Using naturalistic procedures to enhance learning in individuals with autism: A focus on generalized teaching within the school setting

Empowering Persons with Autism Through Cross-Reality and Conversational Agents

Autism Spectrum Disorder is a neurodevelopmental condition that can affect autonomy and independence. Our research explores the integration of Cross-Reality and Conversational Agents for Autistic persons to improve ability and confidence in everyday life situations. We combine two technologies of the Virtual-Real continuum. User experiences unfold from the simulation of tasks in VR to the execution of similar tasks supported by AR in the real world. A speech-based Conversational Agent is integrated with both VR and AR. It provides contextualized help, promotes generalization, and stimulates users to apply what they learned in the virtual space. The paper presents the approach and describes an empirical study involving 17 young Autistic persons.

The Ethics of Actually Helping People: Targeting Skill Acquisition Goals That Promote Meaningful Outcomes for Individuals with Autism Spectrum Disorder

As a field that predominately supports individuals with autism spectrum disorder (ASD), we have an ethical duty as behavior analysts to ensure that the goals we write and interventions we prescribe promote best outcomes across the lifespan. This is critical, given that as it stands now, outcomes in adulthood for individuals with ASD are poor in every area assessed. The Ethics Code for Behavior Analysts can be interpreted to provide support for teaching the right goals, the right way, with respect to inherent rights of those we serve, in order to help affect positive changes in these outcomes. The present article highlights ethical themes that are relevant in order to affect these changes that are supported by the Code, as well as actionable steps to take next. The aim is to provide a resource for practitioners to use in clinical practice and in making ethical decisions that will help to improve outcomes for individuals with autism in adulthood. In addition, recommendations are made about integrating these values and approaches in terms of training, supervision, advocacy, and research.

Universal Teacher-Child Interaction Training in early childhood special education: A cluster randomized control trial

Growing evidence suggests that Teacher-Child Interaction Training-Universal (TCIT-U) is effective for increasing teachers' use of strategies that promote positive child behavior, but more rigorous research with larger, diverse samples is needed to understand the effects of TCIT-U on teacher and child outcomes in early childhood special education. Using a cluster randomized control trial, we evaluated the effects of TCIT-U on (a) teacher skill acquisition and self-efficacy and (b) child behavior and developmental functioning. Teachers in the TCIT-U group (n = 37) exhibited significantly greater increases in positive attention skills, increased consistent responding, and decreased critical statements relative to teachers in the waitlist control group (n = 36) at post and 1-month follow-up (d's range from 0.52 to 1.61). Teachers in the TCIT-U group also exhibited significantly fewer directive statements (d's range from 0.52 to 0.79) and greater increases in self-efficacy compared to waitlist teachers at post (d's range from 0.60 to 0.76). TCIT-U was also associated with short-term benefits for child behavior. Frequency (d = 0.41) and total number of behavior problems (d = 0.36) were significantly lower in the TCIT-U group than in the waitlist group at post (but not follow-up), with small-to-medium effects. The waitlist group, but not the TCIT-U group, demonstrated an increasing trend in number of problem behaviors over time. There were no significant between-group differences in developmental functioning. Current findings build support for the effectiveness of TCIT-U as universal prevention of behavior problems with an ethnically and racially diverse sample of teachers and children, including children with developmental disabilities. Implications for implementation of TCIT-U in the early childhood special education setting are discussed.

"It's about sharing a moment": Parents' views and experiences of home reading with their autistic children with moderate-to-severe intellectual disabilities

BACKGROUND

The home literacy environment plays a critical role in the development of children's literacy and language development. Little is known, however, about the home literacy environment of autistic children, especially those with moderate-to-severe intellectual disabilities.

AIMS

The current study used a sequential mixed-methods design to understand how parents attempt to engage their autistic children in reading activities and support them in learning to read.

METHODS AND PROCEDURE

First, 63 parents (53 mothers) whose autistic children attended an autism-specific special school completed a bespoke questionnaire about the home literacy environments for their children (n = 69, age range = 3-11 years, 61 boys, 8 girls). Second, a subsample of parents (n = 19, 15 mothers) participated in focus groups to understand in-depth their views and experiences of home reading with their children (n = 20, age range = 3-11 years, 19 boys, 1 girl). We used reflexive thematic analysis to analyse the focus group data.

OUTCOMES AND RESULTS

Across questionnaire and focus group methods, parents were united in considering reading to be an important life skill, a sentiment that was reflected both by their often literacy-rich homes and the ingenuity in their efforts to engage their children in shared home-reading activities - even when such engagement could be challenging. They also emphasised, however, the importance of valuing these activities as an opportunity to "catch a moment" with their child.

CONCLUSIONS AND IMPLICATIONS

Parents and teachers should work together to identify ways to enhance autistic children's engagement in shared home-reading activities, listening to and learning from each other's experiences and expertise, and to show what is possible within each learning context.

Classroom Teachers' Implementation of the Social Stations Intervention to Improve the Verbal Initiations and Responses of Students with Autism

Students with autism often show challenges in social communication, particularly in initiating and responding behaviors. While the classroom offers a natural context for peer interactions, few interventions are designed specifically for classroom settings. This study investigated the effects of a classroom-teacher implemented social communication intervention, known as Social Stations, on the initiating and responding behaviors of students with autism. The study was set in an inclusive primary school, with the teacher embedding the intervention into the student's daily literacy lessons. All students with autism showed significant improvements in the targeted behaviors, with improvements maintained over time. This study suggests that social communication interventions can be implemented by teachers as part of a daily classroom program.

Naturalistic teaching approach to develop spontaneous vocalizations and augmented communication in children with autism spectrum disorder

Naturalistic developmental behavioral interventions (NDBI) have been shown to facilitate the development of spontaneous language in individuals with speech and language impairment. Several meta-analyses have reported a small number of studies that utilized naturalistic teaching approaches combined with augmentative and alternative communication (AAC) interventions to develop requesting skills in individuals with autism spectrum disorder (ASD). Therefore, the main purpose of this study was to determine whether a natural language paradigm (NLP) and time delay is effective in expanding vocal and augmented requesting skills in three children with ASD between the ages of 4 and 6 years. A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the intervention. The results of the study demonstrated that the participants were successful in emitting vocal requests when both modalities were available and NLP combined with time delay was effective in increasing spontaneous vocal requests in all participants.

Universal Teacher-Child Interaction Training in Early Special Education: A Pilot Cluster-Randomized Control Trial

Using a pilot matched-pairs cluster-randomized control trial, we evaluated the acceptability and preliminary outcomes of universal Teacher-Child Interaction Training (TCIT-U) with students with disabilities in early special education programs. Twelve classrooms (clusters) were paired by age and type and then randomly assigned within pairs to either TCIT-U (81 students, 20 teachers) or wait-list control (63 students, 16 teachers) with services as usual. We analyzed the effects of TCIT-U on (a) teachers' skills acquisition via masked observational coding and (b) students' behavior and developmental functioning via teacher questionnaires. For child-directed interaction skills, teachers receiving TCIT-U exhibited significantly greater increases in behavior descriptions and labeled praise than teachers who did not receive TCIT-U at posttreatment and follow-up. No significant group differences were observed in use of teacher-directed interaction skills. Qualitative data from teachers expanded on these findings, suggesting that teachers found child-directed interaction skills more acceptable than teacher-directed interaction skills. Teachers receiving TCIT-U reported small but significant improvements in student behavior problems and socioemotional functioning at posttreatment and follow-up, as compared to wait-list students. We discuss considerations for future implementation and tailoring of TCIT for young students with disabilities, which may have positive impacts on future cohorts of students beyond teachers' initial training.

iPads for Teaching Graphic Symbols to People With Autism Spectrum Disorder

Individuals with low functioning autism spectrum disorders (LFASD) who demonstrate significant cognitive and communication needs benefit from using technology for learning graphic symbols for enhancing participation. This study investigated if an iPad application would increase identification of graphic symbols by children and adults with LFASD. Adults and children with LFASD used an application to learn 15 graphic symbols. Participants were able to focus for the duration of the activity and use the educational software for learning graphic symbols. By the end to the study, 50% of the participants in both groups recognized the meaning of more symbols after intervention. iPad use enabled control of the stimulus by reducing communication barriers, which increased participants' ability to learn symbols. Even participants with little ability to focus were able to complete the whole activity. Technology enabled learning of most of the symbols though the specially created application.

Play to Teach: Coaching Paraeducators to Facilitate Communication in the Preschool Classroom

Paraeducators are ideal candidates for delivering communication interventions to children with developmental disabilities and delays (DD) because they spend a significant amount of time with these children. However, professional development is often inadequate and limited research supports best practices. Additionally, paraeducators work with multiple children with varying skill levels. Little research has been conducted on the use of existing strategies with multiple children. This single-case study examines the effect of a training package on paraeducators' fidelity of intervention implementation with a child dyad and subsequent child outcomes. Results suggest that formal coaching contributed to improved fidelity of intervention implementation. Furthermore, paraeducators were able to use intervention strategies with children with varying communication skills and goals. Variable increases in child communication were also detected.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.

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.

Comparison of Traditional and Embedded DTT on Problem Behavior and Responding to Instructional Targets

Embedded discrete trial training (DTT) involves the presentation of instructional targets in an activity-based situation, and serves as an alternative to traditional, table-top instruction (Geiger, Carr, LeBlanc, Hanney, Polick, et al. Behavior Analysis in Practice 5, 49-59, 2012). The current study compared the effects of Traditional and Embedded DTT on responding to instructional targets and problem behavior for one child with autism. Although the results showed similar levels of accuracy for instructional targets across both conditions, there were more target exposures and no problem behavior during Embedded DTT. The results are discussed along with future directions for research and clinical practice.

Parents Suggest Which Indicators of Progress and Outcomes Should be Measured in Young Children with Autism Spectrum Disorder

Evaluation of interventions for children with autism spectrum disorder (ASD) is hampered by the multitude of outcomes measured and tools used. Measurement in research with young children tends to focus on core impairments in ASD. We conducted a systematic review of qualitative studies of what matters to parents. Parent advisory groups completed structured activities to explore their perceptions of the relative importance of a wide range of outcome constructs. Their highest ranked outcomes impacted directly on everyday life and functioning (anxiety, distress, hypersensitivity, sleep problems, happiness, relationships with brothers and sisters, and parent stress). Collaboration between professionals, researchers and parents/carers is required to determine an agreed core set of outcomes to use across evaluation research.

Lessons learned: Engaging culturally diverse families in neurodevelopmental disorders intervention research

Low-income and ethnic minority families continue to face critical disparities in access to diagnostic and treatment services for neurodevelopmental conditions, such as autism spectrum disorder and attention deficit hyperactivity disorder. Despite the growing cultural diversity of the United States, ethnic minority children and families continue to be substantially underrepresented across research on neurodevelopmental disorders, and there is a particularly concerning lack of research on the treatment of these conditions in low-income and ethnic minority communities. Of note, there are currently no published studies on adapting autism spectrum disorder treatment for low-income Latino communities and relatively few studies documenting adapted treatments for children with attention deficit hyperactivity disorder in these communities. This article describes methodological considerations and adaptations made to research procedures using a Diffusion of Innovation framework in order to effectively recruit and engage low-income, ethnic minority, particularly Latino, families of children with neurodevelopmental disorders, in a comparative effectiveness trial of two school-based interventions for executive dysfunction.

A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism

Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with an adult-directed ABA approach on disruptive behavior during language intervention in the public schools. A randomized clinical trial design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior.

Conducting a Function-Based Intervention in a School Setting to Reduce Inappropriate Behaviour of a Child With Autism

Although function-based interventions have been shown to be effective, the methods utilised to carry out functional behaviour assessments (FBA) have practical limitations. This study explored the relative utility and feasibility of three FBA methods in a school setting to inform a function-based intervention to reduce problem behaviour in a boy with autism. The study consisted of (1) indirect and direct assessments, (2) a modified functional analysis, and (3) the intervention. New video technology, Behavior Capture, was trialled to facilitate data collection in the classroom. All methods contributed to identifying the function of the problematic behaviour, though only the functional analysis provided conclusive results. A peer-mediated intervention based on these findings conducted in the school playground reduced the problem behaviours. All FBA methods could be applied in the school setting and provided useful information. Novel technology was helpful in facilitating data collection. A naturalistic intervention was successful in reducing problem behaviours and increasing play skills.

Staff training effective in increasing learning opportunities for school-aged children with autism spectrum disorders

OBJECTIVE

This study examined the effectiveness of instruction and video feedback on staff's ABA skills during one-to-one play situations and initiations of children with autism spectrum disorder (ASD).

METHODS

Data were collected within a multiple baseline design across 5 dyads. A continuous 20 s interval recording system was used to record motivation, creating opportunities, prompting and reinforcement of staff and child initiations. Training included instruction, consisting of instructions, video examples and role-plays. After this, a 4-h delayed video feedback condition started.

RESULTS

Three staff members created significantly more learning opportunities during post-instruction and a significant increase occurred during video feedback for one staff member. Initiatives increased significantly in two children during post-instruction. During follow-up, three children showed unprompted initiatives. The mean percentage of spontaneous initiations increased during follow-up.

CONCLUSION

The findings provide support for training staff in a clinical setting to create learning opportunities, which also may result in concomittant improvement in child initiations.

Manipulation of motivating operations and use of a script-fading procedure to teach mands for location to children with language delays

The effects of contriving motivating operations (MOs) and script fading on the acquisition of the mand "Where's [object]?" were evaluated in 2 boys with language delays. During each session, trials were alternated in which high-preference items were present (abolishing operation [AO] trials) or missing (establishing operation [EO] trials) from their typical locations. Both participants learned to mand during EO trials and not to mand during AO trials during training. Generalization of manding was demonstrated across novel instructors, stimuli, and settings and maintained 3 to 4 weeks following the intervention.

Social skills interventions for individuals with autism: evaluation for evidence-based practices within a best evidence synthesis framework

This paper presents a best evidence synthesis of interventions to increase social behavior for individuals with autism. Sixty-six studies published in peer-reviewed journals between 2001 and July 2008 with 513 participants were included. The results are presented by the age of the individual receiving intervention and by delivery agent of intervention. The findings suggest there is much empirical evidence supporting many different treatments for the social deficits of individuals with autism. Using the criteria of evidence-based practice proposed by Reichow et al. (Journal of Autism and Developmental Disorders, 38:1311-1318, 2008), social skills groups and video modeling have accumulated the evidence necessary for the classifications of established EBP and promising EBP, respectively. Recommendations for practice and areas of future research are provided.

The costs of services and employment outcomes achieved by adults with autism in the US

This article examines the cost of services and employment outcomes obtained by adults with autism within the United States vocational rehabilitation (VR) system. It found that the number of such individuals has increased by more than 121 percent from 2002 to 2006. Moreover, though adults with autism were employed at higher rates than most disability groups investigated, they tended to work far fewer hours and earn less in wages per week. The study also found that adults with autism were among the most costly individuals to serve.