JOURNAL OF APPLIED BEHAVIOR ANALYSIS              2007, 40, 565–570                               NUMBER    3 (FALL 2007) ...
566                                   EMILY A. JONES et al.pervasive developmental disorder (not otherwise      domains (e...
SPONTANEOUS RESPONSES                                              567‘‘Are you okay?’’ when someone grabbed his or       ...
568                                   EMILY A. JONES et al.interspersed with opportunities for the child to     eralizatio...
SPONTANEOUS RESPONSES                                                     569   Figure 1. Percentage of opportunities with...
570                                    EMILY A. JONES et al.instruction had just begun, we purposefully did       importan...
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Teaching spontaneous responses to young children with autism jones


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Teaching spontaneous responses to young children with autism jones

  1. 1. JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2007, 40, 565–570 NUMBER 3 (FALL 2007) TEACHING SPONTANEOUS RESPONSES TO YOUNG CHILDREN WITH AUTISM EMILY A. JONES AND KATHLEEN M. FEELEY C. W. POST CAMPUS OF LONG ISLAND UNIVERSITY AND JENNIFER TAKACS DEVELOPMENTAL DISABILITIES INSTITUTE Using a multiple probe design across responses, we demonstrated the effectiveness of intensive intervention in establishing spontaneous verbal responses to 2 3-year-old children with autism with generalization to novel settings involving novel persons. Intervention involved discrete-trial instruction (i.e., repeated instructional opportunities presented in close proximity to high rates of reinforcement), specific prompts, and error correction. Spontaneous responses were defined as specific verbal utterances (e.g., the child says ‘‘bless you’’) following discriminative stimuli that did not involve explicit vocal directives (e.g., adult sneeze). The development of effective interventions to address the social-communicative needs of very young children with autism is discussed. DESCRIPTORS: autism, spontaneous responses, discrete-trial instruction, generalization ________________________________________ Spontaneous communication in children with requesting interactions (e.g., ‘‘play with me’’ inautism has been the focus of many researchers. response to the presentation of a game requiringSeveral have taught spontaneous requesting skills two people; Matson et al., 1993). Across these(e.g., requesting food items) (e.g., Charlop, studies, spontaneity was defined as respondingSchreibman, & Thibodeau, 1985). Others have in the absence of explicit adult vocalizationsaddressed spontaneous communication skills (Charlop et al.). Responses were acquired andsuch as greetings that occur in response to the generalized to a novel setting or person. With thearrival of an adult (Charlop & Trasowech, exception of Matson et al. (1993), whose1991); saying ‘‘thank you’’ in response to being participants were 4 to 5 years of age, thehanded a desired object (Matson, Sevin, Box, & participants in all of these studies were childrenFrancis, 1993; Matson, Sevin, Fridley, & Love, with autism between 6 and 11 years. Because1990); expressing affection (e.g., saying ‘‘I love spontaneous communication is demonstrated byyou’’ in response to being hugged; Charlop & children from a very young age (Wetherby,Walsh, 1986); requesting information (e.g., Warren, & Reichle, 1998) and is often impaired‘‘Where were you, Mom?’’ in response to in children with autism (e.g., Carr & Kolo-mother’s return; Charlop & Trasowech); and ginsky, 1983), we sought to extend the use of behavioral interventions to address spontaneous We are grateful to the children, parents, teachers, and communication in very young children withclassroom assistants who devoted time and effort to this autism (i.e., 3 years of age).project. We thank the Developmental Disabilities Institutefor providing partial funding for this project and theircontinued support of research. We also thank Joe Reichle METHODfor providing scholarly critique of this manuscript. Address correspondence to Emily A. Jones, Department Participantsof Psychology, C. W. Post Campus of Long Island Two 3-year-old preschool children, HarryUniversity, Brookville, New York 11548 (e-mail: and Steven, participated in this study. Both doi: 10.1901/jaba.2007.40-565 boys had been diagnosed at 2 years of age with 565
  2. 2. 566 EMILY A. JONES et al.pervasive developmental disorder (not otherwise domains (e.g., communication, cognitive, andspecified) by pediatric neurologists not associ- motor skills), but spontaneous communicationated with this research. Harry also had been skills had not been addressed for either par-diagnosed with an expressive language delay. ticipant. Procedures were implemented at theAlthough both participants used vocal utter- center in an instructional room (2 m by 2 m)ances to communicate and had vocal imitation that contained a table, two chairs, a rolling two-skills, they had been referred by their teachers drawer file cabinet, and two shelves withfor participation in this study because they instructional materials and toys. Interventionrarely used spontaneous vocal utterances. was implemented by a certified special educator Evaluation of Harry conducted prior to this and at least one teacher’s assistant trained instudy revealed a standard score (SS) of 57 on applied behavior analysis (all of whom werethe Bayley Scales of Infant Development members of the children’s instructional teams).(BSID-II; Bayley, 1993). On the Vineland Generalization was assessed during unrelatedAdaptive Behavior Scales (VABS-II; Sparrow, activities (e.g., free play, transitions) with aBalla, & Cicchetti, 1984), his scores fell in the person not currently a member of the partici-average range in the area of motor skills (SS 5 pant’s educational team (e.g., an assistant from94), but in the moderately low range in the a different classroom) in a location in theareas of communication (SS 5 69), daily living preschool that the child frequented during(SS 5 80), and social skills (SS 5 84). His break times but where intervention had notoverall score also fell in the moderately low taken place (e.g., hallway, gymnasium, play-range (SS 5 76). On the Preschool Language ground). For example, when participants playedScale (PLS-3; Zimmerman, Steiner, & Pond, in the gym, an assistant from another classroom1992), he scored in the first percentile in the was recruited to deliver the discriminativeareas of receptive (SS 5 61) and expressive (SS stimuli (SDs) to assess generalization of target5 67) language development. Evaluation of responses.Steven conducted prior to this study revealeda standard score in the average range (SS 5 84) Design and Response Definitionson the BSID-II. On the VABS-II, he also scored A multiple probe design across three com-within the average range in the areas of municative responses replicated with 2 partic-communication (SS 5 91), daily living (SS 5 ipants was used, with single-opportunity probes86), social skills (SS 5 89), and motor skills (SS to examine generalization across people, set-5 91). On the PLS-3, he scored in the average tings, and materials. The dependent measurerange in the area of auditory comprehension (SS was unprompted spoken words produced5 89) with mild delays in the area of expressive within 5 s of the presentation of the SD. Eachcommunication (SS 5 74). Steven also showed child’s parent chose three target SD responsesdelays in the area of pragmatics (i.e., difficulty from a list (developed by the investigators basedusing language to maintain a topic, relate past on common situations and responses encoun-events, express opinions, and interact socially tered by preschool children) of potentialwith peers) based on the Prutting Pragmatic discriminative stimuli, corresponding commu-Checklist (Prutting & Kirchner, 1987). nicative responses, and natural consequences. Steven’s targets were (a) responding ‘‘bless you’’Setting when someone sneezed, resulting in the person Participants attended a center-based program saying ‘‘thank you’’; (b) asking ‘‘what?’’ whenthat provided intensive intervention as well as someone whispered, resulting in the personsupport in community preschools. The pro- raising his or her voice volume as he or shegram provided intervention across multiple repeated what had been said; and (c) asking
  3. 3. SPONTANEOUS RESPONSES 567‘‘Are you okay?’’ when someone grabbed his or had been effective (i.e., resulted in acquisition) ofher arm, winced, and vocalized pain (e.g., other target behaviors for both participants.‘‘ouch!’’), resulting in the person confirming Intervention occurred in sessions of 10 opportu-that he or she is not seriously hurt (e.g., saying nities; the number of sessions varied between one‘‘I’m okay, just a booboo’’). Harry’s targets were and six each day. During initial teaching(a) responding ‘‘shh!’’ when someone spoke opportunities, the teacher presented the SD,loudly, resulting in the person lowering his or immediately prompted the correct response, andher voice volume as he or she repeated what had provided natural consequences (e.g., talked softlybeen said; (b) asking ‘‘what?’’ when someone when the child said ‘‘shh!’’) paired with thewhispered, resulting in the person raising his or delivery of items (e.g., edible items) that hadher voice volume as he or she repeated what had a history of functioning as reinforcers for otherbeen said; and (c) responding ‘‘coming’’ when behaviors, in addition to praise (e.g., ‘‘great!’’).someone produced the ‘‘come here’’ gesture Once the participant began to produce the(i.e., waving hand toward self), resulting in the response independently (i.e., began to produceperson confirming the child’s response (e.g., by the response prior to the delivery of thesaying ‘‘okay’’). prompt), the teacher presented the SD and then provided the participant with a 5-s interval inProcedure which to produce the target response. If the Baseline was implemented in sessions that participant produced a correct response, naturalconsisted of two to five opportunities. After consequences (e.g., the teacher responded ‘‘I’mobtaining the child’s attention (e.g., by calling okay’’ when the child asked ‘‘Are you okay?’’),his name), the teacher presented the SD, waited reinforcers, and praise were delivered. If an5 s for the child to respond, and thenterminated the opportunity in the absence of incorrect or no response occurred within the 5-sfeedback (i.e., whether the child responded interval, an error-correction procedure was usedcorrectly or incorrectly or did not respond, the that involved verbal feedback (i.e., the teacherteacher refrained from delivering consequences). gently said ‘‘no’’ or ‘‘uh uh’’) and repetition ofBetween opportunities, the teacher delivered the SD. If the participant responded correctly onpraise (e.g., ‘‘good job!’’) and primary rein- the second presentation of the SD, reinforce-forcers to participants for remaining attentive. ment was delivered (as described previously). IfItems used as primary reinforcers were selected the participant did not respond or respondedbecause they had been previously demonstrated incorrectly on the second presentation of theto have reinforcing effects, such that when SD, verbal feedback was again provided, and thedelivered as a consequence for engagement in SD was presented for a third time and wastarget behaviors there was an increase in those immediately followed by the delivery of abehaviors. prompt to ensure a correct response. This The multicomponent intervention involved prompted response was followed by the deliverythe use of discrete-trial teaching (i.e., multiple of reinforcers.opportunities provided in close proximity to During intervention, opportunities for a spe-correct responses followed by delivery of a pre- cific target response were initially presented indetermined reinforcer) with specific prompts, isolation (i.e., repeated presentation of the SDnatural consequences, and an error-correction for one target response). Once the childprocedure (described below). All procedures performed at least 80% correct responding(e.g., frequency of sessions, error correction) during one session when intervention opportu-were already in place in the preschool program nities were presented in isolation, teachingand were continued in this study because they opportunities for that specific response were
  4. 4. 568 EMILY A. JONES et al.interspersed with opportunities for the child to eralization). Percentage agreement cumulatedperform previously mastered responses (e.g., across all opportunities was 93% for Stevenanswering simple questions, following simple and 100% for Harry. For Steven, interventiondemands, or emitting previously mastered integrity data, recorded for the same 20% ofspontaneous responses). The use of primary opportunities for which response reliability datareinforcers was terminated once the participant were recorded, was 100% for correct presenta-responded independently on 80% of the tion of the SD, 100% for correct promptingopportunities during one session in which the procedures, and 95% for delivery of appropriatetarget response was interspersed with other consequences. Intervention integrity data wereresponses. Mastery criterion was 80% indepen- not collected for Harry.dent correct responding during two con-secutive sessions, in which teaching opportuni- RESULTS AND DISCUSSIONties were interspersed with previously masteredresponses, across 2 days and two teachers. Figure 1 illustrates performance during base-Following mastery, intervention sessions con- line, intervention, and generalization probes fortinued once or twice per week to ensure that Harry and Steven. Baseline sessions consisted ofparticipants continued to demonstrate target two to five opportunities, intervention sessionsskills. consisted of 10 opportunities, and generaliza- To reflect more naturally occurring situa- tion probes involved a single opportunitytions, generalization was assessed with single- (reflecting naturally occurring opportunities toopportunity probes with a novel teacher (e.g., display the response). During baseline, Harryassistant from another classroom) in a novel did not produce any target responses (0%).setting (e.g., playground, gymnasium). During Within 10 intervention sessions he mastered thegeneralization probes conducted prior to in- first response (i.e., ‘‘shh!’’), and within 15tervention, the teacher gained the participant’s intervention sessions he mastered the secondattention, delivered the SD for one target response (i.e., ‘‘what?’’). For his final targetresponse and, regardless of the participant’s response (‘‘coming’’), he performed at 90%performance (engagement in target response, an correct responding during one session whenincorrect response, or no response), terminated opportunities were presented in isolation andthe opportunity after 5 s in the absence of any then 90% during one session when mixedconsequences. Once intervention began for each intervention opportunities (i.e., both the targetof the target responses, generalization probes response and previously mastered responses)were conducted in the same manner; however, were presented. At this point, Harry moved toif the participant emitted a correct response, the a new school and was no longer available forteacher delivered natural consequences (e.g., the continued participation. Thus, intervention wasparticipant says ‘‘what?’’ and the teacher speaks terminated after only one session (instead oflouder). Thus, primary reinforcers were not two) at or greater than 80% independentprovided and, if the participant emitted an performance when teaching opportunities wereincorrect response or no response, correction interspersed with previously mastered responses.procedures were not delivered. During baseline, Steven did not produce any target responses (0%). Within five interventionReliability sessions he mastered the first response (i.e., Response reliability data were recorded by the ‘‘bless you’’), within seven sessions he masteredfirst author for 20% of opportunities for Steven the second response (i.e., ‘‘what?’’), and withinand 22% for Harry, distributed across each six sessions he mastered the third targetcondition (i.e., baseline, intervention, and gen- response (i.e., ‘‘Are you okay?’’). Generalization
  5. 5. SPONTANEOUS RESPONSES 569 Figure 1. Percentage of opportunities with an independent correct response for Harry and Steven across threecommunicative responses during baseline and intervention as well as performance during generalization probes. Thedashed line indicates when intervention began; the dotted line indicates when mastery (i.e., performing at or above 80%across two consecutive sessions in which teaching opportunities were interspersed with previously mastered responses,across 2 days and two teachers) occurred.was observed for both participants across novel responses. There are a variety of stimuli thatsettings and persons. occasion communicative responses, including The purpose of this study was to examine an nonvocal stimuli such as those used in this study.intervention that consisted of discrete-trial in- There are also a variety of forms of responses thatstruction, prompting, and error correction to could occur in response to those stimuli. Theteach spontaneous communicative responses to responses taught in this study were vocal responsesyoung children with autism. As demonstrated in (e.g., the child says, ‘‘bless you’’) in response tothis study, even very young children with autism nonvocal SDs. Thus, a further expansion of thiscan be systematically taught to not only respond research would be to examine other forms ofto nonvocal stimuli but to demonstrate general- responses. For example, spontaneous nonvocalized performance of spontaneous responses, responses, such as holding the door open whensuggesting the importance of this type of in- seeing someone coming who is struggling withtervention. In many instances, early intensive a heavy package (SD), could be taught.behavioral intervention programs rely heavily Due to the young age of the participantson vocal stimuli in teaching communicative and the fact that spontaneous communication
  6. 6. 570 EMILY A. JONES et al.instruction had just begun, we purposefully did importance of including social communicativenot begin by teaching discriminative respond- behaviors as targets within intensive behavioraling. Thus, another area of inquiry would be treatment programs for very young childreninstruction in conditional use of communica- with autism.tion skills (Reichle & Sigafoos, 1991). Teachingwhen and when not (i.e., negative teaching REFERENCESexamples) to produce a response would establish Bayley, N. (1993). Bayley scales of infant development (2ndmore sophisticated social communication skills. ed.). San Antonio, TX: Psychological Corporation. The multipcomponent intervention imple- Carr, E., & Kologinsky, E. (1983). Acquisition of signmented in this study involved repeated oppor- language by autistic children: II. Spontaneity and generalization of effects. Journal of Applied Behaviortunities presented in close proximity to high Analysis, 16, 297–314.rates of reinforcement (including primary re- Charlop, M. H., Schreibman, L., & Thibodeau, M. G.inforcers, praise, and natural contingencies), (1985). Increasing spontaneous verbal responding inspecific prompts, and error correction. Because autistic children using a time delay procedure. Journal of Applied Behavior Analysis, 18, 155–166.this was a package intervention, the relative Charlop, M. H., & Trasowech, J. E. (1991). Increasingimportance of each of these components in autistic children’s daily spontaneous speech. Journal ofterms of acquisition cannot be determined. Applied Behavior Analysis, 24, 747–761. Charlop, M. H., & Walsh, M. E. (1986). IncreasingFirst, the primary reinforcers were faded during autistic children’s spontaneous verbalizations ofthe course of intervention when participants affection: An assessment of time delay and peershowed at least 80% correct performance modeling procedures. Journal of Applied Behavior Analysis, 19, 307–314.during one session; however, the number of Matson, J. L., Sevin, J. A., Box, M. L., & Francis, K. L.sessions was limited. Thus, examination of (1993). An evaluation of two methods for increasinglong-term maintenance of these responses self-initiated verbalizations in autistic children. Jour-would clarify the role of primary reinforcers in nal of Applied Behavior Analysis, 26, 389–398. Matson, J. L., Sevin, J. A., Fridley, D., & Love, S. R.this intervention. Second, previous research has (1990). Increasing spontaneous language in threeoften used a prompt delay (in which a prompt is autistic children. Journal of Applied Behavior Analysis,delivered if an independent response does not 23, 227–233. Prutting, C. A., & Kirchner, D. M. (1987). A clinicaloccur within a specified period of time). In this appraisal of the pragmatic aspects of language. Journalstudy, the prompt was initially delivered of Speech and Hearing Disorders, 52, 105–119.immediately following the SD, and then, once Reichle, J., & Sigafoos, J. (1991). Establishing spontaneitya level of independent performance was and generalization. In J. Reichle, J. York, & J. Sigafoos (Eds.), Implementing augmentative andachieved, the prompt was delivered again only alternative communication: Strategies for learners withafter two occasions of incorrect responses, with severe disabilities (pp. 157–171). Baltimore: Brookes.both incorrect responses followed by the de- Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Vineland adaptive behavior scales (2nd ed.). Circlelivery of verbal feedback (i.e., the teacher gently Pines, MN: American Guidance Service.said ‘‘no’’ or ‘‘uh uh’’). There is little research Wetherby, A. M., Warren, S. F., & Reichle, J. (Eds.).examining the effectiveness of verbal feedback. (1998). Transitions in prelinguistic communication. Baltimore: Brookes.Thus, its contribution to the acquisition of the Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (1992).target response cannot be determined, and thus, Preschool language scale (3rd ed.). San Antonio, TX:we cannot determine whether avoidance of the Psychological Corporation.‘‘no’’ or positive reinforcement resulted in Received June 29, 2006acquisition of the target responses. In conclu- Final acceptance November 21, 2006sion, the present results appear to support the Action Editor, Mark Dixon