THE EFFECTS OF PARENT‐IMPLEMENTED PECS TRAINING ON IMPROVISATION OF MANDS BY CHILDREN WITH AUTISM

The present study examined the extent to which mothers were able to train their children, 2 boys with autism, to exchange novel pictures to request items using the picture exchange communication system (PECS). Generalization probes assessing each child's ability to mand for untrained items were conducted throughout conditions. Using a multiple baseline design, results demonstrated that both children improvised by using alternative symbols when the corresponding symbol was unavailable across all symbol categories (colors, shapes, and functions) and that parents can teach their children to use novel pictorial response forms.     

Multiply controlled verbal operants: an analysis and extension to the picture exchange communication system

This paper presents Skinner's (1957) analysis of verbal behavior as a framework for understanding language acquisition in children with autism. We describe Skinner's analysis of pure and impure verbal operants and illustrate how this analysis may be applied to the design of communication training programs. The picture exchange communication system (PECS) is a training program influenced by Skinner's framework. We describe the training sequence associated with PECS and illustrate how this sequence may establish multiply controlled verbal behavior in children with autism. We conclude with an examination of how Skinner's framework may apply to other communication modalities and training strategies.     

Object interest in autism spectrum disorder: a treatment comparison

A randomized control trial comparing two social communication treatments for children with autism spectrum disorder examined the effect of treatment on object interest. Thirty-two children, 18-60 months, were randomly assigned to the Picture Exchange Communication System (PECS) or Responsive Education and Prelinguistic Milieu Teaching (RPMT) condition. Assessment of object interest was conducted in an unstructured play session with different toys, activities, adult, and location than experienced in treatment. Results indicated children in the RPMT condition showed greater increases in object interest as compared to children in the PECS condition. Because child characteristics such as interest in objects may influence response to interventions using object play as contexts for treatment, it is important to improve our understanding of whether intervention can affect object interest.     

Functional analysis and treatment of social-communicative behavior of adolescents with developmental disabilities.

This investigation used functional analyses to identify the social variables that maintained the inappropriate social-communicative behaviors of 2 adolescent students with mental retardation. Analyses were performed in the students' classrooms with the assistance of peers and teachers. The results of these assessments were used to identify appropriate, functionally equivalent behaviors that the students were taught to self-monitor. Findings showed substantial decreases in inappropriate social responding and increases in the use of appropriate social skills.     

Teaching children with autism to engage in peer-directed mands using a picture exchange communication system

We evaluated differential reinforcement of alternative behavior (DRA) plus prompting to increase peer-directed mands for preferred items using a picture exchange communication system (PECS). Two nonvocal individuals with autism participated. Independent mands with a peer increased with the implementation of DRA plus prompting for both participants. In addition, peers engaged in brief social interactions following the majority of mands for leisure items. These results suggest that teaching children to use PECS with peers may be one way to increase manding and social interactions in individuals with limited or no vocal repertoire.     

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.     

Antecedent stimulus control: using orienting cues to facilitate first-word acquisition for nonresponders with autism

Although considerable progress has been made in improving the acquisition of expressive verbal communication in children with autism, research has documented that a subpopulation of children still fail to acquire speech even with intensive intervention. One variable that might be important in facilitating responding for this nonverbal subgroup of children is the use of antecedent orienting cues. Using a multiple baseline design, this study examined whether individualized orienting cues could be identified, and whether their presentation would result in the production of verbal expressive words. The results showed that this antecedent stimulus control procedure produced improvements in responding to verbal models in all of the children, and subsequent gains in speech for some of the children. Theoretical and applied implications of orienting cues as they relate to antecedent stimulus control for children with autism are discussed.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

Joint attention and children with autism: a review of the literature

Preverbal communication and joint attention have long been of interest to researchers and practitioners. Both attending to social partners and sharing attentional focus between objects or events and others precede the onset of a child's first lexicon. In addition, these prelinguistic acts also appear to have important implications with regard to learning to socialize. The construct of joint attention has been noted as an early developing area prior to the transition to symbolic communication. Thus, the importance of joint attention in typically developing children, and the lack thereof in children with autism, has interested researchers for use in diagnosis and intervention for autism. That is, joint attention has been gaining momentum as an area that not only helps characterize children with autism, but also as a prognostic indicator and a potential intervention goal. In this paper, the status of the literature about initiation of joint attention by young typically developing children and young children with autism was examined. Empirical studies regarding joint attention behaviors, including eye gaze alternation, the use of protodeclaratives and protoimperatives, and studies that investigated joint attention as a predictor of language acquisition were reviewed. Possible areas for future research for children with autism are discussed.     

INCREASING COMMUNICATIVE INTERACTIONS OF YOUNG CHILDREN WITH AUTISM USING A VOICE OUTPUT COMMUNICATION AID AND NATURALISTIC TEACHING

We evaluated the effects of a voice output communication aid (VOCA) and naturalistic teaching procedures on the communicative interactions of young children with autism. A teacher and three assistants were taught to use naturalistic teaching strategies to provide opportunities for VOCA use in the context of regularly occurring classroom routines. Naturalistic teaching procedures and VOCA use were introduced in multiple probe fashion across 4 children and two classroom routines (snack and play). As the procedures were implemented, all children showed increases in communicative interactions using VOCAs. Also, there was no apparent reductive effect of VOCA use within the naturalistic teaching paradigm on other communicative behaviors. Teachers' ratings of children's VOCA communication, as well as ratings of a person unfamiliar with the children, supported the contextual appropriateness of the VOCA. Probes likewise indicated that the children used the VOCAs for a variety of different messages including requests, yes and no responses, statements, and social comments. Results are discussed in regard to the potential benefits of a VOCA when combined with naturalistic teaching procedures. Future research needs are also discussed, focusing on more precise identification of the attributes of VOCA use for children with autism, as well as for their support personnel.     

Assessment of social communication skills in preschoolers

This paper orients the reader to social communication assessment and reviews methods for assessing social communication behavior in children from toddlerhood through the preschool years. Most standardized, normed tests of language in this age range focus on morpho-syntactic and semantic comprehension and production abilities. While social communication is perhaps one of the most important skills for peer acceptance, these skills are often overlooked in language evaluation with children. However, there are a number of caregiver questionnaires, interviews, or direct social-communication sampling methods that are available to assist clinicians or researchers in documenting social-communication skills or behaviors. Since assessment of social communication is essential in clinical work with children with an autism spectrum disorder, some of the tools described below are outgrowths of autism research or provide autism-related scores. While many children receiving social communication assessments do not have autism, the need to assess social communication skills in children with language impairment is highlighted by the growing literature documenting social and pragmatic difficulties in this population (Bishop 2000 Causes, Characteristics, Intervention, and Outcome. Hove, UK: Psychology press). Regardless of whether the measures presented herein were initially designed for children with autism or not, they will provide insights into the social communicative behaviors or tendencies in young children.     

Parental perceptions of supplemental interventions received by young children with autism in intensive behavior analytic treatment

Parents of children with autism in applied behavior analytic treatment were surveyed on their use and perceptions of supplemental treatments. In study 1, respondents (N=121) reported enrolling their children in an average of seven supplemental interventions, most commonly non‐behavior‐analytic speech therapies (85%), megavitamins (61%), Sensory Integration Therapy (56%), and elimination diets (50%). In study 2, parents (N=24) were interviewed about these four interventions and typically reported little or no benefit. Factors that parents cited as influencing their decision to obtain supplemental interventions for their children varied substantially, depending on the individual intervention. Because of the extensive use of unvalidated interventions that parents deemed unhelpful, it seems important to reduce children's participation in such interventions. However, because of the diverse influences on parents' decisions to obtain the interventions, a multifaceted strategy may be needed. Copyright © 2000 John Wiley & Sons, Ltd.     

Teaching spontaneous responses to young children with autism

Using a multiple probe design across responses, we demonstrated the effectiveness of intensive intervention in establishing spontaneous verbal responses to 2 3-year-old children with autism with generalization to novel settings involving novel persons. Intervention involved discrete-trial instruction (i.e., repeated instructional opportunities presented in close proximity to high rates of reinforcement), specific prompts, and error correction. Spontaneous responses were defined as specific verbal utterances (e.g., the child says "bless you") following discriminative stimuli that did not involve explicit vocal directives (e.g., adult sneeze). The development of effective interventions to address the social-communicative needs of very young children with autism is discussed.     

Early communication development and intervention for children with autism

Autism is a neurodevelopmental disorder defined by impairments in social and communication development, accompanied by stereotyped patterns of behavior and interest. The focus of this paper is on the early development of communication in autism, and early intervention for impairments in communication associated with this disorder. An overview of components of communication is provided. Communication characteristics that are diagnostic of autism are summarized, with consideration of the overlap between social and communication impairment, particularly for children with autism functioning at the prelinguistic level. Early communication development and predictors of communication functioning in autism are examined, based on a review of prospective and retrospective studies. The focus of the discussion then turns to intervention. Consideration is given to the rationale for beginning intervention as early in life as possible for children with autism. Implications of motor, imitation, and play deficits for communication-based intervention are examined. Finally, issues related to the design and delivery of intervention for young children with autism are presented, along with a review of the major early intervention approaches for autism.     

TREATMENT OF SOCIAL BEHAVIOR IN AUTISM THROUGH THE MODIFICATION OF PIVOTAL SOCIAL SKILLS

We examined acquisition of individual social communicative behaviors and generalization across other social behaviors in 2 children with autism. The results of a multiple baseline design showed that the children's treated social behaviors improved rapidly and that there were generalized changes in untreated social behaviors. These improvements were accompanied by increases in subjective ratings of the overall appropriateness of the children's social interactions. The results suggest the possibility of identifying pivotal response classes of social communicative behavior that may facilitate the understanding of social behavior in autism as well as improve peer interactions, social integration, and social development.     

The effects of token reinforcement on attending in a young child with autism

The benefits of token economies have been widely established, however there are very few empirical studies on the effects of token reinforcement on the behavior of young children with autism. The establishment of conditioned reinforcers such as tokens may be important in interventions for children with autism. Token reinforcement was used to increase the attending behavior of a young child with autism during discrete trials instruction for academic and communication skills. A reversal design showed that token reinforcement sustained attending only when the back‐up reinforcer was available and was accessed immediately. The results extend and corroborate findings on token reinforcement reported in other applied settings and are also consistent with findings from basic research on conditioned reinforcement. Copyright © 2006 John Wiley & Sons, Ltd.     

Preliminary evidence on the use of telehealth in an outpatient behavior clinic

Previous studies have shown that telehealth can be an effective way to deliver behavior‐analytic services. In this study, we provided a demonstration of the use of telehealth to assess and initiate treatment of problem behavior in an outpatient clinic. We coached parents of children with autism via telehealth to conduct functional analyses during 1 appointment that lasted 1 hr and subsequently coached them as they implemented functional communication training during 3 subsequent appointments (15 min each). Social functions were identified for most children, and problem behavior was reduced by an average of 65.1%.     

Treating the core features of autism: are we there yet?

A wide variety of nonestablished treatments have been proposed as "cures" for the core features of autism and are used frequently despite having largely escaped scientific scrutiny. In contrast, a growing body of empirical evidence supports the use of a few forms of theory-based and empirically validated treatment for some aspects of the core features of autism. These include behavioral/psychoeducational interventions and specific forms of medication treatment, which can produce significant improvements in communication, social interaction, and problem behaviors that both maintain over time and generalize across settings. While there is no doubt that treatment and educational services for persons with autism have improved over the past 6 decades, it also appears that significant issues remain with respect to (1) the routine application of validated treatments for the majority of cases with autism, (2) the resistance to even validated forms of treatment for a substantial minority of cases with autism, and (3) the extent to which validated treatments effectively treat the specific core features of autism that are most disabling for persons with autism and their families.     

Intentions vs. resemblance: Understanding pictures in typical development and autism

Research has debated whether children reflect on artists’ intentions when comprehending pictures, or instead derive meaning entirely from resemblance. We explore these hypotheses by comparing how typically developing toddlers and low-functioning children with autism (a population impaired in intentional reasoning) interpret abstract pictures. In Experiment 1, both groups mapped familiar object names onto abstract pictures, however, they related the same representations to different 3-D referents. Toddlers linked abstract pictures with intended referents they did not resemble, while children with autism mapped picture-referent relations based on resemblance. Experiment 2 showed that toddlers do not rely upon linguistic cues to determine intended referential relations. Experiment 3 confirmed that the responding of children with autism was not due to perseveration or associative word learning, and also provided independent evidence of their intention-reading difficulties. We argue that typically developing children derive meaning from the social-communicative intentions underlying pictures when resemblance is an inadequate cue to meaning. By contrast, children with autism do not reflect on artists’ intentions and simply relate pictures to whatever they happen to resemble.     

Teaching mands for information using speech generating devices: A replication and extension

Approximately 30% of individuals diagnosed with autism spectrum disorder (ASD) fail to develop vocal communication and, therefore, use some form of augmentative or alternative communication system. The current study replicates and extends previous research on teaching “Who?” and “Which?” mands for information to 3 young children diagnosed with ASD using a speech generating device. Procedures were evaluated using a multiple baseline across participants design. All participants learned to mand for information and, subsequently, used the information to access preferred items.