The Autism Society Event and Education Recordings Archive

This session will present a comprehensive description of a 3-week staff/parent autism training program. Training is comprised of a series of workshops, videotaped modeling, and feedback geared towards successful intervention with individuals with autism. Each module of the training is accompanied by a competency-based post-test. A multiple baseline evaluation of the efficacy of the program will be presented along with pre- and post-data on the level of caregiver stress experienced by the families in the study. The study took place in a clinical training facility for individuals with autism spectrum disorders. The facility was a two story building with classrooms on both floors. All of the classrooms were equipped with a laptop and a PowerPoint projector for presentation of the training material. Each classroom was comprised of large tables and folding chairs for the trainees to sit in. The first floor of the facility had a number of  individual therapy rooms where the parent-child interactions took place. Each classroom had a large one way mirror on one of the walls for observation purposes. A video camera was also positioned in a corner of the room near the ceiling in each therapy room to record clinical sessions. An individual observation room was located adjacent to each of the therapy rooms. Television monitors were located in these rooms. The monitors were equipped with VHS recording equipment. Observers could observe what was happening in each therapy room via the video and audio recording devices described above.

Subjects            The subjects that took part in the study were three parent child dyads that were enrolled in a 3 week parent training program. The children were in the age range of 2-6 years and were all diagnosed with an autism spectrum disorder. Susan was 2 years old and had been diagnosed with autism. She was on no medications at the time of the study. She spoke in 4-5 word sentences. Charles, was 2 years old and had a diagnosis of autism. He used some words to indicate preferences and express his needs. His sentences were typically comprised of only 1 or 2 words. He was not taking any prescription medication at the time of the study. Dan was 2 years old and engaged in a number of stereotypic behaviors of a verbal nature. He spoke in 3-4 word sentences, but the intelligibility of his speech was an issue.

Design

A multiple baseline design across parent-child dyads was used to examine the efficacy of the training program. Due to the clinical challenges of scheduling separate families 3 months ahead of time and having them come in for baseline measurements, a non-concurrent multiple baseline design was employed (Watson & Workman, 1981). When implemented properly, the non-concurrent multiple baseline design controls for all of the same confounding variables that a concurrent multiple baseline does.

Dependent Variables

In order to more fully assess the impact of the parent training program, three separate overt behavioral measures were taken on both the parent and the child in each of the dyads in the study. These separate measures were utilized to determine the behavioral changes that took place in both members of the dyad as opposed to focusing on the behavior of the parent alone. The overt behaviors that were measured were as follows:

Child Behaviors:

Prompted eye contact –the child’s head is oriented toward the therapist and eye gaze is directed toward the trainer and held in place for at least 2 seconds. Any turning away from the direction of the therapist or looking away for at least 3 seconds constitutes 1 instance of the behavior.                                                                                                                                                                                                                                                                                                   

Out of seat behavior – defined as the student’s being out of his/her chair or with his/her upper body (from waist to chin) not being perpendicular to the table (unless picking up dropped items).

Number of words – frequency count of mands, tacts, echoics, and intraverbals per 20 minute session.

Parent Behaviors:

Reinforcement of appropriate behavior- when the parent provides a praise statement “good job,” that is descriptive in that a description of the behavior being praised is included. Reinforcement should be delivered after every request that is followed through on.

Use of contingency statements – statements that provide an indicator to the child of what behavior to engage in and what the results would be. There is a temporal order of responding given such as, “when you finish this problem, we can end the session.”

Proper Ignoring of problem behavior (extinction) – defined as the parent not attending to inappropriate responding by the child. This could be through turning away from the child or positioning their head and eyes in a manner that is not giving attention to the child during their display of unwanted behavior.

Dependent Measures.

Caregiver Stress Inventory - This inventory is a series of 24 questions seperated into 5 categories such as time, physical health, and other areas where the stress from being a caregiver of a child with autism could pose problems. Each of these questions included a 5 point Likert type scale that indiocated the degree to which each item was experienced. This inventory was administered prior to the first baseline session and again 2 months after the completion of training.

Acceptance and Action Questionnaire - The AAQ correlates significantly with existing measures of avoidance and quality of life issues. It is used to asses the degree of acceptance of thoughts and feelings, and whether or not the person is ready to engage in behavior that is consistent with their values. This measure was administered prior to the first baseline session and, again, 2 months post training.

Reliability Measures

Reliability data were taken for 33 percent of the therapy sessions for each parent-child dyad in the study. Each session was videotaped, which allowed the raters to code each session according to the child’s behaviors and the parent’s behaviors separately on different viewings. The director of the training department at the treatment facility and a board certified behavior analyst served as reliability observers throughout the course of the study. Individual sessions were coded by observing the sessions through a one way mirror when feasible and reviewing videotapes of each of the sessions. Reliability measures were taken for the specific number of each of the behaviors described above that were observed during each 20 minute session on which inter-observer reliability (IOR) data were obtained. The data were scored for reliability by the first author who is a doctoral level board certified behavior analyst. Reliability was determined by taking the total number of agreements and dividing that by the total number of agreements and disagreements across each session and multiplying that number by 100.  Reliability data were taken for one third of all of the sessions. The reliability score for all phases of the experiment was 98% with a range from 91-100%.

Treatment Phases

Baseline

Each of the 3 parent child dyads were randomly assigned to differing baseline lengths to control for the potential internal threat to validity of history effects. Each of the families was contacted 1 week prior to the time that their training program was to start. They were then brought in and told that they were to spend a 20 minute period of time interacting with their child as they typically would at home. They were able to utilize select items from home such as their child’s favorite toys, or to use other items based on their preferences prior to each session. The parent in each dyad was not instructed in any manner as to what to do or say. A timer was set for 20 minutes at the outset of each session. When the timer went off, the investigators knocked on the door to let the parents know that the session was over. No feedback was given to them at the conclusion of each of these sessions.

Parent Training (Classroom procedures + competency based post tests)

Each of the modules that contained a competency based post test will be presented below with their titles:

Workshop: The Autism Spectrum

Workshop: A Thinking Set That Works

Workshop: Objectivity

Workshop: Exchanges

Workshop: Behavior Development Principles I

Workshop: Behavior Development Principles II

Workshop: Communication

Workshop: Behavior Development Strategies

Workshop: Contingencies

Workshop: Teaching Strategies

Workshop: Exchange Principles and Analysis

Workshop: Data

Workshop: Scheduling

Workshop: Cost Analysis

Workshop: Developing Option Sheets

Workshop: Developing Option Sheets (Jannie Option Sheet)

Workshop: Sensory Integration

Workshop: Rehearsal as a Teaching Strategy

Workshop: Summary Review (Exchanges)

Summary Review (Objectivity)

Summary Review (Behavior Development Strategies)

Summary Review (Exchange Principles & Analysis)

Summary Review (Cost Analysis)

Practicum: Adapting Option Sheets

Workshop: Work Session Procedures I

Workshop: Creating Your Own Teaching Materials

Practicum: Graph Data

Practicum: Writing an Option Sheet

Practicum: Writing an Option Sheet

Practicum: Write Schedules for Home Sessions

Workshop: General Review

Parent Training (Modeling) – During the modeling phase of the study, the parents of the children were able to observe, via a one way mirror, 20 minute therapy sessions that their child was involved in. In these sessions, the therapist sat across a table from the child and selected materials were presented based upon a pre-determined schedule that the therapist had constructed. The parents were instructed to observe and to take data on certain problematic behaviors that they had identified with their therapist prior to the session.

Parent Training (in-vivo feedback)- During the third week of training, each of the parents were systematically faded into the therapy room with their child. As the parents were conducting their 20 minute therapy session, they were given prompts and feedback related to the manner in which they conducted the session through an earpiece. The feedback was provided by the child’s trainer that was observing the therapy session from a one way mirror. The results from this study and the content of the presentation will be presented in a series of multiple baseline graphs that depict the efficacy of the training program that will be outlined in the presentation. Videotaped sessions of some of the children that took part in the study will also be included as further evidence of the efficacy of the behavioral methods that will be discussed in the presentation.

Results and Discussion

Data will be presented, in a multiple baseline format, for each of the parent child dyads in the study. Each of the dyads demonstrated significant improvements in all of the behaviors that were targeted for intervention in the study. A detailed presentation will be made related to these outcomes as they apply to each of the components of the parent training program. Implications and future directions for this line of research will be discussed.

Learning Objectives: