The role of the reflexive conditioned motivating operation (CMO-R) during discrete trial instruction of children with autism.

Abstract

Comprehensive intensive treatment based upon the application of behavior analytic principles has proven to be an effective form of intervention for children with autism (Green, 1996). Several comparative studies have demonstrated the superiority of behavior analytic programs over other approaches to autism treatment or differing levels of intensities of services (Birnbrauer & Leach, 1993; Cohen, Amerine-Dickens, & Smith, 2006; Eikseth, Smith, Jahr, & Eldevik, 2002, 2007; Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Lovaas, 1987; Sallows & Graupner, 2005; Remington et al. , in press; Smith, Groen, & Wynne, 2000). This research has provided clear evidence that intensive intervention guided by behavior analytic principles can produce substantial benefits for children with a disorder that was once thought to be resistant to all forms of treatment. There are reports of children with autism entering regular education classrooms, achieving substantial cognitive gains and developing age appropriate social skills after many years of intensive behavioral intervention (Lovaas, 1987). Recently, evidence has been gathered that suggests that school, community, and home applications of intensive behavioral intervention can be equally successful (Eikseth et al. , 2002; Howard et al. , 2005). At least five published manuals (Leaf & McEachin, 1999; Lovaas, 1981, 2003; Maurice, Green, & Foxx, 2001; Maurice, Green, & Luce, 1996) for parents and practitioners are available to provide a summary of the effective teaching methods discovered through controlled studies. These manuals have provided a user-friendly method of disseminating effective behavior analytic methods for teaching children with autism. The result may be greater acceptance and widespread application of behavior analytic methods with children with autism. Much of the research and all of the manualized treatment packages have emphasized the importance of motivating children to respond to teacher directed instructional tasks. Koegel, Carter, and Koegel (1998) and Koegel, Koegel, Shoshan & McNerney (1999) suggested that motivation is pivotal to the teaching of children with autism because its creation is critical to the development of a wide range of skills. Moreover, given the tendency of these children to engage in high rates of escape and avoidance behaviors (Koegel, Koegel, Frea, & Smith, 1995) within instructional demand settings, methods that increase the motivation to respond may be essential to positive long-term outcomes. The ultimate outcome for many children with autism may depend at least partially upon their learning to attend to teacher-directed activities and respond correctly and quickly for reasonable periods of time each day (Drash & Tudor, 1993). This is especially important for children with autism because they frequently fail to learn through exposure to typical social environments (Smith, 2001). As an alternative to mere exposure to everyday experiences, the method of discrete trial instruction (Lovaas, 1981, 1987; Smith, 2001) has been demonstrated to be one of the most effective instructional tools for teaching important language, social, and cognitive skills to children with autism as a component of a comprehensive program of intervention. The method is modeled after Skinner's (1968) three-term contingency arrangement whereby a stimulus is presented by a teacher, a response occurs, and a consequence follows the response in order to strengthen or weaken the likelihood that it will occur again under similar conditions. When discrete trial instruction has been used as a component of a comprehensive program of intensive intervention for children with autism, long-term benefits have been achieved with many children (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Smith, 1999). Notwithstanding the benefits of this method, its proper implementation presents substantial challenges to practitioners. …