Early Intensive Behavioral Intervention Research Articles

Analyzing the Functional Interdependence of Verbal Behavior with Multiaxial Radar Charts

AbstractThe functional analysis of complex verbal behavior requires an evaluation of topographically similar responses under multiple sources of control. Traditional graphical displays of behavior were designed to show the manipulation of isolated controlling variables and may not be amenable to displaying the multidimensional properties of complex behavior. Researchers have recently demonstrated the use of multiaxial radar charts for comparing the functional performance of biological systems. Here we extend the use of multidimensional analyses to compare the relative performance distributions of verbal behavior across four potential controlling variables. First, we provide a conceptual analysis of intraverbal and extraverbal control as continua along which stimuli range from formal to thematic and explain how the intersection of these stimulus fields creates a radar chart for multidimensional analysis. Then we demonstrate how data may be gathered through a verbal operant experimental analysis. We employed repeated measures to map the conditioning history of a child with autism spectrum disorder across 2 years of early intensive behavioral intervention and analyzed the results using shape descriptors for quantitative comparisons. We also compared the polygonal language profiles of children with autism against that of a neurotypical peer. Extending a multidimensional analysis to the field of verbal behavior provides the basis for a language growth chart that researchers and clinicians can use to monitor language acquisition over time. We discuss the use of radar charts as a framework for understanding the interdependence of verbal operants and suggest their use for complex analyses of complex verbal behavior.

Effects of Parent and Teacher Mediated Pivotal Response Treatment and Discrete-Trial Training in Improving Communication Skills of Children with Autism

The main purpose of this study was to investigate the effects of parent and teacher-mediated pivotal response treatment and discrete-trial teaching in improving the communication skills of children with Autism. The research deployed an ABAB research design. ABAB was divided into 4 phases; A1, B1, A2, and B2. A1 was a baseline, B1 was treatment, A2 was the removal of the treatment, and B2 was the treatment resumed following the break, and at last, a follow-up was conducted. In the study, three children who fulfilled the inclusionary criteria participated. The three children received PRT and DTT from their parents and teachers respectively. The instruments used for assessment were social communication questionnaire-Lifetime, Autism diagnostic interview-revised, and Vineland -3 Adaptive behavioral scale (communication domain). The study result indicated that Parent and Teacher mediated PRT and DTT significantly improved the communication skills of children with ASD.

Comparative efficacy of family mediated intervention versus early intensive behavioural intervention on symptom domains in children with autism spectrum disorder: A randomized controlled trial

BackgroundFamily Mediated Intervention (FMI) and Early Intensive Behavioural Intervention (EIBI) are found to be standard of care for children with Autism Spectrum Disorder (ASD). Comparison of their efficacy were assessed using ISAA as primary outcome measure. MethodsThis study was a parallel arm, open label, randomized active- controlled non-inferiority clinical trial. 50 Children diagnosed with ASD were randomized into FMI and EIBI groups. Clinical status was checked by using Indian scale for assessment of autism (ISAA), Oro- motor and sensory profile at baseline, after three and six months. ResultsDifference between change in mean ISAA score between FMI and EIBI group at the end of 6 months as per protocol (PP) analysis was −7.23 (CI=-18.41, 3.94), which was within pre-defined clinically relevant non-inferiority (NI) margin of – 24. FMI was found to be non-inferior to EIBI at the end of 6 months as the lower bound of 95% CI (-18.41) for ISAA score was higher than NI margin. ISAA scores were found to be statistically lower in both FMI and EIBI groups at the end point compared to baseline which indicated improvement in symptom severity. ConclusionFMI was non-inferior to EIBI as therapy for children with ASD at the end of six months. Finding also indicated longer duration of treatment is required for FMI to be superior. FMI can be recommended for children with ASD in view of improved ISAA scores reported in our study. Clinical trial registration numberCTRI/2020/08/027099 (Registered with Clinical Trials Registry- India)

Replicative Study of the Impacts of Applied Behavior Analysis on Target Behaviors in Individuals With Autism Using Repeated Measures.

Background The effectiveness of interventions based on applied behavior analysis (ABA) for individuals with autism has been well documented in numerous meta-analyses, systematic reviews, and cost-benefit analyses. However, an observed 'efficacy-effectiveness gap' exists, which can be attributed to various factors. This third replication study, therefore, has significant implications for the field. By assessing the impact of ABA treatment, specifically involving discrete trial training and mass trials, within a naturalistic environment, the study provides valuable insights that can inform and improve the delivery of ABA treatments in real-world settings. Methods The study was conducted using a repeated measures research design. Retrospective chart review data were collected from 62 individuals with autism, age(M=8.65, SD=4.53), all of whom were level two autistic and required moderate support in communication, socialization, and daily life. These individuals received ABA treatment over five months. The study measured cumulative target behaviors using a repeated measures design, which allowed for the identification of statistically significant differences across 12 time points. This robust methodology ensures the validity and reliability of the study's findings. Results Mixed repeated measures analysis of variance (ANOVA) indicated statistical significance (sphericity assumed), F(11,495) = 55.432, p < 0.001 (time). Multiple comparisons using bootstrapped paired t-tests showed p < 0.05 on time points 1-8 and non-significance (p > 0.05) on time points 9-12. There was a significant interaction effect (sphericity assumed) with time x (age category), F(44,495) = 2.338, p < 0.001. Interaction contrasts indicated statistically significant differences over time, mainly within the one-year to four-year-old, five to eight-year-old, and most in the nine to 12-year-oldage groups. There was some significance within the 13- to 16-year-old age group and no significance within the 17- to 26-year-old age group. Conclusions Over five months, individuals with autism who underwent ABA treatments demonstrated a statistically significant enhancement in general target behaviors. This finding is crucial as it underscores the effectiveness of ABA treatments in a naturalistic environment. Moreover, the study's discovery of a significant interaction between time and age in these behaviors provides valuable insights into the impact of age on treatment outcomes. Extensive large-N studies of general ABA broad effectiveness and repeated measures designs are lacking and can lead to further research to improve quality and outcomes. These findings contribute to the body of empirical evidence and emphasize the importance of replicative efficacy studies in ensuring the reliability of research findings.

Treating Target Behaviors of Autistic Individuals With Applied Behavior Analysis: An Ongoing Replication Study.

Background Ongoing outcome data replication on target behaviors with autistic individuals using applied behavior analysis (ABA) confirms its effectiveness and remains an essential evidenced-based standard of care. This replication study aims tofurther confirm the impact of discrete trial training and mass trials on general target behaviors within a naturalistic environment. Methods Data was gathered from 92 children and four adult autistic individuals over one month from 7/7/23to 8/8/23using a repeated measures design. This study used a retrospective chart review with general target behaviors to determine the effectiveness of ABA treatments using discrete trial training and mass trials across time and age categories in a naturalistic environment. Results A mixed analysis of variance (ANOVA) indicated statistical significance (sphericity assumed), F(2,168) = 31.663, p < 0.001 (time). Multiple comparisons using bootstrapped paired t-tests indicated p < 0.001 on the three comparisons. There was a significant interaction effect (sphericity assumed) with timex age category, F(8,168) = 2.918, p = 0.004. Interaction contrasts indicated statistically significant differences over time within the 1-4 years, 5-8 years, and a portion of 9-12 years, and not within the 13-16 years and 17-73 years age groups. Conclusions Autistic individuals receiving ABA demonstrated statistically significant improvement in target behaviors over one month. There was a significant interaction between timeand ageon target behaviors, suggesting a significant association between time and age categories.The reporting of ongoing intervention outcomes provides further justification for continued treatmentsrelative to target behavior mastery with autistic individuals.

Outcomes for children with autism spectrum disorder and their families after two years of school based early intensive behavioural intervention.

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.

Predicting Behavioral Target Mastery With Age, Intensity and Duration, Open Targets, and Maintenance Failure With Applied Behavior Analysis in Individuals With Autism.

Background Researchers have studied the effects of age, treatment intensity, andtreatment duration with applied behavior analysis (ABA) outcomes in autistic individuals. This study's primary objective was to evaluate the predictive capabilities of age, intensity, and duration of treatment, open behavioral targets, and behavior maintenance failure on behavioral target mastery. Methods A retrospective cohort of 100 autistic individuals treated with ABAwith functional analysis and discrete trial training, mass trials, and naturalistic training were treated and analyzed. Target behavioral mastery data was collected via a retrospective chart review contained within the "Catalyst" tracking software. ABA treatment was administered for three months between March 19, 2023, and June 11, 2023. Multiple linear regression was performed using the percentage of behavioral targets mastered as the dependent variable. The independent variables were age, average trials to behavioral mastery, average teaching days to behavioral mastery, and percentage of behavioral targets that failed in maintenance. Results The multiple linear regression model was statistically significant (R=0.443, R²=0.196, adjusted R2=0.150, F(5, 87)=4.239, p=0.002). The average teaching days to mastery (β=0.416, p=0.019) and percentage of targets failed in maintenance (β=0.201, p=0.047) significantly predicted the percentage of behavioral targets mastered. However, age (β=0.079, p=0.419), average trials to mastery (β=-0.271, p=0.114), and open targets (β=0.184, p=0.081) did not significantly predict the percentage of behavioral targets mastered. The analysis of variance (ANOVA) resulted in non-significant (p>0.05) age group differences between the above variables. Conclusions The predictor variables average teaching days to mastery (intensity and duration) and percentage of targets failed in maintenance had a statistically significant effect on the percentage of behavioral targets mastered. The predictor variables age, average trials to behavioral mastery (intensity and duration), and open behavioral targets had a non-significant influence on the percentage of behavioral targets mastered. A non-significant difference between age groups was found in all study variables.

Examining the Effects of Discrete Trials, Mass Trials, and Naturalistic Environment Training on Autistic Individuals Using Repeated Measures.

Behavioral interventions based on applied behavior analysis (ABA) form current evidence-based practices in treating autism spectrum disorder (ASD). Research is scarce relative to the broad effects of intensive repetitive, discrete trial training, and mass trials combined with a naturalistic environment as measured by overall general target behaviors.The primary objective of this study was to evaluate the effectiveness of a mixed behavioral model consisting of discrete trial training and mass trial interventions in the naturalistic environment, using a repeated measures design with a retrospective snapshot cohort of 93 individuals with autism. A repeated measures analysis tracked 89 autistic children with four adultautistic individuals over seven time points during a three-month snapshot period from March 19, 2023, to June 11, 2023. This study determined the effectiveness of applied behavior analysis (ABA) interventions combining discrete trial training, mass trials, and naturalistic environment training on mastered broad target behaviors in autistic individuals using a mixed (between and within) ANOVAstatistical design. Mixed (between and within) ANOVAindicated overall statistical significance, F (6,674)=45.447, p<0.001, partial eta squared=0.365across time. These results indicated a large effect size. Multiple comparisons showed statistical significance (p<0.001) on all 21 multiple comparisons between timepoints. There was also a significant interaction effect with time× age category,F (24,474)=2.961, p<0.001, partial eta squared=0.130. These results alsoindicated a large effect size. Autistic individuals who received applied behavior analysis combining discrete trial training, mass trials, and naturalistic environment training intervention demonstrated statistically significant improvement in target behaviors over the three-month snapshot period, the most prominent being in the 13-16 yearsage category.

Early Intervention for Children with Autism Spectrum Disorder in Dubai: A Rapid Review and Policy Option Analysis

Background:: Autism Spectrum Disorder (ASD) is a complex and heterogeneous neurodevelopmental disorder that is associated with functional impairments across an individual’s lifespan. The complexity and increasing global prevalence of ASD pose significant strains on healthcare systems. Early Intensive Behavioral Interventions (EIBI) are cost-effective evidence-based interventions that improve outcomes for individuals with ASD, especially when implemented in early childhood. Objectives:: This study reviews the disease burden of ASD and analyzes four potential financing models for EIBI in Dubai. Methods:: A rapid literature review was conducted to synthesize the disease burden of ASD and EIBI services in Dubai. Bardach’s eightfold model for policy analysis was used to analyze four policy options for EIBI in Dubai: (1) Government financing and provision of EIBI through specialized centers, (2) Government financing of EIBI through contracting private providers, (3) Mandating insurance coverage of EIBI for children with ASD, and, lastly, (4) A mixed model that includes both mandating insurance coverage for EIBI and government provision through non-profit organizations. Results:: EIBI services were available in Dubai but were associated with a substantial out-of-pocket (OOP) burden on families. Many young children with ASD were unable to access EIBI. Option (4) of using the mixed financing model of EIBI was optimal in the context of Dubai, based on evaluation criteria, including accessibility, cost-effectiveness, quality, and implementability, with minimal OOP burden on families. Conclusion:: To ease the burden on families with children suffering from ASD, the stakeholders, including the government of Dubai, should consider a mixed financial model to provide EIBI.

The Effect of Applied Behavior Analysis (Discrete Trial Training) in Improving Sensory Skills in Mentessori Approach for Children with Autism spectrum disorder (ASD)

The Effect of Applied Behavior Analysis (Discrete Trial Training) in Improving Sensory Skills in Mentessori Approach for Children with Autism spectrum disorder (ASD)

Effect of Discrete Trial Training and Scripting on Third Person Past Tense Marking of Children with Autism and Cochlear Implant in Tamil Language

The purpose of the study was to evaluate the effect of Discrete Trial Training and scripting on third person past tense marking in children with Autism and cochlear implanted children in Tamil language. Total of 8subjects, 4 children with Autism and 4 with cochlear implant with age group between 6 to 12 yrs. Both the groups were assessed using past tense scoring. Both groups scored 0% in pre therapy assessment. Whereas both groups scored 100% in post therapy assessment. Drastic improvement was recorded. The conclusion of this study indicates that the Discrete Trial Training and Scripting are effective in improving past tense marking of children with Autism and cochlear implant.

Assessing the Verbal Behavior of a Linguistically Diverse Speaker with Autism

AbstractFor speakers belonging to multiple verbal communities, functional analyses of verbal behavior allow for dynamic control over response topography. The simple practice of allowing the speaker the freedom to select the language of instruction minimizes cultural bias and hegemony. We extended the research on functional analyses of verbal behavior to include a speaker of multiple languages in a quasi-experimental case study. We employed verbal operant experimental (VOX) analyses as a repeated measure of language acquisition with a linguistically diverse, 7-year-old Indian boy with autism. The VOX analyses were conducted as part of the child’s early intensive behavioral intervention, and we observed the impact of an immersive foreign language experience on his verbal repertoire with follow-up VOX analyses conducted in three topographically distinct languages: English, Telugu, and Tamil. The results show a dynamic hierarchy of strength between the three languages, with overarching patterns across the three assessments. The implications for using VOX analyses to assess the functional language skills of multilingual speakers with autism are discussed, and areas of future research are highlighted.

Effect of Teacher-Mediated Discrete-Trial Training in Improving Communication Skills of Children with Autism Spectrum Disorder

The main purpose of this study was to investigate the effect of teacher-mediated discrete trial training in improving the communication skills of children with Autism. The research deployed an ABAB research design, ABAB was divided into 4 phases; A1, B1, A2, and B2. A1 was a baseline, B1 was treatment, A2 was the removal of the treatment, and B2 was the treatment resumed following the break, and at last, a follow-up was conducted. In the study, three children with ASD who fulfilled the inclusionary criteria received Discrete-Trial Training from their teachers. In the study, the instruments used for assessment were social communication questionnaire-Lifetime, Autism diagnostic interview-revised, and Vineland -3 Adaptive behavioral scale (communication domain). To examine the intervention effect on each participant, visual analysis, raw score, v-scale score, and standard score comparisons were used. The study result indicated that teachers successfully learned the procedures of DTT and significantly improved the communication skills of students with ASD. This research shows that when DTT intervention is found important for children with ASD, teachers obtain intensive training to learn techniques and deliver interventions with fidelity. Training further allows teachers to improve the skills of children with ASD.

A Pilot Feasibility Study Assessing the Combined Effects of Early Behavioral Intervention and Propranolol on Autism Spectrum Disorder (ASD).

Autism spectrum disorder (ASD), a neurodevelopmental disorder typified by differences in social communication as well as restricted and repetitive behaviors, is often responsive to early behavioral intervention. However, there is limited information on whether such intervention can be augmented with pharmacological approaches. We conducted a double-blinded, placebo-controlled feasibility trial to examine the effects of the β-adrenergic antagonist propranolol combined with early intensive behavioral intervention (EIBI) for children with ASD. Nine participants with ASD, ages three to ten, undergoing EIBI were enrolled and randomized to a 12-week course of propranolol or placebo. Blinded assessments were conducted at baseline, 6 weeks, and 12 weeks. The primary outcome measures focusing on social interaction were the General Social Outcome Measure-2 (GSOM-2) and Social Responsiveness Scale-Second Edition (SRS-2). Five participants completed the 12-week visit. The sample size was insufficient to evaluate the treatment efficacy. However, side effects were infrequent, and participants were largely able to fully participate in the procedures. Conducting a larger clinical trial to investigate propranolol's effects on core ASD features within the context of behavioral therapy will be beneficial, as this will advance and individualize combined therapeutic approaches to ASD intervention. This initial study helps to understand feasibility constraints on performing such a study.

Evaluation of a rapport‐building intervention for early interventionists working with children on the autism spectrum

AbstractRapport, or the therapeutic relationship between a therapist and client, is essential for successful intervention. In behavior analytic interventions for autistic children, practitioners commonly use pairing to establish rapport. A limited body of research has evaluated how to train interventionists to pair with their child clients. Furthermore, fewer studies have examined the effects of pairing on client behavior. Therefore, we implemented behavioral skills training to teach interventionists pairing skills and assessed the effects of presession pairing on child interfering behavior using a concurrent multiple probe design (with replication). We implemented a pairing protocol before early intensive behavioral intervention sessions with four children (3–5 years old) on the autism spectrum. Interventionists mastered pairing skills during training sessions, which were generally maintained when working with child clients. When interventionists implemented presession pairing, child participants demonstrated fewer interfering behaviors. We discuss implications of our preliminary findings and future directions.

"On an island by myself": implications for the inclusion of autistic students in self-contained classrooms in public elementary schools.

Autistic students have limited access to inclusive classes and activities in their schools. Principals and special education teachers who directly teach and administer programs for autistic elementary students can offer critical insight into factors, such as educators' attitudes, that may impact inclusive opportunities in schools. These attitudes may serve as barriers to or facilitators of promoting an inclusive school setting. Semi-structured interviews with 26 elementary school principals and 26 special education teachers explored their experiences implementing evidence-based practices for autistic students (pivotal response training, discrete trial training, and visual schedules) in 26 self-contained classrooms in the United States. Autism-specific culture and inclusion emerged as a theme, which was analyzed for this paper. An inductive approach to thematic analysis revealed principals' and special education teachers' perspectives regarding the "autism-specific culture" in the school, including attitudes towards and inclusion of autistic students in self-contained classrooms in the broader school environment. Analysis of text related to "autism-specific culture" detailed aspects of inclusion, factors (i.e., barriers and facilitators) affecting inclusion, principals' and special education teachers' attitudes towards autistic students placed in self-contained classrooms, attitudes of other school staff towards teachers in self-contained classrooms, and recommendations to support an inclusive school environment for autistic students. Results suggest that valuing "equal" access to classes and activities for autistic students in self-contained classrooms may not be sufficient for promoting an inclusive school environment, Educators may benefit from targeted strategies to facilitate inclusion. Strategies range from supporting educators' attitudes and knowledge of autism to shifting physical aspects of the school environment (e.g., location of classrooms). Additional implications for supporting the true inclusion (i.e., inclusion that goes beyond physical inclusion) involves of autistic students in self-contained classrooms schools are discussed.

Efficacy of nonpharmacological interventions targeting social function in children and adults with autism spectrum disorder: A systematic review and meta-analysis.

This paper aimed to evaluate the use of nonpharmacological interventions for the management of autism spectrum disorder (ASD). The effects of acupuncture and behavioural therapy, two nonpharmalogical interventions, on social function in ASD patients are still controversial. This meta-analysis investigated the impact of these two treatments and compared their effects. Seven electronic databases were systematically searched to identify randomized controlled trials (RCTs) on the use of acupuncture or behavioural therapy for ASD. A meta-analysis was carried out using Review Manager 5.4 software. Continuous data are reported as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). An assessment of methodological quality using the Cochrane risk-of-bias (ROB) tool for trials was carried out. The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality (certainty) of evidence for results regarding social function indicators. Thirty RCTs on acupuncture and 36 on behavioural therapy were included. Compared with the control condition, body acupuncture (SMD: 0.76, 95% CI: [0.52, 1.01]; low certainty), modern acupuncture technology (SMD: 0.84, 95% CI: [0.32, 1.35]; low certainty), cognitive behavioural therapy (SMD: 0.42, 95% CI: [0.26, 0.58]; high certainty), the Denver model (SMD: 0.61, 95% CI: [0.23, 0.99]; moderate certainty) and social skills training (SMD: 0.56, 95% CI: [0.41, 0.71]; moderate certainty) improved social functioning. Behavioural therapies (such as CBT, the Denver model, social skills training), improved the social functioning of patients with ASD in the short and long term, as supported by high- and moderate-quality evidence. Acupuncture (including scalp acupuncture, body acupuncture and use of modern acupuncture technology) also improved social functioning, as supported by low- and very low-quality evidence. More high-quality evidence is needed to confirm the effect of acupoint catgut embedding and Early Intensive Behavioural Intervention (EIBI).

Remote training of educators in Taiwan to disseminate discrete trial training for students with developmental disabilities

AbstractEducators in many areas of the world lack the necessary resources and training to serve students with developmental disabilities effectively. Telehealth technologies and a train‐the‐trainer approach may help disseminate evidence‐based instructional strategies to teachers in underserved areas. In this study, experimenters combined synchronous and asynchronous remote training to prepare six teachers in Taiwan to implement discrete trial training (DTT) with students. First, the experimenter taught three teachers from a private school to implement DTT with their students. Then, they trained these participants to teach another educator at their school. Finally, the three teachers trained those additional educators. Results indicated that the training was effective for all participants and that the DTT skills of the three trainers maintained over time and transferred to their in‐classroom instruction. These findings replicate and extend the current literature suggesting that the use of telehealth and a train‐the‐trainer model is a promising and socially valid method for disseminating ABA to countries with limited resources.

Comparing the Effectiveness of Discrete Trial Training Delivered via Telehealth and In-Person on Skill Acquisition

Comparing the Effectiveness of Discrete Trial Training Delivered via Telehealth and In-Person on Skill Acquisition

DailyConnect: Piloting Interventions of Situation-Based Emotional Understanding in Naturalistic Home Settings for Children with Autism Spectrum Disorder

DailyConnect is a visual-based mobile application that supports children with autism spectrum disorder (ASD) in recalling memories by reviewing photos through discrete trial training (DTT) to understand situation-based emotions. To assess DailyConnect and its adaptability to a child’s characteristics and emotional situations, a pilot study was conducted that included 15 children with ASD and their parents and teachers. The DTT steps—memory recall and situation recognition, emotion recognition, emotion cues, facial expression recognition, and response behavior—were reliable in assessing the understanding of emotional situations when compared before and after the intervention in four categories of emotional situations, namely, happiness, sadness, anger, and fear. The results revealed that DailyConnect improves the understanding of situation-based emotions, particularly negative emotions (e.g., sadness: mean diff = −.687, sig. < .01, T = −3.866, d = 1.006; anger: mean diff = −.952, sig. < .01, T = −6.187, d = .705; fear: mean diff = −.961, sig. < .01, T = −5.522, d = .627); however, its effectiveness varied for children in different emotional situations. Furthermore, subjective feedback from participants and users (parents and teachers) provided insights into design considerations for similar mobile aids.