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.     

Parent‐implemented brief functional analysis and treatment with coaching via telehealth

We evaluated the use of parent‐implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent‐implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.     

Group Intensive Family Training (GIFT) for preschoolers with autism spectrum disorders

Early, intensive behavioral intervention is effective in treating children with autism spectrum disorders (ASDs), but can be cost prohibitive. Expenses may be defrayed if children can benefit from parents acting as therapists. This quantitative case series examines the efficacy of the Group Intensive Family Training (GIFT) program, a 12‐week (180 h, delivered 3 h each weekday) parent‐training for preschoolers with ASDs. Parents were individually mentored in the hands‐on application of behavior analytic techniques, implementing these skills in vivo within a group of six parent–child dyads. Seventy‐two parents and children (ages 25–68 months) with ASDs participated in this study. Children's cognitive and adaptive functioning was assessed before and after the intervention program. Analyses revealed average gains of eight standard score points on the Mullen Early Learning Composite and five standard score points on the Vineland Adaptive Behavior Composite after 12 weeks of treatment. Additionally, 14% and 11% of the children moved from the ‘impaired’ to ‘non‐impaired’ range on Mullen and Vineland composite scores, respectively. This preliminary investigation suggests that GIFT's behavioral, group parent‐training can lead to significant, yet cost‐ and time‐efficient gains for children with ASDs. Results must be interpreted with caution because of the absence of a control group. Copyright © 2008 John Wiley & Sons, Ltd.     

Generality of the practical functional assessment and skill‐based treatment among individuals with autism and mental health disorders

A practical functional assessment format was recently developed that informed a skill‐based treatment for the problem behavior of children diagnosed with autism spectrum disorder. Since its inception there have been multiple replications of the procedures; however, the comprehensive model has rarely been applied to populations with more complex comorbid disorders and severe problem behavior such as those diagnosed with anxiety or depression. We conducted the current study to systematically replicate the entire practical functional assessment and skill‐based treatment model with two participants diagnosed with multiple mental health disorders admitted to a severe behavior outpatient unit. The practical functional assessment identified reinforcers that were provided contingent on increasingly complex forms of communication. Problem behavior remained low for both participants after reinforcement was thinned by increasing a response requirement of completing difficult tasks. Furthermore, the results were socially validated by the parents and teachers and the treatment was extended to the home setting.     

Evaluation of a telehealth parent training program in teaching self-care skills to children with autism

The present study used synchronous video conferencing to remotely deliver a behavioral skills training-based (BST) parent training program to 3 parents of children with autism in the family home. Parents were taught to implement graduated guidance to teach their children several important self-care skills. Parents did not correctly implement graduated guidance after receiving detailed written instructions only. After parents received the BST parent training package, however, all parents implemented graduated guidance with near-perfect levels of fidelity, and all children completed the targeted self-care skills with substantially higher levels of accuracy and independence. Furthermore, parents reported high levels of satisfaction with graduated guidance, the telehealth BST training package, and their children's ability to complete self-care skills.     

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.     

Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism

The current study used an AB crossover design to directly compare the effects of sensory integration therapy (SIT) and behavioral intervention (BI) on the challenging behavior of 10 participants with autism spectrum disorder. During the intervention phase, all participants received both treatments. Follow‐up probes were conducted 1 month following intervention for 4 participants implementing the more effective intervention. The results showed that BI successfully reduced challenging behavior to low‐ or near‐zero levels. In contrast, SIT resulted in higher and more variable rates of challenging behavior. One exception was noted for Participant 4 who engaged in a decreased level of challenging behavior during SIT. The findings are discussed in relation to implication for practice and future research.     

Effects of behavioral skills training on parental treatment of children's food selectivity

We used behavioral skills training to teach parents of 3 children with autism spectrum disorder and food selectivity to conduct a home-based treatment package that consisted of taste exposure, escape extinction, and fading. Parent performance following training improved during both taste sessions and probe meals and was reflected in increases in children's acceptance of bites and decreases in their disruptive behavior. Parents also reported that increases in diet variety were maintained at follow-up.     

Early intensive behavioral intervention: emergence of a consumer-driven service model

Parents are becoming influential stimulators and shapers of public policy in regard to educational services for their children. Increasingly, this advocacy has created a controversy about the role of applied behavior analysis as a foundation for early intensive behavioral intervention in autism. Uncertainties exist in policy regarding the role of behavior analysis in early intervention and the capacity of behavior analysis to field a trained work force. Based on contacts with parents of children with autism and information available in a variety of forms on the Internet, there is a rising demand for fundamentally better early intervention services that are available and accessible, provide active intervention, and are based on principles of behavior analysis. Contemporary movements in special and early education, however, appear to be nonconducive to scientifically based treatments, and school districts seem hostile to an increasing role for behavior analysis and to the establishment of services that are responsive to changing parental priorities for the education of their children with autism and related disorders.     

Telehealth mask wearing training for children with autism during the COVID‐19 pandemic

SARS‐CoV‐2 is the virus causing COVID‐19 and is spread through close person‐to‐person contact. The use of face masks has been described as an important strategy to slow its transmission. We evaluated the effects of coaching caregivers via telehealth technologies to teach face mask wearing to children with autism spectrum disorder. Six participants with a history of challenging behavior associated with mask wearing were recruited from different parts of the world, and trained using graduated exposure, shaping, and contingent reinforcement. By the end of the intervention, all participants wore a face mask for a period of 10 min without exhibiting challenging behavior. The skills generalized to a novel mask or a community setting. Mask wearing did not affect the percentage of oxyhemoglobin saturation of participants, and caregivers found the intervention useful. The findings support previous tolerance training treatment evaluations in children with developmental disorders exhibiting resistance to healthcare routines.     

Attachment and Autism: Parental Attachment Representations and Relational Behaviors in the Parent-Child Dyad

While attachment research has demonstrated that parents’ internal working models of attachment relationships tend to be transmitted to their children, affecting children’s developmental trajectories, this study specifically examines associations between adult attachment status and observable parent, child, and dyadic behaviors among children with autism and associated neurodevelopmental disorders of relating and communicating. The Adult Attachment Interview (AAI) was employed to derive parental working models of attachment relationships. The Functional Emotional Assessment Scale (FEAS) was used to determine the quality of relational and functional behaviors in parents and their children. The sample included parents and their 4- to 16-year-old children with autism and associated neurodevelopmental disorders. Hypothesized relationships between AAI classifications and FEAS scores were supported. Significant correlations were found between AAI classification and FEAS scores, indicating that children with autism spectrum disorders whose parents demonstrated secure attachment representations were better able to initiate and respond in two-way pre-symbolic gestural communication; organize two-way social problem-solving communication; and engage in imaginative thinking, symbolic play, and verbal communication. These findings lend support to the relevance of the parent’s state of mind pertaining to attachment status to child and parent relational behavior in cases wherein the child has been diagnosed with autism or an associated neurodevelopmental disorder of relating and communicating. A model emerges from these findings of conceptualizing relationships between parental internal models of attachment relationships and parent-child relational and functional levels that may aid in differentiating interventions.     

Subjective Quality of Life for Parents of Children with Autism Spectrum Disorders in Croatia

The purpose of this study was to investigate the subjective quality of life (SQoL) of parents of children with autism spectrum disorders (ASD) who are primary carers. The study included 346 parents: 177 parents of children with ASD and 169 parents of non-disabled children comprised the control group. The Personal Wellbeing Index (PWI) was used to assess SQoL. Parents’ general health perception was assessed with a single question scored on a scale from 1 (poor health) to 5 (excellent health). Parents of children with ASD reported a significantly lower SQoL and general health perception with more physiological symptoms as compared to parents of non-disabled children. In Croatia parents of children with ASD, as primary caregivers, is an especially vulnerable part of the population and need increased social support and assistance in order to achieve and maintain the well-being of the whole family.     

Teacher Implementation of Trial-Based Functional Analysis and Differential Reinforcement of Alternative Behavior for Students with Challenging Behavior

The purpose of this study was to examine the effects of a training package on three middle school special education teachers’ accurate implementation of trial-based functional analysis (TBFA) and differential reinforcement of alternative behavior (DRA) with their students with autism spectrum disorders or emotional and behavioral disorders in the classroom setting. We also examined the effects of the DRA on six students’ challenging and replacement behaviors. Using a multiple probe across teacher participants design, we demonstrated that all three teachers implemented TBFA during TBFA training with performance feedback conditions and DRA during DRA training with performance feedback conditions with high procedural fidelity. Further, two of three teachers generalized high procedural fidelity with a new student. Finally, results indicated a reduction in all six students’ challenging behavior and an increase in their replacement behavior after the teachers received training and performance feedback on DRA implementation. Limitations and implications for research and practice are discussed.     

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.     

Evaluation of a French parent-training program in young children with autism spectrum disorder

Parent training programs (PTs) in young children with autism spectrum disorders (ASDs) are known to reduce parenting stress and improve child's behavior and parent-child interactions. Few PTs are available to French speaking families. In order to provide them with this type of intervention, we developed a French parent-training program of 12 bimonthly sessions and three individual home visits based on applied behavior analysis. The purpose of this study is to evaluate the social validity and efficacy of this new PT on eighteen parents who have a child with ASD and developmental delay. For 16 parents, the PT was considered effective, the objectives targeted important and the strategies learned acceptable for use with children. They have significantly improved their knowledge in ASD and behavioral intervention strategies and their children's socialization skills, and reduce their parental stress. This new French PT program seems to be a promising intervention.     

The effectiveness of function‐based interventions to treat sleep problems,including unwanted co‐sleeping,in children with autism

This study investigated the effectiveness of functional behavioral assessment (FBA)—informed interventions for sleep problems, particularly co‐sleeping, in children with autism spectrum disorder (ASD). Seven children, who exhibited multiple sleep problems including unwanted co‐sleeping, participated. FBA, based on information derived from interviews and parent‐recorded sleep diaries, was used to develop individualized case formulations upon which multicomponent, parent‐implemented interventions were based. These were evaluated using a single‐case, non‐concurrent multiple‐baseline‐across‐participants design. Improvements were observed across all sleep problems, including the elimination of co‐sleeping. Gains were maintained at follow‐up for five out of seven children, though two children did not complete intervention. Parents reported high levels of satisfaction with the program. FBA‐based interventions for sleep problems in children with ASD and their clinical implications are further discussed.     

Parent‐selected interventions for infants at‐risk for autism spectrum disorders and their affected siblings

Infants with older siblings having Autism Spectrum Disorders (ASD) are at genetically increased risk for showing characteristics of ASD in the first 2 years of life. Parents, who already have at least one child with ASD, may closely monitor their later born children and implement interventions as soon as the children begin to show what the parents believe is aberrant behavior or development that may be early stages of ASD. To date, no study has examined the number and types of services and interventions these parents access for their at‐risk infants. Using a Service and Intervention Questionnaire developed for this study, we interviewed 23 parents involved in a larger prospective study of genetically at‐risk infants who reported developmental and/or behavior problems in their at‐risk infants. Parents reported utilizing a mean of 1.83 and 7.26 services and/or interventions for their at‐risk infants and older children with ASD, respectively. Two‐thirds of the interventions received by the infants were also given to their older affected siblings. The interventions included empirically validated approaches (e.g., early intensive behavioral intervention), professional services (speech–language therapy, occupational therapy), and non‐validated treatments (e.g., diet and vitamin therapies). Overall, 81 non‐validated and 18 validated interventions were used. On a Likert‐type rating scale, parents reported being involved and satisfied with what they generally thought were effective services. They felt more involved and satisfied with ABA, and felt it was more effective than non‐validated interventions. The findings suggest that parents with infants at‐risk for ASD and an older affected child will access a variety of autism services for both children, but the parents will implement primarily non‐validated interventions. Parent education is recommended to help parents make informed treatment decisions for their children. Copyright © 2009 John Wiley & Sons, Ltd.     

Maintenance of Parent-Implemented Discrete-Trial Instruction during Videoconferencing

Access to behavior-analytic professionals who can implement interventions like discrete-trial instruction (DTI) may be limited for families living in rural communities. We trained four rural parents of children with autism to implement DTI accurately with a confederate using in vivo behavioral skills training. The DTI skills that parents demonstrated with a confederate generalized to working with their children. We then assessed whether periodic supervision during videoconferencing maintained parents’ DTI skills following training. Parents accurately implemented untrained DTI programs with their children and maintained accurate implementation over several months of remote supervision occurring twice a week, weekly, and biweekly. Videoconferencing may be an effective way for individuals responsible for direct implementation to maintain contact with behavior analysts who are not locally accessible.     

Evaluation of a trial-based interview-informed synthesized contingency analysis

We evaluated the viability of an interview-informed synthesized-contingency analysis (IISCA) conducted in a trial-based format with 3 children with autism spectrum disorders who engaged in problem behavior. We compared results to those from typical trial-based and traditional functional analyses and found high degrees of correspondence. The trial-based IISCA format took the least amount of time to conduct and was associated with the lowest frequencies of problem behavior. Results are discussed in terms of merits of each of the 3 types of functional analysis arrangements and directions for future research.