1 4 Discrete Trial Training (DTT) effect on children with ASD Introduction Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual. According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017). The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder i ...

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4
Discrete Trial Training (DTT) effect on children with ASD
Introduction
Autism Spectrum Disorder (ASD) is a condition that affects the
development of an individual affecting their behaviour and the
ability to communicate (Autism Spectrum Disorder, 2021). In
most cases, this disorder exhibits its symptoms within the initial
two years of an individual, despite its diagnosis being plausible
for individuals of all ages. Persons diagnosed with this disorder
often have repetitive behaviours and restricted interests, find it
difficult to partake in social interactions and communicatio n
with others, and show other symptoms that may impede the
individual's ability to perform well in school, work and several
other aspects of life ("Autism Spectrum Disorder, 2021). The
individuals diagnosed with the disorder will, in some cases, be
reliant on their families and individuals close to them for help
and support. Despite the disorder's potency as a life-long
condition, some services and treatments are provided, helping
an individual diagnosed with the condition improve the quality
of their life. It is also important to note that the disorder has

2. several different variations; hence, the spectrum of different
characteristics, unique to every diagnosed individual.
According to studies conducted, one in fifty-four children is
diagnosed with the disorder in the United States, occurring in
children of all racial backgrounds and socioeconomic groups
("Data and Statistics on Autism Spectrum Disorder | CDC,"
2021). According to the same report, the disease is four times
more likely to occur in boys than in girls. Between 2009 to
2017, the number of children aged between 3-17 years
diagnosed with development disorders, inclusive of ASD,
increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use
of discrete trial training (DTT), children are taught a pl ethora of
skills, which include academic, language, and social skills,
necessary to facilitate their development. In the treatment of
ASD, options are limited. However, early diagnosis, coupled
with behaviour interventions, is considered to have the best
outcomes in managing the disorder's symptoms (Masi et al.,
2017).
The prevalence of ASD in children has been noted to rise
significantly in the population (Masi et al., 2017; "Data and
Statistics on Autism Spectrum Disorder | CDC," 2021),
affecting a larger portion of the population. This number of
affected individuals is projected to rise even higher in the
coming years, a problem in society that needs to be addressed.
In the treatment of the disorder, drug interventions, while
widely used, have failed to prove their efficiency in improving
or managing symptoms in most cases (Masi et al., 2017). The
treatment options for the disorder are also very limited. The use
of drug interventions, early diagnosis, and early behavioural
interventions is very expensive and inaccessible to many
individuals affected by the condition. Identifying the disorder is
also proven to be difficult, given the complex nature and
multiple variations that convert the diagnosis process into an
arduous task. Thus, treatment of the wide array of symptoms
that originate from the variety of ASD strains in the known
spectrum proves to be difficult. Thus, there is a need for more

3. research to broaden the scope of diagnosis and treatments with
new methods to further enhance the information available on the
condition while providing more knowledge that may contribute
to the development of more accessible, less costly, and more
efficient treatments for the disorder. Given the nature of the
condition, it is hard for the researcher to find a pool of many
affected individuals to perform trials and develop better
treatment methods or determine the effectiveness of some of the
existing methods. The use of discrete trial training (DTT) has
also been under-explored, having been limited to clinical or
university study settings (Ünlü et al., 2018). This outcome is
because of the costly nature that impedes the conducting of
research on such a scale. Thus, there is a need to explore the
effectiveness of this intervention, especially in the growing
children population, as it will serve to provide a larger pool of
knowledge, increasing understanding of the condition, and
eventually contributing to treatment data and developments to
suit better the individuals affected, improving their quality of
life.
Literature review
In a study conducted by Unlu et al., (2018), a group, family
training program developed to upskill the parents to current
discrete trial training (DTT) behaviours were assessed to
establish its effectiveness. In this study, 42 participants were
involved, 14 children and their parents. Half of the study
sample for the parents represented members of each gender; 14
females and 14 males. In the study, measures for the DTT
behaviours exhibited by the families were made. The family
training program used was made up of two 120-minute weekly
sessions for four weeks in total. In training, aids such as
videos, lectures, video assessments, video feedback, written and
visual materials, and role activities were used to teach parents
discrete trial training behaviour. The training to several stages,
starting from basic information and later graduating to examples
of discrete trial training. A post-training interactive discrete
trial training disk was issued to the families to enhance skill

4. maintenance. The assessment was done using the Discrete Trial
Training Forms to evaluate the parents' behaviour. The
receptive language levels of the participating children were also
measured. The imitation skill levels of the participating
children were also quantified using the Imitation Skills
Assessment Tool (ISAT). Evaluations were done before and
after study completion. According to the results obtained, a
difference was obtained when discrete trail training was given
to the intervention group and control group, with an increase
noted. Thus, it is evident that the training was effective in
attaining the outcomes intended by the researcher. The study
also established that the discrete trail training yielded effective
outcomes outside the control group setting, which yielded no
changes following the training. However, the learning and
imitation skills in the children showed no dramatic changes but
slightly improved their skills. This result was attributed to the
slow speed of the process, which reflects in the results. The
parents' performance was also not to differ when analyzed along
gender lines. Parents also registered high satisfaction levels
with the study and suggested recommending the program to
other parents.
Similarly, another study tested two different discrete trial
training programs, virtual classroom and individualized
coaching, to assess the fidelity of execution by teachers when
dealing with children diagnosed with ASD. In the study
conducted by Garland et al., (2012), the multiple baseline
approach was used in the testing for the existence of a
functional relationship between individualized clinical coaching
and TeachLiveE™ (TLE) virtual classroom laboratory and the
fidelity of implementation discrete trial training showcased by
teachers when working with a student diagnosed with ASD. It
featured four Caucasian female students as participants who had
tangible experience in the classroom setting. These individuals
were then employed in the classroom environment, prior
experience in the setting having been established to be absent.
The sessions were thus conducted using the virtual classroom

5. facilitated by cameras and microphones to bolster interaction.
The teacher was shown to manipulate an avatar with a set of
movements made to facilitate ten sessions with a student
participant diagnosed with ASD symptoms. Thus, coaching was
carried out using feedback and demonstrations. In the study, the
participants' performance was the dependent variable measured
by the discrete trial teaching evaluation rubric (DTTER). Tapes
were reviewed, including those of non-participants in the study,
to establish a baseline. Results demonstrated that the teacher
demonstrated the existence of a functional relationship between
individualized clinical coaching using the virtual classroom and
fidelity of implementation of discrete trial training. During the
sessions, participant discrete trial training accuracy was
observed to improve by a 50% margin, from 37% to 87%.
The research by Siller et al., (2013) where underlying causal
mechanisms were investigated to establish whether responsive
parental behaviour was a good predictor of language gains in
children with ASD. A randomized clinical trial using an
experimental intervention was conducted to help enhance
parental communication. Seventy children participated in the
research, 64 boys and six girls, attending sessions with their
mothers in tow. These participants were then divided into an
intervention group and a control group with descriptive data and
activities delivered separately. Data were collected over a three-
year period, between 2004-2007. Assessment sessions were
conducted in the lab and the family's home. After participating
in the caching program, parents were assessed with invitations
to follow-up being issued after one year. According to the
results obtained, FPI had a significant effect on the parents'
responsive behaviour. The study also revealed a conditional
effect on the children's language outcome in a follow-up that
was done after twelve months. This method was noted to be
highly beneficial to children who exhibited low baseline
language skills. Those below the twelve months mark were more
likely to benefit than those above this mark.
In another study, research was conducted to determine if

6. differences existed in the effects of traditional discrete trial
training (T-DTT) and embedded discrete trial training (E-DTT)
in response to the relevant targets of the instruction and
problem behaviour for a child diagnosed with autism (Haq and
Aranki., 2019). A single seven-year-old male was to receive
three-hour sessions at home for four days every week. The boy
was a level one learner, according to evaluations made using the
Verbal Behavior Milestones Assessment and Placement Program
(VB-MAPP) made before the start of the study. The participant
was also noted to have a history of problem behaviour such as
aggression and elopement. The rate of problem behaviour was
recorded as a frequency, and inter-trial observer agreement
calculated from trial-by-trial methods were used to assess inter-
trial observer agreement. T-DTT sessions were noted only to
occur if the participant was seated at the table for thirty
seconds. On the other hand, E-DTT was more flexible,
occurring anywhere the participant was in the home. According
to the results, E-DTT resulted in no problem behaviour and 75%
correct responses compared to the use of T-DTT sessions, which
featured a 90% correct response. Target accuracy for both
studies was similar. However, higher levels of exposure and less
problem behaviour were observed in the use of E-DTT.
In another study conducted by McKinney and Vasquez (2014),
the “Bug in your Ear” (BIE) program was used to determine the
accuracy of discrete trial teaching (DTT) implementation. The
study involved three pre-service teachers, one majoring in
exceptional education and two teachers majoring in elementary
education. A Discrete Trial Teaching Evaluation Form (DTTEF)
was used to measure the accuracy of the DTT implementation.
The study was done in a room with a two-way mirror in an
American university. The interactions were recorded on video
and an over-the-table camera to record BIE feedback issued to
the participants by the researcher. The dependent variable was
identified as the accuracy of implementation measured by the
DTTEF mentioned above. Participants were chronologically
moved across several pre-arranged sessions, each session having

7. its own set of rules. A significant increase between the
participant's baselines, suggesting the existence of a functional
relationship between accurate DTT implementation and BIE
feedback.
In many of the articles reviewed (Garland et al.,2012; Unlu et
al., 2018), the studies were used to determine the effects and the
effectiveness of using DTT programs in promoting positive
outcomes in children suffering from ASD. These articles add to
the pool of knowledge, delving even further to identify the
suitable adjustments made to improve the performance of
communication skills in various age-groups. The articles also
managed to exercise some groundbreaking innovations. The
research also tested new methods and their effectiveness outside
the lab setting, where most of the data is focused (Siller et al.,
2013). These different setups contributed to creating a more
practical and tech-savvy approach to the accurate and effective
provision of DTT services using new methods that may become
less costly and more accessible to the growing population of
affected children.
In this paper, emphasis will be on establishing the potency of
DTT on the acquisition of communication skills. The study
design will assess the two factors to examine the existence of a
functional relationship between the use of DTT programs and
the gaining in language skills exhibited by children diagnosed
with ASD. In this study, a high-level of cultural considerations
will be done given the absence of some marginalized groups in
the studies reviewed. This will provide a better reflection of the
disorder in society.
Methods
Participants
Here is where you would discuss your participants
subsection.
Setting/Materials
Here is where you would discuss your setting and materials
subsection.

8. Experimental Design
Dependent Variable and Response Measurement
Interobserver Agreement
Procedures
Informed consent. You would start your informed consent
information here, immediately after the subsection’s period.
Baseline. You would start your baseline information here,
immediately after the subsection’s period.
(Name of your Intervention). You would start your intervention
information here, immediate after the subsection’s period.
Treatment Integrity
Here is where you would discuss your treatment integrity
subsection.
Social Validity
References
Autism Spectrum Disorder (ASD) | CDC. (2021). Retrieved 13
February 2021, from
https://www.cdc.gov/ncbddd/autism/index.h tml
Garland, K., Pearl, C., & Vasquez, e. (2012). Efficacy of
Individualized Clinical Coaching in a Virtual Reality Classroom
for Increasing Teacher's Fidelity of Implementation of DTT.
Education and Training In Autism And Development
Disabilities, 47(4), 502-515.
Haq, S., & Aranki, J. (2019). Comparison of Traditional and
Embedded DTT on Problem Behavior and Responding to
Instructional Targets. Behavior Analysis In Practice, 12(2),
396-400. doi: 10.1007/s40617-018-00324-3
Masi, A., DeMayo, M., Glozier, N., & Guastella, A. (2017). An
Overview of Autism Spectrum Disorder, Heterogeneity, and

9. Treatment Options. Neuroscience Bulletin, 33(2), 183-193. doi:
10.1007/s12264-017-0100-y
NIMH » Autism Spectrum Disorder. (2021). Retrieved 13
February 2021, from
https://www.nimh.nih.gov/health/topics/autism-spectrum-
disorders-asd/index.shtml
Siller, M. Swanson, M., Gerber, A., Hutman, T., & Sigman, M.
(2014). A Parent-Mediated Intervention That Targets
Responsive Parental Behaviors Increases Attachment Behaviors
in Children with ASD: Results from a Randomized Clinical
Trial. Journal Of Autism And Developmental Disorders, 44(7),
1720-1732. doi: 10.1007/s10803-014-2049-2
Ünlü, E., Vuran, S., & Diken, İ. (2018). Effectiveness of
Discrete Trial Training Program for Parents of Children with
Autism Spectrum Disorder. International Journal Of Progressive
Education, 14(3), 12-31. doi: 10.29329/ijpe.2018.146.2