Concurrent Multiple Baseline Design Research Articles

Combining Social Stories and Video Modelling for Teaching Mealtime Skills to Children with Intellectual Disability

ABSTRACT This study aimed to investigate the effect of combining social stories and video modelling in a multimedia programme for teaching mealtime skills to students with mild intellectual disability. In a concurrent multiple-baseline design across participants and behaviours, three subsets of mealtime skills were taught through three social story sessions followed by three video modelling sessions. The outcome measure was a culturally appropriate index of mealtime skills developed for this study. The results showed that the scores, which were stable during the baseline phase, increased during the social story phase. The elevation continued or stabilised during the video modelling phase. It seems that the utilisation of social stories as an addition to video modelling may be an effective strategy for training daily life skills. This combination may help fill the inefficiencies observed in the video modelling method by incorporating social information into the training, allowing for more complicated skills to be trained.

Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match): A Virtual Parent-Mediated Intervention Package for Young Children with Developmental Disabilities.

This study aimed to evaluate Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match), a parent-mediated naturalistic developmental behavioral intervention package. An expansion from an earlier pilot study (see Kunze et al., 2021), PRRFCT Match incorporates virtual coaching between a novice coach and parent to implement evidence-based, applied behavior analytic (ABA) techniques during play to increase engagement and decrease unengaged behavior exhibited by their young child with developmental delays(26-50 months old). Ten parent-child dyads were matched with a coach in this concurrent multiple baseline design across participants. Simulating the clinical training level of a novice early interventionist, nine graduate student clinicians received training as coaches on PRRFCT Match implementation and weekly supervision by a research team member. All aspects of training and intervention were delivered virtually. A visual analysis of the data combined with Tau-U revealed a strong basic effect between clinician coaching and parent strategy use. For child participants, a visual analysis and Tau-U results suggest that most increased engagement and decreased their unengaged behavior during the intervention. High variability, overlap, and high engagement at baseline are discussed. This study shows promise for the PRRFCT Match intervention package. The ABA technologies mediated by parents during play increased child engagement and decreased unengagement for most participants.

Effects of a Teacher-Facilitated Peer-Mediated Intervention on Social Play of Preschoolers with Autism.

Children with autism often display differences in functional and symbolic play and may experience barriers to social inclusion with peers in preschool settings. Therefore, interventions supporting social play between children with autism and their peers that can be feasibly implemented by teachers in inclusive settings are needed. A teacher-implemented peer-mediated Stay Play Talk (SPT; Goldstein et al. in Top Lang Disord 27(2):182-199, 2007) intervention package targeting the type of play children with autism engage in with peers was implemented using a concurrent multiple baseline design across four participant/peer dyads. Using a cascading coaching model with behavioral skills training, a teacher was trained in intervention strategies and then taught and supported four peers to implement the intervention. In addition to visual analysis, to statistically analyze effects, we calculated effect sizes using the parametric measure standardized mean difference. A functional relation between the intervention and increases in interactive play and initiations and decreases in solitary play was demonstrated across all dyads. Results generalized to novel settings and maintained following withdrawal of teacher support. Results suggest that SPT can be effectively implemented by a teacher to support interactive play between children with and without autism in an inclusive classroom. Implications for future research and clinical practice are discussed.

Varying Syntax to Enhance Verb-Focused Intervention for 30-Month-Olds With Language Delay: A Concurrent Multiple Baseline Design.

The purpose of this study is to determine if 2.5-year-olds with language delay would learn verbs (spill) when presented with varying syntactic structure ("The woman is spilling the milk"/"The milk is spilling"; milk = patient or theme) in a therapeutic context. Children with language delay have proportionally small inventories of verbs, which limits expressive language development. Children who have typical language development learn verbs more robustly when presented with alternating arguments than with a single argument structure. Three toddlers with expressive language delay (29-30 months of age) participated in a verb-focused treatment study using a concurrent multiple baseline design. Participants were shown action videos accompanied by sentences with varied argument structure for each target verb. To assess learning pre- and posttreatment, participants were asked to demonstrate actions corresponding to each verb. Visual inspection and tau analyses reveal significant posttreatment gains of target verbs taught with varying argument structures. Our results indicate that learning verbs with high variability of argument roles may facilitate a strong link between lexical representations of verbs and their syntactic structures. Using argument structure variability to teach verbs as an intervention strategy has great potential and should be tested further in larger group studies.

Narrative Intervention for Preschoolers Who Are Deaf and Hard of Hearing Using Listening and Spoken Language: A Pilot Study.

This pilot study aimed to examine the effects of a caregiver-supported, narrative-based intervention program on the story retelling skills of a group of preschoolers who are deaf and hard of hearing (D/HH) using listening and spoken language (LSL). A concurrent multiple baseline design across participants was used to determine the effect of a narrative intervention on the story retelling skills of three preschool-age participants who demonstrated complex language delays. Their primary caregivers also functioned as participants. The 6-week narrative intervention program was implemented using a caregiver coaching model during individual therapy sessions. The dependent variable probes were administered twice per week across phases to assess the preschool participants' story retelling skills, including story grammar, complexity, and completeness. Social validity was also evaluated using a caregiver questionnaire. A functional relation was demonstrated between the intervention and story retelling across all three preschool participants with notable increases in the inclusion of story grammar elements and episodic completeness. All three participants maintained scores above baseline levels on dependent variable probes across the 6-week maintenance period. Social validity was strong according to the results of a caregiver questionnaire completed at the conclusion of the intervention. These findings offer preliminary support for the use of a caregiver-supported, narrative-based intervention program to improve storytelling and retelling skills in preschoolers who are D/HH using LSL.

Teaching receptive vocabulary to two autistic children: A replicated, clinic-based, single case experimental design.

This study was conducted in a clinical setting with the aim of replicating previously used procedures for teaching receptive vocabulary. Researchers increased the number of vocabulary words and maintained use of match-to-sample (MtS), prompting, and reinforcement procedures. Researchers were also interested in the efficacy of the intervention from caregivers' perspectives. Using a concurrent multiple baseline design, two autistic preschoolers with receptive language impairment were taught to identify 30 common objects. MtS, prompting, and reinforcement procedures were individualized to support each child. Maintenance checks and generalization probes were completed after a predetermined number of intervention sessions (i.e. three or four clinic sessions). A social validity questionnaire was completed by parents following the final maintenance check. Receptive object identification improved significantly for both participants. Despite exposure to vocabulary targets for only three or four sessions, they generalized the vocabulary targets to non-identical pictures and maintained words at maintenance checks. Participants were most successful when researchers individualized prompting and reinforcement. MtS, prompting, and reinforcement were effective procedures for improving object identification, even with a limited number of intervention sessions. To support varying learner profiles, modifying prompting and reinforcement procedures was necessary. Caregivers of both participants reported positive improvements in areas such as communication, attention, and behaviors. This replicated study provides support for MtS, prompting, and reinforcement as means of teaching receptive vocabulary to autistic preschoolers in a clinical setting. The materials used were simple and cost-effective. Overall, this study outlines and supports a flexible and effective evidence-based practice to teach receptive language to autistic children.

A 12-week in-phase bilateral upper limb exercise protocol promoted neuroplastic and clinical changes in people with relapsing remitting multiple sclerosis: A registered report randomized single-case concurrent multiple baseline study.

Relapsing-Remitting Multiple Sclerosis manifests various motor symptoms including impairments in corticospinal tract integrity, whose symptoms can be assessed using transcranial magnetic stimulation. Several factors, such as exercise and interlimb coordination, can influence the plastic changes in corticospinal tract. Previous work in healthy and chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. Altered corticospinal plasticity due to bilateral lesions in the central nervous system is common after Multiple Sclerosis, yet the effect of in-phase bilateral exercise on the bilateral corticospinal plasticity in this cohort remains unclear. Our aim was to investigate the effects of in-phase bilateral exercises on central motor conduction time, motor evoked potential amplitude and latency, motor threshold and clinical measures in people with Relapsing-Remitting Multiple Sclerosis. Five people were randomized and recruited in this single case concurrent multiple baseline design study. The intervention protocol lasted for 12 consecutive weeks (30-60 minutes /session x 3 sessions / week) and included in-phase bilateral upper limb movements, adapted to different sports activities and to functional motor training. To define the functional relation between the intervention and the results, we conducted a visual analysis. If a potential sizeable effect was observed, we subsequently performed a statistical analysis. Results demonstrated bilateral reduction of the motor threshold alongside with improvement of all clinical measures, but not in any other corticospinal plasticity measures. Our preliminary findings suggest that in-phase bilateral exercise affects motor threshold in people with Relapsing-Remitting Multiple Sclerosis. Therefore, this measure could potentially serve as a proxy for detecting corticospinal plasticity in this cohort. However, future studies with larger sample sizes should validate and potentially establish the effect of in-phase bilateral exercise on the corticospinal plasticity and clinical measures in this cohort. Clinical trial registration: ClinicalTrials.gov NCT05367947.

The Engaged Learners Program: Effects on Student Engagement During Small Group Reading Instruction.

In this study we tested the usability, feasibility, social validity, and effectiveness of Engaged Learners, a behavior support program designed to be integrated into small group reading interventions. Participants included eight Grade 3 to 5 students with co-occurring reading difficulties and inattention. A concurrent multiple-baseline design was utilized to test the effects of Engaged Learners on engagement outcomes. Visual analysis and effect sizes indicated an improvement in engagement for seven students. Interventionists and students viewed the Engaged Learners program to be effective and socially valid. Limitations included lower than expected levels of fidelity for one interventionist and high student absenteeism. More research is needed to identify the extent to which Engaged Learners can support reading outcomes. Educators seeking an effective behavior support program that requires minimal training and coaching may consider integrating Engaged Learners into their small group reading instruction.

Examining behavior specific praise as an individual behavior management strategy in a high-need educational setting

Behavior specific praise (BSP) is widely regarded as an evidence-based classroom management strategy, with decades of research supporting its use. However, relatively few studies have examined the effect of BSP as a targeted intervention strategy, particularly for traditionally underrepresented students. The present study evaluated the utility of BSP as an individual behavior management strategy for diverse students in the context of a high-need educational setting. Specifically, it examined the effects of BSP on teacher’s ratings of academically engaged and disruptive behavior in the classroom using Direct Behavior Ratings–Single Item Scales (DBR-SIS). A concurrent multiple baseline design was implemented with three racially/ethnically minoritized (REM) target students across one third and one fourth grade classroom. Results demonstrated that teachers’ estimated rates of BSP delivered to target students were successfully increased to a criterion level of six per hour following delivery of a multicomponent training package, with high levels of treatment integrity. All participating students demonstrated statistically significant improvements in behavior, although visual analysis suggested only one clear demonstration and one replication of effect. Social validity data revealed high levels of teacher acceptability and willingness to implement the BSP strategy, with mixed perceptions from students. Implications for research and practice are discussed.

Efficacy of a Parent-Implemented Pivotal Response Treatment for Children with Autism Spectrum Disorder.

Pivotal response treatment (PRT) is a well-established intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as a key component. The current study aimed to examine the effects of PRT parent training on parent fidelity and provide descriptive analyses of parent-child interactions before and after parent training. It also probed parental acceptance and satisfaction with the program. A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the parent training program. Four parents (range 32-47 years old) and their children with ASD participated in the study. The intervention comprised 12 one-on-one parent training sessions over six consecutive weeks. The visual analysis and effect size calculation (Tau-U) were used to evaluate functional relationship between independent and dependent variables. The descriptive analysis was used to analyze parent-child interaction data. The findings reveal that all parents learned and maintained PRT with a high level of fidelity, they also enhanced awareness to create more opportunities for interactions during free play, and the parents were very satisfied with the program. The results also indicate that the six-week parent training program is effective in teaching parents to implement PRT with their children. These results suggest that the parent training program may be a promising treatment model that is effective, efficient, and cost-effective. Implications for future research and practice are then discussed.

Identifying and Validating Indices of Happiness and Unhappiness in Autistic Children and Examining Them as Quality of Life Indicators During Presession Pairing

ObjectivesHappiness is paramount to an improved quality of life (QoL), but there are barriers to assessing the happiness and overall QoL of autistic children using traditional measures. To address this, Study 1 aimed to identify and validate the idiosyncratic mood indices of three autistic children. In Study 2, these indices were measured as QoL indicators during discrete trial teaching (DTT) sessions that followed presession pairing. Task engagement was recorded as a secondary measure.MethodsThree preschool boys on the autism spectrum participated in both studies. Their individualized indices of happiness and unhappiness were first identified and validated using an abbreviated procedure that extended previous research. The effects of presession pairing were then examined using a concurrent multiple baseline design across participants. The idiosyncratic mood indices were measured using 10-s partial interval recording, while task engagement was measured using 15-s whole interval recording.ResultsStudy 1 demonstrated that the abbreviated procedure was efficient for identifying and validating the idiosyncratic mood indices of the participants. Study 2 found that presession pairing improved the mood of all three children during DTT, but there were minimal increases in task engagement. Percentage of nonoverlapping data (PND) scores initially revealed no effects for indices of happiness (M = 43.2%), large effects for indices of unhappiness (M = 76.4%), and no effects for task engagement (M = 37.6%). Contrary to this, omnibus Tau-U scores suggested large effects for indices of happiness (Tau-U = 0.7), very large effects for indices of unhappiness (Tau-U = 0.9), and moderate effects for task engagement (Tau-U = 0.5).ConclusionsIndividualized indices of happiness and unhappiness can and should be used as QoL indicators during behavioral interventions for autistic children.

Evaluating Technology-Based Self-Monitoring of Performance with Differential Reinforcement for Students with Disabilities.

This study evaluated the use of a technology-based self-monitoring of performance (SMP) with differential reinforcement to increase task completion and reduce off-task behavior for three 5th-grade students with disabilities. A concurrent multiple baseline design across participants was used to examine the impact of the intervention on the targeted behaviors when implemented by a general education teacher and its maintenance effects with a delay of reinforcement. The implementation involved training students to use a mobile app for SMP and providing differential reinforcement contingent on task completion and accuracy of self-monitoring during academic periods. The secondary measure of off-task behavior was included to evaluate the relationship between task completion and engagement. The results demonstrated that the technology-based SMP with differential reinforcement increased task completion and reduced off-task behavior for all students. Furthermore, the gradual fading of the reinforcement, with a 45 min delay, was successful for all students. The efficiency and immediacy of the intervention suggest that technology-based SMP with differential reinforcement holds promise as a practical, efficient, and effective school-based intervention.

A Mobile Self-control Training App to Improve Self-control and Physical Activity in People With Severe Mental Illness: Protocol for 2 Single-Case Experimental Designs

Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice. This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels. A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023. The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants. PRR1-10.2196/37727.

A Novel Nutrient Intervention of Probiotics, Glutamine, and Fish Oil in Psychological Distress: A Concurrent Multiple Baseline Design.

Objectives: The aim of this study was to investigate whether a combination of nutrients designed to promote gut and brain health also lowers psychological distress. The hypothesis is that a probiotic with fish oil, and glutamine supplement will reduce psychological distress. Design: A multiple baseline design was used to collect data from seven naturopathic patients in private naturopathic clinics in Australia. Patients were between 18 and 65 years of age, and had a Kessler-10 (K10) score between 16 and 30 and symptoms associated with mild gastrointestinal discomfort experienced several times most weeks for 3 months. They were randomized into one of three pathways to stagger the introduction of the intervention. Interventions: Participants received either a supplement incorporating a probiotic formulation (including Lactobacillus rhamnosus), a glutamine powder formulation, and fish oil, or matched placebos. The primary outcome measure was psychological distress as measured by the K10 scale of psychological distress. Results: The data showed a general trend toward lower K10 scores during the active phase compared with the baseline phase, with a marked reduction in the variances between phases. After controlling for time and baseline values, no significant difference between the phases for the K10 and the Perceived Stress Scale was found, but there was still a significant reduction in symptoms on the Gastrointestinal Symptom Rating Scale. Conclusions: A combination of a probiotic formulation, a glutamine powder formulation, and fish oil did not affect psychological distress and perceived stress, but had a significant beneficial effect on gastrointestinal symptoms in patients with high distress and concurrent gut symptomology. Clinical trial registration number: ACTRN12620000928910.

Implementation of Check-In/Check-Out to Improve Classroom Behavior of At-Risk Elementary School Students.

The multi-tiered school-wide positive behavioral interventions and supports offers a comprehensive model for the prevention of behavioral and academic problems in schools. This study evaluated Check-in/Check-out (CICO), a Tier 2 intervention, with three elementary school students from a high-need population, whose problem behavior was hypothesized to be maintained by teacher attention. The study employed a concurrent multiple baseline design across participants, a single case experimental design to examine the effects of CICO on student academic engagement and problem behavior during instruction. Results indicated that implementation of CICO with fidelity by the CICO coordinator, classroom teachers, and parents lead to increased academic engagement and reduced problem behavior in all three students. Tau-U Effect sizes were medium to large for academic engagement and small to medium for problem behavior across students. Data on two students indicate that systematically fading the number of times teachers utilize the daily report card has the potential for promoting maintenance effects. For one student, fading of the coordinator was successful. Social validity assessment indicated high levels of satisfaction with the CICO intervention by the participating students, teachers, and one parent.

An Evaluation of Virtual Training for Teaching Dance Instructors to Implement a Behavioral Coaching Package.

Few dance instructors receive formal training on how to teach dance skills using behavioral coaching methods and may employ an authoritarian teaching style that utilizes coercive feedback, which can adversely affect dancers' experiences. A behavior analytic approach to dance education may provide dance instructors with strategies that increase the accuracy of dance movements and positively affect dancers' satisfaction with their dance classes. Using a concurrent multiple-baseline design across five dance instructors, we evaluated the outcomes of a virtual training informed by the behavioral skills training framework on dance instructors' implementation of an introductory behavior analytic coaching package consisting of four strategies: task analyzing, emphasizing correct performance with focus points, assessing performance through data collection, and using behavior-specific feedback. We selected these strategies to provide dance instructors with a solid foundation to behavioral coaching methods. It is promising that all dance instructors who participated in virtual training met mastery criteria and maintained their performance at a 1-month follow-up. Future research may consider exploring virtual adaptations that promote more efficient training methods for teaching dance instructors to implement behavioral coaching methods.

Effects of eCoaching on the Occurrence, Equity, and Variety of Behavior Specific Praise During Mursion™ Simulations

Engaging in deliberate practice opportunities during special education teacher preparation may increase the implementation and sustainability of evidence-based practices with fidelity in K-12 classrooms. We used a concurrent multiple baseline design across participants to evaluate the effects of providing immediate feedback through eCoaching with online Bug-In-Ear (BIE) technology on special education teacher candidates’ acquisition and sustained use of behavior specific praise (BSP) during Mursion™ classroom simulations. We also measured equitable praise rates and used the Behavior Specific Praise Observational Tool (BSP-OT) to evaluate teacher candidates’ praise variety. Results showed a functional relation between the intervention and teacher candidates’ use of BSP. Maintenance, equity, and praise variety data indicated promising social validity findings.

Investigation of in-phase bilateral exercise effects on corticospinal plasticity in relapsing remitting multiple sclerosis: A registered report single-case concurrent multiple baseline design across five subjects.

Relapsing-remitting Multiple Sclerosis is the most common demyelinating neurodegenerative disease and is characterized by periods of relapses and generation of various motor symptoms. These symptoms are associated with the corticospinal tract integrity, which is quantified by means of corticospinal plasticity which can be probed via transcranial magnetic stimulation and assessed with corticospinal excitability measures. Several factors, such as exercise and interlimb coordination, can influence corticospinal plasticity. Previous work in healthy and in chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. During in-phase bilateral movement, both upper limbs are moving simultaneously, activating the same muscle groups and triggering the same brain region respectively. Altered corticospinal plasticity due to bilateral cortical lesions is common in MS, yet, the impact of these type of exercises in this cohort is unclear. The aim of this concurrent multiple baseline design study is to investigate the effects of in-phase bilateral exercises on corticospinal plasticity and on clinical measures using transcranial magnetic stimulation and standardized clinical assessment in five people with relapsing-remitting MS. The intervention protocol will last for 12 consecutive weeks (30-60 minutes /session x 3 sessions/week) and include in-phase bilateral movements of the upper limbs, adapted to different sports activities and to functional training. To define functional relation between the intervention and the results on corticospinal plasticity (central motor conduction time, resting motor threshold, motor evoked potential amplitude and latency) and on clinical measures (balance, gait, bilateral hand dexterity and strength, cognitive function), we will perform a visual analysis and if there is a potential sizeable effect, we will perform statistical analysis. A possible effect from our study, will introduce a proof-of-concept for this type of exercise that will be effective during disease progression. Trial registration: ClinicalTrials.gov NCT05367947.

Exploring Asynchronous Online Parent Training on Transition Knowledge of Parents of Youth With Disabilities

Parents of youth with disabilities require knowledge to support their children in secondary school. In the 21st century, online asynchronous training is one way to provide knowledge to parents in learning secondary transition concepts. We explored the use of an asynchronous online intervention on three parents’ knowledge of the secondary transition process and confidence levels in supporting their children with disabilities. We used a single-case, concurrent multiple baseline design across three transition areas to evaluate parents’ knowledge of secondary transition planning. Preliminary evidence showed the asynchronous online training improved parents’ knowledge of secondary transition for two participants who completed the entire training program across all three transition areas. Limitations and recommendations for future research and practice are discussed.

Evaluating the Prevent–Teach–Reinforce Model for High School Students With Autism Spectrum Disorder

This study evaluated the use of the Prevent–Teach–Reinforce (PTR) model as an intensive individualized behavior intervention. Three educators and three high school students with autism spectrum disorder participated in the study. A concurrent multiple baseline design across participants was used to demonstrate the outcomes. The results indicated that the educators implemented the PTR intervention plans with high levels of fidelity, and their implementation of the intervention plans led to decreases in problem behavior and increases in replacement behavior across all three participating students with autism spectrum disorder. The educators demonstrated using the Individualized Behavior Rating Scale Tool effectively as designed to monitor student progress, and the educators and students found the PTR intervention to be acceptable and satisfactory. All three educators expressed interest in continuing to implement the PTR intervention after the completion of the study. Implications and areas for future research are discussed.