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    Increasing spontaneous language in three autistic children matson Increasing spontaneous language in three autistic children matson Document Transcript

    • JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1990,231,227-233 NumBEP, 2 (summEp, 1990) INCREASING SPONTANEOUS LANGUAGE IN THREE AUTISTIC CHILDREN JOHNNY L. MATSON, JAY A. SEvN, DuNE FRIDLEY, AND STEVEN R. LoVE LOUISIANA STATE UNIVERSITY A time delay procedure was used to increase spontaneous verbalizations of 3 autistic children. Multiple baseline across behaviors designs were used with target responses, selected via a social validation procedure, of two spontaneous responses ("please" and "thank you") and one verbally prompted response ("youre welcome"). The results indicate gains across target behaviors for all children, with occurrence across other stimuli and settings. These gains were validated socially with 10 adults. Furthermore, increases in appropriate language had no effect on levels of inappropriate speech. DESCRIPTORS: spontaneous language, time delay, social validation Language programs for autistic children have trained stimuli were examined, once again as amost frequently focused on increasing verbally replication and extension of previous work. Socialprompted responses cued by the speech of the ther- validation was used to assess treatment efficacy,apist. Only two studies have attempted to increase given the importance of demonstrating the prac-rates of spontaneous language in autistic children ticality of the training with autistic children. Third,(Charlop, Schreibman, & Thibodeau, 1985; Char- unlike previous studies, maintainence of learnedlop & Walsh, 1986). As defined by Charlop et al. behaviors was assessed at follow-up. Fourth, the(1985), a spontaneous response is a verbal response relationship between rates of appropriate and in-to a nonverbal discriminative stimulus in the ab- appropriate verbalizations was examined.sence of a verbal discriminative stimulus. Overre-liance on verbal cueing, as opposed to nonverbalreferents, may result in a very restricted use of METHODspeech in response to a limited set of stimuli (Halle, Subjects and SettingBaer, & Spradlin, 1981). Also, spontaneous ver- Three autistic children with moderate mentalbalizations are less likely to occur when the child retardation, all of whom met DSM-III-R and ASAis trained to respond only to others. Thus, the criteria for autism, participated in this study. Allpersons efforts to make his or her desires known 3 children displayed little or no spontaneous speechand the development of normal conversational pat- and were from self-contained dassrooms. Child 1terns are limited. was an 1 1-year-old female whose speech consisted The present study was designed to replicate those of echolalia and repetition of cartoon scenarios. Sheof Charlop et al. (1985) and Charlop and Walsh was also diagnosed as hyperactive according to(1986) on spontaneous communication training for DSM-III-R criteria and was being treated with aautistic persons by using a time delay, modeling, stable dosage (25 mg) of fenfluramine while thisand food reinforcement procedure to teach three study was in progress. The 2nd child was an 11-previously untrained verbal responses. These con- year-old male whose verbal repertoire consisted en-sisted of two spontaneous responses and one ver- tirely of echolalia and the inappropriate repetitionbally cued response. Second, several additional un- of a few food words. Child 3 was a 9-year-old male whose entire verbal repertoire consisted of labeling Requests for reprints should be addressed to Johnny L. approximately a dozen common words in responseMatson, Department of Psychology, Louisiana State Univer- to being asked, "What is this?" Child 3 oftensity, Baton Rouge, Louisiana 70803. refused to remain in his seat, frequently struck or 227
    • 228 JOHNNY L. MATSON et al.kicked the therapist, and also made attempts to welcome," the child was required to say "youredestroy furniture and pictures in the room. Com- welcome" within 10 s of the experimenter sayingmunication levels were 1 year, 9 months for Child "thank you" and before the response was modeled.1; 1 year, 8 months for Child 2; and 1 year, 5 Inappropriate speech. Any verbalizations un-months for Child 3 as measured by the Vineland related to the task at hand or the immediate en-Adaptive Behavior Scale. vironment were considered irrelevant. Comments Baseline and treatment sessions took place two about the stimuli (e.g., "Crayon is blue"), theafternoons per week in an experimental room. Dur- experimenter or rater (e.g., "Shirt is pretty" bying baseline and treatment sessions, the experi- Child 1), or reinforcers (e.g., "Candy, please" bymenter and child were seated facing each other, Child 2 at follow-up) were not considered irrelevantseparated by a small table. Training periods gen- even if they were wrong ("Crayon is orange").erally lasted 1 hr and consisted of 15 to 25 trials. Echolalia, perseverations, and nonsensical utter-The number of trials per day varied within and ances were considered inappropriate for all of thebetween children. A tape recorder was placed on a children.window sill behind the child during all sessions. Stimulus MaterialsTarget Behaviors A variety of toys and play objects were selected Social validation. To select target behaviors by the experimenter and then placed in the chil-used frequently in the natural environment, a social drens presence to informally assess desirability. Fivevalidation procedure using 30 college students was stimuli were then chosen for each child to be usedemployed (Kazdin & Matson, 1981). The students during treatment. Stimuli included blocks, crayons,were each given an open-ended questionnaire and stuffed animals, and other toys.were asked to think about specific normal socialinteractions between themselves and significant oth- Experimental Conditions and Proceduresers. They were then asked to generate a list of words, Experimental design consisted of pretest, base-interjections, and social responses that were com- line, treatment, assessment of novel stimuli, andmonly used during the imagined interactions. From follow-up sessions. Three single subject designs werethis list, two spontaneous responses, "please" and carried out in multiple baseline fashion across target"thank you," and one verbally cued response, behaviors. For each child, target behaviors were"youre welcome," were selected as target behaviors trained in the following order: (a) "please," (b)for treatment. All of the children in the present "thank you," and (c) "youre welcome."study failed to use these words prior to treatment, Pretest. A pretest was administered to each childas reported by parents and teachers. to determine whether he or she was able to label Verbal responses. The child was required to each of the preferred stimuli. Each object was heldspontaneously emit the verbal response within 10 before the child while the experimenter asked,s after presentation of the stimulus. Responses were "What is this?" When the child responded correctlyconsidered correct only if spoken before the model. three consecutive times, it was determined that heThe words trained were "please," "thank you," or she could label the object. If a child failed toand "youre welcome." meet this criterion, the correct label of that object For "please," the child was required to say, was modeled for the child until he or she inde-"(Item), please," within 10 s of being shown the pendently labeled the object three consecutive times.item and before the response was modeled. For Baseline. Prior to each session, the five stimuli"thank you," the child was required to say "thank were arranged in random sequence for presentation.you" within 10 s of receiving the desired object The first of the five objects was held up by theand before the response was modeled. For "youre experimenter for 10 s, and the child was rated on
    • INCREASING LANGUAGE 229whether he or she requested the item by saying, ulus was presented. After a 2-s interval, the re- "(Item), please" within 10 s. If the child did not sponse "(Item), please" was modeled by the ex- emit the correct response, the response was modeled perimenter. A correct imitation of the modeled by the experimenter. The next four objects were response or a spontaneous response was immedi- then presented one after the other, but correct re- ately reinforced with (a) the stimulus just requested sponses were not modeled by the experimenter dur- (e.g., crayon), (b) an edible reinforcer (M&M 0s, ing baseline. Correct responses were reinforced with grapes, popcorn, etc.), and (c) verbal praise. Inverbal praise. If the child reached or grabbed for addition, at the conclusion of each session, children an object, it was withheld until the end of the 10-s were allowed to play with the objects they hadperiod. This procedure was continued until all five appropriately requested. An additional reinforcer (a objects had been presented. picture book) was used if a child failed to show For the "thank you" response, the five objects improvement of at least 10% after several trials.were presented again in random order. This time Both correct imitations of the modeled responsethe objects were immediately handed one at a time and unmodeled responses were reinforced. How-to the child, who was allowed to hold each object ever, only when the response was emitted sponta-for 10 s. The child was required to say, "thank neously and completely was it rated as correct.you," within this 10-s period. If no response oc- Inappropriate words were recorded by the raterscurred during this time, "thank you" was modeled and ignored by the therapist.by the experimenter (for the initial stimulus only) When the child had correctly imitated four ofand the next stimulus was presented. five responses appropriately for two consecutive ses- For the "youre welcome" response, the child sions, the time delay between presentation of thestarted with the five preferred stimuli. The exper- stimulus and the model was increased to 4 s. Theimenter requested the items one at a time by saying, delay was gradually increased by 2-s intervals in "May I have the (item), please?" When the child this manner until the time delay before modeledhanded over the correct object, the experimenter responses reached 10 s or until spontaneous re-took it and said, "Thank you." The child was given sponses were successfully mastered by the child. 10 s to respond, "Youre welcome," before the When the first target response had been mas-response was modeled (for the initial trial only) and tered, treatment began with the "thank you" re-the next object requested. If the child handed over sponse in accordance with the multiple baselinean object that had not been requested, the exper- design across behaviors. Treatment was continuedimenter again asked for the object until it was given until all three target responses improved. Food re-to him by the subject. These procedures were con- inforcement was continuous at first but was fadedtinued until all five stimuli had been received by to a variable-ratio schedule after the child correctlythe experimenter. used that response 80% of the time for three con- During each session, Child 1 and Child 2 were secutive sessions.also rated for the presence or absence of inappro- Assessment of novel stimuli. Following training,priate speech during the 10-s interval following additional sessions were conducted to assess re-stimulus presentation (partial interval sampling). sponding to five untrained stimuli. Procedures wereAll sessions were recorded on audiotape to calculate identical to those used in treatment sessions. Novelreliability. stimuli consisted of various toy items. Treatment. Random order of the five stimuli Follow-up. Sessions were conducted 2 months,was predetermined. A 2-s graduated time delay 6 months, and 1 month after final treatment ses-plus modeling, food reinforcement, and praise pro- sions for Children 1, 2, and 3, respectively. Theycedure was used with all five stimuli. were conducted in the same manner as treatment For the "(Item), please" response, the first stim- sessions, using a 10-s delay interval with stimulus
    • 230 JOHNNY L. MATSON et al. BASELINE TREATMENT PACKAGE FOLLOW-UPA) Luoe0 In LUILU do 0.I--LUmU I--I-WLU I)-z -O u De SESSIONS Figure 1. Percentage of target behaviors across baseline, treatment, and 2-month follow-up sessions for Child 1.objects randomly chosen from original and novel ond rater was blind to the order in which sessionsstimuli. occurred. Each trial in a session was rated as to whetherSocial Validation of Treatment the child correctly verbalized the appropriate target A group of 10 adult community members were response for that trial. Agreement occurred whenshown two video recordings of sessions with each both raters scored a behavior as having occurred orchild. These induded a recording of the first base- not occurred within a particular trial. Interraterline and last treatment sessions for each child. Tapes reliability was calculated by dividing the total num-were presented in random order; after viewing each ber of agreements by the total number of agree-video recording, community members were asked ments plus disagreements and multiplying by 100.to rate the children using a five-point Likert-type For Child 1, reliability for target behaviors rangedscale on overall social appearance and appropriate from 92.3% ("youre welcome") to 98.5%use of the specific target behaviors. ("please") and averaged 96.7%. Reliability for theRaters and Reliability correlative behavior (inappropriate speech) aver- An undergraduate senior psychology major served aged 91.8%. For Child 2, reliability ranged fromas the primary rater. Interrater reliability was cal- 92.0% ("thank you") to 96.5% ("please") andculated for 20% of sessions by having a second averaged 94.7%. For inappropriate speech, the av-assistant (also a senior psychology major) rate be- erage agreement between raters was 94.2%. Forhaviors from the tape-recorded sessions. Both raters Child 3, agreement on target behaviors ranged fromwere blind to experimental conditions, and the sec- 91.8% ("thank you" and "youre welcome") to
    • INCREASING LANGUAGE 231 TREATMENT 100 - In oe 0 W 44 lU LUI 0* m 100 I- LU 0 40 I- LL XI- I- 0 0* LU 0 100 ~-. uj z >LU LU u DO LU 0- SESSIONS Figure 2. Percentage of target behaviors across baseline, treatment, and 6-month follow-up sessions for Child 2.95.9% ("please") and averaged 93.2% for total improved performance as a result. These responsesbehaviors rated. continued with introduction of untrained stimuli. For Child 2, all three behaviors increased imme- diately with treatment (see Figure 2), and continued RESULTS with novel stimuli. For Child 3, improvement in Results are provided in Figures 1, 2, and 3. all three target responses occurred quickly and, asChild 1 responded at 100% during pretest, but with other subjects, treatment effects continued withChildren 2 and 3 were unable to label three of the five novel stimuli.their stimuli and therefore required two and three The significance of change was corroborated by30-min teaching sessions, respectively. As shown the findings on the social validition data. For Childin Figure 1, spontaneous use of target words was 1, analysis of pre- and posttreatment ratings usingnear zero during baseline for Child 1. With the t tests indicated that community members reportedintroduction of treatment, Child 1 rapidly im- a significant difference both in overall social ap-proved in making spontaneous requests for objects. pearance, t(9) = 4.49,p < .01, and in appropriateHowever, with initial treatment ofthe second target use of the three target responses, t(9) = 10.53, pbehavior, she failed to imitate the models "thank < .01. Also, for Child 2, a significant differenceyou." A second reinforcer (picture book) was there- occurred between pre- and posttreatment measuresfore induded in treatment, and her use of "thank both in overall social appearance, t(9) = 7.41, pyou" quickly improved. This second reinforcer was < .01, and in appropriate use of the three targetalso introduced when Child 1 failed to respond responses, t(9) = 10.36, p < .01. For Child 3,during treatment for the third target behavior, with however, rated improvement reached significance
    • 232 JOHNNY L. MATSON et al. TREATMENT PACKAGE 100 Vn uJ 0 -J m IITarget I LU 00 JAck Stimuli a. I) I- 100. us LU U -i. I~- U- 0 I- 0 u 40- U X>-u 100 z -0 nc LU u LU a- SESSIONS Figure 3. Percentage of target behaviors across baseline, treatment, and 1-month follow-up sessions for Child 3.only in the childs use of target responses, t(9) = trained stimuli and were maintained at follow-up.7.27, p < .01, perhaps because aggressive behavior The experimenters and raters also anecdotally ob-persisted throughout treatment. Percentages of in- served that the children used "please" and "thankappropriate speech during each session were cor- you" with other stimuli and acquired other requestsrelated with session number for each child using ("Work, please," "Water, please," etc.).the Pearson Product-Moment coefficient. For both At the completion of treatment, parents wereChild 1 and Child 2, the measures were uncorre- asked to rate the use of target responses, otherlated, indicating no decreases in inappropriate lan- spontaneous responses, and general behavior forguage over time. improvement in the home setting. A five-point Two-month follow-up for Child 1, 6-month fol- Likert-type scale ("no" to "noticeable improve-low-up for Child 2, and 1-month follow-up for ment") was used. Parents of Child 1 and Child 2Child 3 indicated that treatment gains were main- rated high improvement in use of target responses,tained by all 3 children. in use of spontaneous speech, and in general be- havior observed at home. Parents of Child 3 rated noticeable improvement in the use of target re- DISCUSSION sponses, slight improvement in spontaneous speech, Prior to treatment, the children grabbed for de- and no improvement in general behavior, corrob-sired objects, often displaying temper tantrums when orating the social validity data from the 10 adults.desires were thwarted. Our participants were suc- These data are dearly anecdotal and biased (parentscessfully taught to self-initiate several requests, to were aware of treatment and no pretreatment mea-appropriately thank the experimenter, and to use sures were obtained) and are included only as gen-the "youre welcome" response. Furthermore, these eral impressions of social validity.responses occurred in the presence of several un- One important finding was that increases in ap-
    • INCREASING LANGUAGE 233 propriate responding had no observable effect on time delay and reinforcement components prevents the inappropriate speech of Children 1 and 2, who condusions about either component of treatment. still exhibited echolalia, perseverations, and non- Future studies might focus more thoroughly on sense sounds and phrases between trials at rates generalization, treatment acceptability, conducting comparable to those prior to treatment. Because treatment in more natural settings, and examination abnormal speech patterns are frequently severe and of treatment components in isolation to find the develop over many years, many autistic children most parsimonious treatment package. Also, par-may require treatment specifically focused on the ticipants in this study had severe language impair-alleviation of these particular problems. However, ments. Future studies may wish to address whetherany program to decrease inappropriate speech should greater or swifter effects occur with autistic childrenbe accompanied by an equally rigorous program to who have less severe impairments.increase appropriate language skills. The present findings should be viewed in light REFERENCESof several limitations of the study. First, assessment Charlop, M. H., Schreibman, L., & Thibodeau, M. G.of performance with untrained stimuli should not (1985). Increasing spontaneous verbal responding in autistic children using a time delay procedure. Journalbe construed as generalization data because baseline of Applied Behavior Analysis, 18, 15 5-166.probes were not obtained. However, given that Charlop, M. H., & Walsh, M. E. (1986). Increasing autisticneither the parents nor teachers of the target chil- childrens spontaneous verbalizations of affection: An as-dren had ever heard the children use the target sessment of time delay and peer modeling procedures. Journal of Applied Behavior Analysis, 19, 307-314.responses prior to treatment, generalization appears Halle,J. W., Baer, D. M., & Spradlin,J. E. (1981). Teach-to have occurred. ers generalized use of delay as a stimulus control pro- A second limitation is that the target responses cedure to increase language use in handicapped children. Journal of Applied Behavior Analysis, 14, 389-409.were trained in the same order for all 3 children, Kazdin, A. E., & Matson, J. L. (1981). Social validationresulting in possible order effects. Third, two of the with the mentally retarded. Applied Research in Mentalthree target responses improved for Child 1 only Retardation, 2, 39-54.after the indusion of an additional reinforcer, mak- Received February 6, 1989ing it impossible to isolate the effects of the time Initial editorial decision April 3, 1989 Revisions received May 30, 1989; July 19, 1989delay procedure. Although the treatment package Final acceptance August 10, 1989as a whole was effective, the concurrent use of the Action Editor, David P. Wacker