The use of behavioral skills training to improve staff performance of discrete trial training

Well‐trained staff are a prerequisite for successful implementation of treatment plans when working in human service contexts. The high rate of turnover makes the use of efficient and effective staff training all the more important. Previous research has used behavioral skills training to train teachers in correct implementation of discrete trial training of children with autism. They showed that a brief 10‐min procedure could effectively train staff and result in improved performance. The current study elaborated on previous work by using participants without prior exposure to the method, including treatment integrity data and testing for maintenance 1 month after training ended. The mean percentage of correct teaching responses for the three participants increased from 70%, 58%, and 66% during baseline to 97%, 96%, and 99%, respectively, following training. Results indicated that the training package was effective and the results were maintained 30 days later.     

Mapping differential responses to cognitive training using machine learning

We used two simple unsupervised machine learning techniques to identify differential trajectories of change in children who undergo intensive working memory (WM) training. We used self‐organizing maps (SOMs)—a type of simple artificial neural network—to represent multivariate cognitive training data, and then tested whether the way tasks are represented changed as a result of training. The patterns of change we observed in the SOM weight matrices implied that the processes drawn upon to perform WM tasks changed following training. This was then combined with K‐means clustering to identify distinct groups of children who respond to the training in different ways. Firstly, the K‐means clustering was applied to an independent large sample (N = 616, M_age = 9.16 years, range = 5.16–17.91 years) to identify subgroups. We then allocated children who had been through cognitive training (N = 179, M_age = 9.00 years, range = 7.08–11.50 years) to these same four subgroups, both before and after their training. In doing so, we were able to map their improvement trajectories. Scores on a separate measure of fluid intelligence were predictive of a child's improvement trajectory. This paper provides an alternative approach to analysing cognitive training data that go beyond considering changes in individual tasks. This proof‐of‐principle demonstrates a potentially powerful way of distinguishing task‐specific from domain‐general changes following training and of establishing different profiles of response to training.     

The use of matrix training to promote generative language with children with autism

Matrix training consists of planning instruction by arranging components of desired skills across 2 axes. After training with diagonal targets that each combine 2 unique skill components, responses to nondiagonal targets, consisting of novel combinations of the components, may emerge. A multiple‐probe design across participants was used to evaluate matrix training with known nouns (e.g., cat) and verbs (e.g., jumping) with 5 children with autism spectrum disorders (ASD). Following baseline of Matrix 1 and a generalization matrix, diagonal targets within Matrix 1 were trained as noun–verb combinations (e.g., cat jumping). Posttests showed recombinative generalization within Matrix 1 and the generalization matrix for 4 participants. For 1 participant, diagonal training across multiple matrices was provided until correct responding was observed in the generalization matrix. Results support the use of matrix training to promote untrained responses for learners with ASD and offer a systematic way to evaluate the extent of generalization within and across matrices.     

Adaptive working memory training can reduce anxiety and depression vulnerability in adolescents

Adolescents can be at heightened risk for anxiety and depression, with accumulating research reporting on associations between anxiety and depression and cognitive impairments, implicating working memory and attentional control deficits. Several studies now point to the promise of adaptive working memory training to increase attentional control in depressed and anxious participants and reduce anxiety and depression symptoms, but this has not been explored in a non‐clinical adolescent population. The current study explored the effects of adaptive dual n‐back working memory training on sub‐clinical anxiety and depression symptomology in adolescents. Participants trained on either an online adaptive working memory task or non‐adaptive control task for up to 20 days. Primary outcome measures were self‐reported anxiety and depression symptomology, before and after intervention, and at 1‐month follow‐up. Self‐reported depression (p = 0.003) and anxiety (p = 0.04) decreased after training in the adaptive n‐back group relative to the non‐adaptive control group in the intention‐to‐treat sample (n = 120). These effects were sustained at follow‐up. Our findings constitute proof of principle evidence that working memory training may help reduce anxiety and depression vulnerability in a non‐clinical adolescent population. We discuss the findings’ implications for reducing risk of internalizing disorders in youth and the need for replication.     

Assessing long‐term maintenance of staff performance following behavior skills training in a home‐based setting

We used a multiple baseline across participant design to evaluate the effects of behavior skills training on teaching three behavior therapists to implement discrete trial teaching (DTT) and evaluate the long‐term maintenance of skills acquired through behavioral skills training. For participants whose skills did not maintain, the authors evaluated an independent self‐evaluation procedure on their performance. Following DTT implementation training, maintenance probes were assessed at 2‐, 4‐, 6‐, and 8‐week follow‐ups. The results demonstrated that one participant maintained 100% procedural integrity (PI) through all follow‐ups, one participant decreased below mastery criterion at the 2‐week follow‐up, and one participant dropped below mastery criterion at the 4‐week follow‐up. Those participants that demonstrated decreased accuracy of implementation of DTT programs and were taught to implement a self‐evaluation procedure. Following self‐evaluation, PI maintained for up to 7 weeks for one participant. Our results suggest that if PI does not maintain, self‐evaluation may be a supplementary intervention to increase and maintain PI of new employees.     

Telehealth and in‐person training outcomes for novice discrete trial training therapists

The efficacy and efficiency of telehealth and in‐person training were compared while teaching seven undergraduate students to implement components of discrete trial training. A multiple‐baseline design across skills with elements of multiple probe and delayed multiple baseline combined with an alternating‐treatments design was used to evaluate the effects of behavioral skills training (BST) on (a) implementing a multiple stimulus without replacement preference assessment, (b) setting up an instructional context, (c) delivering antecedent prompts, and (d) delivering consequences for accurate and inaccurate responding. Two skills were trained via telehealth and two skills were trained in‐person using BST procedures with a mock student. All participants provided high acceptability ratings for both training procedures. Results also showed that telehealth training was as efficacious and efficient as in‐person training for all skills across all participants. Five of six participants showed high levels of maintenance of the newly acquired skills; these five also exhibited the skills during a novel instructional task.     

Functional analysis skills training for residential caregivers

Functional analysis is the most effective assessment for identifying the maintaining contingencies of aberrant behavior. However, it is suggested that functional analyses are not conducted regularly due to the level of skill required. A multiple baseline design across participants was used to assess if four residential caregivers, with limited experience with applied behavior analysis, could be trained to implement the standard analog functional analysis conditions. The training consisted of a lecture, written information, modeling, rehearsal, and feedback. Results showed that all participants attained percentage correct responding scores above 95% on three consecutive trials following training. One caregiver showed positive generalization of skills to the assessment of another behavioral topography. The result of this study provides further evidence that lay individuals can be trained to assist in conducting functional analyses. Copyright © 2008 John Wiley & Sons, Ltd.     

Teaching complex verbal operants to children with autism and establishing generalization using the peak curriculum

The present study evaluated the feasibility of the PEAK Relational Training System's Generalization Module (Dixon, 2014b) to teach and establish generalization of autoclitic mands, distorted tacts, and creative path finding in three children diagnosed with autism spectrum disorder. Using a multiple‐baseline design across behaviors, each participant was provided with differential reinforcement and a least‐to‐most prompting hierarchy for correct responses to a subset of stimuli, and responses to other similar stimulus sets were probed for emergent generalization. Following training, each participant successfully acquired the directly trained behaviors and demonstrated generalization to the nonreinforced test exemplars. These data support the utility of Skinner's (1957) analysis to teach complex forms of verbal operants, and suggest that a manualized curriculum such as PEAK may have utility for promoting skill development and generalization for front line staff and caregivers of children with autism.     

Student outcomes after 1 year of front line staff implementation of the PEAK curriculum

Systems‐level interventions built by behavior analysts often rely on others to implement, and this may be especially true in public education settings where behavior analysts are scarce. This study evaluated the effectiveness of the Promoting the Emergence of Advanced Knowledge Direct Training (PEAK‐DT) curriculum when implemented by school teachers and direct care staff. Thirty‐nine children with autism took part in the study (19 PEAK, 15 control), where the experimental group received applied behavior analytic instruction through the PEAK‐DT curriculum, and the quasi‐randomized control group received training as usual. The PEAK‐DT assessment was first administered to the participants at the onset of the study and again following 1 year. Participants who received PEAK training gained more skills on the PEAK‐DT assessment compared to the control group (PEAK: M = 16.0, SD = 17.8; control: M = 6.1, SD = 14.4, F(1,33) = 10.66, p < .05), suggesting that systems level implementation of behavior analytic procedures can be effective in teaching language skills as prescribed in a packaged curriculum designed by behavior analysts.     

Effects of three-step prompting on compliance with caregiver requests

Three-step prompting is a procedure commonly used in behavioral assessments and interventions; however, little research has evaluated the effects of this procedure on increasing children's compliance with caregiver requests. In this study, caregivers of children who demonstrated low levels of compliance were trained to use three-step prompting when presenting task requests to their children. Results indicated that training caregivers to implement this procedure decreased the frequency of caregiver-delivered prompts and increased compliance by the children.     

Train‐the‐trainer: Methodology to learn the cognitive interview

Research has indicated that police may not receive enough training in interviewing cooperative witnesses, specifically in use of the cognitive interview (CI). Practically, for the CI to be effective in real‐world investigations, police investigators must be trained by law enforcement trainers. We conducted a three‐phase experiment to examine the feasibility of training experienced law enforcement trainers who would then train others to conduct the CI. We instructed Federal Bureau of Investigation and local law enforcement trainers about the CI (Phase I); law enforcement trainers from both agencies (n = 4, 100% male, mean age = 50 years) instructed university students (n = 25, 59% female, mean age = 21 years) to conduct either the CI or a standard law enforcement interview (Phase II); the student interviewers then interviewed other student witnesses (n = 50, 73% female, mean age = 22 years), who had watched a simulated crime (phase III). Compared with standard training, interviews conducted by those trained by CI‐trained instructors contained more information and at a higher accuracy rate and with fewer suggestive questions.     

Utilizing in-vivo feedback for caregiver training of pediatric feeding protocols

Researchers have used multicomponent behavioral skills training packages including written and verbal instructions, modeling, rehearsal, and feedback when teaching caregivers to implement pediatric feeding treatment protocols (e.g., Anderson & McMillan, 2001; Seiverling et al., 2012). Some investigators have shown that fewer behavioral skills training components may be necessary for effective training (e.g., Mueller et al., 2003; Pangborn et al., 2013). We examined the use of in-vivo feedback following written instructions to train caregivers to implement pediatric feeding treatment protocols using a multiple baseline design across 3 caregiver dyads. Correct implementation of the feeding treatment procedures was low during baseline (written instructions only), increased with only the addition of in-vivo feedback, and remained high during follow-up sessions for all caregivers. Results are discussed in terms of clinical implications and caregiver satisfaction.     

Telehealth parent training for a young child at risk for autism spectrum disorder

The global pandemic has highlighted the importance of telehealth to access behavioral interventions. Face-to-face parent training improves the development and behaviors of young children at risk for autism spectrum disorder (ASD). We evaluated a telehealth parent training intervention for a child at risk for ASD. Two parents identified possible early ASD symptoms in their 30-month-old son (lack of imitation, pointing, and vocal manding). Both parents simultaneously received telehealth behavioral skills training on the Parent Intervention for Children at Risk for Autism program for 1 hour per week over 29 weeks. Multiple baseline designs across parent and child behaviors showed that both parents improved their parent teaching fidelity above 80% and the child improved on all trained behaviors. This study expands the utility of telehealth behavioral parent training to young children at risk for ASD to mitigate early symptoms of ASD.     

Pyramidal training for families of children with problem behavior

The pyramidal training model was extended to multiple family members of children with behavior disorders. Three primary caregivers were taught to implement individualized treatments for problem behavior. They were then taught how to use various instructional strategies (e.g., prompting, feedback) to teach 2 other family members to implement the treatment. Results showed that pyramidal training was effective in increasing caregiver implementation of treatments across three families.     

Effects of motor-cognitive coordination training and cardiovascular training on motor coordination and cognitive functions

ObjectivesNumerous recent studies showed that physical training can enhance cognitive abilities, such as attention, spatial ability, memory performance, and executive functions. However, most of these studies focused on the efficiency of cardiovascular training, whereas evidence for combined motor-cognitive training emphasizing coordination abilities is scarce. Therefore, the aim of the present study was to investigate the effects of motor-cognitive coordination training and moderate cardiovascular training on cognitive functions and to test whether these effects were related to participant's fitness level.Design and methodWe tested 50 physically active (mean age = 23.5 years, SD = 3.2) and 56 sedentary participants (mean age = 23.4 years, SD = 3.2) in a pretest-training-posttest design with 12 sessions of moderate cardiovascular training (≈60% HRmax) or motor-cognitive coordination training. The training groups were compared to a passive control group. At pretest and posttest, participants performed an untrained motor-cognitive coordination task, measures of executive control (cognitive flexibility, inhibition, working memory), spatial ability, and fluid intelligence.Results and conclusionsWe found improved coordination abilities in the coordination training group, but no transfer of training to cognitive measures in physically active participants. However, sedentary participants showed larger improvements in terms of inhibition in the coordination training group compared to the remaining groups, while the cardiovascular training group improved in cognitive flexibility compared to the remaining groups. In sum, there are positive but differential effects of cardiovascular training and coordination training on cognitive performance in sedentary young participants, suggesting that coordination training may be a useful intervention especially for individuals that cannot perform cardiovascular training.     

INCREASING INDEPENDENCE AMONG CHILDREN DIAGNOSED WITH AUTISM USING A BRIEF EMBEDDED TEACHING STRATEGY

The purpose of this study was to evaluate the effects of a brief embedded teaching procedure, involving least‐to‐most prompting for two paraprofessional staff in order to increase independent responses of two children diagnosed with autism in an inclusive setting. Training was given using a behavioral skills training approach, involving instructions, modeling, rehearsal, and feedback. A multiple‐baseline design across behaviors was used to evaluate the effects of the embedded teaching procedure. Maintenance of training effects was evaluated two weeks, following the end of the study. After training of the brief embedded prompting procedure and during following up probes, both students showed increased independence in each skill that staff were trained to teach. Copyright © 2012 John Wiley & Sons, Ltd.     

The effects of training on caregiver implementation of incidental teaching

A brief training package consisting of modeling, rehearsal, and feedback was evaluated to train caregivers to use incidental teaching to teach 3 children with autism to request an item or activity. The training package improved correct implementation of the incidental teaching procedure by caregivers. In addition, probes indicated that caregivers could apply these skills to teach the child an additional skill.     

Brief training to promote the use of less intrusive prompts by nursing assistants in a dementia care unit

We evaluated the efficacy of a brief staff-training procedure to increase the use of graduated prompting by 2 certified nursing assistants (CNAs) while they helped to dress 3 persons with dementia in a seven-bed dementia care unit. The multiple baseline design across participants showed that CNAs dressed residents with minimal resident involvement during baseline observations. Following brief in-service training, CNAs provided graduated prompts and praise appropriately, suggesting that CNAs can promote active involvement in personal care routines by older adults with dementia.     

SEQUENTIAL APPLICATION OF CAREGIVER TRAINING TO IMPLEMENT PEDIATRIC FEEDING PROTOCOLS

The purpose of this study was to evaluate the effectiveness of current caregiver training practices by implementing training components sequentially, to teach parents mealtime protocols. A multiple baseline design was implemented across two caregiver dyads. Therapist‐fed meals were conducted prior to training to identify an effective intervention to increase food acceptance and decrease food refusal. The package consisted of seven components: observation, written and verbal protocol review, video review, structured observation, modeling, role play, and immediate feedback. Correct implementation of mealtime protocols, by caregivers, were evaluated throughout the training process by having caregivers conduct meal sessions following each training component to determine if additional training was necessary. Results showed that the training procedures were effective in teaching caregivers to implement mealtime protocols, and systematic introduction of the training components produced systematic and incremental changes in correct caregiver implementation. In addition, all participants completed training without requiring all seven training components. Copyright © 2012 John Wiley & Sons, Ltd.     

Teaching college students to pour accurately using behavioral skills training: Evaluation of the effects of peer modeling

Excessive alcohol consumption among college students is a serious problem. Alcohol education courses, during which students are taught to free‐pour accurate servings of alcohol, have been proposed as one strategy to reduce this problem. However, few studies have evaluated the effects of peer models on free‐pour skill maintenance. We used a nonconcurrent multiple‐baseline across subjects design to assess the effects of peer modeling on maintenance of college students' (N = 19) pouring skills of a standard serving of beer immediately following Behavioral Skills Training (BST). Results indicated participants who inaccurately poured a standard serving of beer at baseline (n = 17) accurately poured following receipt of BST, and all participants (N = 19) maintained accurate pouring in the presence of peer confederate models who poured inaccurately or accurately. Results suggest BST is an efficient (i.e., low to no‐cost, requires no sophisticated laboratory space or software, and makes use of available and affordable materials) and effective tool for teaching college students to pour standard servings of beer and that the immediate introduction of inaccurately pouring peer models has little or no effect on skill maintenance.