Teaching Listener Selection to Children With Autism: Emphasizing the Role of Joint Control

Autism spectrum disorder (ASD) is associated with early differences in children's social interactions, communication, and play/interests. In many countries, considerable resources are invested in early intensive behavioral intervention (EIBI) programs for children with ASD, which aim to build adaptive skills and prevent or treat problem behavior. However, these programs vary widely in structure and delivery. Research evidence supports the efficacy of EIBI, but large knowledge gaps remain about the effectiveness of publicly funded EIBI programs. With policy-makers as formal research partners, we compared children's progress over 1 year in public preschool programs in adjacent Canadian provinces, New Brunswick (NB) and Nova Scotia (NS). In NB, children received up to 20 hr/week of comprehensive EIBI in a publicly funded, privately provided program. In NS, children received up to 15 hr/week of Pivotal Response Treatment and Positive Behavior Support delivered through the publicly funded healthcare system. In this observational parallel cohort study, we collected parent-reported data on 298 NB preschoolers (76.5% boys) and 221 NS preschoolers (86.9% boys) at EIBI start and 1 year later. Multilevel analysis revealed significant differences at baseline: NS children were older, with lower adaptive functioning and more severe ASD symptoms than NB children. Despite these pre-treatment differences that favor NB, children in both provinces showed similar adaptive functioning gains and reductions of maladaptive behavior. No changes were seen in mean ASD symptom severity in either province over time. Results highlight the value of evaluating interventions in their implementation contexts, and have important implications for devising optimal ASD policy. Autism Research 2019, 12: 667-681. © 2019 International Society for Autism Research,Wiley Periodicals, Inc. LAY SUMMARY: We need to know more about the impact of different forms of early intensive behavioral intervention (EIBI) for young children with autism spectrum disorder (ASD). We showed that preschoolers with ASD gained important skills while in public EIBI programs in two Canadian provinces. We also saw that differences in how EIBI programs are structured and characteristics of children who are served may affect outcomes. For these reasons, policy making requires evidence that fits the local context.

Recommendations for ABA for children with Autism have exponentially increased, creating a shortage of qualified ABA consultants. The increase in demand, lack of financial support for in-home programs and difficulty of maintaining in-home staff create a need for alternative delivery models for Early Intensive Behavioral Intervention (EIBI). We present a preliminary analysis of learning rates and psychometric outcomes for children in 3 different delivery models--Home based EIBI, only; and Home and School EIBI; Home Based EIBI with alternative school methods. ********** An impressive body of research exists that supports the effectiveness of early intensive behavioral intervention (EIBI) programs based on principles of applied behavior analysis (ABA) implemented with preschool age children diagnosed with autism and PDD-NOS (see New York State Department of Health Early Intervention Program, 1999a, 1999b, 1999c). Traditionally, these programs have included 40+ hours per week of programming conducted by trained therapists in home settings over a period of 2-3 years. Given the daunting financial and logistical demands inherent in organizing and implementing programs of this type, it is often necessary to implement different service delivery models. Some of these models have included school-based programs (often housed in special needs schools), combined home/school programs, and partial home programs - among others. Relatively little research has been done comparing the outcomes and relative effectiveness of these program variants. Effective EIBI programs can significantly increase the quality of life of children and families, and can significantly reduce costs to society (Jacobson, Mulick, & Green, 1998). Increased knowledge of the comparative efficacy of EIBI program variants can be of benefit to school districts and parents of autistic children attempting to balance limited resources with effective intervention. This study is viewed as a pilot project. Data are presented for children in 3 different service delivery models: Home based EIBI, only; Home based and School EIBI; and Home based EIBI and alternative school program. The intent of the study is to obtain initial data to be used in formulating follow-up studies of the efficacy of alternative EIBI service delivery models. Method Participants This study was conducted with children of preschool age (N = 5) initially diagnosed with autism or PDD-NOS currently in EIBI programs followed by the psychology department of Columbus Children's Hospital. Participants were between 3 and 6 years of age, who received a comprehensive psychological evaluation at least twice by the Psychology Department, have received at least 10 hours per week of EIBI intervention over the past 18 months (or more), and have tutors other than parents. Exclusionary criteria included diagnoses of Asperger's, Rett's, Fragile X without Mental Retardation, Mental Retardation without Autism, and Tuberous Sclerosis. See Table 1 for a brief description of each participant. Materials Because of age and skill differences, children received a variety of standardized cognitive and language measures. These measures included: Cognitive measures: 1. Bayley Scales of Infant Development Second Edition (Bayley; Bayley, 1993) The Bayley was designed to assist professionals in early identification of developmental delays. Standardized scores for cognitive, motor, and behavioral development are available. Correlations with measures of cognitive ability (e. g. IQ tests) are adequate for estimates of developmental delay (correlation with WPPSI-R Full Scale IQ = .73). Test-retest reliability for the mental scale was also adequate (.87). 2. Mullen Scales of Early Learning Manual (Mullen; Mullen, 1995) The Mullen was designed to provide estimates of cognitive development for young children. …

Background: In recent years, the delivery of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder (ASD) in the United States has significantly changed. More children with ASD than ever before are eligible to use publicly funded EIBI. Yet, the challenges to large-scale implementation of EIBI remain unclear.Specific Aims: We examined parent perceived challenges to treatment utilization, predictors of increased challenges to treatment utilization, and parent recommendations for increasing utilization in a statewide EIBI program.Method: Using a cross-sectional design, we surveyed parents of children with ASD receiving EIBI through South Carolina’s Pervasive Developmental Disorder Program (N = 145). To examine the contributions of parent demographic characteristics, parent social support, and child challenging behaviors to perceived challenges to utilization, we used multiple linear regression. Parent recommendations were collected using a single open-ended question.Findings: The most frequently endorsed challenges included the child’s school schedule (62.1%) and the child being overburdened with other treatment demands (65.2%). Greater child challenging behaviors were associated with a greater degree of perceived challenges, and social support was associated with a lesser degree of perceived challenges.Discussion: Parents perceived various challenges to utilization, and child and family characteristics may increase the risk for experiencing challenges to utilization. As the delivery of EIBI continues to evolve in the United States and elsewhere, these findings have implications for policy, programming, and future research.

The current study examined instructors' discrete-trial teaching responses after a performance-based training procedure in which instructors were required to demonstrate criterion-level performance on written and oral quizzes and on performance demonstrations. Twelve discrete-trial teaching responses were labeled and operationally defined. Post-training measures of the target responses were obtained during home-based early intervention teaching sessions with young children with autism. The director provided discrete-trial performance feedback to the instructor after each session. Mean accuracy of performance for the instructors was 92% or above across 10 sessions. These data were contrasted with the substantially lower levels of accuracy from normative data of instructors conducting sessions in a comparable setting. These data suggest the importance of requiring criterion-level performance during training. Keywords: autism; discrete-trial teaching; early intensive behavioral intervention; staff training. ********** The purpose of the current study was to examine instructors' discrete-trial teaching performance with young children with autism after a training procedure that included a stringent accuracy criterion was implemented. Training to criterion is not typically established in the staff training literature (Matson, 1990). Discrete-trial teaching is an instructional method that incorporates the principles of applied behavior analysis by breaking down complex tasks into small units and presenting them in a simplified, repeated manner to facilitate learning (Green, 1996; Newman, Reeve, Reeve, & Ryan, 2003; Sarokoff & Sturmey, 2004; Sundberg & Partington, 1998). Discrete-trial teaching is used to: (a) allow data collection and assessment of learner and instructor behavior, (b) clarify what is expected of the learner and instructor, and (c) maintain consistent teaching conditions and requirements. Green (1996) and Smith (2001) noted that discrete-trial teaching is an effective strategy for teaching new skills with children with autism. In the present study, instructors were trained to emit discrete-trial teaching responses using staff training procedures established and accepted in the literature, including verbal, written, and video instructions; modeling; role-playing; in-vivo practice; and performance feedback (Gardner, 1972; Gladstone & Spencer, 1979; Harris, Bushell, Sherman, & Kane 1975; Johnson & Fawcett, 1994; Kazdin & Moyer, 1976; Kissel, Whitman, & Reid, 1983; Koegel, Russo, & Rincover, 1977; Reid & Green, 1990, Sepler & Meyers, 1978). Following training, accuracy of discrete-trial teaching behavior was assessed during home-based teaching sessions for young children with autism. Feedback for teaching performance was presented following each teaching session during the Post-training phase. Method Participants Three special education instructors (22 to 45 years old) of children with autism participated in the study. All participants were informed of the nature of their participation and provided consent for their participation. The instructors were employed through an early intensive behavioral intervention agency that served children with autism and their families. The instructors were not previously trained in using behavior analytic methods. The children served by the agency were 2 to 3 years old, and were diagnosed with an autistic-spectrum disorder, as documented by a physician and psychologist. For purposes of the current study, two male children with autism were involved during instructor training sessions. Each child was allotted 20 hours/week of behavior analytic services delivered by special educators. Setting The study took place in the urban homes of children participating in a home-based early intensive behavioral intervention program for children with autism. The areas of the homes used during teaching sessions were arranged prior to conducting teaching sessions. …

This study examined Pathways Early Autism Intervention, a community-based, parent-mediated, intensive behavioral and developmental intervention program for children with autism spectrum disorders that could be used as a model for state-funded early intervention programs. A single-subject, multiple-baseline, across-participants design was used. Four boys with autism spectrum disorder and their mothers participated. Interventionists made weekly home visits and worked with caregivers to establish and maintain face-to-face reciprocal social interaction and eye contact. Each session included a 10-min video of parent-child interaction. Evidence of intervention effectiveness was measured by percentage of nonoverlapping data points. Social validity was measured using questionnaire items in regard to parents' perception of the intervention. The intervention was effective for the measures of eye contact, social engagement, and verbal reciprocity but not for nonverbal turn taking. Parents perceived the intervention as beneficial and easy to learn and incorporate into daily life.

Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviour modification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI. Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected. Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance. Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.

Implementation evaluation of an early intensive behavioral intervention program across three agencies serving young children with Autism: A mixed methods study

Early intensive behavioral intervention (EIBI) programs are among the most widely known interventions in autism, but their effects on families have received less attention despite the role that parents play in educating their child. The scarce literature on this topic primarily concerns the experiences of Anglophone, White, and Western families. This study documented the experience of 28 mothers and fathers who immigrated to Canada and received EIBI services provided by the province of Québec. Semi-structured interviews queried families’ vision of EIBI and its consistency with their values and practices, their perception of the family-provider partnership, and the facilitators and obstacles they encountered in implementing EIBI. Results highlighted that families valued being involved and consulted, their partnerships with staff, and the professional and socioemotional competence of staff. These characteristics of EIBI implementation are consistent with the idea of cultural humility in applied behavior analysis.

Early intensive behavioral intervention (EIBI) is one of the most widely used treatments for children with autism spectrum disorder (ASD). The purpose of our review was to examine the research on EIBI. We found a total of five studies that compared EIBI to generic special education services for children with ASD in schools. Only one study randomly assigned children to a treatment or comparison group, which is considered the 'gold standard' for research. The other four studies used parent preference to assign children to groups. We examined and compared the results of all five studies. A total of 203 children (all were younger than six years old when they started treatment) were included in the five studies. We found that children receiving the EIBI treatment performed better than children in the comparison groups after about two years of treatment on tests of adaptive behavior (behaviors that increase independence and the ability to adapt to one's environment), intelligence, social skills, communication and language, autism symptoms, and quality of life. The evidence supports the use of EIBI for some children with ASD. However, the quality of this evidence is low as only a small number of children were involved in the studies and only one study randomly assigned children to groups.

The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorders. Early intensive behavioral intervention (EIBI) is a treatment based on the principles of applied behavior analysis. Delivered for multiple years at an intensity of 20 to 40 hours per week, it is one of the more well-established treatments for ASD. This is an update of a Cochrane review last published in 2012. To systematically review the evidence for the effectiveness of EIBI in increasing functional behaviors and skills, decreasing autism severity, and improving intelligence and communication skills for young children with ASD. We searched CENTRAL, MEDLINE, Embase, 12 additional electronic databases and two trials registers in August 2017. We also checked references and contacted study authors to identify additional studies. Randomized control trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. We used standard methodological procedures expected by Cochrane.We synthesized the results of the five studies using a random-effects model of meta-analysis, with a mean difference (MD) effect size for outcomes assessed on identical scales, and a standardized mean difference (SMD) effect size (Hedges' g) with small sample correction for outcomes measured on different scales. We rated the quality of the evidence using the GRADE approach. We included five studies (one RCT and four CCTs) with a total of 219 children: 116 children in the EIBI groups and 103 children in the generic, special education services groups. The age of the children ranged between 30.2 months and 42.5 months. Three of the five studies were conducted in the USA and two in the UK, with a treatment duration of 24 months to 36 months. All studies used a treatment-as-usual comparison group.Primary outcomesThere is low quality-evidence at post-treatment that EIBI improves adaptive behaviour (MD 9.58 (assessed using Vineland Adaptive Behavior Scale (VABS) Composite; normative mean = 100, normative SD = 15), 95% confidence interval (CI) 5.57 to 13.60, P < 0.0001; 5 studies, 202 participants), and reduces autism symptom severity (SMD -0.34, 95% CI -0.79 to 0.11, P = 0.14; 2 studies, 81 participants; lower values indicate positive effects) compared to treatment as usual.No adverse effects were reported across studies.Secondary outcomesThere is low-quality evidence at post-treatment that EIBI improves IQ (MD 15.44 (assessed using standardized IQ tests; scale 0 to 100, normative SD = 15), 95% CI 9.29 to 21.59, P < 0.001; 5 studies, 202 participants); expressive (SMD 0.51, 95% CI 0.12 to 0.90, P = 0.01; 4 studies, 165 participants) and receptive (SMD 0.55, 95% CI 0.23 to 0.87, P = 0.001; 4 studies, 164 participants) language skills; and problem behaviour (SMD -0.58, 95% CI -1.24 to 0.07, P = 0.08; 2 studies, 67 participants) compared to treatment as usual. There is weak evidence that EIBI may be an effective behavioral treatment for some children with ASD; the strength of the evidence in this review is limited because it mostly comes from small studies that are not of the optimum design. Due to the inclusion of non-randomized studies, there is a high risk of bias and we rated the overall quality of evidence as 'low' or 'very low' using the GRADE system, meaning further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.It is important that providers of EIBI are aware of the current evidence and use clinical decision-making guidelines, such as seeking the family's input and drawing upon prior clinical experience, when making recommendations to clients on the use EIBI. Additional studies using rigorous research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.

Implementation evaluation of early intensive behavioral intervention programs for children with autism spectrum disorders: A systematic review of studies in the last decade

The effectiveness of a school based Early Intensive Behavioural Intervention (EIBI) program was assessed over a two-year period for a cohort of 16 pre-school children with autism spectrum disorder (ASD) and their families. Children with a mean age of 40 months, were assessed prior to intervention, after 1 year of intervention, and again after 2 years. Significant improvements were observed on measures of adaptive behaviour, communication ability and challenging behaviour. Parents of children attending the program also reported increased familial quality of life, specifically improved emotional and physical well-being and increased parenting capacity over the duration of the program. The current study suggests that EIBI for young children with ASD can be effective in facilitating improvements in communication ability, reducing challenging behaviours and improving quality of life for families. Children's pre-intervention adaptive skills appeared to be the strongest predictor of post intervention gains as initial level of adaptive ability was positively related to improved post-intervention outcomes.

We examined the sustained effects of early intensive behavioral intervention (EIBI) on 66 children with autism spectrum disorder who participated in the Future Center’s EIBI program. Children were assessed using the childhood autism rating scale (CARS), autism behavior checklist (ABC), and adaptive behavior scale (ABS-Arabic) 3 years after leaving the program. Continued positive effects were observed in several areas, including adaptive behavior and autism symptoms. However, participants’ social skills might have declined on the ABS-Arabic after service withdrawal. Additionally, a significant negative association (p < .001) was found between participants’ performance on the CARS and the number of weekly trials. This is encouraging, given the lack of EIBI services and regional instability. Future research should increase the sample size and use a more rigorous design.

There is currently limited research on early, intensive behavioral intervention (EIBI) within Australia. The purpose of this paper was to provide a programmatic description and preliminary findings of an intervention approach which provides a high level of intensity of intervention to preschool aged children diagnosed with autism spectrum disorder (ASD). A total of 154 children with autism participated in the program from 2011 to 2022. At the group level, children who received 27 hr per week of intervention showed significant gains on standardized cognitive and adaptive behavior measures during an average one year of intervention. Further examination of the response to intervention at an individual level demonstrated that 84% of children showed an acceleration in their rate of learning during intervention, with 52% more than doubling their rate of learning in this time. Age was determined to predict improvement in developmental trajectory, but intake cognitive abilities did not. In general, children who commenced intervention at a younger age made substantial improvements in their rate of learning, but children who commenced intervention at an older age made even greater improvements relative to their skills at commencement. The results as well as limitations given the exploratory nature of this paper are discussed, along with implications for addressing the needs of young autistic children in Australia.

Early intensive behavioral intervention appears beneficial for young children with autism spectrum disorders