syndrome do not utilize natural speech and therefore require alternative and augmentative communication (AAC). The purpose of the current study was to investigate the use of high- and low-tech AAC modalities by three individuals with Rett syndrome given similar instruction for using both modalities. For all participants, the number of sessions to criterion and cumulative number of trials with independent requests during simultaneous or alternating instruction in the use of a high- and low-tech AAC modality were investigated. Parents conducted all sessions with remote coaching from a research assistant via telecommunication. Each participant exhibited idiosyncratic response patterns in terms of use of their high- and low-tech AAC modalities during instruction but ultimately demonstrated the ability to use both modalities to make requests. Implications for future research and practice pertaining to AAC of individuals with complex communication needs are discussed. This paper is a companion to Girtler et al. (2023).

The Effect of Caregiver-Implemented Training on Augmentative Alternative Communication Use by Individuals with Rett Syndrome: Remote Coaching via Telehealth.

Limited published literature exists demonstrating functional relations between idiosyncratic responses or augmentative alternative communication (AAC) and social reinforcement for individuals with Rett syndrome. In this study, six females with Rett syndrome ages 2-25 demonstrated requesting for preferred items using both idiosyncratic responses (e.g, looking, reaching) and AAC (e.g. single response microswitches). Researchers connected remotely via telehealth to coach caregivers to implement all sessions in home environments. Researchers individualized response prompt delays during AAC sessions (request/mand training) based on each participants' latency to respond during baseline. Implications for practice and directions for future research are discussed.

An Investigation of the Correspondence between Results of Contingency Space Analysis and Intervention Effects for Addressing Interfering Behavior of Middle-School Youth.

The literature provides various tools for identifying successful interventions for interfering behavior of individuals with intellectual or developmental disabilities, yet less literature is available pertaining to students who do not have cognitive impairments. The purpose of the current study was to investigate the correspondence between the results of contingency space analyses (CSA) and interventions for four middle-school boys who engaged in interfering behavior. Researchers directly observed natural interactions between each student, his teacher, and peers during three baseline sessions. The students' teacher then implemented three intervention conditions. Using direct observation data, researchers conducted a CSA of the baseline data and determined the natural contingencies between student behavior and social consequences. The results of the CSAs were then compared to the effects of the intervention conditions. For three students, results of the CSA were consistent with results of the intervention analysis. Results provide preliminary support for the CSA as a tool for identifying hypothesis-based interventions.

Delivering Interventions Via Telehealth: Functional Communication Training with a Child with Autism as a Case Example.

In this article, we provide a case example of how telehealth can be used by care providers in their homes to access empirically validated procedures such as functional communication training. As shown in the case example, complex assessment and intervention procedures were implemented successfully by care providers in their homes while receiving real-time coaching by behavior analysts who were located in a hospital in a different city. This case example is representative of the results we obtained thus far; substantial improvements in challenging and adaptive behavior occurred. Given these results obtained to date with telehealth, in terms of both outcomes of interventions and rated acceptability of the procedures by care providers, further and more widespread application of telehealth is warranted.

Comparison of Reading Growth Among Students With Severe Reading Deficits Who Received Intervention to Typically Achieving Students and Students Receiving Special Education.

This study compared the reading growth of students with and without learning disabilities, and students with and without reading deficits in response to tier 2 reading interventions within a response-to-intervention framework. Participants were 499 second- and third-grade students in six urban schools. Students who scored at or below the 10th percentile on the fall reading screening assessment were identified as having a severe reading deficit and received a tier 2 reading intervention that was targeted to their needs. Results showed a significant effect between groups on reading growth. Students with severe reading deficits receiving targeted tier 2 intervention grew at a rate that equaled the rate of growth of students without reading deficits and was significantly higher than students who were receiving special education services for reading. Implications for practice, suggestions for future research, and study limitations are discussed.

Caregiver Training Via Telehealth on Behavioral Procedures: A Systematic Review.

Telehealth has been utilized to provide behavioral services to families with children with autism spectrum disorder (ASD) and other disabilities. This systematic review provides an update on current research pertaining to the use of telehealth to provide behavior analytic-based services and train caregivers in implementing behavioral procedures. This review also describes information on reported training components and caregivers' procedural fidelity. Empirical studies were collected from five databases. Overall, the studies provide evidence of the utility of telehealth as a service delivery model for providing behavior analytic-based services and for training caregivers to implement behavioral assessments and procedures. The authors discuss potential considerations for developing training packages and training caregivers via telehealth. Future research should use experimental methods to determine effective components for training individuals via telehealth to use behavioral procedures with good fidelity as well as to detect other factors that may influence procedural fidelity.

Agreement Between Structured Descriptive Assessments and Functional Analyses Conducted Over a Telehealth System.

This study examined whether experimental functional analyses (FAs) conducted by parents at home with coaching via telehealth would produce differentiated results, and compared these results to the functions identified from structured descriptive assessments (SDAs) also conducted by parents at home via telehealth. Four boys between the ages of 4- and 8-years old with intellectual and developmental disabilities and their parents participated. All assessments were conducted in the children's homes with their parents serving as intervention agents and with coaching from remote behavior therapists using videoconferencing technology. Parent-implemented FAs produced differentiated results for all 4 children in the study. Overall, analyzing antecedent-behavior (A-B) and behavior-consequence (B-C) relations from the SDA videos identified only half of the functions identified by the FAs. For children whose SDA results were differentiated, analyzing A-B relations correctly identified 4 of 5 functions. Analyzing B-C relations correctly identified 5 of 6 functions identified by the experimental FA, but overidentified attention for all children. Implications for conducting functional analyses and interpreting structured descriptive assessment via telehealth are discussed.

Comparison of progress monitoring data from general outcome measures and specific subskill mastery measures for reading.

Interventionists often monitor the progress of students receiving supplemental interventions with general outcome measures (GOMs) such as curriculum-based measurement of reading (CBM-R). However, some researchers have suggested that interventionists should collect data more closely related to instructional targets, specific subskill mastery measures (SSMMs) because outcomes from GOMs such as CBM-R may not be sufficiently sensitive to gauge intervention effects. In turn, interventionists may prematurely terminate an effective intervention or continue to deliver an ineffective intervention if they do not monitor student progress with the appropriate measure. However, such recommendations are based upon expert opinion or studies with serious methodological shortcomings. We used multi-variate multilevel modeling to compare pre-intervention intercepts and intervention slopes between GOM and SSMM data collected concurrently in a sample of 96 first, 44 second, and 53 third grade students receiving tier 2 phonics interventions. Statistically significant differences were observed between slopes from SSMM consonant-vowel-consonant words and CBM-R data. Statistically significant differences in slopes were not observed for consonant blend, digraph or consonant-vowel-consonant-silent e (CVCe) SSMMs. Results suggest that using word lists to monitor student response to instruction for early struggling readers is beneficial but as students are exposed to more complex phonetic patterns, the distinction between SSMMs and CBM-R become less meaningful.

Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities Via Telehealth.

Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three young children with ASD (2) and Rett syndrome (1). Efficacy of the intervention was evaluated using single-case experimental designs. First, functional assessment was used to identify idiosyncratic/potentially communicative responses and contexts for each child. Next, parents implemented functional communication training (FCT). All of the children acquired the targeted communication responses. The findings support the efficacy of telehealth as a service delivery model to coach parents on intervention strategies for their children's early communication skills.

Effects of the good behavior game across classroom contexts.

The Good Behavior Game (GBG), a well-researched classroom group contingency, is typically played for brief periods of time, which raises questions about the effects on subsequent contexts. This study used a multiple baseline design and showed that when the GBG was implemented in one context, behavior improved in only that context. Behavior improved in the subsequent activity only when the GBG was implemented.

Communication Intervention to Teach Requesting Through Aided AAC for Two Learners With Rett Syndrome.

Evidence on effective communication interventions for persons with Rett syndrome is needed to drive the standard of care with this population. This study examined the effectiveness of an intervention package to teach multiple, aided communication requests for two persons with Rett syndrome (ages 27 and 7) through within participant, adapted multiple baseline designs across items/activities. Participants were taught graphic mode requests on speech generating devices, with access methods based on motor ability; one participant responded by pressing a touch screen, and one participant responded by fixed eye-gaze. Results are discussed in relation to the effectiveness of the intervention packages on increasing the accuracy of independent request selection responses emitted and the number of sessions required to reach an a priori performance criterion for both participants. Difficulties during initial prompting and during prompt fading with the eye-gaze response are considered. The findings suggest implications related to emerging evidence on the intervention methods to teach requesting skills to this population, and future research directions for communication intervention options for persons with severe communication impairment and limited motor repertoires.

Accuracy of student performance while reading leveled books rated at their instructional level by a reading inventory.

Identifying a student's instructional level is necessary to ensure that students are appropriately challenged in reading. Informal reading inventories (IRIs) purport to assess the highest reading level at which a student can accurately decode and comprehend text. However, the use of IRIs in determining a student's instructional level has been questioned because of a lack of research. The current study examined the percentage of words read correctly with 64 second- and third-grade students while reading from texts at their instructional level as determined by an IRI. Students read for 1 min from three leveled texts that corresponded to their instructional level as measured by an IRI, and the percentage of words read correctly was recorded. The percentage read correctly correlated across the three books from r=.47 to r=.68 and instructional level categories correlated from tau=.59 to tau=.65. Percent agreement calculations showed that the categorical scores (frustration, instructional, and independent) for the three readings agreed approximately 67% to 70% of the time, which resulted in a kappa estimate of less than .50. Kappa coefficients of .70 are considered strong indicators of agreement. Moreover, more than half of the students with the lowest reading skills read at a frustration level when attempting to read books rated at their instructional level by an IRI. The current study questions how reliably and accurately IRIs identify students' instructional level for reading.

Effects of Positive and Negative Reinforcement in a Concurrent Operants Arrangement on Compliance and Problem Behavior / Efectos del Reforzamiento Positivo y Negativo en un Arreglo de Operantes Concurrentes sobre la Obediencia y la Conducta Problemática

Functional analysis (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) is a robust approach to identifying function-based interventions for problem behavior, including self-injury, aggression, and destruction. Such interventions, however, may be difficult for untrained caregivers to implement with fidelity in natural environments. Further research is needed to identify simple antecedent strategies for promoting appropriate behavior among children with significant problem behavior. The purpose of the current study was to utilize a concurrent schedules arrangement to identify conditions under which two children with autism spectrum disorder (ASD) and developmental delays who engaged in problem behaviors would choose to complete academic tasks to earn access to preferred items. In both cases, problem behaviors were shown to be sensitive to reinforcement in the forms of escape from task demands and access to preferred items. A concurrent operant arrangement in which the participants could choose to complete work tasks to earn access to preferred activities, or to take a break without demands or preferred items, was implemented. The schedule requirements in the demand component were systematically increased across opportunities, while the amount and type of reinforcement was kept constant. The results show, at the lowest levels of task demands, both participants allocated more opportunities to the work option. At higher levels, however, both participants allocated a majority of their choices to the break option. Despite the absence of preferred items in the break component, no instances of problem behavior were observed following selection of the break option. This indicates that this type of analysis could be used to identify conditions for compliance among individuals who engage in escape- or multiply-maintained problem behaviors, without the need to provoke or reinforce problem behavior. Limitations of the current study and recommendations for future research are discussed.

El análisis funcional (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) es una aproximación robusta para identificar intervenciones basadas en la función para la conducta problemática, incluyendo la autolesión, agresión y destrucción. Tales intervenciones, no obstante, pueden ser difíciles de implementar fidedignamente en escenarios naturales por cuidadores no entrenados. Se requiere más investigación para identificar estrategias antecedentes simples para promover la conducta apropiada entre niños con problemas significativos de conducta. El propósito del presente estudio fue utilizar un arreglo de programas concurrentes para identificar las condiciones bajo las cuales dos niños con trastorno del espectro autista (ASD, por sus siglas en inglés) y retraso en el desarrollo que emitían conducta problemática escogerían completar tareas académicas para ganar acceso a ítems preferidos. En ambos casos, las conductas problemáticas fueron sensibles al reforzamiento consistente en escape de las demandas de la tarea y en acceso a ítems preferidos. Se implementó un arreglo de programas concurrentes en el que los participantes podían escoger entre completar una tarea académica para ganar acceso a ítems preferidos o tomar un descanso sin demandas y sin ítems preferidos. Los requisitos del programa en el componente de demanda fueron incrementados sistemáticamente a través de las oportunidades de elección, mientras que el tipo y cantidad de reforzamiento se mantuvo constante. Los resultados mostraron que en el nivel más bajo de demandas, ambos participantes prefirieron la opción de trabajo. A niveles de demanda más altos, no obstante, ambos participantes eligieron la opción de tomar un descanso. A pesar de la ausencia de ítems preferidos en el componente de descanso, no se observaron instancias de conducta problemática después de esta opción. Esto indicó que este tipo de análisis puede ser usado para identificar condiciones que conducen a la obediencia entre individuos cuya conducta problemática se mantiene por escape o bien por múltiples reforzadores, sin la necesidad de provocar o reforzar la conducta problemática. Se discuten las limitaciones del presente estudio y se ofrecen recomendaciones para futura investigación.

A Prospective Sequential Analysis of the Relation Between Physical Aggression and Peer Rejection Acts in a High-Risk Preschool Sample.

Research Findings: In early childhood education, the social ecology of the child is considered critical for healthy behavioral development. There is, however, relatively little information based on directly observing what children do that describes the moment-by-moment (i.e., sequential) relation between physical aggression and peer rejection acts in early childhood contexts. Such information could be useful for policy and practice because it may inform specific intervention targets. In this descriptive study, a real-time direct observation protocol was used to measure the frequency of physically aggressive acts and peer rejection acts. The sequential association between directly observed physical aggression and peer rejection acts was examined for 5 high-risk preschool children (Child Behavior Checklist/Teacher Report Form clinical scores) at the beginning (Time 1 [T1]) and end (Time 2 [T2]) of their preschool year. Descriptive analyses showed that both aggression and peer rejection acts increased over the course of the preschool year. Sequential analyses showed that there was a significant (p < .05) increase in the likelihood of physical aggression followed by peer rejection acts from T1 to T2 as indexed by Yule's Q (a transformed odds ratio that controls for differences in the frequencies of children's target behavior). Similarly, there was a significant (p < .05) increase in the likelihood of peer rejection acts followed by physical aggression from T1 to T2. Practice or Policy: Considering the long-term adversity that aggression and related early conduct problems can introduce into the education and social service system, additional studies using direct observation to study early social dynamics between peer rejection acts and physical aggression in at-risk children seem warranted to improve experts' ability to disrupt this developmental trajectory and improve peer relationships.

Differential reinforcement of alternative behavior increases resistance to extinction: clinical demonstration, animal modeling, and clinical test of one solution.

Basic research with pigeons on behavioral momentum suggests that differential reinforcement of alternative behavior (DRA) can increase the resistance of target behavior to change. This finding suggests that clinical applications of DRA may inadvertently increase the persistence of target behavior even as it decreases its frequency. We conducted three coordinated experiments to test whether DRA has persistence-strengthening effects on clinically significant target behavior and then tested the effectiveness of a possible solution to this problem in both a nonhuman and clinical study. Experiment 1 compared resistance to extinction following baseline rates of reinforcement versus higher DRA rates of reinforcement in a clinical study. Resistance to extinction was substantially greater following DRA. Experiment 2 tested a rat model of a possible solution to this problem. Training an alternative response in a context without reinforcement of the target response circumvented the persistence-strengthening effects of DRA. Experiment 3 translated the rat model into a novel clinical application of DRA. Training an alternative response with DRA in a separate context resulted in lower resistance to extinction than employing DRA in the context correlated with reinforcement of target behavior. The value of coordinated bidirectional translational research is discussed.

Functional analysis and treatment of self-injurious behaviour in a young child with traumatic brain injury.

PRIMARY OBJECTIVE: There has been no research evaluating the utility of functional analysis (FA) in identifying effective interventions for severe problem behaviour in very young children with traumatic brain injury (TBI). It was hypothesized that FA technology would be applicable for this population and facilitate effective intervention development. RESEARCH DESIGN: A within-subject A-B-A reversal design was used to evaluate a functional communication training (FCT) intervention. This design allows for a demonstration of experimental control of the intervention over behaviour in single-case research. METHODS AND PROCEDURE: The authors conducted an FA of self-injurious behaviour (SIB) in an 18-month old boy with TBI. Results of the FA suggested that SIB was maintained, at least in part, by contingent maternal attention. An FCT intervention was used to teach a request for attention using an alternative communication device. MAIN OUTCOMES AND RESULTS: The FCT intervention reduced SIB to near zero and resulted in consistent use of an alternative communication device, functionally replacing SIB with desirable behaviour. The child's mother was coached to conduct all treatment sessions and reported satisfaction with the process. CONCLUSION: Analysis of behavioural function may play an important role in developing effective interventions for very young TBI patients with behaviour problems.