The effects of parent implemented pecs training on improvisation of mands-chaabane
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2009, 42, 671–677 NUMBER 3 (FALL 2009) THE EFFECTS OF PARENT-IMPLEMENTED PECS TRAINING ON IMPROVISATION OF MANDS BY CHILDREN WITH AUTISM DELIA B. BEN CHAABANE MARSHALL UNIVERSITY SHEILA R. ALBER-MORGAN THE OHIO STATE UNIVERSITY AND RUTH M. DEBAR SAM HOUSTON STATE UNIVERSITY The present study examined the extent to which mothers were able to train their children, 2 boys with autism, to exchange novel pictures to request items using the picture exchange communication system (PECS). Generalization probes assessing each child’s ability to mand for untrained items were conducted throughout conditions. Using a multiple baseline design, results demonstrated that both children improvised by using alternative symbols when the corresponding symbol was unavailable across all symbol categories (colors, shapes, and functions) and that parents can teach their children to use novel pictorial response forms. DESCRIPTORS: autism, improvisation, parent training, picture exchange communication system ________________________________________ Augmentative and alternative communication color, shape, or function). When individuals learnsystems such as the picture exchange communi- to improvise their requests by using descriptivecation system (PECS) provide an effective means features of preferred items, they can potentiallyof enabling children with autism or severely mand for a much greater number of preferredlimited communication skills to exercise control items with fewer picture cards. Marckel, Neef, andover their environment by requesting preferred Ferreri (2006) investigated the effects of PECSitems (Bondy & Frost, 1994). PECS involves improvisation training by teaching 2 children withteaching individuals to use picture cards to request autism to mand for items or activities usingitems or activities. To make picture communica- picture cards that showed the color, shape, ortion systems more efficient, individuals can be function of the desired item. Results demonstrat-taught to use improvisation. That is, when a ed that both children were able to consistentlyspecific PECS card representing a preferred item is request items using descriptor cards and tounavailable, the individual can mand for an item generalize the use of the descriptor cards towith a picture card that describes the item (e.g., by untrained preferred items. The present study is a systematic replication of Marckel et al. in which We thank the parents and children who participated in the same training procedures were implementedthis research. We also thank the West Virginia Autism by parents rather than experimenters.Training Center for their support during the study. Delia Ben Chaabane is now with the Mercer CountySchools and Concord University. Address all correspondence to Sheila R. Alber-Morgan, METHODThe Ohio State University, 356 PAES Building, 310 W Participants and Setting17th Ave., Columbus, Ohio 43210 (e-mail: Morgan.email@example.com). Two children with autism spectrum disorders doi: 10.1901/jaba.2009.42-671 and their mothers participated in this study. 671
672 DELIA B. BEN CHAABANE et al.Myles (6 years old) received self-contained asked him to match the different colors. Thisspecial education services and attended a regular assessment procedure was also used for shapesfirst-grade classroom for about 25% of the and functions. Both Myles and Cliff were ableschool day. He had used PECS consistently for to match colors, shapes, and functions without1 year prior to the study. Cliff (5 years old) prompting to 100% accuracy.attended preschool 2 days per week where he Preference assessment. A list of potentiallyreceived special education services. Cliff started preferred items was generated for each stimulususing PECS 4 months before the study began. category by interviewing the parents. TheseBoth children had been trained to indepen- items were then further assessed with adently mand for preferred items using PECS multiple-stimulus (without replacement) proce-and met the following criteria for inclusion in dure (DeLeon & Iwata, 1996). High- andthis study: (a) an individual education plan medium-preference items were used for subse-recommendation for an augmentative or alter- quent training and generalization probes. Itemsnative communication system; (b) a prerequisite the child chose during the assessment, but didrepertoire of matching colors, shapes, and not eat, drink, or play with, were identified asfunctions; and (c) parents’ regular use of the neutral items.PECS system with their children. Both mothers(30 and 45 years old) were Caucasian middle- Measurementclass high-school graduates. Dependent variables. Observers scored child All sessions were conducted in a quiet area in responses in each trial as a correct improvisa-the participants’ homes. Approximately 85% of tion, an error, or a nonresponse. A correctthe sessions were videotaped; data were record- improvisation was scored each time a childed live during the remaining sessions. manded (pointed to or handed) with one or more correct descriptor cards (e.g., brown,Materials square, or eat) for a preferred item (e.g., graham Preferred foods, drinks, and toys served as the cracker). An error was scored if the childstimuli for the communication exchanges manded with a card that did not correspondduring training and generalization probes. to the preferred item (e.g., picture of a squarePreferred items for each child were identified for a round cookie) or for the neutral item (e.g.,through a parent questionnaire and direct silver card for paper clip). An error was alsoobservation. Laminated pictures of the preferred scored if the he attempted to mand inappro-items (e.g., graham cracker) and descriptor priately (e.g., moving the adult’s hand to thecards of their characteristics (e.g., brown, item, grunting and pointing to the item). Asquare, eat) served as the communication nonresponse was scored when the child did notstimuli. Distracter pictures consisted of charac- attempt to mand for an item (i.e., did not pointteristics that did not match the preferred item to or hand any of the picture cards to his(e.g., blue, round, drink). These stimuli were mother, did not attend to any of the items,the same form as PECS icons (i.e., Boardmaker walked away, or exhibited disruptive behavior).drawings, line drawings, clip art). Procedural integrity of parent implementation. For each condition (baseline, follow-up, andPreexperimental Assessments generalization), the experimenter developed a Skill assessment. The experimenter (the first procedural checklist to assess the extent toauthor) used direct observation to assess which mothers accurately implemented theproficiency with color, shape, and function procedures. Observers viewed videotaped ses-matching. She showed each child various sions and used the procedural checklists toobjects that were red, blue, and yellow and assess procedural integrity of implementation.
IMPROVISATION OF MANDS 673For each step in each trial, observers scored preferred item and three were not) in front ofcorrect or incorrect implementation of the the child. If he manded using one or moreprocedure. Each trial’s procedural integrity descriptor cards, she provided brief access to thescore was calculated by dividing the number preferred item. If he made no attempt to mandof correctly implemented steps by the total for the item within 10 s, she moved thenumber of steps for the trial. The trial scores preferred item closer to the pictures. If hewere averaged to produce a session score, and emitted no response, the trial ended andthen session scores were averaged to summarize another trial began. The trial also ended if heprocedural integrity of implementation. attempted to mand with a distracter picture (e.g., circle for juice pack) or reached for theExperimental Design object. A multiple baseline design across symbol Improvisation training. The mother placed acategories (colors, shapes, and functions) was preferred item (e.g., graham cracker) and aused to examine the effects of parent-imple- neutral item (e.g., paper clip) in front of themented training on improvisation of mands, child, along with the corresponding descriptorgeneralization to untrained items, and parent cards (e.g., brown, silver). If he reached for theperformance. The parent conducted training preferred item (e.g., graham cracker) instead ofand follow-up trials on colors until the child manding for the item by pointing to or handingachieved mastery during the follow-up probes. a descriptor card, she guided his hand to theThe follow-up trials on colors were then corresponding descriptor card (e.g., brown) andfollowed by training and follow-up probes on provided brief access to the preferred item (e.g.,shapes and then functions. gave the child a piece of the graham cracker). IfProcedure he manded for the preferred item using the correct card, she provided brief access to the Parent training. The experimenter taught the item and immediate verbal feedback (e.g.,mothers how to implement baseline and ‘‘Good, you asked for the graham cracker usingtraining procedures using written instructions, the color brown.’’).explanation, modeling, practice, and feedback. If the child pointed to or handed theData collection began after the mother was ableto perform the procedures to 90% accuracy on descriptor card of the neutral item, the motherthree consecutive trials. If implementation fell handed the item to the child. If he did not playbelow 80% accuracy during the experiment, she with the item (or eat or drink the item if it waswere retrained. food or beverage), the item was still considered Baseline. The mother placed one of the neutral. The mother then guided the child’spreferred items (e.g., juice pack) in front of hand to the correct picture card (of thethe child and the corresponding picture directly preferred item) while stating the color, shape,below the item. She provided descriptive or function (e.g., ‘‘This is brown.’’). She thenfeedback and praise (e.g., ‘‘Good, you asked reset the materials and started the trial again. Iffor the juice pack.’’) and brief access to the item the child made two consecutive errors, she(a small bite or sip of food or drink, 30-s access physically guided his hand to exchange theto toys) if the boy pointed to or handed the correct descriptor card on the third trial. Thepicture to her (i.e., manded). duration of each session ranged from 10 to An improvisation probe trial was conducted 30 min. The mother conducted one to threeimmediately after. The mother moved the sessions each day, with a minimum of 15 minpictures out of sight and placed six descriptor between sessions. The duration and number ofsymbols (three were characteristics of the sessions were based on whether or not the child
674 DELIA B. BEN CHAABANE et al.continued to be attentive and cooperative. If he Parents and significant others were also asked towalked away or began displaying noncompli- record any improvisations of mands for un-ance or disruptive behavior, the training session trained items or in untrained settings.ended. Following each training session, themother conducted a follow-up probe to assess Interobserver Agreement for Children’s Responsesthe effectiveness of improvisation training. A second observer independently scored at Follow-up probes. The mother placed the least 25% of sessions for each child. Andescriptor and distracter cards from all catego- agreement was scored if both observers recordedries in front of the child, along with a preferred the same response (e.g., correct improvisation,item. During the probes that followed training error, or nonresponse) emitted by the child for asessions for each category (color, shapes, given trial. Agreement was calculated byfunctions), if the child manded using the dividing the number of agreements by agree-symbol for the category that had been trained ments plus disagreements and converting this(e.g., color symbol for color) or a combination ratio to a percentage. Mean agreement was 87%of previously trained symbols once the mother and 93% for Myles and Cliff, respectively.had trained more than one symbol (e.g., color Interobserver Agreement ofand shape for shape, color, shape, and function Mothers’ Implementationfor function), the mother provided him with To obtain interobserver agreement data onbrief access to the item. If he manded using an the extent to which mothers implemented eachincorrect symbol or emitted no response, she experimental procedure correctly, two observersdid not provide access to the item and ended assessed at least 25% of the sessions. Theythe trial. If he used the same symbol to mand independently viewed the videotapes and usedfor the preferred item more than three times procedural integrity checklists to determinefollowing training for shape and function (i.e., whether the mothers correctly followed thehe used the shape symbol to mand for the shape procedures in each condition and across symbolmore than three times), she removed the card to categories. The checklists were then examinedpromote the use of other potential descriptors. to determine the number of agreements andWhen the child achieved 85% accuracy for disagreements. Interobserver agreement wasthree consecutive follow-up probe sessions in calculated by dividing the number of agree-one mand category (e.g., colors), improvisation ments by agreements plus disagreements andtraining began in the next category (e.g., converting this ratio into a percentage. Meanshapes). The mother used the same preferred agreement was 91% (range, 80% to 100%) forstimuli (five to seven and 10 to 15 items for Myles’ mother and 95% (range, 87% to 100%)Myles and Cliff, respectively). for Cliff’s mother. Generalization probes. The experimenter con-ducted generalization probes in each symbol RESULTS AND DISCUSSIONcategory throughout the baseline and improvi-sation conditions. The generalization probes Figures 1 and 2 show the results of thewere identical to the follow-up probes with one follow-up probes for Cliff and Myles. Duringexception: The stimuli for the generalization baseline, with the exception of Cliff’s fifthprobes consisted of untrained preferred items session for shapes, both children emitted noand their corresponding descriptor and distrac- correct improvisations. Across all baselineter cards. sessions, mean percentages of errors and non- Social validity. Social validity was assessed responses were 36% and 63%, respectively, forusing an experimenter-designed questionnaire. Cliff and 23% and 67%, respectively, for
IMPROVISATION OF MANDS 675 Figure 1. Percentage of Cliff’s correct improvisations (circles) and errors (triangles) during baseline andimprovisation training conditions across colors (top), shapes (middle), and functions (bottom). Responses togeneralization stimuli are depicted by the open data points.Myles. When mothers implemented the train- 100% accuracy on 12 of the 16 sessions foring condition, there was an immediate and Cliff’s mother). The results of the social validitysubstantial increase in correct improvisations questionnaire indicated that the mothers foundduring follow-up probes across categories for the procedures easy to implement, were happyboth children (Cliff, M 5 83%; Myles, M 5 with the results, and would continue to use84%). Neither boy emitted improvised mands improvisation training. They also reported theto novel stimuli during baseline, but with the use of correct improvisations outside theexception of Session 6 for Myles, both boys experimental sessions.showed generalization to untrained stimuli The results of the present study show a clearduring training (range, 80% to 100%). functional relation between parent-implement- High percentages of treatment integrity likely ed training and improvisation of mands bycontributed to the intervention’s effectiveness children with autism. This supports the findings(M 5 97% [range, 88% to 100%] with 100% of Marckel et al. (2006), who demonstrated thataccuracy on nine of the 15 sessions for Myles’ children with autism can learn to improvisemother and 98% [range, 85% to 100%] with across symbol categories to mand for untrained
676 DELIA B. BEN CHAABANE et al. Figure 2. Percentage of Myles’ correct improvisations (circles) and errors (triangles) during baseline andimprovisation training conditions across colors (top), shapes (middle), and functions (bottom). Responses togeneralization stimuli are depicted by the open data points.preferred items. The present study also demon- Another limitation of the study was that, duestrates that parents can effectively implement to technical difficulties or evidence of overtimprovisation training. reactivity by the child, only about 85% of the To assess generalization prior to improvisa- sessions were videotaped. On the remainingtion training, the experimenter conducted sessions, live data were recorded. Because we wereprobe trials of untrained items during baseline. unable to record 15% of the sessions, we couldA limitation of this procedure was that, if the not assess any of those sessions for interobserverchild used the correct descriptor card, he would agreement measures of children’s responses orhave been provided access to the preferred item. mothers’ implementation. Another limitation wasThis would have constituted a differential that there was not enough time to implement areinforcement procedure. For this reason, the maintenance phase. Future research would begeneralization probes used during baseline may enhanced by including data on maintenance ofactually be considered a training procedure. improvisation after the conclusion of training.However, it should be noted that neither child This would provide important support for theemitted any correct improvisations during the long-term outcomes of parent-implemented in-baseline generalization probes. terventions. Future research may also examine the
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