Using telehealth to teach valued skills to adults with intellectual and developmental disabilities

Telehealth uses electronic information and telecommunication technologies to deliver long-distance clinical services. It has successfully been used by clinical professionals to teach family and staff members to provide evidence-based assessment and treatment procedures. There is no research to date, however, evaluating the use of telehealth to directly teach individuals with intellectual and developmental disabilities (IDD). Thus, we evaluated the efficacy of a telehealth intervention using total task chaining with least-to-most prompting delivered via videoconference to 2 adults with IDD. Both participants demonstrated low independent responding during baseline with enhanced written instructions present. During intervention, which included vocal and model prompting, both participants met the mastery criterion for each skill in fewer than 15 sessions, which maintained after 2 weeks. Finally, both participants expressed satisfaction with the goals, procedures, and effects of the intervention. We discuss the broader scope of the intervention for individuals with disabilities when face-to-face services may not be feasible.     

Embedded prompting may function as embedded punishment: detection of unexpected behavioral processes within a typical preschool teaching strategy

This study describes an unexpected behavioral process that influenced behavior during the teaching of concepts to a 4-year-old girl. The efficacy of and preference for three strategies that varied in teacher directedness were assessed in a multielement design and concurrent-chains arrangement, respectively. The strategy that involved the most teacher direction was most efficacious and preferred. In addition, embedded teacher prompts, common in child-led teaching procedures, functioned as a punisher for the child's toy play. Implications for designing effective and preferred teaching conditions are discussed.     

Effects of parent training on parent instruction and child learning of intellectual skills

The present investigation examined the effects of a brief parent training package on parental application of behavioral procedures during child instruction. In addition, it investigated the effects of parent training on child learning of two intellectual skills. Forty-nine parents and their $\text{2}\text{1}\text{2}$ to 5-year-old children participated. A discriminant analysis revealed that the parent training package produced variations in parental use of modeling, physical prompting, verbal instructional prompting, and aversive control. However, the pattern of variations differed across instructional tasks. Regression analysis showed that parent training produced differences in child learning in one of the two skills targeted for instruction.     

An evaluation of preference for video and in vivo modeling

We assessed preference for video or in vivo modeling using a concurrent-chains arrangement with 3 children with autism. The two modeling conditions produced similar acquisition rates and no differential selection (i.e., preference) for all 3 participants.     

Choice for aperiodic versus periodic ratio schedules: A comparison of concurrent and concurrent-chain procedures

Choice between mixed-ratio schedules, consisting of equiprobable ratios of 1 and 99 responses per reinforcement, and fixed-ratio schedules of food reinforcement was assessed by two commonly used procedures: concurrent schedules and concurrent-chains schedules. Rats were trained under concurrent fixed-ratio mixed-ratio schedules, in which both ratio schedules were simultaneously available, and under a concurrent-chains schedule, in which access to one of the mutually exclusive ratio schedules comprising the terminal links was contingent on a single “choice” response. The distribution of responses between the two ratio schedules was taken as the choice proportion under the concurrent procedure, and the distribution of “choice” responses was taken as the choice proportion under the concurrent-chains procedure. Seven of eight rats displayed systematic choice; of those, each displayed nearly exclusive choice for fixed-ratio 35 to the mixed-ratio schedule under the concurrent procedure, but each displayed nearly exclusive choice for the mixed-ratio schedule to fixed-ratio 35 under the concurrent-chains procedure. Thus, preference for a fixed or a mixed schedule of reinforcement depended on the procedure used to assess preference.     

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.     

Improving reading outcomes for children with learning disabilities: using brief experimental analysis to develop parent-tutoring interventions

The present study assessed the effects of summer parent tutoring on 3 children with learning disabilities using empirically derived reading interventions. Brief experimental analyses were used to identify customized reading fluency interventions. Parents were trained to use the intervention strategies with their children. Parents implemented the procedures during parent-tutoring sessions at home and results were measured continuously in high-word-overlap and low-word-overlap passages to determine whether generalization occurred. Parent and child satisfaction with the procedures was assessed. Results demonstrated generalized increases in reading fluency in both high-word-overlap and low-word-overlap passages as a function of parent tutoring. Also, acceptability ratings by children and their parents indicated that they viewed the interventions as acceptable and effective. Results are discussed in terms of structuring reading fluency interventions that promote generalization and maintenance of treatment effects.     

Choice: A local analysis

Analyses of free-operant choice usually employ one of two general procedures: the simple concurrent procedure (i.e., a concurrent variable-interval variable-interval schedule) or the concurrent-chains procedure (i.e., concurrently available initial links, each leading to an exclusively available terminal link). Theories about choice usually focus on only one of the two procedures. For example, maximization theories, which assert that behavior is distributed between two alternatives in such a way that overall rate of reinforcement is maximized, have been applied only to the simple concurrent procedure. In the present paper, a form of the pairing hypothesis (according to which pairings between one stimulus and another affect the value of the first, and pairings between responses and reinforcers affect the value of the former) is developed in a way that allows it to make qualitative predictions with regard to choice in a variety of simple concurrent and concurrent-chains procedures. The predictions include matching on concurrent variable-interval variable-interval schedules, preference reversal in the self-control paradigm, and preference for tandem over chained terminal links.     

On the effectiveness of and preference for punishment and extinction components of function-based interventions

The current study describes an assessment sequence that may be used to identify individualized, effective, and preferred interventions for severe problem behavior in lieu of relying on a restricted set of treatment options that are assumed to be in the best interest of consumers. The relative effectiveness of functional communication training (FCT) with and without a punishment component was evaluated with 2 children for whom functional analyses demonstrated behavioral maintenance via social positive reinforcement. The results showed that FCT plus punishment was more effective than FCT in reducing problem behavior. Subsequently, participants' relative preference for each treatment was evaluated in a concurrent-chains arrangement, and both participants demonstrated a dear preference for FCT with punishment. These findings suggest that the treatment-selection process may be guided by person-centered and evidence-based values.     

Preliminary Evaluation of Sleepwise Program for Children With Sleep Disturbance and Developmental Delay

Sleep disturbances are very prevalent in children with developmental delay. Parental-assisted behavioral strategies have been used effectively in school-aged children; however, multimodal treatment for preschool-aged children is lacking. The current study is a preliminary investigation of the effectiveness of a parent group program called Sleepwise designed for young children with developmental delay and incorporating behavioral, communicative, and sensory strategies. Six parents attended three workshop sessions and implemented individualized treatment plans. Initial results revealed significant posttreatment reductions in child sleep disturbances and behavioral problems, with high treatment acceptability ratings by parents. Outcomes were generally maintained at 1-month follow-up.     

Caregiver‐mediated joint attention intervention

Joint attention is a pivotal social communication skill often absent or impaired in young children with autism spectrum disorder. Joint attention is the shared and alternating attention of two individuals on an object or event, and has implications for later communication and social communication skills. This study used a concurrent multiple‐baseline design across 3 caregiver–child dyads to train caregivers to teach response to joint attention behaviors to their 3–6 years old children with moderate to severe autism spectrum disorder. Caregivers were trained on strategies including prompting, time delay, and elements of naturalistic teaching and implemented the intervention in brief 10‐min sessions 2–3 times per week. Results indicate parent mastery of intervention and substantial increase in child response to joint attention behaviors both prompted and independent. Implications for practice and areas for future research are discussed.     

Effects of a Center-Based Parent Training Package on Parents’ Accuracy of Generalized Program Implementations at Home

Abstract

The purpose of this study was to evaluate the effects of a parent training package on parents’ accuracy of program implementations and their children’s goal achievements on parent-implemented programs at home. Parents also completed a quiz with questions about three-contingencies before and after the training. Three mother-child dyads participated in this study. All three children were 4-year-old boys with developmental delays. We employed a multiple baseline across three parent-child dyads as the primary design combined with a pretest and posttest. The individual parent training sessions consisted of office meetings and in-vivo classroom coaching sessions on program implementations. Each parent was trained individually to mastery criteria on program implementations using the Teacher Performance Rate Accuracy Scale (TPRA). After completing the parent training package, all parents acquired program implementations skills, and their program implementation skills were generalized to teach new behaviors at home with a high level of fidelity. Their quiz scores on three-term contingencies also increased to a relatively high level.     

Comparing the Effectiveness and Efficiency of Response Repetition to Simultaneous Prompting on Acquisition and Maintenance of Multiplication Facts

This study compared the effectiveness and efficiency of an error-correction procedure, response repetition, to a prompting procedure, simultaneous prompting, on the acquisition and maintenance of multiplication facts for three typically developing 3rd grade students. This study employed an adapted alternating treatments design nested in a multiple probe design across three sets of multiplication facts. Results indicated that correct responding increased upon intervention implementation for all participants. For two participants, response repetition was a more effective teaching procedure. For one participant, while both teaching procedures were effective, response repetition was more efficient in terms of sessions to mastery while simultaneous prompting was more efficient in terms of errors and seconds to mastery. Maintenance data were variable. Discussion focuses on conceptual differences between response repetition and simultaneous prompting that might have accounted for results.     

Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training

Training behavioral technicians mainly focuses on teaching accurate implementation of structured behavioral intervention programs. Often behavioral technicians are unable to adequately promote their clients' learning in less structured environments, which can limit opportunities for generalization of the clients' skills to the natural environment. The aim of the present study was to evaluate the effectiveness of using behavioral skills training to coach behavioral technicians on the implementation of naturalistic behavioral interventions. Naturalistic behavioral interventions take advantage of naturally occurring situations to teach new skills and practice mastered skills in natural settings, thus promoting generalization across environments and in the presence of natural contingencies. Five behavioral technicians were trained to implement a novel protocol based on play therapy. Specifically, they were coached to engage in well‐defined positive behaviors during their interactions with clients (e.g., labeled praise). All participants reached mastery criteria, maintained skills at follow‐up, and demonstrated generalization of skills with novel clients.     

An Investigation of Student-Selected and Parent-Delivered Reading Interventions

In this study, we examined whether individualized, student-selected, parent-delivered reading interventions would produce generalized oral reading fluency improvements. Three 3rd-grade students received reading fluency interventions (repeated readings, modeling, error correction, and flashcard instruction) 1 at a time and were shown the results that each intervention produced. The students then selected the intervention strategies they wanted their parents to use. We trained parents in the student-selected reading intervention package who delivered the interventions for 4–5?weeks, and students were given the opportunity to earn rewards for generalized performance improvements at the end of each week in school. Using an alternating treatments design, results of parent tutoring were compared to a control condition that included a reinforcement contingency for generalized performance improvements to control for reinforcement effects across conditions. Generalized improvements in oral reading fluency (to high-word-overlap passages) were found for all participants. Results are discussed in terms of how educators can improve parent-tutoring outcomes by influencing students’ motivation to engage in tutoring procedures.     

EVALUATION OF CLIENT PREFERENCE FOR FUNCTION-BASED TREATMENT PACKAGES

Functional communication training (FCT) and noncontingent reinforcement (NCR) are commonly prescribed treatments that are based on the results of a functional analysis. Both treatments involve delivery of the reinforcer that is responsible for the maintenance of destructive behavior. One major difference between the two treatment procedures is that client responding determines reinforcement delivery with FCT (e.g., reinforcement of communication is delivered on a fixed-ratio 1 schedule) but not with NCR (e.g., reinforcement is delivered on a fixed-time 30-s schedule). In the current investigation, FCT and NCR were equally effective in reducing 2 participants' destructive behavior that was sensitive to attention as reinforcement. After the treatment analysis, the participants' relative preference for each treatment was evaluated using a modified concurrent-chains procedure. Both participants demonstrated a preference for the FCT procedure. The results are discussed in terms of treatment efficacy and preference for control over when reinforcement is delivered. In addition, a method is demonstrated in which clients with developmental disabilities can participate in selecting treatments that are designed to reduce their destructive behavior.     

Integrating Parents' Views on Sibling Relationships to Tailor an Evidence‐based Parenting Intervention for Sibling Conflict

Parents play a crucial role in the development of their children's relationships with their siblings. Despite this, relatively few evidence‐based parenting programs exist that specifically offer parents the strategies and techniques they desire and require for managing their children's sibling relationships. One way of bridging this gap is to design a tailored parenting intervention for sibling relationships that incorporates the parent voice in various aspects of program design. The current study recruited a convenience sample of 409 Australian parents to complete an online survey relating to their views on difficult sibling behaviors and what, if any, help they desire in dealing with the issue. The majority of respondents were Caucasian, middle‐ to upper‐class mothers. Respondents predominantly attributed the causes of sibling conflict to their child's internal traits, but expressed strong desire for assistance with managing behavioral problems, especially when sibling relationships were marked by physical aggression. Respondents reported high levels of acceptability for positive, rather than punitive, parenting strategies and showed a clear preference for parenting interventions delivered in easy‐to‐access formats. The findings are interpreted in the context of guiding the development of a tailored parenting intervention for enhancing sibling relationships and reducing conflict.     

Evaluating the effect of parent reading interventions on improving reading fluency of students with reading difficulties

The current study examines the effect of parent reading interventions on the reading fluency of students with reading disabilities. The experimental procedure was carried out in two stages. In the first stage, the Brief Experimental Analysis procedure was followed to determine the most effective reading fluency intervention for all participants, and in the next step, the parental delivery of the selected intervention procedure took place. Brief experimental analysis was used to identify appropriate reading fluency intervention for each participant. Parents were trained to use the intervention strategies with their children. They implemented the procedures during parent‐tutoring sessions at home and results were measured continuously to determine whether generalization occurred. Parent and child satisfaction with the interventions was assessed. Results demonstrated generalized increases in reading fluency in both high‐word‐overlap and low‐word‐overlap passages as a function of parent tutoring. Also, acceptability ratings by children and their parents indicated that they viewed the interventions as acceptable and effective.     

Issues in the treatment of depressed children

Basic research into the cognitive, behavioral, familial, and physiological disturbances associated with depressive disorders during childhood is reviewed. Implications for the development of a treatment program are discussed and a comprehensive treatment model is proposed. The proposed model includes intervention strategies for the child, parents, family, and school. The child component consists of intervention strategies for the affective, cognitive, behavioral, and physiological disturbances that are evident from the existing research. The parent training component is designed to address disturbances in parenting due to cognitive disturbances and skills deficits. The family therapy component emphasizes changing interaction patterns that communicate schema-consistent maladaptive interactions. A school consultation component is proposed in which school personnel support the skills training through prompting use of the skills and reinforcement of the use of the coping skills.