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Autism Research at the Center for Excellence in Disabilities

The PITA-T research study ended on June 30, 2014. The purpose of the study was to investigate ways to improve rural access to applied behavior analysis (ABA) for children with autism spectrum disorders. The PITA-T team worked with parents, teachers, and therapists to implement several projects designed to improve access to ABA. Project descriptions, findings, as well as references for published findings are below. Be sure to check back for updated information on new publications.

Principal Investigators: Claire St. Peter, Ph.D., BCBA-D, Susannah Poe, Ed.D, BCBA, and Mark Clingan, Ed.D, BCBA.

This study was supported in part by grant R40 MC 20444 from the Maternal and Child Health Bureau (Combating Autism Act of 2006), Health Resources and Services Administration, Department of Health and Human Services.

Intervention Barriers for Rural Families

Discrete-trial instruction (DTI) is a common method used to teach children with autism a wide range of social, language, and academic skills. Although effective, DTI may be expensive and difficult for some families to access. This is especially true for families living in rural areas, where long travel times and the presence of few trained DTI providers may be additional barriers to accessing needed services. In such cases, parents of children with autism can learn to implement DTI with their children.

Adherence to Discrete-Trial Instruction Procedures by Rural Parents of Children with Autism

Just like medication, which needs to be taken regularly to be effective, behavioral treatments need to be delivered correctly and regularly to be effective. We provided parents with written or video instructions and feedback to teach them to implement discrete-trial instruction (DTI), an empirically based method for teaching new skills to children with autism. We determined the extent to which the training format influenced how often the parents implemented the DTI procedures with their children.

Findings: Parents who received video instructions and feedback were about five times more likely to conduct DTI teaching sessions than parents who received written instructions and feedback.

Application: Providers should carefully consider the format used when providing instructions to parents as the format might affect parental adherence.

For more information about this project, please see the full article in Behavioral Interventions.

Reference:

St. Peter, C. C., Brunson, L. Y., Cook, J. E., Subramaniam, S., Larson, N. A., Clingan, M., & Poe, S. G. (2014). Adherence to discrete-trial instruction procedures by rural parents of children with autism. Behavioral Interventions, 29, 200-212. doi:10.1002/bin.1386

Maintenance of Parent-Implemented Discrete-Trial Instruction with Videoconferencing

We trained four parents of children diagnosed with autism to implement discrete-trial instruction (DTI; an empirically based method of teaching new skills to children with autism) with their children at a local clinic. Parents received individualized behavioral skills training, which consisted of instructions, trainer models, opportunities to role play, and feedback on how well the parents implemented. Training continued until parents could accurately implement the skills. After learning the skills, parents implemented DTI with their children at home and received feedback through web-based video consultation with a behavior analyst. We gradually decreased the frequency of video conference from twice a week to once every two weeks (the minimum recommended frequency from the Behavior Analyst Certification Board).

Findings: Parents maintained DTI skills learned during one day of training over 6 months and successfully applied these skills to teach new, untrained programs. All together, the four children learned over 150 new skills!

Application: Videoconferencing with parents may be an effective method for maintaining skills trained onsite and providing supervision of services for families living in rural areas.

Reference:

Manuscript in preparation for submission to a peer-reviewed journal.

Effects of Fixed-time Reinforcement Schedules on Resurgence of Problem Behavior

Rural parents may find it particularly difficult to implement procedures consistently when their child engages in frequent or severe problem behavior. Although there are several known behavioral interventions to reduce problem behavior, they require consistent implementation by the caregiver. Inconsistent implementation can result in treatment relapse. We examined the extent to which treatment relapse occurred when interventions were abruptly discontinued (as occurs when parents implement with low adherence). We compared relapse (resurgence of problem behavior) in this condition to a condition in which the reinforcer delivered during the intervention was freely given to the child.

Findings: Providing fixed-time (free) access to reinforcers during treatment challenges reduced treatment relapse.

Application: When caregivers are unable to implement intervention procedures for problem behavior fully, providing the child with short-term, "free" access to reinforcers may prevent problem behavior from returning.

Reference:

Marsteller, T. M., & St. Peter, C. C. (2014). Effects of fixed‐time reinforcement schedules on resurgence of problem behavior. Journal of Applied Behavior Analysis, doi:10.1002/jaba.134

Effective Strategies for Dissemination

Families living in rural areas often lack access to professionals qualified to provide behavior-analytic assessments and interventions to children with autism. Although several of our projects focused on training parents, we recognize that this may not be the best fit for the needs of every family. Teachers and paraprofessionals can also be trained to implement behavior-analytic assessments and interventions. Training teachers and paraprofessionals has the added impact of benefiting additional members of the community.

Teacher Acquisition of Functional Analysis Methods Using Pyramidal Training

Pyramidal training is a training strategy that involves an experienced professional teaching a small group of trainees to implement an intervention. Following training, each of these trainees goes on to train others to implement the intervention. By using pyramidal training, a single experienced professional can indirectly train a large number of people, reducing costs and speeding dissemination. Pyramidal training also helps to build capacity in rural systems, thereby reducing reliance on outside consultants. We used pyramidal training to teach teachers to conduct functional analyses to determine the cause of challenging behaviors.

Findings: Teachers learned to conduct functional analyses by receiving training from teachers previously trained in the procedure. Although the teachers were taught using role-play scenarios with confederates, they were able to apply those skills to conducting functional analyses with students without the need for further training.

Application: Pyramidal training is an effective and efficient strategy for training a large number of people in behavior-analytic procedures, such as conducting functional analyses.

For more information about this project, please see the full article in the Journal of Behavioral Education.

Reference:

Pence, S. T., St. Peter, C. C., & Giles, A. F. (2014) Teacher acquisition of functional analysis methods using pyramidal training. Journal of Behavioral Education, 23, 132-149.

Teaching Paraprofessional Staff to Implement Discrete-Trial Instruction Procedures

Training classroom staff to implement discrete-trial instruction (DTI; an empirically established method for teaching new skills to children with autism) can increase the amount of instructional time a child with autism receives while at school. Training DTI can be very time-intensive, and it is not always clear how well performance during training carries over to performance on the job. We trained paraprofessionals to implement DTI using a six-hour training package. After providing the initial training, we streamlined it to require only three hours. We then provided this condensed training to a different group of paraprofessionals.

Findings: Paraprofessionals learned to implement DTI effectively following training and these skills maintained for several months. They were able to apply the skills to new untrained programs as well as in the classroom when working with students. This training was just as effective when streamlined to just three hours.

Application: Paraprofessionals can be trained to implement DTI in a minimal amount of time (i.e. 3 hours) which provides students with access to ABA services that may not be otherwise be available in their community.

Reference:

Manuscript in preparation for submission to a peer-reviewed journal.

Methodological Issues

Discrete-trial instruction (DTI) is a common method used to teach children with autism a wide range of social, language, and academic skills. DTI consists of several components and is most effective when therapists implement all components correctly (i.e. high treatment integrity). Implementing interventions with high treatment integrity helps ensure treatment success, but how it is measured may make it difficult for supervisors to detect errors.

Global Measures of Treatment Integrity May Mask Important Errors in Discrete-Trial Instruction

Measuring global treatment integrity provides an overall picture of how well an intervention is implemented, but may hide repeated errors on individual intervention components. This is important because implementing individual components correctly is often critical to treatment success. We provided undergraduate students with instructions for conducting DTI teaching sessions and monitored their performance.

Findings: Global treatment integrity measures of undergraduate student performance did not accurately represent performance on individual components. Without looking at treatment integrity for individual components, errors made by the students would have gone undetected because of high global integrity scores. When errors were detected, students received additional training until treatment integrity was high not only globally, but for individual components as well.

Application: Supervisors/trainers should measure and monitor treatment integrity both globally and for individual components when training staff to deliver interventions in order to ensure the intervention is implemented correctly.

Reference:

Submitted for publication to a peer-reviewed journal.