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Bejnö H, Roll-Pettersson L, Klintwall L, Långh U, Odom SL, Bölte S. Adapting the preschool environment to the needs of children on the autism spectrum in Sweden: A quasi-experimental study. Scand J Occup Ther 2023; 30:278-297. [PMID: 34696666 DOI: 10.1080/11038128.2021.1993330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Hampus Bejnö
- Department of Special Education, Stockholm University, Stockholm, Sweden
| | | | - Lars Klintwall
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ulrika Långh
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden
- Autism Center for Young Children, Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | - Samuel L Odom
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Sven Bölte
- Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
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2
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Bradley RL, Noell GH. Rule-Governed Behavior: Teaching Social Skills via Rule-Following to Children with Autism. Dev Neurorehabil 2022; 25:433-443. [PMID: 34951556 DOI: 10.1080/17518423.2021.2018735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rule-governed behavior (RGB) is behavior that is controlled by verbal descriptions of contingencies rather than by direct contact or a history of direct contact with the contingencies. Humans rely on RGB to navigate a multitude of life experiences, and in doing so, we avoid direct contact with destructive or harmful contingencies or contingencies that would be inefficient to contact. However, individuals with autism spectrum disorders (ASDs) frequently struggle with RGB, leaving them at increased risk of contacting aversive consequences. As a result, acquiring RGB can be a valuable developmental outcome for individuals with ASD. The current study examined the effectiveness of an intervention program designed to promote acquisition and generalization of rule-governed social skills in children with ASD. Multiple exemplar training (MET) resulted in increased performance of the target behavior as well as successful discrimination.
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Affiliation(s)
| | - George H Noell
- Louisiana State University, Old Dominion University, USA
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3
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Långh U, Perry A, Eikeseth S, Bölte S. Quality of Early Intensive Behavioral Intervention as a Predictor of Children's Outcome. Behav Modif 2020; 45:911-928. [PMID: 32436396 DOI: 10.1177/0145445520923998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has directed surprisingly little attention to the quality of Early Intensive Behavioral Intervention (EIBI) in autism spectrum disorder (ASD) as a potential predictor of outcome. Therefore, using a preschool delivery model within a sample of 30 children, we examined the predictive power of EIBI quality on treatment outcome. EIBI quality was assessed at baseline by the York Measure of Quality of Intensive Behavioral Intervention (YMQI) and treatment outcome was evaluated after a period of 4 to 6 months using a battery of behavioral tests and scales to evaluate treatment success. Multinomial logistic regressions demonstrated that general EIBI quality predicted clinically significant change at follow-up. Particularly improvements in basic language and learning skills and global clinical impression were observed. Specific quality indicators that influenced overall treatment success were treatment organization, teaching level and differential reinforcement. In addition to previously examined predictors of EIBI treatment effects, such as child characteristics and intervention quantity, our findings highlight the importance of adequate EIBI quality assurance.
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Affiliation(s)
- Ulrika Långh
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Karolinska Institutet, Stockholm, Sweden.,Autism Center for Young Children, Habilitation & Health, Stockholm County Council, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Adrienne Perry
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Svein Eikeseth
- Department of Behavioral Science, Oslo Metropolitan Uninversity, Norway
| | - Sven Bölte
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Region Stockholm, Stockholm, Sweden
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Callahan K, Foxx RM, Swierczynski A, Aerts X, Mehta S, McComb ME, Nichols SM, Segal G, Donald A, Sharma R. Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners. J Autism Dev Disord 2019; 49:3557-3570. [PMID: 31127484 PMCID: PMC6707962 DOI: 10.1007/s10803-019-04082-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated interpersonal skills associated with the concept of behavioral artistry (BA), a repertoire of practitioner behaviors including care, attentiveness, and creativity, among others, associated with the effective delivery of applied behavior analysis (ABA) treatment. Survey results indicated parents of children with autism preferred BA descriptors for ABA therapists over non-BA descriptors. A separate survey of 212 university students on a standardized personality assessment revealed students majoring and/or working in the field of ABA had lower levels of BA than those in other human services professions. Practitioners with higher BA scores were observed and rated more positively in their delivery of ABA for children with autism. Implications for training/supervising effective ABA practitioners within a BA model are discussed.
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Affiliation(s)
- Kevin Callahan
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA.
| | - Richard M Foxx
- Pennsylvania State University College of Medicine, Hershey, USA
| | - Adam Swierczynski
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Xing Aerts
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Smita Mehta
- Department of Educational Psychology, UNT, Denton, USA
| | - Mary-Ellen McComb
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Susan M Nichols
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Gabrielle Segal
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Andrew Donald
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Rachita Sharma
- Department of Rehabilitation and Health Services, UNT, Denton, USA
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Långh U, Cauvet E, Hammar M, Bölte S. Cross-Cultural Validation of the York Measure of Quality of Intensive Behavioral Intervention. Behav Modif 2017; 41:808-828. [PMID: 28691542 DOI: 10.1177/0145445517719397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Early intensive behavioral intervention (EIBI) is widely applied in young children with autism spectrum disorder. Little research has addressed the significance of adherence to EIBI practices for treatment outcomes. The York Measure of Quality of Intensive Behavioral Intervention (YMQI) was designed to assess EIBI quality delivery in Ontario, Canada. The objective of this study was to examine the cross-cultural validity of the YMQI in a clinical Swedish community sample of 30 boys and four girls with autism aged 2.5 to 6 years. Internal consistency was alpha = .87 for the full scale YMQI. Interrater reliability among three raters on 97 video-recorded therapy sequences was .71 (intraclass correlation coefficient [ICC]), and intrarater reliability of two raters re-scoring 15 sequences after 6 months was ICC = .87. The convergent validity of the YMQI with EIBI expert ratings was r = .49. Findings endorse the psychometric properties of the YMQI and its usability outside of Anglo-Saxon countries.
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Affiliation(s)
- Ulrika Långh
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
| | - Elodie Cauvet
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
| | - Martin Hammar
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
| | - Sven Bölte
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
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Leaf JB, Leaf R, McEachin J, Taubman M, Smith T, Harris SL, Freeman BJ, Mountjoy T, Parker T, Streff T, Volkmar FR, Waks A. Concerns About the Registered Behavior Technician™ in Relation to Effective Autism Intervention. Behav Anal Pract 2017. [PMID: 28630819 DOI: 10.1007/s40617-016-0145-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
In 2014, the Behavior Analyst Certification Board (BACB®) initiated a program for credentialing behavior technicians. The new credential, Registered Behavior Technician™ (RBT®), is for providers of behavioral intervention to a wide range of individuals with mental health needs and developmental delays, including individuals diagnosed with autism spectrum disorder (ASD). The RBT® would represent the entry-level position within the range of the BACB® credentials. Despite the increasing acceptance of this newest level of credential from the behavioral community, the authors of this paper have substantial concerns with the RBT® credential as it relates to the delivery of intervention to individuals diagnosed with ASD. The purpose of this paper is to detail these concerns and propose remedies that would ensure that individuals diagnosed with ASD receive effective behavioral intervention.
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Affiliation(s)
- Justin B Leaf
- Center for the Advancement of Behavior Analysis, 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Ronald Leaf
- Center for the Advancement of Behavior Analysis, 200 Marina Drive, Seal Beach, CA 90740 USA
| | - John McEachin
- Center for the Advancement of Behavior Analysis, 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Mitchell Taubman
- Center for the Advancement of Behavior Analysis, 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Tristram Smith
- University of Rochester Medical Center, Rochester, NY USA
| | - Sandra L Harris
- Rutgers-The State University of New Jersey, New Brunswick, NJ USA
| | - B J Freeman
- UCLA School of Medicine, Los Angeles, CA USA
| | | | | | - Todd Streff
- Streff Behavior Consulting, Foristell, MO USA
| | - Fred R Volkmar
- Child Study Center-Yale University School of Medicine, New Haven, CT USA
| | - Andi Waks
- Autism Partnership Foundation, Seal Beach, CA USA
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7
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Abstract
Applied behavior analysis (ABA) is a science and, therefore, involves progressive approaches and outcomes. In this commentary we argue that the spirit and the method of science should be maintained in order to avoid reductionist procedures, stifled innovation, and rote, unresponsive protocols that become increasingly removed from meaningful progress for individuals diagnosed with autism spectrum disorder (ASD). We describe this approach as progressive. In a progressive approach to ABA, the therapist employs a structured yet flexible process, which is contingent upon and responsive to child progress. We will describe progressive ABA, contrast it to reductionist ABA, and provide rationales for both the substance and intent of ABA as a progressive scientific method for improving conditions of social relevance for individuals with ASD.
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Dixon DR, Linstead E, Granpeesheh D, Novack MN, French R, Stevens E, Stevens L, Powell A. An Evaluation of the Impact of Supervision Intensity, Supervisor Qualifications, and Caseload on Outcomes in the Treatment of Autism Spectrum Disorder. Behav Anal Pract 2016; 9:339-348. [PMID: 27920965 DOI: 10.1007/s40617-016-0132-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ample research has shown the benefits of intensive applied behavior analysis (ABA) treatment for autism spectrum disorder (ASD); research that investigates the role of treatment supervision, however, is limited. The present study examined the relationship between mastery of learning objectives and supervision hours, supervisor credentials, years of experience, and caseload in a large sample of children with ASD (N = 638). These data were retrieved from a large archival database of children with ASD receiving community-based ABA services. When analyzed together via a multiple linear regression, supervision hours and treatment hours accounted for only slightly more of the observed variance (r2 = 0.34) than treatment hours alone (r2 = 0.32), indicating that increased supervision hours do not dramatically increase the number of mastered learning objectives. In additional regression analyses, supervisor credentials were found to have a significant impact on the number of mastered learning objectives, wherein those receiving supervision from a Board Certified Behavior Analyst (BCBA) mastered significantly more learning objectives. Likewise, the years of experience as a clinical supervisor showed a small but significant impact on the mastery of learning objectives. A supervisor's caseload, however, was not a significant predictor of the number of learning objectives mastered. These findings provide guidance for best practice recommendations.
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Affiliation(s)
- Dennis R Dixon
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
| | - Erik Linstead
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Doreen Granpeesheh
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
| | - Marlena N Novack
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
| | - Ryan French
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Elizabeth Stevens
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Laura Stevens
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Alva Powell
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
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9
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MacDonald R, Parry-Cruwys D, Dupere S, Ahearn W. Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3632-3644. [PMID: 25241118 DOI: 10.1016/j.ridd.2014.08.036] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/22/2014] [Accepted: 08/28/2014] [Indexed: 06/03/2023]
Abstract
Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. Although several studies have identified behaviors that are possible indicators of best outcome, changes in performance are typically measured using norm-referenced standardized scores referencing overall functioning level rather than via repeated observational measures of autism-specific deficits (i.e., social behavior). In the current study, 83 children with autism (CWA), aged 1, 2 and 3 years, and 58 same-aged typically developing children (TDC) were directly observed in the areas of cognitive skills, joint attention (JA), play, and stereotypic behavior using a measure called the Early Skills Assessment Tool (ESAT; MacDonald et al., 2006). CWA were assessed at entry into an EIBI program and again after 1 year of treatment. Changes in performance were compared pre- and post-treatment as well as to the normative data by age. Results indicate significant gains on the ESAT across all age groups with the greatest gains seen in the children who entered treatment prior to their second birthday. Increases were seen on direct measures of JA, play, imitation and language while decreases were seen in stereotypy regardless of level of performance at entry into EIBI. The ESAT, a direct measurement tool, served as a sensitive tool to measure changes in autism symptomatology following EIBI treatment.
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Affiliation(s)
| | | | - Sally Dupere
- The New England Center for Children, Southborough, USA
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