Improvements in problem behavior in a child with autism spectrum diagnosis through synthesized analysis and treatment: A replication in an EIBI home program

A recent study described a synthesized treatment where a functional analysis was based on an open‐ended interview and combined with functional communication and delay‐tolerance training. The treatment resulted in a reduction in problem behaviors and an increase in appropriate requests. Most of the analysis and intervention were done in a clinic setting, and required weekly visits by the family. This present study is a systematic replication, where we conducted the same synthesized treatments, with a young child with Autism Spectrum Disorder (ASD) enrolled in a home‐based Early Intensive Behavior Intervention program, EIBI. Outcomes were similar with a marked reduction in problem behaviors and an increase in appropriate requests. These findings suggest that it is possible to conduct this intervention in a home setting, with weekly consultations with parents. Our study show the utility of the synthesized treatment in an EIBI program in a home setting and how this can contribute to client time and costs.     

Training parents to implement pediatric feeding protocols

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.     

An evaluation of a caregiver training protocol on the generalization and maintenance of successful pediatric feeding interventions

Previous researchers have documented the positive effects achieved by trained clinicians providing behavioral interventions for pediatric feeding disorders; however, few have evaluated the maintenance of those treatments when subsequently implemented by primary caregivers. Further, the majority of previous caregiver training research has relied on the use of multicomponent training packages making it difficult to determine which components are necessary for success. The purpose of the current investigation was to evaluate the effects of instructions and feedback on caregivers' implementation of feeding protocols in a home setting. Results of the current study suggest that feedback may be the most effective training component in training packages designed to teach caregivers to implement an effective feeding protocol. Potential concomitant changes in child behavior are also discussed.     

Videoconference to supervise early intensive behavioral intervention: A preliminary evaluation of acceptability

At present, early intensive behavioral intervention (EIBI) for children with autism spectrum disorders is the intervention that has the strongest empirical support. EIBI requires frequent supervision by qualified professionals. Norway, like many other countries, has a shortage of qualified supervisors, particularly in rural regions. This study used a reversal design to investigate how supervisors and supervisees perceive the quality of EIBI supervision and the local team's preparedness when supervision was provided either on-site or via videoconference. Calculations were made on how much time could be saved on travel when part of the supervision was provided via videoconference. There were no significant differences in the supervisors' and supervisees' ratings of on-site and videoconference supervision. Moreover, the supervisors found the local EIBI teams to be better prepared when supervision was provided via videoconference, and the videoconference supervision meetings were shorter. The study discusses the implications of these findings for the accessibility of EIBI and case capacity and proposes some areas for further research.     

A review of recommendations for sequencing receptive and expressive language instruction

We review recommendations for sequencing instruction in receptive and expressive language objectives in early and intensive behavioral intervention (EIBI) programs. Several books recommend completing receptive protocols before introducing corresponding expressive protocols. However, this recommendation has little empirical support, and some evidence exists that the reverse sequence may be more efficient. Alternative recommendations include teaching receptive and expressive skills simultaneously (M. L. Sundberg & Partington, 1998) and building learning histories that lead to acquisition of receptive and expressive skills without direct instruction (Greer & Ross, 2008). Empirical support for these recommendations also is limited. Future research should assess the relative efficiency of receptive-before-expressive, expressive-before-receptive, and simultaneous training with children who have diagnoses of autism spectrum disorders. In addition, further evaluation is needed of the potential benefits of multiple-exemplar training and other variables that may influence the efficiency of receptive and expressive instruction.     

Cost–benefit estimates for early intensive behavioral intervention for young children with autism—general model and single state case

Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost–benefits of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder—not otherwise specified (PDD—NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD—NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost–benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI effects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of effectiveness and in constant dollars, this model estimates that cost savings range from $187,000 to $203,000 per child for ages 3–22 years, and from $656,000 to $1,082,000 per child for ages 3–55 years. Differences in initial costs of $33,000 and $50,000 per year for EIBI have a modest impact on cost–benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI. © 1998 John Wiley & Sons, Ltd.     

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.     

Traduction et adaptation du TEI-SF afin de documenter l’acceptabilité sociale de l’intervention comportementale intensive

Early intensive behavioral intervention is more widely used in large-scale community-based services in Autism Spectrum Disorder. There is an increased need to evaluate the social acceptability of these programs. The present study used a measure of social acceptability as part of a social validation procedure to evaluate a community-based EIBI offered in inclusive childcare, as well as two focused interventions associated with this program. To do so, the Treatment Evaluation Inventory Short-form (TEI-SF) questionnaire was adapted and translated to French. The validation results for the TEI-SF, as well as for the social acceptability of the EIBI programs and procedures, are presented. The results are the first evidence of the validity of the TEI-SF (adapted and translated to French), presenting scores of validity of intervention and a favourable perspective related to the early intensive behavioral intervention and opening the door to further research.     

USING REINFORCEMENT AND CUEING TO INCREASE HEALTHY SNACK FOOD CHOICES IN PRESCHOOLERS

We examined the effects of behavioral procedures to modify the food choices of preschoolers during a snack period at school (training setting) and at home (generalization setting). In the first experiment, we evaluated the usefulness of nutrition training and a generalization programming strategy of cueing to improve healthy snacking; in the second experiment we investigated the effect of nutrition training alone. In addition, three cases are presented that illustrate individualized procedures to facilitate generalization of healthy snacking to home. Results indicated that children's healthy snack choices increased in the preschool training setting, that generalization to home was achieved only when procedures to program it were implemented, and that the best results were found when the generalization procedures were tailored to the individual child.     

Central ghrelin increases anxiety in the Open Field test and impairs retention memory in a passive avoidance task in neonatal chicks

Ghrelin (Grh) is an endogenous ligand for the growth hormone secretagogue receptor. Although Ghr stimulates feeding in rats, it inhibits feeding in neonatal chicks. However, little is known about other central behavioral effects of Ghr. Therefore, we investigated the Ghr effects, injected intracerebroventricularly, on anxiety and memory retention of neonatal chicks in an Open Field test and in a one-trial passive avoidance task, respectively. In the Open Field test, the administration of Ghr in a dose-dependent manner increased the latency to ambulate but decreased ambulation activity, indicating an anxiogenic effect. Furthermore, chicks trained on a passive avoidance task and injected with a dose of 30 pmol of Ghr immediately after training showed an impairment of memory retention. However, there were no significant effects on the number of pecks during the pretraining, training, retention and discrimination. In addition, different doses of Ghr produced an inhibition in food intake at different times after injection. Our results indicate that Ghr induces anxiogenesis in chicks. Moreover, we have shown for the first time that Ghr can decrease memory retention in a non-mammalian species, suggesting that Ghr may play an important role in the processes of memory retention in birds.     

The effects of a behavioral skills training and general‐case training package on caregiver implementation of a food selectivity intervention

We used behavioral skills training with general‐case training to teach 3 caregivers to implement a behavioral feeding intervention with their children. The percentage of correctly performed steps of the feeding intervention increased for all 3 caregivers and was maintained at follow‐up. For all 3 children, the number of bites consumed increased and the number of bites with inappropriate mealtime behavior decreased across treatment. Increases in bites consumed and bites without behavior problems were maintained for 2 participants at follow‐up.     

A comparison of the effects of child management and planned activities training in five parenting environments

This study compared the effects of two procedures designd to enhance the extratraining effects of behavioral parents training. Twenty parents of oppositianal children were randomly assign to either a child manangment training condition or a combined child management plus planned activity condition. A further 10 nonproblem children and their parents serve as a social validation group. Observation of both parents and children behavior were conducted in each of five home observation setting (breakfirst time, kindy (kindergarten) or school exit, a structured playtime, bathtime, and bedtime). Both training procedures result in change in both child oppositional and parents oversive behaviosr in all observation settings. In addition, desire positive parents behaviour also improve in all setting. Treatment effect were maintained in all setting at 3-month follow up. Composition between oppositional children following treatment and children in the social validation group showed that they each displayed similarly low lavels of oppositional behaviour in all settings. The inplecation of the results for faciliating generalised changes in behavioral parent training are discusssd.This study was supported by a grant from the National Health and Medical Research Council (NHMRC324 82 579049). We wish to thank all families, therapists, and observers who participated in the project.     

An evaluation of behavioral treatments for Tourette syndrome.

The present study evaluated the effectiveness of self-monitoring, relaxation training and habit reversal in the treatment of 6 Tourette Syndrome (TS) subjects with multiple motor and vocal tics. A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror. Tics were reduced by an average of 55% with habit reversal, 44% with self-monitoring, and 32% with relaxation training and each behavioral procedure was the most effective treatment for at least one subject. All three treatment approaches may have some utility in the behavioral treatment of TS.     

EFFECTS OF SELF-EFFICACY AND POST-TRAINING INTERVENTION ON THE ACQUISITION AND MAINTENANCE OF COMPLEX INTERPERSONAL SKILLS

This study examined the effects of self-efficacy and a two-stage training process on the acquisition and maintenance (i.e., retention) of complex interpersonal skills. In stage one, all participants received basic training in negotiation skills; behavioral measures of negotiation performance were taken following this training. During stage two, alternative post-training interventions (goal setting and self-management) were offered to facilitate skill maintenance. Six weeks later, behavioral measures of performance were repeated. Results indicated that pre-test self-efficacy contributed positively to both initial and delayed performance. While training condition contributed to skill maintenance, self-efficacy also interacted with post-training method to influence delayed performance. Specifically, self-management training attenuated the self-efficacy performance relationship, while goal-setting training accentuated performance differences between high and low self-efficacy trainees. Implications of these findings are discussed for researchers and practitioners concerned with interpersonal skills training.     

The impact of synthesis teaching and parent training with mothers of conduct-disordered children

A procedure to enhance the impact of parent training with multistressed mother — child dyads was explored with 29 clinic-referred dyads. The procedure, called synthesis teaching, was provided for one randomly selected group of dyads, while the other group was engaged in problem discussions about their children. Both groups received parent training as the principal intervention for the mothers' conduct-disordered children. Results showed that these interventions had no effects on dyads in the clinic setting, but had a progressively more significant effect at home for the synthesis teaching group. That is, mothers in this group showed reductions in their indiscriminate parenting and their children demonstrated behavioral improvements. In contrast, mothers in the control group did not change their behavior and their children did not demonstrate observed behavioral changes. Interpretations of the results center on how synthesis teaching might have produced these effects.The research data reported in this paper were generated by support from grant R01-1068-58 from the National Institute of Mental Health, Crime and Delinquency Section.     

Conversation skills training for socially isolated children

A social skills training program consisting of instructions, modeling, behavior rehearsal, performance feedback, and programmed generalization set was used to teach conversational behavior to four socially isolated children. Effects of training were assessed in a multiple-baseline analysis across behavior. Subjects were selected on the basis of peer sociometric ratings, a behavioral role-playing task, naturalistic observation, and teacher ratings. All subjects demonstrated noticeable improvement in the target behavior as well as in overall conversational ability. However, these gains were maintained unequally in the children at follow-up probe administrations (4-and 8-weeks). Generalization assessment revealed some transfer of treatment effects to the school setting for all children. Results are discussed in terms of the complexity of social isolation in children and factors which influenced generalizability of the treatment program.     

Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism

The financial implications of the increased prevalence of autism, though rarely discussed, will be extremely important to society. We compared the costs associated with 18 years of special education to the costs associated with the implementation of an average of 3 years of Discrete Trial Training as an Early Intensive Behavioral Intervention (EIBI) in an effort to minimize the need for special education. Our results indicate that the state of Texas would save $208,500 per child across eighteen years of education with EIBI. When applied to the conservative estimate of 10,000 children with autism in Texas, the State would save a total of $2.09 billion with EIBI. Implications for taxpayers, policymakers, and treatment are discussed.