INCREASING COMPLEX SOCIAL BEHAVIORS IN CHILDREN WITH AUTISM: EFFECTS OF PEER-IMPLEMENTED PIVOTAL RESPONSE TRAINING

Two children with autism were taught to engage in a variety of complex social behaviors using peer-implemented pivotal response training (PRT), a set of procedures designed to increase motivation and promote generalization. Typical peers were taught to implement PRT strategies by modeling, role playing, and didactic instruction. After training, peers implemented the procedures in the absence of direct supervision in a classroom environment. After the intervention, both children with autism maintained prolonged interactions with the peer, initiated play and conversations, and increased engagement in language and joint attention behaviors. In addition, teachers reported positive changes in social behavior, with the largest increases in peer-preferred social behavior. Further, these effects showed generality and maintenance. Implications of these findings are discussed.     

EFFECTS OF SELF-EVALUATION ON PRESCHOOL CHILDREN'S USE OF SOCIAL INTERACTION STRATEGIES WITH THEIR CLASSMATES WITH AUTISM

This study investigated effects of a self-evaluation procedure on preschool children's use of social interaction strategies among their classmates with autism. Three triads of children (comprised of 1 trained normally developing peer, 1 untrained peer, and 1 child with autism) participated. A multiple baseline design across subjects was used to demonstrate that peers who were taught facilitative strategies increased their use of strategies only after the self-evaluation intervention was introduced. Improvements in social behavior of children with autism was associated with peers' increased strategy use. Untrained peers demonstrated little change in their social behavior. Treatment effects were replicated when trained peers were asked to use self-evaluation with other children with autism during other play times. Self-evaluation procedures enhanced the use of social interaction strategies on the part of normally developing peers during social skills interventions.     

Social stories, written text cues, and video feedback: effects on social communication of children with autism.

This study investigated the effects of written text and pictorial cuing with supplemental video feedback on the social communication of 5 students with autism and social deficits. Two peers without disabilities participated as social partners with each child with autism to form five triads. Treatment was implemented twice per week and consisted of 10 min of systematic instruction using visual stimuli, 10 min of social interaction, and 10 min of self‐evaluation using video feedback. Results showed increases in targeted social communication skills when the treatment was implemented. Some generalized treatment effects were observed across untrained social behaviors, and 1 participant generalized improvements within the classroom. In addition, naive judges reported perceived improvements in the quality of reciprocal interactions. These findings support recommendations for using visually cued instruction to guide the social language development of young children with autism as they interact with peers without disabilities.     

Using multiple-exemplar training to teach a generalized repertoire of sharing to children with autism

The current study examined the utility of multiple-exemplar training to teach children with autism to share. Stimuli from 3 of 4 categories were trained using a treatment package of video modeling, prompting, and reinforcement. Offers to share increased for all 3 children following the introduction of treatment, with evidence of skill maintenance. In addition, within-stimulus-category generalization of sharing was evident for all participants, although only 1 participant demonstrated across-category generalization of sharing. Offers to share occurred in a novel setting, with familiar and novel stimuli, and in the presence of novel adults and peers for all participants during posttreatment probes.     

Effects of Video Modeling and Feedback on Mothers' Implementation of Peer‐to‐Peer Manding

Children with autism spectrum disorder (ASD) exhibit deficits in appropriate requesting such as manding to peers. Experiment 1 used feedback and modeling to train three mothers to increase manding between three children with ASD and their typical siblings or peers. Video modeling and feedback increased the mother's correct implementation of the treatment but a causal relation was not established over the children's manding. Experiment 2 aimed to address the lack of functional control observed in the children's data using a partial component analysis. For one of the children there was a functional relation between the materials' location, which appeared to act as a motivating operation. When Sam's mother positioned the materials correctly his manding increased. These data indicated that a simple training protocol could be used to train caregivers to implement a complex social skill such as peer‐to‐peer interaction. Copyright © 2015 John Wiley & Sons, Ltd.     

Testing a Theory of Implementation Leadership and Climate Across Autism Evidence-Based Interventions of Varying Complexity

Prominent theories within the field of implementation science contend that organizational leaders can improve providers’ fidelity to evidence-based practices (EBPs) by using focused implementation leadership behaviors that create an organizational climate for EBP implementation. However, this work has been criticized for overreliance on nonspecific, self-report fidelity measures and poor articulation of the boundary conditions that may attenuate leadership and climate’s influence. This study tests the predictions of EBP implementation leadership and climate theory on observed fidelity to three school-based EBPs for autism that vary in complexity: pivotal response training (PRT), discrete trial training (DTT), and visual schedules (VS). Educators in kindergarten to third-grade autism support classrooms in 65 schools assessed their principals’ EBP implementation leadership and school EBP implementation climate prior to the school year. Mid-school year, trained observers rated educator fidelity to all three interventions. Expert raters confirmed PRT was significantly more complex than DTT or VS using the Intervention Complexity Assessment Tool for Systematic Reviews. Linear regression analyses at the school level indicated principals’ increased frequency of EBP implementation leadership predicted a higher school EBP implementation climate, which in turn predicted higher educator fidelity to PRT—however, there was no evidence of a relationship between implementation climate and fidelity to DTT or VS. Comparing principals whose EBP implementation leadership was ±1 SD from the mean, there was a significant indirect association of EBP implementation leadership with PRT fidelity through EBP implementation climate (d = 0.49, 95% CI [0.04, 0.93]). Strategies that target EBP implementation leadership and climate may support fidelity to complex behavioral interventions.     

TRAINING PROSOCIAL BEHAVIORS TO YOUNG CHILDREN: AN ANALYSIS OF RECIPROCITY WITH UNTRAINED PEERS

We examined the effects of a social skills training package on the play behaviors of three young girls. Two children were taught to invite their peers to play and to use social amenities during their conversations with other children. A combined reversal and multiple baseline across responses design demonstrated that both children directed more social behaviors to their classroom peers after training and that these two children's play invitations were maintained in the later absence of experimental contingencies. In addition, both target children received a greater number of play invitations from their peers during the free play periods. In contrast, a third child's play invitations were not reciprocated by peers; her invitations subsequently decreased in rate after training was discontinued. An interdependent group contingency produced a reciprocal exchange of invitations between this child and her classroom peers. A reversal design demonstrated partial maintenance of subject-peer exchanges after the group intervention was discontinued. The results obtained with the three target children suggest that peer reciprocity may facilitate the maintenance of children's play invitations over time.     

ADHERENCE TO DISCRETE‐TRIAL INSTRUCTION PROCEDURES BY RURAL PARENTS OF CHILDREN WITH AUTISM

Parents of children with autism spectrum disorders may not attempt treatment, even when effective treatment options are available. Little is known about how to improve frequency of attempts to implement treatment (‘treatment adherence’). We provided 32 rural parents of young children with autism spectrum disorders with either written or video training materials about how to implement discrete‐trial instruction and compared parental adherence between the written (control) and video (experimental) groups. Parents who received video instructions adhered to the training procedures to a significantly greater extent than did parents who received written instructions, suggesting that instruction format is a predictor of training success. Copyright © 2014 John Wiley & Sons, Ltd.     

Teaching conversational speech to children with autism spectrum disorder using text‐message prompting

The present study was designed to teach conversational speech using text‐message prompts to children with autism spectrum disorder (ASD) in home play settings with siblings and peers. A multiple baseline design across children was used. Children learned conversational speech through the text‐message prompts, and the behavior generalized across peers and settings. Maintenance of treatment gains was seen at 1‐month follow‐up probes. Social validity measures indicated that parents of typically developing children viewed the participants' conversational speech as much improved after the intervention. Results are discussed in terms of the efficacy of text‐message prompts as a promising way to improve conversational speech for children with ASD.     

Teaching social skills to isolated children

The effects of a social skill training program on socially isolated children are reported. The training program was derived from the results of a previous study of the specific social skills that discriminated popular from unpopular children. Training effects in the present investigation were assessed on sociometric position, and on the quality, frequency, and distribution of social interaction to peers. Time-series analyses were performed on the frequency and distribution of peer interaction. Two isolated children received social skill training with an adult coach, and two isolated children spent an equivalent amount of time with an adult. Results indicated that socially isolated children in the treatment group changed significantly in sociometric position on a follow-up assessment 9 weeks after the end of the intervention, did not change in the total frequency of peer social interaction, but did redistribute their interaction to peers. The two isolated children who did not receive the treatment program did not change significantly on the total frequency of peer interaction, and tended to withdraw from peers rather than redistribute their interaction. The insensitivity of total peer interaction frequency as a measure of outcome was discussed.     

THE EFFECTS OF BEHAVIOR SKILLS TRAINING ON CORRECT TEACHER IMPLEMENTATION OF NATURAL LANGUAGE PARADIGM TEACHING SKILLS AND CHILD BEHAVIOR

Natural Language Paradigm (NLP) is a naturalistic teaching strategy for children with autism that increases immediate and delayed imitative utterances, spontaneous utterances and new words, and production of utterances. NLP includes increasing child choice, varying stimulus items, loose shaping contingencies for communicative attempts, and providing reinforcers with a direct relationship to the response. Only one previous study investigated the effects of behavioral skills training (BST) on staff acquisition and generalization of implementation of NLP and child behavior. A BST package of instructions, modeling rehearsal and feedback, was used to train teachers to implement NLP teaching procedures with three pre‐school children with autism spectrum disorder. Training increased correct teacher performance systematically across all three teachers during NLP teaching sessions and with children for whom teachers did not directly receive training. Correct teacher performance increased appropriate child vocalizations and decreased maladaptive behavior for four of six children. BST is effective in quickly training teachers in the generalized implementation of complex NLP teaching procedures across children. Copyright © 2012 John Wiley & Sons, Ltd.     

Effective Educational Inclusion of Students on the Autism Spectrum

Beginning with early efforts to prepare preschool aged children with autism to join their peers in regular education classes, there has been a continuing interest in including children with autism spectrum disorders (ASDs) in regular education classes. A modest body of literature has explored ways to enhance the social interactions of children with ASDs and to more fully integrate them into academic and co-curricular experiences with their peers. These efforts have shown benefits to the children with ASDs as well as their peers in specifically defined situations. While there remains a serious lack of rigorous research in this area and a clear need for additional study regarding the long term impact of full inclusion on both groups of children, the existing research provides some interim strategies for professionals working with these children.     

Behaviors of children with high‐functioning autism when paired with typically developing versus delayed peers: a preliminary study

Children with high‐functioning autistic disorder (HAD) in a comprehensive behavioral treatment program (n = 9, age = 5–7 years) alternated between pairings with a typically developing peer and pairings with a peer who had both autism and developmental delay. All pairings took place in a free play setting. The children with HAD displayed much more interactive play and speech (as well as much less self‐stimulation) with typically developing peers than with delayed peers. They received frequent cues and consequences for interaction from typically developing peers, but not in sessions with delayed peers. These results suggest that placement with typically developing peers is critical for children with HAD in behavioral treatment. Copyright © 2002 John Wiley & Sons, Ltd.     

An interest‐based intervention package to increase peer social interaction in young children with autism spectrum disorder

The literature suggests that children with autism spectrum disorder (ASD) educated in inclusive settings generally do not interact with typically developing classmates during social activities. This study assessed whether an intervention package consisting of interest‐based structured play activities involving adult instruction, modeling, and response to child questions would result in an increase in social interaction with typically developing peers. A multiple baseline design across four participants with an embedded reversal was used to demonstrate the effects of the intervention on social interaction during structured play sessions. Initiations, responses, and interactive play increased for all participants. Generalization to novel peers was observed, and treatment gains were maintained during 6‐week follow‐up sessions. Recommendations for practitioners working with children with ASD in inclusive settings and potential areas of future research are discussed.     

Promoting social initiation in children with autism using video modeling

A large number of studies have shown that children and youths with autism can improve their social skills when provided with appropriate and well planned treatment strategies. Here, a video modeling procedure was implemented with seven developmentally delayed children, using a multiple‐treatment design. Each child watched a videotape showing a model and the experimenter engaged in a simple social interactive play in an adapted play setting. Afterwards each child's behavior was assessed in this setting, while the experimenter's behavior remained the same as that shown in the videotape. The video modeling training enhanced the social initiation skills of four children. It also facilitated appropriate play engagement, which generalized across settings, peers, and toys. These changes maintained after a 1‐ and 2‐month follow‐up period. The intervention was evaluated as a time‐efficient teaching tool as well as a means of enhancing appropriate play skills. Copyright © 2003 John Wiley & Sons, Ltd.     

ACQUISITION OF MANDS AND TACTS WITH CONCURRENT ECHOIC TRAINING

Previous studies have identified a number of effective teaching procedures to increase verbal behavior in individuals with developmental disabilities. However, few studies have evaluated modifications of treatment procedures when children fail to acquire communication skills. In the present investigation, a 4‐year‐old boy with autism failed to acquire unprompted mands and tacts during mand‐only and tact‐only training. Results indicated that combining echoic training with mand or tact training increased unprompted manding and tacting.     

AN EVALUATION OF TWO METHODS FOR INCREASING SELF-INITIATED VERBALIZATIONS IN AUTISTIC CHILDREN

Three children with autism and mental retardation were treated for deficits in self-initiated speech. A novel treatment package employing visual cue fading was compared with a graduated time-delay procedure previously shown to be effective for increasing self-initiated language. Both treatments included training multiple self-initiated verbalizations using multiple therapists and settings. Both treatments were efffective, with no differences in measures of acquisition of target phrases, maintenance of behavioral gains, acquisition with additional therapists and settings, and social validity.