Discrete Trial Training

Do Cultural Adaptations Matter? Comparing Caregiver Training in Different Language for Latino Caregivers of Autistic Children: A Telehealth-Based Evaluation

Culturally and linguistically diverse (CLD) families of autistic children face unique challenges in accessing services that are appropriate for their cultures and languages. The purpose of the current study was to evaluate the impact of training language on caregiver skill acquisition. Using behavioral skills training (BST) through telehealth, three Latino caregivers whose first language is Spanish were taught to implement two different behavioral protocols with their autistic children. For one protocol, BST was done in Spanish; for the other, BST was done in English. Overall, the training in each family's first language was (1) more efficient at promoting the skill acquisition of both caregivers and children; (2) rated by caregivers as more socially valid, and (3) associated with higher levels of caregivers' indices of personalismo, involvement, and happiness. Findings suggest that cultural adaptations may be necessary to provide more effective and enjoyable training for CLD families.

Impacts of Hyperbaric Oxygen Therapy (HBOT) on Verbal Scores in Children With Autism: A Secondary Analysis of the HBOT Trial Using Multivariate Analysis of Variance (MANOVA)

Introduction A secondary analysis employing advanced statistical methodologies constitutes a robust means of validating initial findings in systematic empiricism. The current research will undertake a secondary analysis of the impacts of Hyperbaric Oxygen Therapy (HBOT) on verbal behaviors in children with autism using the original dataset. This approach aims to enhance the robustness of the initial results, thereby providing a deeper understanding of the data and potentially uncovering additional insights. Materials and methods From January 2018 to July 2021, all cohorts of autistic children (n = 65) were scheduled, evaluated, and treated at The Oxford Center (TOC) in Brighton and Troy, Michigan, USA. Trained research assistants retrospectively extracted pretest and posttest data from electronic medical records from the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and the Assessment of Basic Language and Learning Skills (ABLLS). This data collection focused on children with autism who received either non-HBOT control with Applied Behavior Analysis (ABA) treatment only or ABA + HBOT interventions. For the VB-MAPP, the experimental group (ABA + HBOT) included 23 children, while the control group (ABA only) included 12 children. For the ABLLS, the experimental group (ABA + HBOT) consisted of nine children, compared to 21 children in the control group (ABA only). Demographic information was systematically summarized. Two independent sample t-tests were recomputed from the original study. Multivariate Analysis of Variance (MANOVA) were conducted, followed by one-way Analyses of Variance (ANOVA) post hoc analyses to elucidate the findings. Results The ages in both groups ranged from 2 to 17 years (M = 5.7 years ± 3.08), with median ages of four years for the experimental group and five years for the control group. The p-values and effect sizes indicated that the two independent sample t-tests from the original study and the MANOVAs from the current research are in agreement. This concordance provided confirmatory evidence for the validity of the pretest and posttest differences in VB-MAPP and ABLLS scores for the control group (ABA only) and the experimental group (ABA + HBOT), highlighting the impact of HBOT on verbal scores in children with autism. Conclusions The results from the two independent sample t-tests from the initial study exhibited high alignment with those derived from the current study's MANOVAs. Both statistical methodologies were applied to the same VB-MAPP and ABLLS datasets. The convergence of results from these two distinct statistical analyses may reinforce the credibility of the original research findings. It supports the hypothesis that the combined ABA and HBOT intervention may offer additional benefits over ABA therapy alone, with verbal milestone behaviors in children with autism.

The Effects of Discrete Trial and Natural Environment Teaching on Adaptive Behavior in Toddlers With Autism Spectrum Disorder

The literature has yet to review the differential effects of Natural Environment Teaching (NET) and Discrete Trial Teaching (DTT) on adaptive skills. A sample of 142 children diagnosed with ASD between the ages of 16 and 35 months received either DTT, NET, or both interventions (NET+ DTT). The Bayley Scales of Infant and Toddler Development (BSID) Adaptive Subscale and the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) Barriers Assessment were used as baseline and posttest measures. Children who received NET and NET+DTT conditions showed significant improvements compared to the DTT condition indicating that the addition of NET leads to increased adaptive skills and decreased barrier behaviors in participants. DTT may also play a necessary foundational role for children with more significant delays. These results provide support for the use of a combination of teaching strategies in community-based early intervention and refine protocols for teaching adaptive skills to toddlers with ASD.

Systematic Review of Differential Reinforcement in Skill Acquisition

The purpose of this article was to review and summarize the literature investigating the impact of differential reinforcement on skill acquisition. Researchers synthesized data from 10 articles across the following categories: (1) participant characteristics; (2) setting; (3) reinforcement procedures; (4) within-subject replication; (5) results; and (6) secondary measures (e.g., social validity). Results indicated that most of the participants were male, had a diagnosis of autism, and communicated vocally. The differential reinforcement condition in which reinforcement favored independent responses (e.g., edible for independent; praise for prompted responses) was the most frequently employed differential reinforcement condition and it resulted in the acquisition of more responses or faster acquisition for most participants. In addition, when differing reinforcement procedures manipulating different parameters of reinforcements were compared, better outcomes were attained when the schedule of the reinforcer was manipulated within the differential reinforcement procedure relative to when quality or magnitude were manipulated. Limitations of the previous research, recommendations for future research, and implications for clinical practice are discussed.

Treating Target Behaviors of Autistic Individuals With Applied Behavior Analysis: An Ongoing Replication Study

Background Ongoing outcome data replication on target behaviors with autistic individuals using applied behavior analysis (ABA) confirms its effectiveness and remains an essential evidenced-based standard of care. This replication study aims to further confirm the impact of discrete trial training and mass trials on general target behaviors within a naturalistic environment. Methods Data was gathered from 92 children and four adult autistic individuals over one month from 7/7/23 to 8/8/23 using a repeated measures design. This study used a retrospective chart review with general target behaviors to determine the effectiveness of ABA treatments using discrete trial training and mass trials across time and age categories in a naturalistic environment. Results A mixed analysis of variance (ANOVA) indicated statistical significance (sphericity assumed), F(2,168) = 31.663, p < 0.001 (time). Multiple comparisons using bootstrapped paired t-tests indicated p < 0.001 on the three comparisons. There was a significant interaction effect (sphericity assumed) with time x age category, F(8,168) = 2.918, p = 0.004. Interaction contrasts indicated statistically significant differences over time within the 1-4 years, 5-8 years, and a portion of 9-12 years, and not within the 13-16 years and 17-73 years age groups. Conclusions Autistic individuals receiving ABA demonstrated statistically significant improvement in target behaviors over one month. There was a significant interaction between time and age on target behaviors, suggesting a significant association between time and age categories. The reporting of ongoing intervention outcomes provides further justification for continued treatments relative to target behavior mastery with autistic individuals.

Examining the Effects of Discrete Trials, Mass Trials, and Naturalistic Environment Training on Autistic Individuals Using Repeated Measures

INTRODUCTION

Behavioral interventions based on applied behavior analysis (ABA) form current evidence-based practices in treating autism spectrum disorder (ASD). Research is scarce relative to the broad effects of intensive repetitive, discrete trial training, and mass trials combined with a naturalistic environment as measured by overall general target behaviors. The primary objective of this study was to evaluate the effectiveness of a mixed behavioral model consisting of discrete trial training and mass trial interventions in the naturalistic environment, using a repeated measures design with a retrospective snapshot cohort of 93 individuals with autism.

METHODS

A repeated measures analysis tracked 89 autistic children with four adult autistic individuals over seven time points during a three-month snapshot period from March 19, 2023, to June 11, 2023. This study determined the effectiveness of applied behavior analysis (ABA) interventions combining discrete trial training, mass trials, and naturalistic environment training on mastered broad target behaviors in autistic individuals using a mixed (between and within) ANOVA statistical design.

RESULTS

Mixed (between and within) ANOVA indicated overall statistical significance, F (6,674)=45.447, p<0.001, partial eta squared=0.365 across time. These results indicated a large effect size. Multiple comparisons showed statistical significance (p<0.001) on all 21 multiple comparisons between timepoints. There was also a significant interaction effect with time × age category, F (24,474)=2.961, p<0.001, partial eta squared=0.130. These results also indicated a large effect size.

CONCLUSIONS

Autistic individuals who received applied behavior analysis combining discrete trial training, mass trials, and naturalistic environment training intervention demonstrated statistically significant improvement in target behaviors over the three-month snapshot period, the most prominent being in the 13-16 years age category.

Teaching receptive vocabulary to two autistic children: A replicated, clinic-based, single case experimental design

Background and aims

This study was conducted in a clinical setting with the aim of replicating previously used procedures for teaching receptive vocabulary. Researchers increased the number of vocabulary words and maintained use of match-to-sample (MtS), prompting, and reinforcement procedures. Researchers were also interested in the efficacy of the intervention from caregivers' perspectives.

Methods

Using a concurrent multiple baseline design, two autistic preschoolers with receptive language impairment were taught to identify 30 common objects. MtS, prompting, and reinforcement procedures were individualized to support each child. Maintenance checks and generalization probes were completed after a predetermined number of intervention sessions (i.e. three or four clinic sessions). A social validity questionnaire was completed by parents following the final maintenance check.

Results

Receptive object identification improved significantly for both participants. Despite exposure to vocabulary targets for only three or four sessions, they generalized the vocabulary targets to non-identical pictures and maintained words at maintenance checks. Participants were most successful when researchers individualized prompting and reinforcement.

Conclusion

MtS, prompting, and reinforcement were effective procedures for improving object identification, even with a limited number of intervention sessions. To support varying learner profiles, modifying prompting and reinforcement procedures was necessary. Caregivers of both participants reported positive improvements in areas such as communication, attention, and behaviors.

Implications

This replicated study provides support for MtS, prompting, and reinforcement as means of teaching receptive vocabulary to autistic preschoolers in a clinical setting. The materials used were simple and cost-effective. Overall, this study outlines and supports a flexible and effective evidence-based practice to teach receptive language to autistic children.

Adapting the preschool environment to the needs of children on the autism spectrum in Sweden: A quasi-experimental study

BACKGROUND

Children on the autism spectrum may receive Early Intensive Behavioural Intervention (EIBI) in Sweden to support development by providing learning opportunities. However, research suggests a need to improve the quality of their learning environment.

AIM

This pre-registered study (#NCT03634761) aimed to evaluate the Swedish Autism Program Environment Rating Scale (APERS-P-SE) as a means to promote the quality of the pre-school learning environment for children on the autism spectrum, along with outcomes for these children, and their pre-school staff.

MATERIAL AND METHODS

In a quasi-experimental study, pre-school staff (n = 35) conducted either EIBI supported by in-service training and on-site coaching based on APERS-P-SE assessment (at k = 9 preschools) or EIBI only (k = 8), during an 8-months period.

RESULTS

The quality of the immediate learning environment (primary outcome) increased significantly in the EIBI/APERS-P-SE preschools. However, changes in child and pre-school staff measures were not significant.

CONCLUSIONS AND SIGNIFICANCE

In-service training and on-site coaching based on APERS-P-SE assessments can increase the quality of the learning environment in Swedish pre-school. Studies of longer duration and larger sample size are required to determine if using the APERS-P-SE can also achieve desired behavioural change for children-, and impact pre-school staff applying EIBI.

A Comparison Between Direct Telehealth and In-Person Methods of Teaching Expressive Labels to Children Diagnosed With Autism Spectrum Disorder

Recent behavior analytic research has demonstrated that the provision of applied behavior analytic services via direct telehealth can be an effective teaching modality for some learners with autism spectrum disorder (ASD). Historically, teaching procedures based on applied behavior analysis (ABA), including discrete trial teaching (DTT), have been provided and evaluated via in-person delivery. This study sought to compare the implementation of DTT via direct telehealth to DTT implemented in-person within and across participants. Specifically, this study evaluated the two delivery modalities in terms of skill acquisition, maintenance, efficiency, and learner responding during teaching sessions. Results of an adapted alternating treatments design nested into a multiple baseline design demonstrated that all three participants diagnosed with ASD met the mastery criteria for the expressive labels taught. Areas of future research, participant prerequisite skills, and clinical implications will be discussed in the context of these results.

Emergence of auditory-visual discrimination and tacts through exclusionary responding

This study examined if listener behavior and responding by exclusion would emerge after training 3 participants with autism to tact stimuli. Tacts for 2 of 3 stimuli were directly trained using discrete trial training methodology and were followed by an auditory-visual discrimination probe in which auditory-visual discrimination by naming (i.e., bidirectional naming of trained tacts) and auditory-visual discrimination by exclusion were assessed; in subsequent sessions, tacting by exclusion probes were conducted in which tacts for the exclusion target (i.e., stimulus not trained as a tact) were assessed. All 3 participants demonstrated auditory-visual discrimination by naming, auditory-visual discrimination by exclusion, and tacting by exclusion across all comparisons. Results suggest that programming for learning by exclusion can provide an efficient way to enhance skill acquisition.

Assessing Parameters of Reinforcement on Efficiency of Acquisition: A Systematic Review

Discrete-trial training (DTT) is a common method of instruction used in early intervention amongindividuals with autism spectrum disorder and related neurodevelopmental disorders and is an effective method of teaching different skills such as tacting, listener responding, and matching. Delivery of effective reinforcers is a key component of DTT. Although general recommendations have been made for effective reinforcement delivery in DTT, no review has synthesized the available research on the efficiency of various reinforcer parameters on efficiency of acquisition. The current systematic review assessed the efficiency of various reinforcer parameters on acquisition in DTT. Results were idiosyncratic, and a general paucity of repeated measures examining specific reinforcer parameters within and across studies was observed. In general, (1) maintaining high levels of treatment integrity, (2) delivery of tangible (i.e. leisure items) or edible reinforcers in comparison with contingent praise as a reinforcer, and (3) delivery of edible reinforcers in comparison with other topographies of reinforcement were the most successful reinforcer parameter manipulations and always resulted in more efficient skill acquisition. The results of this review provide clinicians with information regarding what reinforcer parameter manipulations may be more or less likely to support efficient acquisition. The present review also provides considerations and makes recommendations for future research.

Accumulated and distributed response-reinforcer arrangements during the treatment of escape-maintained problem behavior

Contingent positive reinforcement has proven more effective in treating escape-maintained problem behavior than contingent negative reinforcement, particularly when problem behavior continues to produce escape. However, this research has overwhelmingly used distributed-reinforcement arrangements, where tasks and reinforcer access are interspersed throughout the work period. An alternative to interspersal involves allowing the individual to accumulate and then receive a larger quantity of reinforcement once work requirements are completed; this is known as an accumulated-reinforcement arrangement. The current study examined the efficacy of, and preference for positive (food) and negative (break) reinforcement contingencies delivered in accumulated and distributed arrangements in the treatment of escape-maintained problem behavior. In Experiment 1, accumulated break was preferred for 4 of 5 participants and accumulated food was preferred for 3 of 5. In Experiment 2, accumulated break was similarly effective to distributed break for 3 of 5 participants and accumulated and distributed food were equally effective for 4 participants.

Behavior analytic interventions for children with autism: Policy and practice in the United Kingdom and China

LAY ABSTRACT

The prevalence of autism is increasing, and the development of these children and the lived experience of their families have become a global concern. Applied behavioral analytic intervention is proved to be effective in improving their cognitive abilities, language skills, and social and emotional skills, but the service delivery between developed and developing countries is different. A qualitative study was conducted to explore personal experiences with actual practice fidelity of behavior analytic services for children with autism in a Western developed country (United Kingdom) and an Eastern developing country (China). The study found: (1) a lack of support for autism and behavioral analytic services in both countries; (2) applied behavioral analytic intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular aspect of behavioral analytic interventions was similar and increased with ongoing training. This study emphasizes the need to support children with autism, and to consider regional adaptations of evidence-based practice of behavior analytic interventions for the affected population.

A randomized clinical trial of three prompting systems to teach tact relations

Prompts are commonly used during discrete trial teaching for individuals diagnosed with autism spectrum disorder (ASD). Three commonly used prompting systems include constant time delay, most-to-least prompting, and flexible prompt fading. Most of the research demonstrating the effectiveness of these three prompting strategies have been completed through the use of single subject experimental designs. Some within the field of behaviorally based approaches to ASD interventions have called for more randomized clinical trials of these approaches. The purpose of the present study was to compare these 3 prompting systems to teach tact relations for 27 individuals diagnosed with ASD through a randomized clinical trial without a control group with respect to pre-post responding, generalization, sessions to mastery, and responding during teaching. Overall, minimal differences were observed across the 3 systems. The results are discussed with respect to future research and clinical application of the methods evaluated.

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.

The Effects of Standard and Enhanced Data Sheets and Brief Video Training on Implementation of Conditional Discrimination Training

Grow and LeBlanc (2013) described practice recommendations for conducting conditional discrimination training with children with autism. One recommendation involved using a specially designed datasheet to provide the preset target stimulus for each trial along with counterbalancing the location of stimuli if a three-item array of comparison stimuli. This study evaluated whether the recommended data sheet would lead to higher procedural integrity of counterbalancing trials compared to a standard data sheet (i.e., targets and arrays are not pre-set). Forty behavior therapists from two provider agencies participated. Participants were randomly assigned to either the standard data sheet condition or the enhanced data sheet condition. Participants watched a short video on Grow and LeBlanc's practice recommendations for a matching task and an orientation to the datasheet for the assigned condition, and then implemented the matching task with a confederate serving in the role of the child with autism. The enhanced data sheet resulted in higher accuracy of implementation on counterbalancing than the standard data sheet, with the largest difference for rotation of the target stimulus across trials and for counterbalancing the placement of the correct comparison stimulus in the array.

Evaluating Three Methods of Stimulus Rotation when Teaching Receptive Labels

The teaching of receptive labels (i.e., auditory-visual conditional discriminations) is common among early intervention programs for individuals diagnosed with autism spectrum disorder (ASD). Discrete trial teaching (DTT) is a common approach used to teach these receptive labels. Some have argued that the stimuli within the array, target and non-target, must be counterbalanced to prevent the development of undesired stimulus control. The purpose of the present study was to evaluate the effectiveness of three different approaches to stimulus rotation to teach receptive labels to five young children diagnosed with ASD. These approaches included counterbalanced, fixed, and clinician's choice. The results of an adapted alternating treatment design replicated across three stimulus sets and five participants indicated that all three methods of rotation were effective. Maintenance and generalization for targets taught in all three conditions was also assessed. The implications of the results with respect to current teaching practices in early intervention programs are discussed.