Naturalistic Behavioral Intervention Research Articles

6.21 Teaching Parents to Facilitate Interaction Between Young Children With Autism Spectrum Disorder and Typically Developing Peers

This poster reviews behavioral outcomes from a randomized controlled trial of the Social SUCCESS program. SUCCESS is a naturalistic behavioral intervention that combines an inclusive social group for children with autism spectrum disorder (ASD) with parent training for setting up effective play dates. A total of 23 children with ASD (4-6 years old; Verbal IQ >70) were randomly assigned to SUCCESS (N = 11) or delayed treatment (delayed treatment group [DTG]; N = 12). SUCCESS participants received 12 social group sessions with typical peers, with therapists arranging cooperative activities to reinforce initiations to peers. Parents attended weekly training to learn behavioral strategies for facilitating peer interactions, and coaching during social-group sessions. DTG participants continued stable community-based services. Acquired skills were measured in both groups at baseline (BL) and posttreatment (PT) using coding from videos of parent-facilitated peer interaction and free play. Parents in the SUCCESS group showed greater change in the number of prompts provided to their child from BL to PT (mean change = 5 additional prompts in 10 minutes; SD = 8.2), compared to minimal change in DTG (mean change = 1.2; SD = 6.2). The greatest increase was in prompting children with ASD to make requests, a skill directly taught during parent training. When their parents used these strategies, children in the SUCCESS group showed a greater increase in the frequency of prompted behavior regulation initiations to peers between BL (M = 1.3; SD = 1.6) and PT (M = 4.3; SD = 2.8), compared to children in the DTG (BL M = 2.6, SD = 2.8; PT M = 2.5, SD = 2.7, F = 6.9, p = 0.015). Children in SUCCESS also showed a greater increase in prompted and unprompted initiations across both parent-facilitated and free-play probes than children in DTG (p = 0.001). Lastly, children in the SUCCESS group increased the number of peer-directed initiations by 56% (p = 0.001), whereas initiations directed toward parents decreased by 38%. Parents of children with ASD can effectively implement naturalistic behavioral strategies for motivating children with ASD to communicate with typical peers. When they do so, their children direct more initiations to peers and fewer to adults, showing promise for enhancing social motivation for peer interactions through parent training.

Assessing and Improving Preverbal Social Communication: Teacher-Led Naturalistic Behavioral Developmental Interventions

Assessing and Improving Preverbal Social Communication: Teacher-Led Naturalistic Behavioral Developmental Interventions

Prelinguistic Interventions

To review studies evaluating interventions for developing the prelinguistic communication skills of young children with developmental disorders and complex communication conditions. Evidence supports the use of naturalistic behavioral interventions for improving the prelinguistic communication skills of young children with developmental disorders provided that the interventions are implemented in relatively high doses. Early intervention to replace or enhance a child’s prelinguistic behavior may help to prevent communicative breakdowns and the emergence of problematic forms of communication. Future research using rigorous methodology is needed to identify the specific intervention components that promote prelinguistic behavior change as this may lead to differential responsivity to interventions.

Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism.

Deficits in social skills are common in children with Autism Spectrum Disorder (ASD), and there is an urgent need for effective social skills interventions, especially for improving interactions with typically developing peers. This study examined the effects of a naturalistic behavioral social skills intervention in improving social initiations to peers through a randomized controlled trial. Analyses of multimethod, multi-informant measures indicated that children in the active group (SIMI) demonstrated greater improvement in the types of initiations which were systematically prompted and reinforced during treatment (i.e., behavior regulation). Generalization to joint attention and social interaction initiation types, as well as collateral gains in broader social functioning on clinician- and parent-rated standardized measures were also observed.

Training Teachers to Implement Classroom Pivotal Response Teaching during Small-group Instruction: A Pilot Study

ABSTRACT Background: Providing effective education to students with autism spectrum disorder (ASD) poses a significant challenge to educators. Although several evidence-based practices (EBPs) have been developed, few have been systematically implemented in educational settings. Pivotal response treatment (PRT) is a naturalistic behavioral intervention that has been adapted for implementation in the school context. Methods: This pilot study used a concurrent multiple baseline design across seven teachers and students with ASD to examine the effectiveness of teacher training in classroom pivotal response teaching (CPRT) on teacher fidelity of implementation during small-group instruction and students’ communication skills and maladaptive behaviors in schools for special education in the Netherlands. Results: Results indicated no replicated effect of CPRT training on teachers’ fidelity of implementation or children’s communications skills and maladaptive behavior, although teachers reported high satisfaction with the CPRT training. Discussion: Implications for clinical practice and directions for future research are discussed.

A Naturalistic Behavioral Intervention to Increase Interaction between Siblings with and without Autism.

Research suggests that including typically developing siblings in interventions for children with autism spectrum disorder (ASD) may be beneficial. However, studies have predominantly involved only participants with mild symptoms of ASD and have not also reported outcomes for the typically developing sibling. The purpose of this study was to address these gaps by replicating and extending an intervention package consisting of structured, interest-based play activities, adult instruction and modeling, and response to child questions. A reversal design across two sibling dyads was used to demonstrate the effects of the intervention on the social interaction behaviors of the child with ASD and typically developing sibling. Social interaction increased for both sibling dyads, results generalized for one dyad, and multiple measures indicated a high level of social validity. Recommendations for practitioners and caregivers working with children with ASD and potential areas of future research are discussed.

The Effects of Prelinguistic Milieu Teaching Implemented in Classrooms for Preschoolers With or at Risk for Autism Spectrum Disorder

Much research exists supporting the efficacy of naturalistic behavioral interventions on increasing social communication skills for children with autism spectrum disorder (ASD); however, these evidence-based interventions are not consistently utilized in preschool classrooms. Prelinguistic Milieu Teaching was used to teach early intentional communication (i.e., purposeful and coordinated use of vocalizations, gestures, and eye contact) to three preschool students with or at risk for ASD. The present study extends prior research demonstrating the effects of PMT in increasing intentional communication through implementation in a preschool special education classroom, measurement of collateral gains related to PMT targets, and measurement of maintenance and generalization of gains. Results indicate students increased their rates of intentional communication upon introduction of PMT. These gains maintained over time for two students. Present study results have implications for future research and practice regarding the efficacy and feasibility of implementing PMT in preschool classrooms.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation.

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.Lay abstractPivotal response treatment is a naturalistic behavioral intervention that teaches pivotal skills to children with autism spectrum disorder to produce widespread gains in other skills. Although most children with autism spectrum disorder benefit from pivotal response treatment, intervention outcomes vary considerably among children. Fidelity of intervention implementation (i.e. the extent to which an intervention is implemented as intended) may affect intervention outcomes. In this study, we studied the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether a child’s age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 pivotal response treatment therapists who videotaped three pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. This study found that therapists’ openness to innovation and their experience with pivotal response treatment predicted fidelity of implementation. Therapist personality, therapist–child relationship, and child characteristics were not related to pivotal response treatment fidelity. The results of this study emphasize that it is important (1) to target therapists’ attitudes toward innovation prior to or during training in pivotal response treatment and (2) to provide therapists with ongoing supervision and feedback after training to increase fidelity of implementation and thus to improve intervention outcomes for children with autism spectrum disorder.

Naturalistic Interventions to Improve Prelinguistic Communication for Children with Autism Spectrum Disorder: a Systematic Review

The current review identified 11 single-case design (SCD) and 14 group-design evaluations of naturalistic behavioral interventions targeting prelinguistic social communication in young children with autism spectrum disorder (ASD). Three SCD studies and eight group design studies utilized methodologically rigorous designs and demonstrated a functional relation between the intervention and child prelinguistic social communication. Results of this systematic review provide information about efficacy of specific naturalistic behavioral interventions, details about the intervention, and characteristics of the implementation agent and setting. Such information may be useful to support implementation of evidence-based practices and increase the quality of future research.

Classroom Pivotal Response Teaching: Teacher Training Outcomes of a Community Efficacy Trial

Classroom Pivotal Response Teaching (CPRT) is a naturalistic behavioral intervention for students with autism spectrum disorder (ASD) that was systematically adapted for teacher use. In this study, the authors evaluate outcomes of a large randomized trial training teachers ( n = 126) to use CPRT. Training involved 12 hours of small group sessions and additional 1:1 coaching in each teacher’s classroom. Overall, CPRT fidelity was significantly higher at the end of the training year relative to the observation year ( B = 0.24, p = .001) and teachers report using CPRT an average of 47 minutes per day. Moderator analyses indicate that training, teacher, and classroom- and school-level characteristics affected CPRT fidelity. Teachers report high overall satisfaction ( M = 4.37, SD = 0.45; 1-5 Likert-type scale) and confidence in their ability to use CPRT with their students ( M = 4.2, SD = 0.57). In this study, the authors indicate the acceptability and feasibility of the CPRT training protocol and adds to the limited number of school-based randomized controlled trials (RCTs) evaluating interventions for students with ASD.

Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training

Training behavioral technicians mainly focuses on teaching accurate implementation of structured behavioral intervention programs. Often behavioral technicians are unable to adequately promote their clients' learning in less structured environments, which can limit opportunities for generalization of the clients' skills to the natural environment. The aim of the present study was to evaluate the effectiveness of using behavioral skills training to coach behavioral technicians on the implementation of naturalistic behavioral interventions. Naturalistic behavioral interventions take advantage of naturally occurring situations to teach new skills and practice mastered skills in natural settings, thus promoting generalization across environments and in the presence of natural contingencies. Five behavioral technicians were trained to implement a novel protocol based on play therapy. Specifically, they were coached to engage in well‐defined positive behaviors during their interactions with clients (e.g., labeled praise). All participants reached mastery criteria, maintained skills at follow‐up, and demonstrated generalization of skills with novel clients.

The influence of maternal language responsiveness on the expressive speech production of children with autism spectrum disorders: A microanalysis of mother–child play interactions

Adult responsiveness is related to language development both in young typically developing children and in children with autism spectrum disorders, such that parents who use more responsive language with their children have children who develop better language skills over time. This study used a micro-analytic technique to examine how two facets of maternal utterances, relationship to child focus of attention and degree of demandingness, influenced the immediate use of appropriate expressive language of preschool-aged children with autism spectrum disorders (n = 28) and toddlers with typical development (n = 16) within a naturalistic mother-child play session. Mothers' use of follow-in demanding language was most likely to elicit appropriate expressive speech in both children with autism spectrum disorders and children with typical development. For children with autism spectrum disorders, but not children with typical development, mothers' use of orienting cues conferred an additional benefit for expressive speech production. These findings are consistent with the naturalistic behavioral intervention philosophy and suggest that following a child's lead while prompting for language is likely to elicit speech production in children with autism spectrum disorders and children with typical development. Furthermore, using orienting cues may help children with autism spectrum disorders to verbally respond.

Disseminating ASD Interventions: A Pilot Study of a Distance Learning Program for Parents and Professionals

There is a need for the adaptation of training in evidence-based interventions to non-traditional methods, particularly for individuals working with children with autism spectrum disorders (ASD). An internet-based self-directed distance learning program was created to teach reciprocal imitation training, a naturalistic behavioral intervention aimed at increasing imitation in children with ASD. A single-subject multiple-baseline design study evaluated the effect of the program on changes in therapist (sample 1) and parent (sample 2) knowledge and behavior, and changes in child behavior. Adult participants improved their knowledge and use of the intervention techniques, and child participants improved their rates of imitation. Results suggest that a self-directed distance learning program may be effective for disseminating evidence-based practices to individuals working with children with ASD.

A Comparison of Developmental Social–Pragmatic and Naturalistic Behavioral Interventions on Language Use and Social Engagement in Children With Autism

Developmental social-pragmatic and naturalistic behavioral interventions share a number of features, but they differ in their use of facilitative strategies and direct elicitation of child language. In this study, the authors investigated whether these approaches produce different language and social outcomes in young children with autism. The authors used an ABACAD design to compare the effects of a developmental social-pragmatic, naturalistic behavioral, and combined intervention on language type and function and social engagement in 5 children with autism. Milieu teaching and the combined intervention produced higher rates of language targets than did responsive interaction. An analysis of the type and function of language targets suggested that differences between conditions were driven primarily by prompted-and, to a lesser extent, spontaneous-requests. Social engagement ratings were higher during each intervention than at baseline, but differences between treatment conditions were not consistent across children. For children with autism, naturalistic interventions that use direct elicitation of child language lead to greater short-term gains in the use of expressive language targets-in particular, prompted requests-than interventions that use facilitative strategies only. All 3 naturalistic language interventions can promote social engagement. For some children, the combined use of direct elicitation and responsiveness-based strategies may enhance treatment response.

The impact of object and gesture imitation training on language use in children with autism spectrum disorder.

Reciprocal imitation training (RIT) is a naturalistic behavioral intervention that teaches imitation to children with autism spectrum disorder (ASD) within a social-communicative context. RIT has been shown to be effective at teaching spontaneous, generalized object and gesture imitation. In addition, improvements in imitation are associated with increases in verbal imitation and spontaneous language. This study used a modified multiple-baseline design across 4 children to examine whether adding gesture imitation training improves the overall rate of appropriate language use in children with ASD who have already been participating in object imitation training. Three of the 4 children showed greater improvements in their use of appropriate language after gesture imitation was begun. Further, the children were more likely to use verbal imitation during gesture imitation training than during object imitation training. These findings suggest that adding gesture imitation training to object imitation training can lead to greater gains in rate of language use than object imitation alone. Implications for both language development and early intervention are discussed.

Pivotal Response Teaching in the Classroom Setting

ABSTRACT Pivotal response teaching (PRT) is an empirically supported naturalistic behavioral intervention proven to be efficacious in the education of children with autism. This intervention involves loosely structured learning environments, teaching during ongoing interactions between student and teacher, child initiation of teaching episodes, child choice of teaching activities or materials, prompting, providing reinforcers directly related to the child's behavior, and providing reinforcement for child goal-directed attempts to respond. PRT has been widely studied and has been effective in increasing verbal communication, joint attention, play skills, peer social interactions, and homework skills. Although the use of PRT in classroom settings has not yet been empirically studied, work is underway to develop PRT-based procedures for such settings. The authors discuss barriers to PRT translation to classroom settings and strategies for improving such implementation.

Teaching the Imitation and Spontaneous Use of Descriptive Gestures in Young Children with Autism Using a Naturalistic Behavioral Intervention

Children with autism exhibit deficits in the imitation and spontaneous use of descriptive gestures. Reciprocal Imitation Training (RIT), a naturalistic imitation intervention, has ben shown to increase object imitation skills in young children with autism. A single-subject, multiple-baseline design across five young children with autism was used to determine whether RIT could be adapted to target the imitation of descriptive gestures. All participants increased their imitation of gestures in the treatment setting and on a structured imitation assessment. Gains generalized to a novel therapist, setting, and materials and maintained at a 1-month follow-up. Three participants also increased their spontaneous use of descriptive gestures. These results provide support for the effectiveness of a naturalistic intervention for teaching gesture imitation.

Teaching Reciprocal Imitation Skills to Young Children with Autism Using a Naturalistic Behavioral Approach: Effects on Language, Pretend Play, and Joint Attention

Children with autism exhibit significant deficits in imitation skills which impede the acquisition of more complex behaviors and socialization, and are thus an important focus of early intervention programs for children with autism. This study used a multiple-baseline design across five young children with autism to assess the benefit of a naturalistic behavioral technique for teaching object imitation. Participants increased their imitation skills and generalized these skills to novel environments. In addition, participants exhibited increases in other social-communicative behaviors, including language, pretend play, and joint attention. These results provide support for the effectiveness of a naturalistic behavioral intervention for teaching imitation and offer a new and potentially important treatment option for young children who exhibit deficits in social-communicative behaviors.