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In the past ten years, insurance funding has become a primary source of payment for applied behavior analytic services for individuals with autism spectrum disorders. The increased accessibility of...

Successfully working with families of children with autism requires technical behavior-analytic skills and critical interpersonal relationship-building skills. Taylor, LeBlanc, and Nosik (2018) suggested that many Board Certified Behavior Analysts might have been trained in graduate programs that focus primarily on conceptual and technical skills with little coverage of skills related to building therapeutic relationships. The current paper provides the results of an online survey of the precredential and postcredential training experiences of behavior analysts. The majority of behavior analysts surveyed indicated that they received no explicit didactic training or reading assignments on relationship-building skills in their graduate coursework in behavior analysis. Approximately half indicated that their practical experience supervisor provided guidance and mentoring on these skills. The majority of behavior analysts indicated that it is very important or extremely important that professional training programs develop formal training in this area.

Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID-19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in-person to telehealth delivery of treatment when shelter-in-place orders were issued. Of these cases, 76% of participants transitioned to technician-delivered telehealth services whereas the rest transitioned to a caregiver-implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in-person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in-person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician-delivered telehealth services.

The practice of behavior analysis has become a booming industry with growth to over 30,000 Board Certified Behavior Analysts (BCBAs) who primarily work with children with autism and their families. Most of these BCBAs are relatively novice and have likely been trained in graduate programs that focus primarily on conceptual and technical skills. Successfully working with families of children with autism, however, requires critical interpersonal skills, as well as technical skills. As practitioners strive to respond efficiently and compassionately to distressed families of children with autism, technical skills must be balanced with fluency in relationship-building skills that strengthen the commitment to treatment. The current article provides an outline of important therapeutic relationship skills that should inform the repertoire of any practicing behavior analyst, strategies to cultivate and enhance those skills, and discussion of the potential effects of relationship variables on treatment outcomes.

Motor imitation skills are usually targeted early in intervention with children with autism. Some children readily acquire motor imitation targets that involve objects (e.g., pushing a toy car) but do not acquire targets without objects (e.g., clapping hands). The disparity in acquisition could occur for various reasons, including differences in attending when an object is present as opposed to when no object is present. It also is possible that the delay in imitation that is required when no object is present could contribute to the discrepancy. The purpose of this study was to validate the use a brief assessment of delayed imitation and attending skills to predict the effectiveness of interventions specifically designed to address the identified deficits. The assessment showed one child with autism had deficits in attending, and an intervention that included a salient stimulus produced the quickest acquisition. The second participant’s assessment did not show any deficits in attending, but showed deficits in delayed imitation. For this participant, the intervention designed to address deficits in delayed imitation (i.e., a secondary prompter) was most successful in establishing motor imitation responses.

This study assessed the effects of a vibrating pager on reduction of rapid eating. The study also evaluated two strategies for fading the pager, by intensity and by frequency. The pager was successful in decreasing the pace of eating to an appropriate level and the pager prompt was successfully faded. Fading by frequency was ineffective in maintaining an appropriate pace of eating while intensity fading was successful.

Grow and LeBlanc (2013) described practice recommendations for conducting conditional discrimination training with children with autism. One recommendation involved using a specially designed datasheet to provide the preset target stimulus for each trial along with counterbalancing the location of stimuli if a three-item array of comparison stimuli. This study evaluated whether the recommended data sheet would lead to higher procedural integrity of counterbalancing trials compared to a standard data sheet (i.e., targets and arrays are not pre-set). Forty behavior therapists from two provider agencies participated. Participants were randomly assigned to either the standard data sheet condition or the enhanced data sheet condition. Participants watched a short video on Grow and LeBlanc's practice recommendations for a matching task and an orientation to the datasheet for the assigned condition, and then implemented the matching task with a confederate serving in the role of the child with autism. The enhanced data sheet resulted in higher accuracy of implementation on counterbalancing than the standard data sheet, with the largest difference for rotation of the target stimulus across trials and for counterbalancing the placement of the correct comparison stimulus in the array.

The current study evaluated the effects of behavioral skills training (BST) on acquisition of basic computer skills using Microsoft Word®, Microsoft Excel®, and Microsoft PowerPoint® by a 15-year-old male diagnosed with autism. A concurrent multiple-baseline design across computer programs (i.e., Word®, Excel®, and PowerPoint®) was used to evaluate the effects of BST on the acquisition of basic computer skills. BST was successful in teaching the participant to learn basic functions in each of the three programs, and he was able to use the programs to complete schoolwork independently following completion of the study.

Receptive language refers to responding appropriately to another person's spoken language. Most curricula dedicate a proportion of early intervention to developing receptive language skills. The specific terms used to refer to the receptive language programs and the recommendations for teaching such skills vary considerably across the early intervention curricula. The present paper will provide a conceptual analysis of the desired controlling variables for different receptive language programs, teaching recommendations, a brief review of the literature to substantiate the teaching recommendations, and a discussion of the potential negative effects of deviating from the recommendations.

The extensive clinical activity occurring in the area of early and intensive behavioral intervention (EIBI) for children with autism represents a promising opportunity to conduct research on clinically relevant problems and on effectiveness and efficiency of various procedures. However, many practitioners providing these services may not have received adequate training in conducting single-case design research in field settings. Training practitioners to implement such research has the potential to improve the use of the scientist-practitioner model in these settings and expand the base of scientific knowledge in this area. Through the current training program, we used a modified behavioral skills training (BST) approach to teach practi tioners to prepare and implement single-case design research protocols in an applied setting. Participants were able to learn and apply a number of important research skills as evidenced by statistically significant improvements on six tests throughout training and high scores on homework assignments that required staff to engage in various research-related behaviors. The results are discussed in the context of preparing EIBI settings for greater research productivity.

Linda A. LeBlanc, Ph.D., BCBA-D, MI Licensed Psychologist, is the Executive Director of Research and Clinical Services at Trumpet Behavioral Health. She received her Ph.D. in child clinical psychology in 1996 from Louisiana State University and completed her internship and postdoctoral fellowship at the Kennedy Krieger Institute and Johns Hopkins University School of Medicine. She served as a professor on the psychology faculties at Claremont McKenna College (1997–1999), Western Michigan University (1999–2008), and Auburn University (2009–2012) before becoming the Executive Director at Trumpet. She has served on the boards of directors of several national and regional professional associations and is a Fellow of the Association for Behavior Analysis International. She has served as an associate editor of the Journal of Applied Behavior Analysis, Behavior Analysis in Practice, and the Analysis of Verbal Behavior and Education and Treatment of Children and has authored many articles and book chapters on behavioral treatment of autism, technology-based behavioral interventions, behavioral gerontology, and system development in human services (Fig. 1).

Studies on teaching tacts to individuals with autism spectrum disorder (ASD) have primarily focused on visual stimuli, despite published clinical recommendations to teach tacts of stimuli in other sensory domains as well. In the current study, two children with ASD were taught to tact auditory stimuli under two stimulus-presentation arrangements: isolated (auditory stimuli presented without visual cues) and compound (auditory stimuli presented with visual cues). Results indicate that compound stimulus presentation was a more effective teaching procedure, but that it interfered with prior object-name tacts. A modified compound arrangement in which object-name tact trials were interspersed with auditory-stimulus trials mitigated this interference.

Discrete trial teaching (DTT) procedures have proven effective in teaching language to children with autism. Discrete trial teaching uses a highly structured, fast-paced format of instruction that is typically conducted in a one-to-one situation at a desk or table with minimal distractions. We compared this traditional model of DTT to a version of DTT in which instruction was embedded within the context of a more naturalistic, activity-based environment. However, all of the other characteristics of DTT (e.g., pacing, tight stimulus control, targets selected by the teacher) were retained. Receptive discriminations were taught to 2 4-year-old boys, diagnosed with autism in traditional or embedded DTT. Results showed that for both boys, traditional and embedded DTT were equally effective and efficient. Additionally, measures were collected on participant affect and a concurrent-chains preference evaluation was used to determine which teaching procedure was preferred by the participants. The two procedures produced similar levels of positive and negative affect and were equally preferred by 1 participant while embedded DTT produced more positive affect and was more preferred by the other.

LeBlanc, Crossett, Bennett, Detweiler, and Carr (2005) described an outpatient model for conducting intensive toilet training with young children with autism using a modified Azrin and Foxx, protocol. In this article, we summarize the use of the protocol in an outpatient setting and the outcomes achieved with a large sample of children with autism spectrum disorders. Thirty archival clinical records were coded for several variables related to treatment implementation and outcome. The majority of participants achieved full continence in an average of approximately 2 weeks. Details on the typical implementation and course of treatment are presented to provide a profile for future practitioners.

Tact training is a common element of many habilitative programs for individuals with developmental disabilities. A commonly recommended practice is to include a supplemental question (e.g., "What is this?") during training trials for tacts of objects. However, the supplemental question is not a defining feature of the tact relation, and prior research suggests that its inclusion might sometimes impede tact acquisition. The present study compared tact training with and without the supplemental question in terms of acquisition and maintenance. Two of 4 children with autism acquired tacts more efficiently in the object-only condition; the remaining 2 children acquired tacts more efficiently in the object + question condition. During maintenance tests in the absence of the supplemental question, all participants emitted tacts at end-of-training levels across conditions with no differential effect observed between training conditions.

A growing workforce of behavior analysts provides services to individuals with autism and intellectual disabilities as legislative initiatives have spurred a growth of funding options to support these services. Though many opportunities currently exist for serving individuals with autism, the growing demand for these services may wane or, at some point, the growth in service providers will meet that demand. Other consumer groups could benefit from behavior analytic services, but typically have limited access to qualified providers. Individuals with dementia and traumatic brain injury are used as example consumer groups to illustrate the necessary tasks for a behavior analyst to expand their scope of practice to a new population. This paper provides strategies for developing competence and creating employment opportunities with new consumer groups.

The Picture Exchange Communication System (PECS) is a picture-based alternative communication method that is widely accepted and utilized with individuals with disabilities. Although prior studies have examined the clinical efficacy of PECS, none have experimentally evaluated its manualized training structure. We experimentally evaluated the effects of training during each of the 6 phases of PECS with 7 children with developmental or language disorders. For all 7 participants, PECS responses consistently increased only after training was completed for each of the first 4 phases, but increases in PECS responses occurred during tests of Phases 5 and 6 as soon as training was completed in Phase 4. Consistent with prior research, PECS was taught in a short period of time and required few prerequisite skills. However, 3 of the 7 participants had difficulty with some aspects of training and were able to acquire the targeted skills only after procedural modifications were made.

The substantial demand for behavior-analytic treatment of early childhood autism has been associated with rapid dissemination of treatment procedures to practitioners and caregivers. This level of demand could plausibly induce premature dissemination of treatments that do not yet have sufficient empirical support. We argue that this might have happened with the use of fluency training for learners with autism and identify four areas of research that are necessary to ensure that dissemination efforts are better matched to the available empirical support for this instructional strategy.

Although the awareness of autism in the general public has increased significantly over the past 20 years, much of the widely disseminated information is not fully grounded in scientific fact. In The Science and Fiction of Autism (2005), Laura Schreibman addresses a series of debates and controversies in areas ranging from diagnostic practices and etiological theories to effective clinical practices. This book provides an overview of the field of autism that is suitable for well-educated parents and new professionals in the field.

Three children with autism were taught abduction-prevention skills using behavioral skills training with in situ feedback. All children acquired the skills, which were maintained at a 1-month follow-up assessment. In addition, 1 of the children demonstrated the skills during a stimulus generalization probe in a community setting.

Stimulus properties of toys may impact the type and amount of play observed between children with autism and their playmates. Six children with autism and their siblings participated in an evaluation of toy characteristics on type of play, problem behavior, social initiations, and responses to social initiations. Separate free operant preference assessments were conducted with toys in two categories: sensory stimulating toys and developmentally oriented toys. Highly preferred items and low to moderately preferred items from each category were then introduced into free play observations with children with autism and their sibling. Generally, highly preferred sensory stimulating items were associated with more problem behavior and solitary play while developmentally oriented toys that were moderately preferred produced the most interactive play and the least problem behavior. Implications for sibling-based play interventions are discussed.

Three parents of children with autism were taught to implement the Natural Language Paradigm (NLP). Data were collected on parent implementation, multiple measures of child language, and play. The parents were able to learn to implement the NLP procedures quickly and accurately with beneficial results for their children. Increases in the overall rate of vocalizations were observed for all three children with a shift from imitative language at the beginning of intervention to spontaneous language at the end of intervention. Clear improvements in play were observed for two of three children while ceiling effects were observed for a third child who already played effectively. In response to a social validity questionnaire, parents indicated that they found the study useful and the NLP procedures simple to implement and that that they would continue to use NLP at home following the conclusion of the study.

Skinner's conceptual analysis of language has influenced one model of early and intensive behavioral intervention with children, which incorporates verbal operants including mands, tacts, intraverbals, etc. Many studies have examined the mand and tact relations, with little focus on teaching intraverbal behavior. In the present experiment, children with autism were taught intraverbals using a transfer-of-stimulus-control procedure (i.e., tact to intraverbal) in combination with errorless learning (i.e., delayed prompting). Three children were successfully taught to name items associated with preselected categories (e.g., “What are some colors?”) with limited generalization to a fourth, non-targeted category, and limited maintenance of skills.

Three children With autism Who Were previously nonresponsive to loW-intensity toilet training interventions Were toilet trained using a modified Azrin and Foxx (1971) intensive toilet training procedure. Effects Were demonstrated using a nonconcurrent multiple baseline design across participants. The training Was conducted across home and school settings by parents and school staff. Each child achieved continence, and 2 children eventually initiated the majority of toileting events. Implications for future research and clinical practice and dissemination are discussed.

The authors comment on Drash and Tudor's operant theory of autism. Concerns with the theory's face validity and empirical support are presented, along with concerns about four aspects of the theory.

A growing number of studies have investigated diverse applications of technology-based interventions with children with autism. The purpose of this paper is to review the growing empirical support for the efficacy of technology-based interventions with children with autism and to recommend future directions for research. This review will focus on five examples of technology introduced as a temporary instructional aid to be removed once the goal of behavior change has been met: (a) tactile and auditory prompting devices, (b) video-based instruction and feedback, (c) computer-aided instruction, (d) virtual reality, and (e) robotics. Future directions for research and practice with each technology are discussed. Keywords: autism; technology-based interventions; computer-aided instruction; virtual reality; robotics. ********** A growing number of studies have investigated diverse applications of technology-based interventions with children with autism. The popularity of technology in the field of psychology is evidenced by the development of new journals in the area (e.g., the Journal of Special Education Technology, the Journal of Educational Multimedia and Hypermedia, the Journal of Computer Assisted Learning, etc.). In addition, clinical psychology journals are recognizing the importance of technology in service delivery and devoting special issues to the topic (e.g., Newman, 2004). Parents and clinicians regularly report that children with autism are drawn to technological devices and researchers have noted the importance of devising treatments that take advantage of this fascination (Colby, 1973). The purpose of this paper is to review the growing empirical support for the efficacy of technology-based interventions with children with autism and to recommend future directions for research. A review of technology-based interventions must first clarify the use of the word technology. The term is broadly defined as "the practical application of knowledge" or "the specialized aspects of a particular field of endeavor" (Merriam-Webster's Collegiate Dictionary, 1994, p. 1210). This broad definition encompasses virtually any information or object that has been used in application to a field of study. For example, the application of stimulus control is technology to a behavioral clinician. A more specific use of the term refers to use of mechanical or electromechanical processes that often increase productivity and reduce or eliminate manual operations or operations done by older technologies. In the twenty-first century, technology commonly denotes a variety of popular electromechanical devices such as cell phones, video recording equipment, and hand-held, desktop, and laptop personal computers. It is the use of these tools with children with autism that will be the subject of this review paper. Some technology-based interventions are designed for indefinite use as an assistive tool (e.g., voice-output augmentative communication devices, microswitches, etc.) while others are introduced as a temporary instructional aid to be removed once the goal of behavior change has been met. This review will focus on five examples of the second category: tactile and auditory prompting devices, video-based instruction and feedback, computer-aided instruction, virtual reality, and robotics. Research support for the use of each technological advancement with children with autism will be reviewed, and directions for future research and practical application will be discussed. Mechanical Prompts Individuals with autism often need external stimulus prompts to initiate, maintain, or terminate a behavior. Commonly used prompts include vocal, gestural, physical, written/pictorial, and signed prompts, and each modality has been demonstrated effective for multiple purposes (MacDuff, Krantz, & McClannahan, 2001). Technological advancements in the last decade have created cost-effective automated prompting devices with the ability to deliver the same level of prompting with less human interaction and obtrusiveness and often less human effort in managing prompt delivery (e. …

Two children with autism were trained in US geography using a match to sample procedure. Different testing procedures commonly used in stimulus equivalence research were compared, including some conditions with reinforcement for responding to enhance motivation. Both children were able to master the trained geography relations and emergent stimulus relations were also noted. All three testing procedures produced similar effects, suggesting that incorporation of procedures to enhance motivation to respond does not invalidate testing in a stimulus equivalence preparation. Copyright # 2003 John Wiley & Sons, Ltd.

The present manuscript reviews four promising procedures for teaching speech to children with autism: Natural Language Paradigm, Speech/Play Enhancement for Autistic Kids, Multiple Incidental Teaching Sessions, and Time Delay. These training procedures are called Naturalistic Teaching Strategies (NaTS) because they incorporate components and strategies known to facilitate acquisition, generalization, and maintenance of new behaviors. These components include motivation, functional relationships, and facilitators of generalization and are briefly defined and discussed in relation to the four teaching procedures. All of the procedures and findings are data-based and can be used in a variety of settings such as classroom, playground, home, and community settings. The manuscript begins with a historical perspective of behavioral speech/language training and the need for NaTS and concludes with a discussion of the merits of NaTS and their importance in the treatment of children with autism.

Several important behavioral intervention models have been developed for teaching language to children with autism and two are compared in this paper. Professionals adhering to Skinner's conceptualization of language refer to their curriculum and intervention programming as applied verbal behavior (AVB). Those primarily focused on developing and using strategies embedded in natural settings that promote generalization refer to their interventions as naturalistic teaching approaches (NTAs). The purpose of this paper is to describe each approach and discuss similarities and differences in terms of relevant dimensions of stimulus control. The discussion includes potential barriers to translation of terminology between the two approaches that we feel can be overcome to allow better communication and collaboration between the two communities. Common naturalistic teaching procedures are described and a Skinnerian conceptualization of these learning events is provided.

Early intensive behavioral intervention is the only well-established treatment for young children with autism spectrum disorders (ASDs). Less intensive behavioral interventions are also effective for targeted concerns with older children and adolescents. This article describes the core features of behavioral treatments, summarizes the evidence base for effectiveness, and provides recommendations to facilitate family understanding of these interventions and identification of qualified providers. Recommendations are also provided for collaboration between pediatric providers and behavior analysts who are serving families of individuals with ASDs.

We assessed preference for video or in vivo modeling using a concurrent-chains arrangement with 3 children with autism. The two modeling conditions produced similar acquisition rates and no differential selection (i.e., preference) for all 3 participants.

We taught 3 children with autism to raise a hand or keep both hands down depending on their status (e.g., having heard a target word, possessing a specific item) using modeling, prompting, and reinforcement. All 3 children acquired accurate hand-raising skills in response to progressively more difficult discrimination tasks during group instruction. The implications for preparing children for general education settings are discussed.

Intensive early intervention training, discrete trials, transitions to new settings, environments and people, tactile defensiveness, difficulty initiating interactions and other factors specific to ASD will be covered. An emphasis on being aware of these specialized problems and how ABA methods have been developed to address them will be reviewed.

The purpose of this study was to examine archival data from an outpatient clinic serving children with autism spectrum disorders to investigate the occurrence of problem behavior functions in this sample. Results indicated that social reinforcement (e.g., attention from others) was involved in maintaining problem behavior for the majority of cases, suggesting that these children lacked socially appropriate responses to access such reinforcement, or that their social environments contained insufficient social reinforcement. Further, the data suggest that problem behavior exhibited by children with autism spectrum disorders can be conceptualized similarly to the problem behavior of children with other developmental disabilities.

Publisher Summary The purpose of this chapter is to highlight the importance of the lifespan approach to autism spectrum disorders (ASDs) and to provide a review of problems and supports provided at critical times in the lifespan. Many psychological theories, referred to as lifespan theories, acknowledge that people continue to grow and change throughout their lives as they are faced with new tasks, challenges, and opportunities. Following further lifespan theories, a review of outcomes evidence and exploration of commonly encountered concerns and successes in key developmental periods are presented. A developmental lifespan approach is predicated on the notion that individual development follows a trajectory over the course of the lifespan and that various factors can impact that trajectory and the subsequent life outcomes experienced by the individual. Since early childhood has been the subject of so many comprehensive reviews and texts, this chapter focuses on critical developmental periods that have been examined less frequently: adolescence, young adulthood, and adulthood. Adolescence is marked by various other changes in psychosocial development, access to community activities and the related safety issues that can accompany those activities, and changing educational structure associated with the transition to middle and high school. Several research areas need to continue to be developed to ensure an adequate understanding of ASDs across the entire lifespan.

Autism spectrum disorders (ASDs) affect approximately 1 in 166 children in the United States, making it likely for the average physician to encounter patients with ASDs in his or her practice. In particular, pediatricians and developmental neurologists play a critical role in early identification, resource referrals, and management of a variety of comorbid physical and medical concerns. This article reviews the current literature on ASDs and provides recommendations for practice in areas critical to the provision of medical services.

The Natural Language Paradigm (NLP) has proven effective in increasing spontaneous verbalizations for children with autism. This study investigated the use of NLP with older adults with cognitive impairments served at a leisure-based adult day program for seniors. Three individuals with limited spontaneous use of functional language participated in a multiple baseline design across participants. Data were collected on appropriate and inappropriate vocalizations with appropriate vocalizations coded as prompted or unprompted during baseline and treatment sessions. All participants experienced increases in appropriate speech during NLP with variable response patterns. Additionally, the two participants with substantial inappropriate vocalizations showed decreases in inappropriate speech. Implications for intervention in day programs are discussed.

We evaluated video modeling and reinforcement for teaching perspective-taking skills to 3 children with autism using a multiple baseline design. Video modeling and reinforcement were effective; however, only 2 children were able to pass an untrained task, indicating limited generalization. The findings suggest that video modeling may be an effective technology for teaching perspective taking if researchers can continue to develop strategies for enhancing the generalization of these new skills.

The picture exchange communication system (PECS) is an augmentative communication system frequently used with children with autism (Bondy & Frost, 1994; Siegel, 2000; Yamall, 2000). Despite its common clinical use, no well-controlled empirical investigations have been conducted to test the effectiveness of PECS. Using a multiple baseline design, the present study examined the acquisition of PECS with 3 children with autism. In addition, the study examined the effects of PECS training on the emergence of speech in play and academic settings. Ancillary measures of social-communicative behaviors and problem behaviors were recorded. Results indicated that all 3 children met the learning criterion for PECS and showed concomitant increases in verbal speech. Ancillary gains were associated with increases in social-communicative behaviors and decreases in problem behaviors. The results are discussed in terms of the provision of empirical support for PECS as well as the concomitant positive side effects of its use.

We conducted functional analyses of the pica of 3 participants. The pica of 1 participant appeared to be maintained by automatic reinforcement; that of the other 2 participants appeared to be multiply controlled by social and automatic reinforcement. Subsequent preference and treatment analyses were used to identify stimuli that would complete with the automatic function of pica for the 3 participants. These analyses also identified the specific aspect of oral stimulation that served as automatic reinforcement for 2 of the participants. In addition, functional analysis-based treatments were used to address the socially motivated components of 2 of the participants' pica. Results are discussed in terms of (a) the importance of using the results of functional analyses to develop treatments for pica and (b) the advantages of developing indirect analyses to identify specific sources of reinforcement for automatically reinforced behavior.