Applying Pivotal Response Training to School Assigned Homework for Children with Autism to Improve Motivation and Performance
Robert L. Koegel, Ph.D., Quy H. Tran, Amanda Mossman, Lynn Kern Koegel
The present study examined the effects of specifically applying Pivotal Response Training techniques to improve parent and child motivation to complete homework assignments and facilitate homework performance among children with autism. A multiple baseline design was used to assess the effects of applying PRT through a parent-training model with three school-aged children with autism. Results indicate that using the motivational techniques from PRT improve child's performance and attitude toward homework by decreasing disruptive behaviors and increasing child's affect and positive statements surrounding homework. These findings support the training of parents in PRT and its specific application toward homework to improve the nature of interaction between parent and child and the performance of children with autism on school assigned work.
Assessing the Processes and Long-Term Impacts of Comprehensive Positive Behavior Support for Severe Problem Behaviors
Robert L. Koegel, Lynn Kern Koegel, Erin K. McNerney, Mendy Boettcher, Daniel Openden
Research in the field of behavior support has made advances in the past decade, particularly in the areas of functional assessment, however problem behaviors such as aggression, self-injury, and disruption often continue to impair the lives of children with autism and their families in home, school, and community environments. The Autism Research Center at the University of California is conducting a study investigating the long-term outcomes of implementation of a comprehensive multi-site behavioral intervention. Data from this project will be used to develop systems-delivery models to advance the field of behavior support.
Coordination of the services provided to the participating families, who have a child with severe problem behaviors, is a key component to the positive behavior support model. Assessments are administered systematically to monitor changes and progress, and serve as a source for reevaluation and treatment planning over time.
Data collection is ongoing, and two themes have emerged thus far: 1) Provision of comprehensive positive behavior support can dramatically reduce the child''s problem behaviors, resulting in decreases in parent stress, and improvements in child and family quality of life, 2) Ongoing assessment and coordination are important factors to a successful positive behavior support team. Our findings suggest that this type of intervention model is feasible, and has broad impacts on the lives of children and families.
Autism Spectrum Disorders Instructional Modules
Robert L. Koegel, Jane Lacy, Karen M. Sze, Quy Tran, Lynn Kern Koegel
The current project seeks to develop one instructional module of an undergraduate course on Autism Spectrum Disorders (ASD). This course is particularly timely and greatly needed as California is reporting geometrically increasing numbers of children currently being diagnosed with ASD. ASD was once considered a rare severe developmental disability occurring in 1 in every 2,500 children. Currently, it is estimated that 1 in every 500 children is being diagnosed with ASD (Center for Disease Control, 2001). However, prevalence of pervasive developmental disorders has been reported to be as high as 1 in every 166 children (Chakrabarti, S. & Fombonne, E., Journal of American Medical Association 2001). Thus, immediate attention to this epidemic increase is critical. The primary goal is to ultimately develop a formalized course that would provide undergraduate students with knowledge of ASD and theoretical training in effective techniques applicable to the disorder. Currently, we plan to develop one training module to be presented to thousands of trainees, and tested with approximately twenty selected participant undergraduate students, and will serve as the basis for the development of additional modules. The instructional module will also serve a practical benefit in numerous courses and other educational opportunities at UCSB. Instructional tools include development of lecture materials and videotaped clinical case examples. The instructional module will be evaluated in a variety of contexts, in coordination with the Office of Instructional Consultation. The goal of this project is to provide undergraduate students with conceptual information and skills that will prepare them for graduate studies and professional careers.
Clinical Impressions of Standard versus Individualized Treatment
Lynn Kern Koegel, Robert L. Koegel, & Laurie Vismara
It appears that individualized intervention programs may meet the needs of individuals with autism. In order to explore this issue parents and children with autism participated in parent education programs. Families were randomly assigned to one of two groups, a standard treatment intervention program or an individualized approach to investigate outcome differences for both parent and child behaviors. All families received interventions using procedures that have been well documented in literature (i.e., Pivotal Response Training, Self-Mangament). Programs were individualized based on family and child needs such as level of disability, family stress factors, and problematic behavior across multiple environments. Currently pilot data is being conducted to determine group differences.
A Cross-Cultural Study of Parents of Children with Autism
Karen M. Sze, Marjorie H. Charlop-Christy
Autism is a severe developmental disability that is prevalent in all cultures worldwide. In spite of this, few studies exist studying autism in other countries outside the United States and the United Kingdom, and no studies to date have addressed cross-cultural differences in the families of children with autism. In order to gain a better understanding of autism in different cultures, how children are treated, how they are raised, and what attitudes toward autism exist, more studies are needed to examine cross-cultural issues. The present study was designed to assess the cross-cultural differences of families with children with autism who are Chinese American and compare them with Chinese families from Hong Kong. American, non-Chinese families were included in the present study as a control group. The specific focus of this study was on attitudes toward parenting and differences in approaches to handling behavior problems typical of children with autism.
Decreasing Depression in Parents of Children with Autism
Lauren I. Brookman, Robert L. Koegel, Lynn Kern Koegel
Although the positive effects of parent education on child behavior and functioning have been highly documented, less research exists on the impact of parent education on parents. This study examines the changes in depression levels of parents of children with autism prior to and following participation in a parent education program. In this program, mothers received 60 hours of parent education in procedures to increase functional communication in their children. Results show that scores on the Beck Depression Inventory (BDI) decreased in a majority of the mothers who participated in the parent education. Interestingly, a majority of fathers'' depression scores also decreased. Other variables that seem related to changes in depression are also discussed. Specifically, this study examines depression scores in relation to family support and parental reports of child-related stress. The results of this study indicate that there may be collateral effects of parent education programs. However, these are limited by the amount of parent perceived external support and stress.
Developmental Trajectories and Longitudinal Intervention Outcomes for Young Nonverbal Children with Autism
Robert L. Koegel, Yvonne Bruinsma, & Lynn Kern Koegel
Researchers and practitioners alike agree that early intensive intervention is crucial to the development and prognosis of young nonverbal children diagnosed with autism. However, relatively few studies have been published that document developmental trajectories and longitudinal intervention outcomes for this group. The current two-part study investigated outcomes for eight young nonverbal children with autism (average age prior to intervention: 27.9 months). The intervention consisted of intensive in home parent education in Pivotal Response Training. The first part of the study assessed changes in number of words and word diversity prior to intervention and at the latest intervention point for eight children. Results indicated that all children demonstrated substantial gains in both the number of words and word diversity. The second part of the study assessed the developmental trajectories prior to and during intervention for five children in greater detail. Baseline assessments ranged from12 to 20 months for individual children. Dependent measures included number of words, word diversity, age equivalence scores on the Communication Domain of the Vineland Adaptive Behavior Scales (VABS), and speech type. Data suggested considerable improvements for all children, with three children accelerating their development trajectories towards the normal range on the Communication Domain of the VABS. Results are discussed in terms of prognosis, hope, and quality of life for very young children with autism and their families.
Effect of Sensory Feedback on Immediate Object Imitation in Children with Autism
Brooke Ingersoll, Laura Screibman, & Quy Tran
This study examined the effect of sensory feedback (e.g., flashing lights and sound) on the imitation performance of children with autism and typical children group-matched for mental age. Participants were administered an immediate object-imitiation task with six novel toys constructed for this study: three with a sensory effect that could be activated by imitating the modeled action and three without a sensory effect. Although overall imitation performance of the participants significantly between groups, the imitation performance of the participants with autism was significantly higher with sensory toys than with nonsensory toys. Typical participants' imitation performance did not differ between the two sets of toys. Both groups played significatnly more with the sensory toys during free play, indicating that sensory toys were more reinforcing for both groups. Additional results demonstrated that typical children used significantly more social behaviors during imitation than children with autism, but they did not differ in object-oriented behaviors, replicating previous findings. It is argued that children with autism may be less motivated to imitate by social interaction, but may be motivated to imitate to receive a nonsocial reward (sensory feedback).
Identifying Early Intervention Targets for Children With Autism In Inclusive School Settings
Lynn Kern Koegel, Robert L. Koegel, Beth Weiland, William D. Frea, Rosy M. Fredeen
The purpose of this study was to assess play and social behavior of young children with autism in inclusive school settings, with the goal of identifying important targets for intervention. Data were collected for five children with autism in six different community school settings, and for typically developing peers in the same settings. All of the children with autism had received or were receiving intervention for autism in one-on-one settings, but did not have IEP goals that provided systematic intervention for developing play and social skills in their school settings. The results demonstrated that under these conditions, the children with autism and their typically developing peers played with a comparable number of stimulus items (e.g.,toys, craft projects, etc.) in school. However, the children with autism engaged in these activities for shorter durations than their typically developing peers. Socially, both the children with autism and their typically developing peers engaged in similar levels of social interactions toward adults. However, in terms of peer-to-peer social interactions, the children with autism rarely or never engaged in social interactions with their peers, whereas their typically developing peers frequently engaged in social interactions with other children. Regardless of setting (public or private, preschool or upper elementary school) or child developmental level, similar patterns of behavior were observed. We discussed these findings in reference to the need for specific types of early intervention for play and social skill development in inclusive school settings.
A Model for Increasing In-home Services to Children with Autism
Lynn Kern Koegel, Robert L. Koegel, Daniel Openden, Erin McNerney, Jennifer B. Symon, & Karen M. Sze
The purpose of this project is to provide a model for increasing the quality and intensity of in-home intervention programs for children with Autism Spectrum Disorders (ASD). Highly qualified paraprofessionals (university students) will be recruited, trained, and supervised, and will receive university course credit for assisting with in-home intervention and support for children with ASD (instead of using untrained individuals who often serve in this role). These students will be supervised and trained in intervention procedures relevant to the individual child with whom they work, and will provide additional assistance with current intervention programs.
Parent Education for Autism: Issues in Providing Services at a Distance
Jennifer Symon
Providing effective support services for families of children with autism living in geographically distant locations is a growing area of concern. There are individual and system level risk factors associated with having autism that could result in poor outcomes. Positive behavioral interventions that address individual and family needs could potentially ameliorate the risk factors. Literature on parent education, effective behavioral interventions, and the importance of viewing the individual within a socioecocultural framework are presented. These components should be considered in designing effective intervention programs for families. This article documents through a review of relevant research the need to provide appropriate services along with the need to develop service delivery models that will increase the spread of effect to reach families who live geographically distant from a specialized autism intervention center.
Parent Education for Families of Children with Autism Living in Geographically Distant Areas
Robert L. Koegel, Jennifer B. Symon, Lynn Kern Koegel
Many families who live geographically distant from a center that specializes in intervention for children of autism have not been able to receive specialized services for their children. This paper describes an evaluation of an intensive, week-long center-based parent education program that teaches parents procedures for improving social communication for children with autism. Five representative families are described. Data were collected on parent implementation of target behaviors using specific teaching procedures including maintaining child attention through selection of child choice activities, contingent reinforcement and reinforcing attempts during naturalistic parent-child interactions. Pre, intervention, and follow-up measures were obtained for both parent and child behaviors. Data suggest improvements in the parents'' use of the procedures, parent affect, and child expressive language during a week-long parent education session. Furthermore, follow-up measures demonstrate that these positive changes generalized to the families'' home communities and maintained over time. These findings suggest feasibility of a short-term intensive parent education program for families who live in areas that are geographically distant from intervention centers.
Parental Empowerment and Parent-Child Interactions
Lauren I. Brookman & Robert L. Koegel
In an effort to decrease the frustration, helplessness and stress that parents may experience when raising a child with special needs, treatment providers have begun to implement interventions aimed at empowering parents through parent education programs. The parent education program implemented in this study empowered parents in two areas: 1) Techniques documented to decrease problem behaviors, increase communication, social and academic skills and 2) Methods to effectively coordinate with service providers. Once parents are empowered with these skills, we expect an increase in parental confidence during parent-child interactions. One measure of the quality of parent-child interactions is the type of verbalizations that parents make to their children. In the current study, positive/ confident and negative/ frustrated parent verbalizations were measured for two children with frequent disruptive behaviors. Results indicate that, before intervention, parents showed more negative/frustrated verbalizations than positive/ confident ones. After intervention, not only were children more responsive, but parents demonstrated significant increases in positive/confident verbalizations and significant decreases in negative/ frustrated ones. Examples of parent verbalizations and child responses are provided. In addition to this increase in parent confidence during parent child-interactions, examples of parent empowerment related to interacting with service providers and improving services for all children with disabilities is also provided.
Pivotal Response Treatment for Multiple Families of Children with
Autism: Efficacy and Effectiveness of a Group Parent Education Workshop
Daniel Openden, Robert L. Koegel, Lynn K. Koegel
According to recent epidemiological reports, autism has been considered an epidemic due to the sudden, rising number of children being diagnosed with autism and autism spectrum disorders. Therefore, mechanisms for systematically disseminating empirically supported treatments (ESTs) to meet the abundance of families of children with autism in need of services need to be developed. The purpose of this randomized controlled study was to examine the effectiveness and efficacy of training a group of parents of children with autism spectrum disorders in the motivational procedures of Pivotal Response Treatment (PRT) within a 4-day group parent education workshop. The existing literature on dissemination of ESTs using randomized controlled trials and group behavior parent training (BPT) provides a strong rationale for employing a group BPT program for quickly disseminating Pivotal Response Treatment (PRT) to the rising number of families with children with autism in need of services. The effects of the workshop were examined using an experimental group-comparison design. Thirty-seven parents of children with autism were matched at pretest on fidelity of implementation of PRT intervention procedures and randomly assigned to either a treatment or waitlist control group. Significant differences between the treatment and waitlist control groups at posttest were found on fidelity of implementation, elevated expressions of positive affect, responsivity to opportunities for language, and functional verbal utterances. The data suggest the efficacy and effectiveness of a group BPT program for parents of children with autism and directions for a programmatic line of research.
Prognostic Factors for Children with Autism
Lynn Kern Koegel, Robert L. Koegel, Yifat Shoshan, Erin McNerney
The purpose of this study was to identify key target behaviors, that if taught, would result in highly favorable outcomes for children with autism. At intake, the behaviors of a subgroup of children who appeared to have an especially good prognosis, according to traditional variables, were examined. Within that subgroup, behaviors that were especially indicative of a good prognosis were isolated. The primary target behavior identified was exhibiting spontaneous initiations (which correlated with exhibiting spontaneous speech, a lack of self-stimulatory behaviors, the number of toys played with, the amount of time engaged in play, and presence of symbolic play). Another subgroup of children, who did not display the aforementioned behavioral characteristics at intake, were then taught the key target behavior of exhibiting spontaneous initiations. Follow-up measures, recorded 4 years later, showed that these children are following typical developmental tracks, both academically and socially. Children who were not taught these behaviors showed very little improvement. Therefore, it appears that knowledge of specific behavioral factors that are indicative of positive treatment outcomes not only allows for the prediction of a child''s prognosis, but can serve as an impetus in identifying target behaviors that, when taught, foster a more positive prognosis for children with autism.
Promoting Play Date Interactions between Children with Autism and Typically Developing Peers
Laurie Vismara, Grace W. Gengoux , Mendy Boettcher, Robert Koegel, Lynn Koegel
Children with autism often exhibit difficulties in social interaction and friendship formation. Specifically, children with autism may demonstrate difficulty with appropriately initiating and maintaining conversation, as well as with engaging in interactive play with peers. Preliminary data will be presented to illustrate how a package, consisting of the use of mutually reinforcing activities and cooperative arrangements with natural reinforcers, may be successfully implemented in play dates to increase positive interactions between children with autism and typically developing peers. Data, analyzed within the context of a multiple-baseline design across participants, show how play dates may be one strategy to improve reciprocal social interaction and affect for these children. These results are discussed in the context of developing a comprehensive social-skills package to encourage and sustain friendship development among children with autism and their peers.
Rapid Initial Acquisition of Speech in Nonverbal Children with Autism
Robert L. Koegel, Karen M. Sze, Lauren Brookman, Lynn Kern Koegel
The current study investigates parents' use of motivationally based procedures to facilitate the rapid production of speech in two nonverbal children with autism. Both children and their mothers were participants in a parent education program in Pivotal Response Training (PRT). Prior to intervention, these children demonstrated either no expressive language or a few inconsistent, non-functional vocalizations and exhibited high levels of disruptive behaviors. Initial data indicate that parents'' consistent and correct use of PRT techniques at the criterion level (80%) appears to be critical to the children''s rapid production of functional speech. Initial findings also suggest collateral improvements in the occurrence of disruptive behavior exhibited by these children following rapid speech production.
Reducing Overselectivity in Early Language Development in Children with
Autism
Robert L. Koegel, Ariella Eichenbaum, Lynn K. Koegel
Children with autism often exhibit stimulus overselectivity, or a lack of response to multiple cues in the environment. This has negative implications for learning new behaviors and the generalization of learned behaviors. It may result in communicative delays in speech and language, and in social delays. The current study examines stimulus overselectivity in young children with autism who are in the early stages of language development. Two children with autism participated in a multiple baseline design that assessed the effects of using the motivational techniques of PRT while modifying the stimulus components (phonemes) of target words to reduce stimulus overselectivity. The results indicate that both children showed a significant decrease in stimulus overselectivity and a large improvement in correct responding to the target words. In addition, both children showed a generalized effect of the treatment for learning new words. The findings support previous research that suggests that stimulus overselectivity varies as a function of stimulus variables and shows that it can be reduced through intervention.
Reducing Problem Behaviors of Children with Autism: A Combination of Functional Analysis and Self Management
Mendy Boettcher, Robert L. Koegel, Lynn Kern Koegel, Josh Harrower, Daniel Openden
The purpose of this study was to investigate the effectiveness of a multi-component intervention designed to reduce problem behaviors of children with autism. The intervention included the use of self-management procedures to immediately reduce the problem behaviors, followed by functional analysis procedures to teach the child appropriate functionally equivalent replacement behaviors. Teaching functional equivalents takes time and replacement behaviors are not always immediately reinforced in the natural environment; therefore, the intervention was implemented in phases, using self-management to immediately reduce problem behaviors until the functional equivalents could be learned. The self-management was then faded, and the data indicate that children exhibited few inappropriate behaviors and many functionally equivalent behaviors at follow up.
Reducing Ritualistic Behavior in Children with Autism Using a Transfer Stimulus
Robert L. Koegel, Jane Lacy, Lynn Kern Koegel
The current study investigates the effects of a transfer stimulus on ritualistic behavior in three children with autism. Specifically, the study seeks to discover whether a counting intervention used in conjunction with a competing reinforcer can effectively facilitate a child's transition away from the object of ritualistic interest to another object. Prior to intervention, all three children demonstrated high levels of interest towards the preferred stimulus and little interest in other objects. In addition, all three children showed high levels of disruptive behavior upon leaving the favored object. Initial data indicate that implementation of this intervention does significantly increase a child's ability to transition calmly away from the preferred object to another stimulus. Initial data also show that the effects of the intervention may generalize to other ritualistic behaviors in the child's routine.
Responding to Multiple Cue Tasks by Typically Developing Children
Jennifer Symon, Robert L. Koegel
Fourteen typically developing and academically gifted children, ages two through eight years old participated in a multi-component task study. Children were rated by their school teachers as ""typically average"" or ""academically gifted"" in regard to their academic performance in the classroom. The tasks required the child to attend to one, two, three, or four components. Results indicate that, consistent with the literature, overall the children responded to the one and two component tasks with greater accuracy than they responded to the three and four component tasks. Furthermore, for the children rated as ""typically average"", the age at which the child''s responses reached 100% accuracy occurred around six years of age. However, for the group rated as "academically gifted", the age at which the children responded correctly to these multi-component tasks was around three years of age.
Stimulus Overselectivity and the Picture Exchange Communication System (PECS)
Grace W. Gengoux& Marjorie H. Charlop-Christy
The Picture Exchange Communication System (PECS; Bondy & Frost, 1994), an augmentative communication system, uses cards with two cues (picture and word) to convey the request for an item. Due to stimulus overselectivity, however, it is possible that some children may not respond to both the picture and the word. In Experiment 1, children with autism were assessed to determine whether, when using PECS, they were selectively responding to the picture. In Experiment 2, a multiple-cue training program (Schreibman, Charlop & Koegel, 1982) was used to teach the children to respond to both cues on the PECS cards. Three of 4 children learned to respond to multiple cues and approach new discriminations as multiple cuers. The results are discussed in terms of using PECS to facilitate word recognition and sight-reading.
Systematic analysis of social initiative potential (SIP) as a pivotal variable in prognosis for children with autism
Robert L. Koegel, Laurie A. Vismara, Lynn Kern Koegel
Recent advances in research, concerning the identification of prognostic indicators, suggest that more positive and long-term gains are associated with children who display specific behavioral characteristics. In order to determine whether certain variables are associated with good prognoses for children with autism, parents and children with autism participated in parent education programs at University of California, Santa Barbara. All children received pivotal response treatment based on applied behavior analysis (ABA) procedures in a Pivotal Response Teaching (PRT) format. Such approaches focus on the pivotal area of motivation to increase engagement and responsiveness in social communicative interaction and joint attention and provide intervention in key pivotal areas that appear to lead to widespread positive effects on many other behaviors. While some of the children achieved particularly excellent outcomes, others showed much smaller improvements.
According to the preliminary data, the differences in outcome might be related to the presence of specific prognostic indicators present at pre-intervention that are associated with exceptionally favorable outcomes. Specifically, if the child engaged in any behaviors focused primarily on obtaining social reinforcement, such as exhibiting a gesture, behavior, or communicative attempt towards the caregiver for the purposes of social reinforcement, as opposed to requesting an object primarily to obtain the object, this variable, coined social initiative potential (SIP), might be associated with children attaining promising outcomes. Therefore, in this study, social initiative potential will be systematically investigated through a programmatic line of research to determine whether it might be influential in predicting why some children with autism attain extremely favorable outcomes and others exhibit poor outcomes despite intervention efforts. Equally important, this study will attempt to examine whether children with autism might be taught to exhibit social initiative potential in order to improve their intervention outcome
Teaching Social Conversation Skills to Children with Autism through Self-Management: An Analysis of Treatment Gains and Meaningful Outcomes
Mendy Boettcher
Deficits in the development of social functioning and pragmatics are universally recognized in the literature as primary symptoms of autism. Ability to successfully participate in reciprocal social conversation is one specific area that has not been extensively addressed in the literature with respect to children with autism. The purpose of this study will be to demonstrate that children with autism can be taught to engage appropriately in social conversation with others through the use of a self-management intervention. Further, the study will then address whether these improvements in social skills constitute a meaningful outcome. The following variables will be investigated: 1) whether self-management can be successfully used to teach social conversation skills to children with autism, 2) whether these treatment gains will generalize and maintain over time once intervention has been faded, 3) whether the children will appear significantly more confident in their interactions and more pragmatically appropriate after intervention, 4) whether they will use their newly acquired skills spontaneously in a novel setting, and 5) whether conversational interactions will become naturally rewarding once they have acquired the skills to successfully interact. Pilot data indicate that self-management is an effective means of teaching social conversations skills, that skills maintain once intervention is faded, and that subjective confidence and pragmatic normalcy ratings are significantly improved with intervention
Training Paraprofessionals to Facilitate Social Interaction between
Children with Autism and their Typical Peers in a Full Inclusive
Educational Setting
Robert L. Koegel, Suzanne Robinson, Lynn K. Koegel
The purpose of this study was to examine the effectiveness of training paraprofessionals via modeling and in-vivo feedback to facilitate social interactions between children with autism and their typical peers. Specifically, paraprofessionals were taught to incorporate PRT (e.g., child choice, shared control, natural and contingent reinforcers) and peer-mediation strategies (e.g., peer-delivered antecedents and consequences) within the natural routines of the classroom. Results show that (a) the paraprofessionals were successfully trained to elicit social responses, and (b) social verbalizations of the children with autism and their peers immediately increased and maintained at follow-up. The results are discussed in terms of understanding and improving the training model for the purposes of increasing the social interactions of children with autism.
Training Paraprofessionals to Facilitate Social Interactions Between Children with Autism and Their Peers in an Inclusive Summer Camp Setting
Robert L. Koegel, Eileen F. Klein, Lynn Kern Koegel, Mendy Boettcher, Lauren Brookman-Frazee, & Daniel Openden
The literature suggests that paraprofessional support personnel frequently engage in hovering behavior, which could impede the social development of children with autism in inclusive settings. Therefore, the purpose of the study was to assess, within a multiple baseline design, whether paraprofessionals could be trained to facilitate social interactions between children with autism and their typically developing peers. The results showed: a) at baseline, the paraprofessionals engaged in high levels of hovering and low levels of social facilitation; b) at baseline, the campers with autism engaged in low levels of social behaviors; c) the paraprofessionals could easily learn to decrease hovering behavior and increase their social facilitation behaviors; d) concurrent with the change in the paraprofessionals' support behaviors, the social behavior of the children with autism with their nondisabled peers increased. Generalization measures indicate that the paraprofessionals continued to use their skills when they worked with new children.
Understanding the Role of Motivation for Joint Attention Behaviors in Children with Autism
Laurie Vismara, Robert L. Koegel, Lynn K. Koegel
Joint attention involves coordinating attention between social partners with respect to objects and events in order to share the experience of the objects or events. Further, joint attention behaviors are characterized by the use of positive affective expression. Common examples of joint attention behaviors include alternating eye gaze to share attention, gesturing to follow the attention of another, and commenting to direct the attention of another. Various explanations have been offered in the literature on the underlying cause of joint attention deficits in autism. The literature suggests that children with autism do not engage in joint attention behaviors because these exchanges typically involve unpredictable, complex, and social stimuli. One possible explanation for the lack of joint attention is that children with autism are not capable of the complex cognitive skills required to produce joint attention under such circumstances. A second possibility is that children with autism are capable of producing joint attention but do not have the motivation to engage in these behaviors. The current study sought to examine whether using motivational procedures may improve joint attention in autism. A reversal design with alternating treatments was employed to assess whether incorporating the children's perseverative interests may result in an immediate increase of joint attention behaviors following intervention for motivation to communicate. Data indicate increases in participants' joint attention initiations as a result of using perseverative interests during intervention. As intervention continued, joint attention initiations were also found to generalize to non-perseverative interests. Lastly, supplemental findings included improvements in the type of communicative behaviors used to initiate joint attention, as well as in the quality of interaction between the participants and their caregivers. Findings are discussed in terms of theoretical and clinical implications for understanding the role of motivation in facilitating the development of joint attention in autism.
Using Multiple Pre-Treatment Vocalizations to Increase Functional Vocabulary in Nonverbal Children with Autism
Robert L. Koegel, Karen M. Sze, Amanda Mossman, & Lynn Kern Koegel
The literature suggests that some previously nonverbal children may acquire speech at a very rapid rate. However, there appears to be a small subset of nonverbal children who may overgeneralize on the use of a first word attempt and have difficulty progressing beyond that point. The purpose of this study was to assess whether incorporating multiple pre-treatment vocalizations into the intervention plan was effective in increasing the children's functional expressive vocabulary. The results, replicated within a multiple-baseline across participants design, showed an increase in speech acquisition and a corresponding decrease in the percent of overgeneralized responses only when multiple pre-treatment vocalizations were used. The results are discussed in terms of their implications for further understanding speech acquisition in nonverbal children with autism.
Using a Self-Management Package to Increase Conversational Skills and Social Fluidity in Teenagers with Asperger's
Robert L. Koegel, Jane Lacy, & Lynn Kern Koegel
The current study investigates the effects of a self management intervention for social conversation on three teenagers diagnosed with Asperger's. Specifically, the study seeks to discover the effectiveness of a self-management package individually designed for each participant targeting various conversational and/or social skills. Prior to intervention, the participants respectively demonstrated low levels of question-asking and initiating, high levels of perseveration on preferred topics, and difficulty in perceiving when conversational partners had lost interest in their topic. Initial data indicate that implementation of this intervention does significantly increase the participants' ability to initiate with others by asking questions, edit their preferred topics to appropriate lengths for conversation, and appropriately notice other's nonverbal pragmatics and change the conversation topic accordingly.
Using a Systematic Desensitization Paradigm to Treat a Child with Autism's Hypersensitivity to Auditory Stimuli
Robert L. Koegel, Daniel Openden, & Lynn Kern Koegel
Many children with autism display reactions to auditory stimuli that seem as if the stimuli were painful or otherwise extremely aversive. This article describes how procedures of systematic desensitization can be used to treat a child with autism's oversensitivty to the sound from a vacuum cleaner, blender, and hand-mixer. A multiple baseline across stimuli with a changing criterion design was employed and data were collected on: (a) the number of hierarchical steps completed as comfortable with the stimulus per week; and (b) the mean level of anxiety per probe. The data show that the child''s response could be modified to the point where the child was comfortable with an operating vacuum, blender, and hand-mixer and suggest that the extreme reactions to auditory stimuli many children with autism exhibit may be related to a phobia rather than pain associated with a stimulus.
Using a High-probability Behavioral Momentum Sequence to Teach Functional Vocabulary to Children with Autism
Karen M. Sze, Robert L. Koegel, & Lynn Kern Koegel
The prognosis for verbal communication in children with autism has improved considerably in light of recent advances in language intervention technologies. However, the literature indicates that the rate of initial word acquisition in these children is typically slow and some children failed to respond to language intervention techniques that are currently available. One documented method to accelerate the development of first words is to systematically incorporate responses that are readily acquired by and are already available to the child, such as pre-treatment phonemes or nonverbal behaviors, into the overall intervention package. Substantial research also suggests that antecedent interventions based on task interspersal or behavioral momentum might be especially promising in enhancing a continuum of communication behaviors in children with developmental disabilities. The current study sought to integrate these converging lines of research on the systematic incorporation of readily available responses and a momentum-based procedure to facilitate initial verbal communication in young nonverbal children with autism within the context of Pivotal Response Treatment (PRT), a naturalistic motivational intervention. The key variable of this investigation was the presentation of a sequence of teaching trials involving high-probability words from the child immediately preceding the presentation of low-probability target word stimuli. A multiple baseline design across four participants was employed to assess the influence of the high-probability intervention on the following experimental measures: (1) level of functional verbal responding to target word stimuli, (2) number of words during probes, (3) vocabulary diversity during probes, (4) type and quality of functional vocabulary use, and (5) observed affect during play interactions. Data indicate increases in participants' functional verbal communication and positive affect as a result of the high-probability sequence procedure. Additionally, these gains were successfully maintained when the high-probability sequence was withdrawn from the standard procedures of PRT and at one-month follow-up. Findings are discussed in terms of theoretical and clinical implications for difficult-to-teach children with autism, as well as future research directions.
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