Comparing In-View to Out-of-View Stimulus Arrangements When Teaching Receptive Labels for Children Diagnosed With Autism Spectrum Disorder.

One common best practice recommendation for teaching receptive labels to individuals diagnosed with autism spectrum disorder is for the stimulus array to be arranged outside of the view of the learner. Another strategy that may have benefits would be to arrange the stimuli in view of the learner. The purpose of this study was to compare the relative effectiveness and efficiency of arranging the stimulus array in view versus out of view of the learner when teaching receptive labels to three children diagnosed with autism spectrum disorder. The results of an adapted alternating-treatments design demonstrated that both conditions were effective, and all participants reached the mastery criterion on all training sets. However, the in-view condition was more, or equally, efficient with respect to sessions to mastery when compared to the out-of-view condition. The results are discussed with respect to clinical and research implications for best practice recommendations related to teaching receptive language.

Evaluating the Cool Versus Not Cool Procedure via Telehealth.

Autistics/individuals diagnosed with autism spectrum disorder (ASD) commonly display qualitative impairments in social behavior that commonly result in the use of interventions directly targeting the development of social skills. The COVID-19 pandemic has highlighted the need for effective social skills interventions that can be delivered directly via telehealth. The Cool Versus Not Cool procedure has continually been documented as effective within the literature. However, its reported use has been limited to in-person delivery. The purpose of this study was to evaluate the effectiveness of the Cool Versus Not Cool procedure conducted via telehealth to teach three children diagnosed with ASD to change the conversation when someone is bored. The results of a nonconcurrent multiple-baseline across-participants design demonstrated that all three participants reached the mastery criterion in four to eight sessions. Responding generalized to another adult for two of the three participants, and all three participants maintained correct responding. Social validity measures indicated the skill was important to teach, the intervention was acceptable and effective, and the telehealth format was an acceptable replacement for in-person intervention for these three participants.

Concerns About ABA-Based Intervention: An Evaluation and Recommendations.

For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.

Toward Efficiency and Effectiveness: Comparing Equivalence-based Instruction to Progressive Discrete Trial Teaching.

Research has found equivalence-based instruction (EBI) to be effective and efficient, with recent research extending these finding to individuals diagnosed with autism spectrum disorder (ASD). EBI has also been compared with more traditional approaches to teaching, such as traditional lectures, reading assignments, and video lectures. However, the authors are unaware of any comparisons of EBI to other similar behavior analytic approaches such as discrete trial teaching (DTT). The purpose of the first experiment was to compare EBI to progressive DTT using an adapted alternating treatments design with typically developing adults. Experiment 2 compared the two teaching methods with children diagnosed with ASD. The teaching approaches were evaluated with respect to mastery of trained relations, emergence of untrained relations for the EBI condition, and participant preferences. Results of the two experiments found that both teaching methods were effective, progressive DTT was found to be more efficient for six participants, EBI was found to be more efficient for two participants, and overall progressive DTT was found to be more preferred by participants. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-022-00687-8.

The effect of early autism intervention on parental sense of efficacy in a randomized trial depends on the initial level of parent stress.

LAY ABSTRACT: This is a study of the secondary effects of interventions for young children with autism on their parents. Specifically, we were interested in the impact on parent's sense of efficacy, or how confident and competent a parent feels about themselves as a parent. We tested three ideas: (1) that the style of the intervention, whether it was more or less structured and whether the parent had a more or less formal role, would impact a parent's sense of efficacy; (2) that the intensity of the intervention, how many hours per week the intervention was delivered, would impact parental efficacy; and (3) that the parent's level of stress prior to intervention would impact how intensity and style effected efficacy. We randomly assigned 87 children with autism, age 13-30 months, into one of four conditions: 15 versus 25 intervention hours crossed with two different styles of intervention. We used statistical tests to examine these ideas. We found that parental efficacy was related to intervention intensity but not style. Parents with higher stress at the beginning of a 1-year, home-based, comprehensive intervention program had a higher sense of parenting efficacy if their child received lower intensity intervention; parents with lower stress at baseline had a higher sense of efficacy if their child received higher intensity intervention. If a parent can emerge from the process of diagnosis and early intervention with an increased sense that they can make a difference in their child's life (i.e. increased sense of efficacy), it may set the stage for meeting the long-term demands of parenting a child with autism.

Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder.

There are three branches of science of behavior analysis [i.e., experimental analysis of behavior, behavior analysis, and applied behavior analysis (ABA)]. ABA can be defined as a systematic approach to understanding behavior of social interest. For the past 40 plus years, researchers have evaluated ABA and ABA based procedures (e.g., behavioral intervention) as they relate to individuals diagnosed with autism spectrum disorder (ASD) and have implemented behavioral intervention in clinical settings for individuals diagnosed with ASD. In this paper, we discuss some of the pivotal contributions in the field of ABA in research and clinical practice. Additionally, we provide recommendations for the science and clinical practice of behavioral intervention in the next 40 years.

A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism.

OBJECTIVE: This randomized, multisite, intent-to-treat study tested the effects of 2 levels of treatment intensity (number of hours) and 2 treatment styles on the progress of young children with autism spectrum disorder (ASD). We predicted that initial severity of developmental delay or autism symptoms would moderate the effects of intensity and style on progress in 4 domains: autism symptom severity, expressive communication, receptive language, and nonverbal ability. METHOD: A total of 87 children with ASD, mean age 23.4 months, were assigned to 1 of 2 intervention styles (naturalistic developmental/behavioral or discrete trial teaching), each delivered for either 15 or 25 hours per week of 1:1 intervention for 12 months by trained research staff. All caregivers received coaching twice monthly. Children were assessed at 4 timepoints. Examiners and coders were naive to treatment assignment. RESULTS: Neither style nor intensity had main effects on the 4 outcome variables. In terms of moderating the effects of initial severity of developmental delay and of autism symptom severity, neither moderated the effects of treatment style on progress in any of the 4 domains. In terms of treatment intensity, initial severity moderated effect of treatment intensity on only 1 domain, namely, change in autism symptom severity; in a secondary analysis, this effect was found in only 1 site. CONCLUSION: Neither treatment style nor intensity had overall effects on child outcomes in the 4 domains examined. Initial severity did not predict better response to 1 intervention style than to another. We found very limited evidence that initial severity predicted better response to 25 vs 15 hours per week of intervention in the domains studied. CLINICAL TRIAL REGISTRATION INFORMATION: Intervention Effects of Intensity and Delivery Style for Toddlers With Autism: https://clinicaltrials.gov/; NCT02272192.

The Importance of Professional Discourse for the Continual Advancement of Practice Standards: The RBT® as a Case in Point.

The Behavior Analyst Certification Board (BACB®) created a third level of certification, the Registered Behavior Technician™ (RBT®) in 2014. The RBT® was created based upon the requests of stakeholders who wanted to credential those individuals who make direct contact with clients under the supervision of a Board Certified Behavior Analyst®. There has been tremendous growth in the number of RBTs® with over 60,000 individuals certified to date. The BACB® recently sent out a newsletter outlining changes to the RBT® certification, including the processes of training, supervising, and becoming an RBT®. These changes represent a number of potential concerns. The purpose of this paper is to highlight these concerns and to propose solutions to improve the RBT® certification.

Interaction of Treatment Intensity and Autism Severity on Frequency and Maturity of Spontaneous Communication in Toddlers with Autism Spectrum Disorder.

This study tested whether the effect of treatment intensity or treatment style on children's frequency and maturity of spontaneous communication varied by initial severity of disability. Eighty-seven toddlers with autism spectrum disorders were randomly assigned to either (a) 15 hrs per week of discrete trial teaching (DTT), (b) 25 hrs per week of DTT, (c) 15 hrs per week of a naturalistic developmental behavioral intervention (NDBI), or (d) 25 hrs per week of NDBI. Trained research staff implemented the 1:1 treatments in homes or educational centers over 12 months. We quantified the frequency and maturity of spontaneous communication during monthly 6-min communication samples. We quantified disability severity at Time 1 using the developmental quotient from the Mullen Scales of Early Learning and the total calibrated severity score from the Autism Diagnostic Observation Schedule-second edition. Higher levels of treatment intensity (i.e., more hours per week) benefited frequency and maturity of spontaneous communication growth rate only in children with relatively mild autism symptoms. Other results were nonsignificant. Autism Res 2020, 13: 1902-1912. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: Eighty-seven toddlers with autism spectrum disorders were randomly assigned to 15 hrs per week of discrete trial teaching (DTT), 25 hrs per week of DTT, 15 hrs per week of a naturalistic developmental behavioral intervention (NDBI), or 25 hrs per week of NDBI. Trained research staff implemented the treatments in homes or educational centers over 12 months. More hours of treatment per week benefited frequency and maturity of spontaneous communication growth rate only in children with relatively mild autism symptoms. Other results were nonsignificant.

Evaluating discrete trial teaching with instructive feedback delivered in a dyad arrangement via telehealth.

Telehealth research in the field of applied behavior analysis (ABA) has focused on the training and supervision of others to implement various behavior analytic procedures. Current guidelines for practicing telehealth suggest that direct telehealth services may be appropriate for some individuals diagnosed with autism spectrum disorder, but more research is needed. This study evaluated the effects of discrete trial teaching with instructive feedback in a dyad arrangement delivered directly via telehealth to teach tact relations to 6 children diagnosed with autism spectrum disorder. All participants and the experimenter were located in different physical locations. All participants learned their primary and secondary targets, and 5 of the participants acquired the observational primary and secondary targets without direct teaching. Areas of future research and clinical implications are discussed in the context of telehealth service delivery.

The Teaching Interaction Procedure as a Staff Training Tool.

The teaching interaction procedure is an evidence-based procedure that has been utilized for the development of social skills. The teaching interaction procedure consists of labeling the targeted skill, providing a meaningful rationale for the importance of the skill, describing the steps of the targeted skill, modeling the skill, and providing feedback throughout the interaction. Although the teaching interaction procedure has been used to teach a variety of social skills to children and adolescents diagnosed with autism spectrum disorder (ASD) and other social and behavioral disorders, its use has not been evaluated for training staff. The purpose of this study was to evaluate the use of a teaching interaction procedure to teach 3 interventionists the skills to implement a teaching interaction procedure to target the development of social skills for children diagnosed with ASD. The results of a multiple-baseline design showed the teaching interaction procedure was effective at teaching all 3 interventionists how to implement a teaching interaction procedure.

Comparing Error Correction to Errorless Learning: A Randomized Clinical Trial.

Errorless learning and error correction procedures are commonly used when teaching tact relations to individuals diagnosed with autism spectrum disorder (ASD). Research has demonstrated the effectiveness of both procedures, as well as compared them. The majority of these studies have been completed through the use of single-subject experimental designs. Evaluating both procedures using a group design may contribute to the literature and help disseminate research related to the behavioral science of language to a larger audience. The purpose of the present study was to compare an errorless learning procedure to an error correction procedure to teach tact relations to 28 individuals diagnosed with ASD through a randomized clinical trial. Several variables were assessed, including the number of stimulus sets with which participants reached the mastery criterion, responding during pre- and postprobes, responding during teaching, efficiency, and the presence of aberrant behavior. The results indicated that both procedures were effective, efficient, and unlikely to evoke aberrant behavior, despite participants in the error correction condition engaging in significantly more independent correct responses and independent incorrect responses.

A randomized clinical trial of three prompting systems to teach tact relations.

Prompts are commonly used during discrete trial teaching for individuals diagnosed with autism spectrum disorder (ASD). Three commonly used prompting systems include constant time delay, most-to-least prompting, and flexible prompt fading. Most of the research demonstrating the effectiveness of these three prompting strategies have been completed through the use of single subject experimental designs. Some within the field of behaviorally based approaches to ASD interventions have called for more randomized clinical trials of these approaches. The purpose of the present study was to compare these 3 prompting systems to teach tact relations for 27 individuals diagnosed with ASD through a randomized clinical trial without a control group with respect to pre-post responding, generalization, sessions to mastery, and responding during teaching. Overall, minimal differences were observed across the 3 systems. The results are discussed with respect to future research and clinical application of the methods evaluated.

Use of a Level System with Flexible Shaping to Improve Synchronous Engagement.

Level systems have been described as a framework which can be used to shape behavior through the systematic application of behavioral principles. Within level systems, an individual moves up and down through various levels contingent upon specific behaviors. Although level systems are commonly used within schools and other settings, they have a limited empirical literature base, and there is debate over the efficacy and overall acceptance of level systems. More especially, there is scant empirical literature on the use level systems to improve socially significant behaviors (e.g., synchronous engagement) with individuals diagnosed with autism spectrum disorder (ASD). The purpose of this study was to evaluate the effectiveness of a level system with a structured, yet flexible approach to movement on improving synchronous engagement with two dyads of children diagnosed with ASD. The results of an ABAB reversal design indicated that the level system was effective at improving synchronous engagement for both dyads. The results are discussed in relation to potential future research difficulties and clinical implications.

The Big Four: Functional Assessment Research Informs Preventative Behavior Analysis.

Current practice guidelines suggest that the assessment and treatment of challenging behavior should consist of conducting a functional behavior assessment following the onset of problem behavior. This assessment process can include indirect and direct assessment, as well as manipulation of variables to determine function. The purpose of this article is to outline a proposal that would add prevention practices to early intervention guidelines for problem behavior. Based on decades of research, the suggestion is to proactively teach children at risk for problem behavior to navigate four of the most common conditions that have been demonstrated to occasion problem behavior. Prevention is made a possibility because a large body of research examining the conditions under which challenging behavior occurs has been reliably replicated. Preventative approaches are an emerging phenomenon and reflect a progression in the practice of behavior analysis. Prevention may lead to acquisition of prosocial behavior before problems arise, to expedited and enhanced treatment, to increased access to favorable learning environments, and, we hope, to improvement in the quality of life for many children at risk for the development of problem behavior.

A Preliminary Evaluation of a Token System with a Flexible Earning Requirement.

Token systems often involve a predetermined number of tokens required prior to exchange for a terminal reinforcer. The effectiveness of token systems implemented in this manner has been well documented within the literature; however, some have discussed the possibility of a fixed earning requirement creating a context in which the learner no longer emits the desired behavior once the terminal number is achieved. A possible alternative to a fixed earning requirement is selecting the earning requirement based upon learner responding and leaving the requirement unknown to the learner until the moment of exchange. The purpose of this study was to evaluate the effectiveness of a token system with a flexible earning requirement to increase the frequency of comments during snack for 3 children diagnosed with autism spectrum disorder. The results of a nonconcurrent multiple-baseline design demonstrated the flexible token system was effective at increasing the rate of comments in addition to the cumulative number of novel comments.

Evaluating Three Methods of Stimulus Rotation when Teaching Receptive Labels.

The teaching of receptive labels (i.e., auditory-visual conditional discriminations) is common among early intervention programs for individuals diagnosed with autism spectrum disorder (ASD). Discrete trial teaching (DTT) is a common approach used to teach these receptive labels. Some have argued that the stimuli within the array, target and non-target, must be counterbalanced to prevent the development of undesired stimulus control. The purpose of the present study was to evaluate the effectiveness of three different approaches to stimulus rotation to teach receptive labels to five young children diagnosed with ASD. These approaches included counterbalanced, fixed, and clinician's choice. The results of an adapted alternating treatment design replicated across three stimulus sets and five participants indicated that all three methods of rotation were effective. Maintenance and generalization for targets taught in all three conditions was also assessed. The implications of the results with respect to current teaching practices in early intervention programs are discussed.

Social Thinking®, Pseudoscientific, Not Empirically Supported, and Non-Evidence Based: a Reply to Crooke and Winner.

J. B. Leaf et al. (Behavior Analysis in Practice, 9, 152-157, 2016) wrote a commentary on social thinking (ST), an intervention commonly implemented for individuals diagnosed with autism spectrum disorder (ASD). The authors described what constitutes scientific, pseudoscientific, and antiscientific evidence and contended that ST aligns with the definition of pseudoscience and, to date, is not empirically supported or evidence based. Crooke and Winner (Behavior Analysis in Practice, 9, 403-408, 2016) responded, arguing that ST meets their definition of an evidence-based practice and identifying purported misconceptions and inaccuracies described by J. B. Leaf et al. In the current article, the authors clarify the original arguments, critically evaluate Crooke and Winner's definition of what constitutes evidence-based practice, further evaluate the research on ST, discuss issues regarding how ST is conceptualized, and express concerns about the endorsement and use of an eclectic approach to treating ASD. As this response was written by behavior analysts, it specifically addresses the conceptual consistency of this approach from a behavior-analytic worldview.

Advantages and Challenges of a Home- and Clinic-Based Model of Behavioral Intervention for Individuals Diagnosed with Autism Spectrum Disorder.

Researchers have demonstrated that comprehensive behavioral intervention can result in significant improvements in the lives of individuals diagnosed with autism spectrum disorder (ASD; e.g.; Lovaas, Journal of Consulting and Clinical Psychology 55(1):3-9, 1987; McEachin et al., American Journal of Mental Retardation 97(4):359-372, 1993). This intervention has occurred in a variety of settings (e.g., school, home, and clinic). Even though procedures based upon the principles of applied behavior analysis (ABA) can be implemented across a variety of settings, there is often confusion about the differences and relative advantages of home- versus clinic-based settings. The purpose of this paper is to provide a discussion of home- and clinic-based intervention within the context of a progressive approach to ABA and discus possible advantages of each type of setting.