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A parent training program combining discrete trial training and incidental teaching in the home environment


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A parent training program combining discrete trial training and incidental teaching in the home environment
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Jones, Lindsey
University of South Florida
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Tampa, Fla
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Adult instruction
Positive reinforcement
Dissertations, Academic -- Child and Family Studies -- Masters -- USF   ( lcsh )
non-fiction   ( marcgt )


ABSTRACT: This study examined the effects of a parent training program teaching discrete trial teaching (DTT) and incidental teaching (IT) methods using a parent training manual. Three families with children between the ages of 5-6 diagnosed with Autism Spectrum Disorder (ASD) participated. Both parents received parent training although Parent A received training from the experimenter and Parent B received training from Parent A. The parents taught their children one skill each from three categories: communication, self-care routines and a household expectation. This study sought to expand upon the literature in the realm of combining DTT and IT as well as adding the dimensions of training in home environments in a short period of time and examined the role of one parent training the other. Results showed that all of the Parent As were able to learn and apply DTT and IT in teaching their children. All Parent A's were then able to teach Parent B's how to use DTT and IT without additional training from the experimenter. The generalization effects of learning skills in multiple environments with different people was also examined and discussed.
Thesis (M.A.)--University of South Florida, 2009.
Includes bibliographical references.
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by Lindsey Jones.
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\A Parent Training Program Comb ining Discrete Trial Training and Incidental Teaching in the Home Environment by Lindsey Jones A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts College of Graduate Studies University of South Florida Major Professor: Tr evor Stokes, Ph.D. Debra Mowery, Ph.D. Mary Fuller, Ph.D. Date of Approval: June 30, 2009 Keywords: adult instruction, children, skills, positive reinforcement, autism Copyright 2009, Lindsey Jones


Dedication This thesis was inspired by all of the families that I have worked with in Virginia and in Florida. I have been bl essed to work with the most amazing parents under the most unexpected circum stances. I have loved working with you and your children. I have had two s upervisors who became lifelong mentors to me: Mary Worley in Virginia and J anis Krempa in Florida have supplied me with wisdom in this field and continue to set the finest examples of practitioners. I decided to earn a master’s degree in th is field because Mary Worley suggested I do so. This thesis is also dedicated to my family, Sam, Linda, Brian, and Katherine Jones whose unconditional love and support are beyond any value.


Acknowledgements I would like to express my sincere thanks and appreciation to Dr. Trevor Stokes. I wanted you to advise my thesis from the start of my first year as a graduate student, but you have also become an invaluable mentor and supporter as I completed my graduate degree. Thank you for the encouragement and inspiration! I would also like to thank the Fletcher family, Johanna Jones, Suzie Berndt, and Katie Kenny for their continued support as I completed this research. Finally, I would like to thank my thesis committee members Dr. Debra Mowery and Dr. Mary Fuller who prov ided critical insight and encouragement.


i Table of Contents List of Figures iii Abstract iv Chapter One: Introduction 1 Parent Training Methods 1 Parents as Trainers 9 Comparing and Combining DTT with IT 11 Generalization 15 Family Context 18 Statement of Purpose 19 Chapter Two Method 22 Participants and Setting 22 Dependent Variables and Measurement 23 Parent Behaviors 23 Child Behaviors 24 Data Collection and Interobserver Reliability 28 Social Validity 29 Experimental Procedures 29 Baseline 29 Parent Training 29 Parent A: Skills 1 and 2 32 Training of Parent B 32 Parent B: Skills 1 and 2 32 Parent B: Skill 3 33 Parent A: Skill 3 33 Experimental Design 33 Chapter Three: Results 35 Social Validity 44 Chapter Four: Discussion 45 References 49


ii Appendices 54 Appendix A: Data Collection DTT 55 Appendix B: Data Collection IT 56 Appendix C: Data Collectio n Parent Training 57 Appendix D: Social Validity Questionnaire for Parents 58 Appendix E: Informed Consent 59


iii List of Figures Figure 1 Multiple Baseline of Parent As for all three families 37 Figure 2 Multiple Baseline of Parent Bs for all three families 39 Figure 3 Multiple Baseline of Child Performance wit h Parent As 41 Figure 4 Multiple Baseline of Child Perfo rmance with Parent Bs 43


iv A Parent Training Program Combin ing Discrete Trial Training and Incidental Teaching in the Home Environment Lindsey Jones ABSTRACT This study examined the effects of a parent training program teaching discrete trial teaching (DTT) and incidental teaching (IT) methods using a parent training manual. Three families with chil dren between the ages of 5-6 diagnosed with Autism Spectrum Disorder (ASD) par ticipated. Both parents received parent training although Parent A received training from the experim enter and Parent B received training from Parent A. The parents taught th eir children one skill each from three categories: communication, self-care routines and a household expectation. This study sought to expand upon the literature in the realm of combining DTT and IT as we ll as adding the dimensions of training in home environments in a short period of ti me and examined the role of one parent training the other. Results s howed that all of t he Parent As were able to learn and apply DTT and IT in teaching their childr en. All Parent A’s were then able to teach Parent B’s how to use DTT and IT without additional training from the experimenter. The generalization effect s of learning ski lls in multiple environments with different people was also examined and discussed.


1 Chapter One Introduction Autism is a type of developmental diso rder of the brain characterized by a spectrum of symptoms divided into th ree categories includi ng impairments in social interactions and communication as we ll as repetitive patterns of behavior. There is no known cause for autism but symptoms appear before an individual is three years of age. There are a variety of treatments and therapies fo r parents of children with autism to choose from including techniqu es used in Applied Behavior Analysis. Two techniques include Discr ete Trial Training (DTT) and Incidental Teaching (IT). These techniques are frequent ly used by behavior analysts in interventions, but can easily be taught to par ents as well. There is a rich history in research about the usage of these tw o methods in a variety of settings including their usage in parent training repertoires. Parent Training Methods A study by Lovaas, Koegel, Simmons and Long (1973) was one of the first to utilize parent trai ning in expanding the skills of their children with autism and maintaining those skills. This study took place in a center and looked at five types of behavior: echolalia, appropriate verbal, social nonverbal, selfstimulation, and appropriate pl ay. The important aspect of this study is that the


2 only children who actually maintained t hese skills and extended upon them were the participants whose parent s received ongoing training. All the children in the study did have improvements, but not as much as the participants with the parent training component. Also, a foll ow up after 1-4 years at the conclusion of training showed that the children whose parents had training we re improving while the children who had been inst itutionalized had stopped making improvements and had regressed in some cases. Another study by Kogel, Russo, and Rincover (1977) looked at the possibility of designing a reliable and valid way to train children with autism. This study worked with 11 teache rs and their 12 students. For training the researchers used training manuals, videotapes, modeling, and feedback. The teachers, for example, were instructed to first read a training manual that described correct and incorrect uses of five categories of behavior modification procedures. Afterwards the teachers obs erved videotapes that reiterated what the training manual contained by showing correct and inco rrect uses of the same procedures. Upon completion a teacher t hen attempted to teach a student a new target behavior with a trainer observing. Every five minutes the trainer would provide feedback to the teacher while modeling procedures that were being performed incorrectly. Twenty-seven beha viors were highlighted for teaching. These were divided into six categories in cluding self-help skills, arithmetic skills, writing skills, picture labeling, abstra ct language skills, and speech skills. The results of this study showed that in t he posttraining condition all 11 teachers performed 90-100% for correct usage of the behavior modification procedures


3 they had been taught. This study is signific ant because it illustrates that it is possible to train and assess a teacher with behavior analysis procedures. A year later a study by Koegel, Gl ahn, and Nieminen ( 1978) examined the generalization of parent tr aining results. This study consisted of two experiments. The first focused on pr oviding parents with a brief demonstration on teaching children with autism new behaviors. Parent behaviors were measured and consisted of pr esentation of the discrim inative stimulus (SD), prompting, shaping, consequence use, and discrete trial implementation. Parents were able to teach those behaviors, but no generalization of new behaviors took place. This experiment also examined a training protocol with parents using general behavior modifica tion procedures which was able to successfully teach the parents skills. T he second experiment reviewed individual effects of the training programs that were generali zed and made up of many different components. This experiment us ed videotapes to teach parents and did not have a trainer show them how to teac h new behaviors to their children. The results showed that the vi deotape condition developed parents with more specific training. Another study by Lovaas (1987) ex amined two groups of children with autism each receiving varying amounts of behavioral treatment. The first group received more than 40 hours a week of one-on-one treatment and the second group received less than 10 hours a week. Trainers and parents were both utilized to work with the children on a variet y of behaviors divided up into years. The first year focused on reducing self-s timulatory behaviors and aggression.


4 During the second year the children were taught expressive and abstract language as well as interactive play skills The third year brought instances of teaching emotions as well as pre-academic skills for the children. The results of this study showed that some children re covered from their extreme behaviors and most children improved significantly. It took only two years of treatment to see observable changes with the child and parent. This study allowed for two years of treatment whic h showed the importance of ongoing therapy for the development of skills in the participant s. The question now remains whether parents can be effective acquiring skills in a shorter amount of training time. Sheinkopf and Siegel’s st udy (1998) took place in the home environment under the direction of parents with the help of clinicians. This study is important not only because of the home environment, but also because of the shorter period of time used for training and impl ementation. The children with autism were compared with a cont rol group of children only receiving school-based interventions. The training was based on Lovaas, Ackerman, Alexander, Firestone, Perkins, and Young (1981) and utilized a manual explaining general principles of learning, operant conditi oning, and a hierarchically organized curriculum. The manual also discuss ed modeling therapy se ssions with discrete trial formats (prompt-response-rein forcing stimulus) with prompting, generalization, and maintenance being high lighted as well. Any punishment procedures consisted of mild verbal co mments. Parents had the assistance of behavior therapists who were proficient wit h the Lovaas training manual. Skills were highlighted and included receptiv e language skills, nonverbal imitation,


5 nonverbal problem solving, and expressive language skills. More activities such as verbal expression, social skills, pl ay skills, and preacademic skills were added later in the study. At the completion of the study, IQ tests were administered and children in the home-based treatment had higher scores than the children in the school-based intervention with a difference of 25 points. The participants had small changes in behaviors that were considered valuable even though all participants retained their original diagnos es. The researchers concluded that home-based interventions can be successful without the directio n of an academic center or company. A study by Lerman, Swiezy, PerkinsParks, and Roane (2000) looked at skill acquisition of parents of children with develop mental disabilities. Three parents learned treatments fo r their children’s probl ematic behaviors with management strategies using written and verbal training from the researchers. The management strategy consisted of wit hholding attention after occurrences of inappropriate behaviors, provi de verbal prompts of a sking their children what they wanted if 10 seconds elapsed of no behaviors, and differential reinforcement for no occurrences of inappropriate behaviors Parents were also trained to use instructional prompts follo wing noncompliance with prai se following compliance to the instruction. The results showed that all paren ts were able to learn the skills using the written and verbal teachi ng plus feedback from the researchers. A follow-up proved that the parents c ontinued to demonstrate their skills with their child. This study is important because it utilizes a training format that is not financially expensive to train initial ski lls and then provides opportunities for


6 supplemental instruction from a clinician if extra help is needed. This saves the clinician from having to train for long peri ods of time instead of being used only if needed by a parent that needed more instruction. That same year another study by Sm ith, Buch and Gamby (2000) looked at parent-directed early intervention te chniques for children diagnosed with Pervasive Developmental Disorder (PDD) Six boys between the ages of 35-45 months and their parents participated. The parents recruit ed therapists who could provide training on how to implem ent the UCLA Treatment Model (Smith & Lovaas, 1998) in their own homes. The parents and their therapists then took part in 6 one-day workshops during a 3-m onth period that took place in their home settings. All participants and therapis ts were also given consultations for the following 2-3 years after the initial st udy. Training on the UCLA Treatment Model consisted of lecture on behavior an alysis principles and procedures and direct treatment with the ch ild by parents, therapist, and trainer. The researchers found that the parent-r ecruited therapists had sufficient knowledge of treatments but were less consistent wit h DTT procedures than the therapists who work in a clinical setting. Results showed that five of the six boys learned receptive language, nonverbal imit ation, and verbal imitation qu ickly after treatment started but during the 2-3 year follow up only two of the six had better scores on standardized tests. Stahmer and Gist (2001) looked at a parent education support group as an addition to an accelerated parent educat ion program. Two groups of parents from 22 families received parent education for 12 weeks separately from one


7 another with one group also attending a parent education support group once a week. The parents all had chil dren with ASD under the age of five. Training for the parents took place in a clinical setti ng and included instructions for presenting clear demands or questions, inters persing maintenance tasks, and the importance of child choice and shared co ntrol. Parents also learned how and when to use reinforcers. Results we re measured with videos of the parents playing with their children before and after training with the frequency of vocalizations of the child ren being recorded. The researchers found that both groups had high higher levels of perform ance with the techniques but the group that attended both the parent education program and the support group increased their overall mastery of teachi ng techniques. Children in both groups increased their vocalizations but the ch ildren of the parents who attended both the groups had higher increases. The res earchers wrote that parent mastery of procedures would naturally increase the success of accelerated programs which would then increase their child ren’s language abilities. A study by Seung, Ashwell, Elder and Valcante (2006) looked at the efficacy of in-home training of communica tion goals of childr en with autism with their fathers. Training consisted of indi vidual sessions between father and trainer and used videos of the fathers with their ow n children. The researchers focused on expectant waiting and imitat ion with animation with t he fathers. They found that the fathers easily lear ned to wait for their childre n to verbally communicate as well as interact with their own children verbally too. The researchers cited that


8 this was another example of the importanc e of social recipr ocity between parent and child. Another study by Ingersoll and Dv ortcsak (2006) showed how parent training can make an early special educatio n program more valuable. This study involved nine families with children ages 3-4 diagnosed with ASD. The researchers used a parent training curricu lum made up of naturalistic intervention techniques to increase social communi cation skills in t he children with ASD during daily routines. The parent training curriculum wa s a conglomeration of a variety of techniques divid ed into two categories: direct and indirect. The indirect consisted of therapies such as Respons ive Teaching (Mahoney & Perales, 2005) and Floor Time (Wieder & Greenspan, 2003) and all occurred during childdirected activities. With these techni ques the parents were to increase their responsivity to their own child’s behavior and learned to follow their child’s lead. Direct interventions consist ed of naturalistic and behaviora l interventions such as incidental teaching, mili eu teaching, and Pivotal Re sponse Training (Stahmer, 1995). The trainers also used prompting, shaping and reinforcement techniques specifically to teach social-communication skills in the children. Parent training took place in group and individual session s over an 8-week period. Teachers were trained concurrently with the parent s and used the same training model. The study did not measure actual behavio r change in parent or teacher behavior but did measure knowledge and satisfaction with the teaching model using surveys at the completion of the study. Parents responded that although they were pleased with the information they le arned, they were not as confident in


9 applying that information in their home setti ngs. One problem with the teaching model is the amount of time it took to train parents and teachers. Only 56% of the parents participated in the entire study and each teacher needed to devote 50 hours to it. Parent training has definitely evolve d from 1973. Not only has research proved the effectiveness of behavior analys is procedures, but it has also shown that parent training program s are equally as effective in the treatment of children with developmental disabilities. Now th e question is: Can parents transfer what they have learned to others? Parents as Trainers A study by Kaiser, Hester, Albert, and Whiteman (1995) looked at the effects of teaching trainers with no prev ious behavioral training to teach parents how to work with their own children with language delays. Thr ee mothers, their children, and three novice trainers were involved in the study. Parent training consisted of meeting twice a week in a clinic setting in a play room and trainer training took place in an office setting wit hin the same clinic. The researchers used videotapes, handouts of explanations, and graphs to teach the trainers. The researchers also had the trainers practice their skills on children who were not involved in the study. The trainers were taught to communicate accurately with the parent, role playing, provide positive and corrective feedback, and coach each parent. After training the trainers had four training se ssions with a parent and child. During these trainings a researcher observed and videotaped the session to provide feedback to the trainer. The results of this study show that the


10 trainers were able to learn procedures from only reading, were not able to implement until they practi ced and were given feedback from researchers who had already mastered the teaching techniq ues. Two of the three children had significant gains in learning their tar get behaviors. The researchers say that these results are due to specif ic distinctiveness of the individual families. Some parents had trouble attending to their children because of their own disabilities. However, following the trai ning the trainers with no exper ience were able to train parents to teach skills to their children. A 2005 study by Symon examined the im pact of teaching pivotal response training to three families in a clinical setti ng. For this study the primary caregiver, child, and the trainer were all present for a five-hou r period per day for five consecutive days. Using a parent educat ion program the trai ners taught pivotal response training by showing how the adult provides clear uninterrupted instruction that vary frequently and in clude maintenance tasks with acquisition skills. They also showed the parents how their child should have significant input in selecting the toys and activities they want to work for t hus making the reward functional. Finally, they demonstrated how rewards should be given immediately to their child after correct trials. An im portant aspect to th is study is how the trainers taught the parents how they could teach others the same procedures. At the completion of parent training with pi votal response training, the parents left the clinic setting and trai ned another family member i ndependently. The results showed that the parents were very successful in transferring what they learned to


11 another family member and the children’s targeted behaviors improved with the parent-trained family member These articles have shown that it is possible for parents to learn skills and then teach those skills to others. These re sults also illustrate that parents who learn how to help their chil dren will continue their childr en’s therapy even when a behavior analyst is not present. This has im portant implications for the future of the child; their parents will spend a ne cessary amount of time helping them acquire and maintain skills. Comparing and Combining DTT and IT Hart and Risley (1975) performed a st udy on incidental teaching in preschool settings. They wrote that inci dental teaching was defined as a way to teach labeling and expressive language skills in a naturally occurring adult-child environment. They defined incidental teac hing as any situation that is childinitiated. Hart and Risley taught 11 children compound sentences when the children requested various materials fr om teachers and other children. A compound sentence occurred in two conditions. The first was with adults: after a child initially asked for an item an adult presented a cue “Why?” or “What for?” and the child then explained the reason for wanting the item. The second condition was with other children: the child asks for an item and the adult says he must ask another child for the item, and th e child then asks another child for the desired item. The results showed that the children’s use of compound sentences increased significantly after incidental teaching began.


12 Hart and Risley expanded on their previo us study in 1978 to include a three-term contingency to incidental teaching for language development which incorporated the student’s initiation, consequences, and the adult’s request for elaboration. They stressed that although the adult can set up a situation they may not prompt an initiation. Hart and Risley expanded on their three-term contingency to include a process for t eaching adults: focus attention, model correct answer, ask for elaboration, pr ompt elaboration by providing a hint, provide correct answer, and finally prov ide reinforcement. Not all steps are necessary all the time because they depen d on what you are teaching and the situation. Hart and Risley also suggested that if corrective f eedback is required from the adult, the incidental teaching session should end immediately. Five years later a study by McG ee, Krantz, Mason, and McClannahan (1983) used incidental teaching to teach receptive language skills to two children with autism who could not initiate social in teractions with others The study took place in the group home env ironment for both childre n during their meal times when the children would prepare their l unches with an adult. The results showed that both children acquired and generalized receptive language skills very quickly once incidental teaching star ted. The study modified the incidental teaching methods because they added a DTT component to test for generalization. This phase was not a teaching phase and served as a way to see the effects of the teaching method on the participants. The previous studies have s hown that incidental teac hing is easy to use in the natural environment and functional for the ch ild in the specific situation, but is


13 it preferred by parents? A study by Schreibman and Koegel (1996) found that naturalistic strategies were more enjoyable for parents. The study also commented that naturalistic strategies in general were easier and less time consuming to train in home environments. The term “naturalistic strategies” refers to those situations that take plac e in a natural environment, such as homes and schools, and not necessarily in a cl inic. Incidental teaching can be considered a type of nat uralistic strategy. A 2005 study looked at the acquisition and generaliz ing effects of discrete trial teaching in a more intensive par ent-training program (Crockett, Fleming, Doepke, & Stevens). Two parents were trained to teac h four functional skills to their own children in a clinical setti ng using DTT procedures. The training consisted of a trainer giving instructions modeling, role playing, and providing feedback. The parents were taught ho w to present antecedents, deliver consequences, conduct intertrial intervals, and record their child’s behavior. Training lasted for two hours a week for 6-9 sessions depending on how quickly the parent learned the repertoire. T he four skills varied for each child but included attending, writing, counting, choosing, labe ling, ball play, and verbal imitation. The parents were not trained how to teach each skill to their child, but were instead instructed to teach one skill at a time using their knowledge of DTT. The results showed that the parents we re able to generalize the DTT methods taught to them and successfully teach their children the four skills. The researchers cited that their study c ould be improved upon by examining the effects of a DTT training program in a more natural setting.


14 A study by Steege, Mace, Perry, and Longenecker (2007) documented the many problems associated with programs that utilize only DTT methods. The authors wrote that although DTT is easy to learn, progressive, allows for numerous trials, and is adequate to develop skills, it requires more steps for generalization, has a difficult time trans ferring to natural environments, and may not be functional enough for mo st children. They reco mmend incorporating more methods instead of using a pure DTT prog ram for children with autism. This leads to the question, what are the po ssible differences between DTT and IT? Many studies compare the effects of DTT and IT in the acquisition and generalization of skills in children with ASD. One such study by Mirande-Linde and Melin (1992) compared the effects of DTT and IT with two boys ages 10 and 12 diagnosed with Autism. DTT and IT were used to teach color adjectives in a school environment. The results showed that DTT led to faster acquisition, but a week later during a follow-up session t here was no difference in the performance of either boy between the two different methods. IT resulted in slower generalization when impl emented in the home envir onment, but during the follow-up session yielded better results than t he traditional DTT. This study is important because it shows the differ ences in time needed to acquire and generalize new skills. A more recent study by Charlop-Ch risty and Carpenter (2000) examined modified incidental teaching sessions (MI TS) against traditional incidental training and DTT. The aut hors wrote that MITS uses both DTT and incidental teaching in regards to acquisition and gene ralization. DTT by itself is credited


15 with rapid learning due to trial repetition and incident al teaching occurs in a natural environment. The parents of thr ee children with autis m were trained to utilize all three techniques using inst ruction, modeling, and feedback. The authors wrote that incidental teaching occurs in natur al environments and DTT leads to rapid learning because of trial r epetition. Results s howed that MITS had more significant acquisition and generaliz ation of target behaviors. Only one child acquired skills with incidental and two children acquired skills with DTT, but all acquired with MITS. No target skills were generalized with incidental teaching by itself or DTT by itself. This study is important because it shows the differences between using a DTT-only pr ogram versus an IT-only program, but its greatest strength is sho wing the importance of combin ing DTT and IT to come up with a very successful par ent-training program. Two different types of successful t eaching methods are DTT and IT. Both are effective separately and, as the previo us articles have sh own, are effective when used together. When used separat ely and by itself, DTT has numerous problems including more time needed for g eneralization and not as functional as other methods (Steege, et. al, 2007). Also, when it is used by itself IT has slower acquisition time for skills (Mirande-Linde & Melin, 1992). When the two methods are combined, however, the Mirande-Lind e and Melin study (1992) showed that skills were acquired and generalized withi n a reasonable amount of time. Generalization Generalization is an important aspect of any autism program. What is the point of teaching language and skills if the child can only use them in situation,


16 environment, or with one other person? An article by Stokes and Baer (1977) examined generalization by synthesizing previous lit erature and provided nine classifications for specific types. Those nine classifications include the following: Train and Hope, Sequential Modification Introduce to Natural Maintaining Contingencies, Train Suffi cient Exemplars, Train L oosely, Use Indiscriminable Contingencies, Program Co mmon Stimuli, Medi ate Generalizatio n, and Train “To Generalize.” A study in 1974 by Stokes, Baer, and Jackson was an example of Train Sufficient Exemplars by looking at incr easing greeting respons es in children with mental retardation to staff members. Th is study found that if they only used one staff member during training, the ch ildren would not generalize the learned greeting responses to the other staff me mbers. When they added additional staff members to the training c ondition the children were able to generalize the greeting responses to other staff members including ones that were not present during training and were not associ ated with training either. In 1989 a study by Stokes and Os nes noted the most effective generalization takes place within the same stimulus class that was present during the training phase. That article also discussed the experimental analysis process and divided it up into three working ca tegories: exploit current functional contingencies, train diversely, and in corporate functional mediators. There are clearly many different ty pes of generalizatio n that can happen as a result of a variety of factors. For example, t he Koegel, Russo, and Rincover study (1977) demonstrated generalization through the training phase by using


17 accurate through correct treatments. A nother study by Mirande-Linde and Melin (1992) looked at the generalization of skills in different environments and with different people. An import ant study by Crockett, Flem ing, Doepke, and Stevens (2005) reviewed generalizati on by teaching DTT proced ures and then examining their participants use of t he DTT procedures to teach untaught skills directly to children. Two mothers taught their ch ildren with autism four skills: attending, writing or labeling, counting or ball play, and choosin g or verbal imitation. The skills were picked by the parents and researchers depending on the child’s developmental abilities. Once the skills were decided the mothers were asked to teach their children the first skill to the best of their ability. The mothers then received training consisting of six to ni ne 2-hour weekly sessions. Starting with a lecture about behavior principles, a videot ape of examples, role-playing, and finally demonstration of the parents’ ability to work with their child using the DTT skills. The results showed that both mothers were able to take the DTT procedures they learned and teach skills to their children. In other words, the mothers were able to generaliz e the DTT training and teach skills to their children using DTT. Most important ly the mothers were able to extend what they learned to teach dissimilar skills. A def icit of this study was that it took place in a clinical setting instead of a more natural setting, su ch as the home environment. A more recent study by Naik-Polan and Budd (2009) investigated generalization of parent skills in the home setting with Parent -Child Interaction Therapy (PCIT). The researchers used a multiple basel ine design to show that the four participating mothers were abl e to increase the quality of family interactions in


18 their home environment even though only three of the four had spontaneous transfer of skills. The quality of inte ractions was measured by the type of behavior the mothers were ex hibiting which could have been types of attention, praise, or reflecting what t heir child had just commented. Family Context When working with families many variabl es need to be taken into account before developing a training program or an in tervention. An article by Santarelli, Koegel, Casas, and Koege l (2001) summarized the important concepts of developing interventions that took into a ccount different situations relating to families. One such exam ple would be considering a family’s socioeconomic status before developing an in tervention. For example, it would be inconsiderate to design a program that needed expensiv e computer equipment if the family could not afford to buy the equipment or maintain it pr operly. The article also discussed the different cultur al factors that can effect a behavior plan. For instance, a family that speaks only German would need a behavior analyst or an interpreter that could adequat ely explain and teach them what they needed to know to help their child. The behavior plan would not be as effective if the behavior analyst was not able to co mmunicate with the family. Another variable that needs to be c onsidered before trai ning or program implementation is the actual design of the plan. An article by Gallimore, Weisner, Bernheimer, Guthrie, and Nih ira (1993) emphasized the im portance of taking into account the family’s daily activities and routines. The authors stressed the importance of each family being involved in the planning and implementation of


19 their own intervention. Like the Cro ckett, et al. study ( 2005), parents should be able to provide input about what they would like thei r children to learn and explain what goals they have for thei r child. By pr oviding parents with opportunities to contribute in the process of helping their child, the parents will be more likely to participate in the therapy itself. A study by Moes and Frea (2002) l ooked at the importance of a concept called family context when assessing and des igning interventions for families. Family context includes caregiver demands, family support systems, and patterns of social interaction. M oes and Frea used information gathered from 3 families with children with autism to individualize behavior support plans for functional communication training (FCT) wi th family routines. The 3 mothers were taught FCT procedures through direct instruction with their child under the tutelage of trainers. The results of the study indicated that FCT can adapt well with families when considering a fam ily’s home environment including values, belief systems, and goals. Statement of Purpose There is a plethora of research on parent training with children who have autism. Most research on parent tr aining combines a variety of ABA methodologies and training techniques. Much research also exists on the characteristics of DTT and IT methodology. The most comprehensive studies on DTT and IT are those that combine them to form a more complex yet more effective autism intervention than if us ed separately. Regardless of the intervention type, some limitations rema in including the possible results of


20 training parents in a natural environ ment with limited time. Likewise, interventions that combine DTT and IT also raise many questions on the effectiveness of parent traini ng in home environments with a limited time frame. Therefore, this study sought to examine the possible re sults of a parent training protocol that combines DTT with IT using a training manual, role-plays, and feedback. Similar to the Crockett, et al study (2005), the present study designed a parent training curriculum that not only a llows parents to provide input in what skills their children will learn, but also al lows for generalization of the procedures by the parents. Unlike the Crockett, et al. study (2005), the present study will take place in the home environment and wi ll not allow the parents to observe the lead researcher work with their children. This way the generalization of the DTT and IT procedures is dependent on the tr aining manual and role-plays. The present study also built upon the study by Kaiser, et al. (1995) in that the Lead Researcher trained only one paren t directly and that parent taught the other parent using any training material s provided by the Lead Researcher. The process of training started with the lead re searcher training the first parent how to use DTT and IT procedures with two skills The first parent then taught the first two skills out of a list of three skills requested. Once the child demonstrated adequate knowledge of the first two skills by the first parent, the first parent trained the second parent. Upon success ful completion of training the second parent reviewed the first two skills and then taught a third skill that was untaught by the Lead Researcher and the first parent.


21 Since the present study nee ded to be completed in a few months it was interesting to observe whet her or not the parent trai ning program was effective enough for the parents to learn DTT and IT procedures and apply them to their children’s therapy.


22 Chapter Two Method Participants and Settings Three families participated. Each fa mily had a child with a diagnosis on the autism spectrum and the presence of two parents or ca regivers that lived in the home. The participating children were 5 and 6 years old with less than a year of Applied Behavior Analysis (ABA) therapy. At the time of this study each family was receiving in-home 1:1 services by the experimenter. The adults and caregivers had no discrete trial training (D TT) and little-to-no incidental teaching (IT) training. Participant one was six y ears old at the time of the study with a diagnosis of PDD-NOS. He could communicate wants with 2-7 word sentences but preferred to speak with the fewest amount of words possible. He had deficits in expressive communication and social skills with peers and family members. He attended a public school in a special ed ucation classroom and had a younger sibling. Participant two was five years old at the time of the study with a diagnosis of Autism. He could say approximately 15 words but used a Go Talk 9+ electronic device to communicate at the time of the study. He lived at home with his mother and an older sibling who acted as a parent figure for him. He attended a public school in a s pecial education classroom.


23 Participant three was six years old at the time of the study with a recent diagnosis of Autism. He could communi cate 1-4 word sentences for wants but had difficulty with expressive communi cation and making choices between preferred items. He lived at home with his par ents and two siblings. His mother home schooled him at the time of this study. The study took place in the individua l home setting. Data collection for each parent took place in the same da y. Observations were conducted individually with each adult while the other adult was supervising the other children elsewhere in the home or at work. Data collection for both parents took place at different times on the same day throughout the study. For the DTT sessions a room was utiliz ed that had few distractions (wall decorations, toys, things that make noi ses) with a child-sized table and two chairs that sat caddy-corner from each ot her. This room was the child’s bedroom for two of the participants and a computer room for the third participant. The IT sessions took place all around the insi de of the house and surrounding yard, such as the foyer to the house, laundr y room, kitchen, bathroom, and garage. Dependent Variables and Measurement Parent behaviors. The first analyzed variable was parent behaviors. The accuracy of parent behaviors were reco rded while teaching their child the targeted skills. These behaviors were m easured using a data sh eet that utilized a check-off list for each step of the skill. These data sheets are located in Appendix A and B.


24 The specific parent behaviors that were measured during the duration of this study were whether or not they we re following the DTT and IT formula. For DTT those behaviors were the following: parent providing a discriminative stimulus, providing a reinforcing stimul us, and making sure that an inter-trial interval took place. A discriminat ive stimulus was the instruction or environmental cue that the parents wanted their child to learn to respond using the desired skill. The reinfo rcing stimulus was a reward to motivate the child to respond and respond correctly to the discrim inative stimulus give n by the parent. The inter-trial interval was a brief paus e (between five and 25 seconds) between consecutive trials. For the ITT sessions, measured parent be haviors consisted of setting up the environment in a way t hat would encourage their ch ild to engage in the skill, providing a discriminative stim ulus or waiting for their child to engage in the skill, and providing a reinforcing stimulus upon co rrect completion of the desired skill. Both the DTT and IT skills were a part of a Training Manual that not only described a formula of how to use them, but also used examples of how to use them and troubleshoot a variety of possible scenarios. Child behaviors. Another dependent variable was the frequency of correct responses of the children to the skills their parents are teaching them. The definition of a correct response depended on the skill being taught but always involved a response that did not co me from a prompt given by the adult. The skills consisted of three target ar eas: communicating, completing a self-care routine and a household expectation. The sp ecific skills within these target areas


25 differed depending on the child’s assessmen ts and requests from parents. This part of the study served as a collabor ation between the re searcher and parents to come up with the best skills for the child and his family.The communication target area had three different skills that the parents picked for their children. These were expressing daily events, gr eetings and making choi ces between food items at meal times. For the first fam ily the skill of expressing daily events was picked for the participant because he had the capacity to co mmunicate to his parents what he did during the school day but had not been taught and therefore was not doing so with anyone. A board with laminated picture and word cards was used to help him organize three events that happened that day. He was taught to pick at least three activities that happened that day put them on the board in descending order, tell his parent s what he did, and then answer one question about each activity. To teach this to him his first parent (Parent A) sat through an hour and fifteen minute session with the Lead Researcher using the Training Manual. The Lead Re searcher and Parent A t hen role played how the first parent could implement the communi cation goal with her child in the DTT setting and the IT setting. The Lead Re searcher gave corrective and positive feedback during the role-plays which lasted around 10 minutes. For the second family the greetings skill involved t he combination of a Go Talk 9+ communication device and waving. After Parent A reviewed the Training Manual with the Lead Researcher they began to role-play how to use DTT and IT and apply them to the desired skills. The pa rticipant learned to use the Go Talk 9+ to say “Hi” or “Bye” and learned to wa ve his hand. It was decided to teach


26 both the Go Talk 9+ and t he waving in case the comm unication device was not available to the child. In those instanc es he could still wave to people as they were coming or going. In the DTT setti ng Parent A was taught through role-play how to prompt their child to push the Go Talk 9+ button when it was time to say “hi” or “bye.” The third family chose making choi ces between food items as their communication goal for their child. Afte r the first parent reviewed the Training Manual with the Lead Researcher they also role-played how to use a visual choice board of preferred food items on laminated 2in by 2in cards. The cards had Velcro on the back and were used to he lp the child organize what he wanted to choose for dinner. To teach this skill Parent A would pick out two choices, place them on top of the blank white choice board and then the child would verbalize what he wanted to eat. Completing a self-care routine was defined as the preparation and/or maintenance of one’s body in regards to daily life. For the first family this skill consisted of getting dressed. The part icipant had to put on and take off underwear, a shirt and a pair of pants by himself without being chased down by his parents. As with the first skill set, t he Parent A learned to teach this skill through role-plays and positive and correctiv e feedback before applying the DTT and IT situations with her child. The second family chose putting on shoes as the self-care routine their child would learn do complete all by hims elf. The participant had to put on either a type of sandal or a shoe involving Velcro straps all by himself. Like the first


27 skill set, the first parent learned to teach this still in DTT and IT settings after completing role plays and receiving positive and corrective feedback from the Lead Researcher. The self-care routine the third family chose was brushing teeth. Similar to the previous skill, the first parent learned to teach their child th is skill in DTT and IT settings after finishing role-plays and receiving corrective and positive feedback from the Lead Researcher. Completing a household expectation was defined as the initiation, follow through, and completion of a task that can be done in the hom e environment that the parents found necessary and important for their children to be able to complete independently. These skills had to be developmentally appropriate for the child. The first family chose sitting at the dinner table and ea ting dinner without leaving, standing on chair, and engaging in excessive self talk as their household expectation for all children. Unlike the previous two skill sets, the second parent had to teach this skill to their child. Afte r the first parent taught the first two skills they trained the second parent using the Training Manual and role-playing. The second parent also was allowed to observe the first parent doing the first two skills with the child after training. When training finished the second parent had to teach the third skill to the child. The second family chose helping with the laundry as their household expectation for all the childr en. Similar to the first fa mily, the second family also had the second parent teach this skill to t he child after successful completion of


28 training by the first parent. This skill comprised of having the child transfer wet clothes to the dryer and then taking the dr y clothes and putting them away in a hall closet. The household expectation the third fa mily chose was feeding the family cat. The second parent taught this skill afte r successful completion of training by the first parent using the Training Manual an d role plays. This skill consisted of taking a cup of food out of the cat food bi n and dumping in into the cat bowl until full. Data Collection and Interobserver Reliability Data collection took place for up to 30 minutes twice a day which was a maximum of 30 minutes per parent. T he DTT session consisted of between 10 and 20 trials per skill lasti ng 24 minutes with each skill ta king around 8 minutes to complete. This data sheet is located in Appendix A. The IT session lasted up to 6 minutes. This data sheet is located in Appendix B. Data for the parents were collected as they completed in dividual trials. Data for the children were collected as they responded to their parents’ teaching. During parent training another data s heet was used to determine if all aspects of the Training Manual were taugh t by the lead researcher to Parent A and whether or not Parent A taught the same material to Parent B. This data sheet is located in Appendix C. The experimenter could not present for all sessions so a Flip video camera and tripod was given to all familie s. Sessions were videotaped using the Flip video camera so t hat interobserver agreement could be measured when the


29 Lead Researcher and research assistan t could watch together. Research assistants were present for 34% of all sessions and took data simultaneously and independent of the experiment er. The interobserver ag reement was obtained by dividing the number of agreement steps by the number of completed plus disagreement steps and multiplying that total times 100 for the measurable behaviors. The final IOA was 96.5%. Social Validity Social validity was assessed through the administering of a questionnaire to all participating parents upon comple tion of the study. A copy of the questionnaire is located in Appendix D. The questionnaire asked the parents about the procedures, goals, a nd the social importance of the effects. The experimenter was not present when parents filled out the questionnaire. Experimental Procedures Baseline Baseline sessions consisted of 24 minutes twice a day. Each parent had 24 minutes and within that time limit they had eight minutes to try to teach each of the three skills. There were between 4-5 sessions a week per family. Prior to starting data collection the lead researcher asked the parent to try their best to teach a skill. Accura cy of the parents’ behav iors and frequency of correct responses of the child were both measured. Parent Training. After baseline Parent A for eac h family received training with the experimenter. Traini ng consisted of teaching t he Training Manual, which incorporated lecture and role-plays in a book format. Parent A received feedback and time to receive clarification on any thing pertaining to the methods being


30 taught. Once Parent A has demonstrated mastery of the criteria needed to teach skills using DTT and IT Parent Training ended. They kept t heir parent training manual and any additional notes taken. The Training Manual itself was a compil ation of teaching strategies that complemented the DTT and IT training itself. The m anual started with a section describing Autism and its di agnosing criteria and followed it with a section about ABA. The ABA chapter discussed how behavior is analyzed and modified, showed the cyclical nature of behavior patterns, discussed antecedents and consequences, and gave examples of the four possible functions for behavior: gain attention, escape a situation, get something, or sensory based. Once Parent A understood the functions of behavior and could answer a series of questions and provide examples, they were ready to move on to the DTT training portion. The DTT portion started with the formula pr actitioners use to measure trials and then described each step. It gave tips on how to start your very first DTT session and then transition to a r outine session compromised of numerous trials. The next session dealt with erro r corrections and was used to help parents react appropriately when their child answered incorrectly dur ing a trial. An error correction took place if the child made an incorrect response and consisted of the parent making a model of t he correct response, provid ing a prompt to help the child answer correctly, a switch to distract the child, and a repeat of the original discriminative stimulus (Frost & Bondy, 2003). The goal of an error correction was to correct the child through further instruction instead of relying on a reinforcing stimulus as the mode of instruction. Pa rent A’s had to demonstrate


31 through role-play that they could do an er ror correction before continuing to the next training portion called Pr ompt Fading. This sect ion showed parents how to fade their prompts and gave exam ples of when to do so. When Parent A demonstrated through ro le-plays that they could perform DTT sessions they were taught the IT po rtion of the manual. The IT section started with an explanation of what IT is and how to do it. It also provided examples of IT sessions when compar ed to DTT sessions. The next chapter then combined DTT and IT together and sh owed how you can teach one skill by starting with DTT and then progressing to IT. It emphasized the need for combining the two techniques and asked questions to test how well the parents had learned the material. After the DTT and IT sections the manual discussed positive reinforcement and preference assessments. Parents were given a large red canvas bag as their “Reward Bag” to st ore a variety of potentially reinforcing items for their child. With this bag t hey were shown how to give preference assessments and role-played doing them (C arr, Nicolson & Higbee, 2000). This chapter was followed by tec hniques to motivate and main tain the child’s attention and offered some problem solving ideas to help parents troubleshoot what to do if their child would not respond or was losing interest in what they were teaching. The final chapter was a short one-page summary on ignoring junk behavior as mentioned in Latham (1994). At the conclusion of the training manual Parent A and the experimenter reviewed the first two skill sets Parent A was going to teach the child. Parent A


32 was allowed to ask any final clarificati on questions about t he skills and received positive and corrective feedback from the experimenter duri ng role plays. All of the Parent As received one training sessi on from the experimen ter that lasted between one hour and an hour and a half, dependi ng on the amount of follow-up or clarification questions they wanted to ask. Parent A: Skills 1 and 2 Parent A taught their child Skill 1 which was expressing daily events. At the same time they taught Skill 2 which was getting dressed. Once the child demonstrated ma stery of at least 80% accuracy for two consecutive sessions for both skills the phase ended. Training of Parent B. Parent A then trained Parent B using the same parent-training manual. The lead resear cher did not prov ide any feedback or training to Parent A or Pa rent B during this phase. Once Parent B demonstrated mastery of DTT and IT procedures their tr aining ended. All tr aining times lasted between one hour and one hour and a half depending on Par ent Bs’ questions to Parent As. Parent B: Skills 1 and 2. Parent B then reviewed Skills 1 and 2 with their child. Once the child dem onstrated 80% accuracy for two consecutive sessions for both skills with Parent B this phase ended. Parent B: Skill 3. Parent B then t aught Skill 3 to their child. Parent A did not teach Skill 3 previously to the child. Once the child demonstrated 80% accuracy for two consecutive sessions the training of Skill 3 ended.


33 Parent A: Skill 3. Parent A finally reviewed Sk ill 3 with their child. Once the child demonstrated 80% accuracy for two or more consecutive sessions the training phase ended. Experimental Design A multiple baseline was us ed to evaluate the chan ges in each child and parent. Since there were three participat ing families all of the mothers were Parent A and all of the fat hers or adult sibling were Pa rent B. Baseline for the first participant consisted of 4 sessions of observing Parent 1A (mother) and 1B (father) trying to teach the child the thr ee skills. Baseline data were taken on all three skills with all three children. Baseline data were also recorded on the parents teaching performance. Once t he stabilization of baseline data was established Parent 1A started traini ng with the experimenter. Parent 1B maintained baseline until t here was an effect with Pa rent 1A and the data for Parent 1B was stable. Once Parent 1A ma stered the training criteria, they were allowed to teach Skills 1 and 2 to their ch ild. After Skill 1 and 2 were mastered, Parent 1B started training by Parent 1A. Once Parent 1B mastered training he started to review Skills 1 and 2 with the child. Once the data showed stabilization Parent 1B moved on to teac h Skill 3. Finally, after Skill 3 stabilized Parent 1A reviewed Skill 3 with their child. Standardization of data was assessed by examining the dimensions of graphs including changes in levels and trend s and looking at patterns or cycles of the data points.


34 After Parent 1A of the first partici pant mastered teaching Skills 1 and 2, Parent 2A for the second participant began training with the expe rimenter. When Parent 2A had successfully t aught their child Skills 1 and 2, Parent 2A trained Parent 2B exactly as previ ously mentioned. Parent 3A (the mother of the third participant) then started parent training. The cycle continued until the completion of the study. Therefore, experimental control was demonstrat ed by showing changes occurred with Parent A when training on Skills 1 and 2 began and sequentially when similar training began with Parent A in the other families, introduced sequentially. In addition, expe rimental control was demons trated within a multiple baseline for the training of the generalization parent by Parent A, because those trainings were also introduced sequentially across families. All adult participants signed informed consent forms approved by the University of South Florida’s In stitutional Review Board (IRB)


35 Chapter Three Results The results for this study as indicated by Figure 1 show that when compared to baseline measures, all Pa rent As’ performance increased after receiving training from the experimenter Figure 1 is a multiple baseline illustrating the performance of all three Parent A’s and demonstrates that after training was introduced their performanc e improved substantially. Their performance also improved with Skill 3 after Parent Bs’ taught them how to teach it. Baseline for Skill 3 continued through th e intervention phase of Skills 1 and 2. Phase three is the intervention data fo r Skill 3 and maintenance data for Skills 1 and 2. All Parent A’s showed an upward trend in their performance of teaching some of the skills prior to receiving par ent training.. Parent 1A had an upward trend in teaching the DTT cond ition of the self care and the communication goals. Parent 2A had an upward trend in teaching the self care goal in both DTT and IT conditions as well as the household expecta tion in the IT condit ion. Parent 3A had a continual upward trend for all of the skills. Upward trends are present, however all Parent As’ performance did not increase substantially until after receiving parent training.


36 Skill 3 for all Parent A’s remained vari able until its teachi ng phase began. All of the data for all of the parents remained high during the maintenance phase of this study. Missing data points represent sessions that parents did not record themselves working with their children ei ther due to lack of time, sickness, or camera malfunction.


37 Figure 1 Multiple Baseline of Par ent As for all three families 0 20 40 60 80 100 Training Baseline Skills 1 and 2Skill 3 and Maintenance Parent 1A 0 20 40 60 80 100% Correct Responses Parent 2A 0 20 40 60 80 100 15913172125 # Sessions Communication Goal-DTT Self-Care Goal-DTT Household E x Comm Goal-IT Self-Care Goal-IT Household E x v Parent 3A


38 Figure 2 is a baseline graph for Parent Bs’ performances. The data shows that their performance increased after rece iving instruction from Parent A’s. Parent 2B showed an upwar d trend in their teaching ability for most of the skills, but did not show a large in crease in performance until after receiving training from Parent A. Data fo r Parents 1B and 3B remained variable until receiving training as well. All of the data for all of the Parent Bs’ remained high during the maintenance phase of this study.


39 Figure 2 Multiple Baseline of Parent Bs for all three families 0 20 40 60 80 100 Baseline Skills 1 and 2 Skill 3 and Maintenance Parent 1B Trainin g 0 20 40 60 80 100% Correct Responses Parent 2B 0 20 40 60 80 100 15913172125 # Sessions Communication Goal-DTT Self-Care-DTT Household Expectation-DTT Communication Goal-IT Self-Care-IT Household Ex p ectation-IT Parent 3B


40 Figure 3 is a multiple baseline showi ng child performance wit h Parent A’s. These data also show a large improvement in performance only after Parent A’s received training. The first child with Parent 1A showed an upward trend in their performance of the self-care goal in the DTT condition. All of the other skills remained variable until a phase change. The second child with Parent 2A had an upward trend with the DTT and IT conditions of the self-care goal. This child also showed an upward trend in their performance of the DTT condition of the household expectation as well. The third child with Parent 3A di splayed an upward trend with the DTT and IT conditions of the communication goal an d both conditions of the self-care goal. All of the children’s performanc e with the household expectation remained variable until they received tr aining from their parents.


41 Figure 3 Multiple Baseline of Child Performance with Parent As 0 20 40 60 80 100 Child Performance: Parent 1A Training Baseline Skills 1 and 2 Skill 3 and Maintenance 0 20 40 60 80 100% Correct Responses Child Performance: Parent 2A 0 20 40 60 80 100 15913172125 # Sessions Comm Goal-DTT Self-Care-DTT Household Expectation-DTT CommGoal IT Self Care IT HouseholdExpectation IT Child Performance: Parent 3A


42 Figure 4 is a multiple baseline showi ng child performance with Parent B’s. Like Figure 3, these data demonstrate an obvious improvement in performance after Parent B’s were trained by Parent A’s. The first two children showed large im provements in their performance of all skills once Parent 1B and 2B received parent training. The third child had an upward trend in their performance of the DTT and IT conditions of their communication goal and the IT condi tion of their self-care goal. All of the children maintained a low performance of their third skill, the household expectation. All of the children also experie nced in a large increase in their skill performance when Parent B’s received parent training.


43 Figure 4. Multiple Baseline of Child Performance with Parent Bs 0 20 40 60 80 100 Child Performance: Parent 1B Skills 1 and 2Skill 3 and Maintenance Baseline Training 0 20 40 60 80 100% Correct Responses Child Performance: Parent 2B 0 20 40 60 80 100 15913172125 # Sessions Comm Goal-DTT Self-Care-DTT Household Expectation-DTT Comm Goal-I T Self-Care-I T Household Ex p ectation-I T 1d 1i 2d Child Performance: Parent 3B


44 Social Validity Social Validity questionnaires were adm inistered to the parents when data collection was complete. All partici pants found the training manual and interventions to be effective and helpful. So cial Validity was rated on a 1-5 Likert type scale where a score of 1 indicated disagreement and a score of 5 indicated agreement. The results of the questionnaires were as follows: 1) The Parent Training Manual was easy to read and und erstand: 5. 2) My coach understood and communicated procedures and techniques effectively: 4.8. 3) The two interventions were easy to us e: 4.9. 4) I would reco mmend a similar intervention to other parents: 4.8. 5) It is important to learn therapeutic interventions to teach my child skills: 5.0. 6) The skills lear ned by my child were beneficial to their development: 4.9. 7) I will continue to use these interventions with my child when a new skills needs to be taught: 5.0. 8) My child learned the skills effectively: 4.75.


45 Chapter Four Discussion This study showed that a parent tr aining manual and role plays were effective in instructing parents how to teac h their own children a variety of skills. The obtained results support previous res earch that showed the implementation of DTT and IT led to faster acquisition and better generalization of skills. Within the organization of a multiple baseline design, parents were systematically trained by the experimenter, worked with their children, and then trained their own spouses or adult child in a rela tively short period of time. The parents in Family 1 had the fastest time for teaching the skills and the child had the fastest acquisition time to lear n the skills. The performance of all the children increased after their parent s received training about how to teach them the three skills. All of the children reached mastery criteria for all the skills except the child In Family 2 who r eached 70% independence with greetings. Parent As did have a faster increase in pe rformance than Parent Bs, but all of the Parent Bs did reach mastery cr iteria within four sessions. The results also add to the body of liter ature for a variety of reasons. This study showed that the training manual was effective in teaching parents how to use DTT and IT, as well as a variety of other techniques used in Applied Behavior Analysis, because the parents were able to teach a new skill that was


46 not introduced to them previously by the experimenter. The training from the experimenter to Parent A generalized from Parent A to Parent B. Parent B was then able to come up with a way to instruct Parent A to teach the child how to acquire the third skill. These results are generalizable bec ause although the three families lived in Florida at the time of the research, they had differe nt socioeconomic statuses, work environments, occupations and number of children, and differing amounts of time to spend with their children. So me mothers worked full time, part time, or not at all. One father was not present for the majority of the child’s week and an older sibling took over the ro le of being a parent figure for him. Despite all these differences, the results for each family were the same. There are also some limitations for this study. The most obvious one concerns future replication of this re search. The current experimenter had a variety of experiences working with par ents and training them in home settings. A future experimenter may not be as effe ctive in parent training as the current experimenter. To replicate this resear ch the experimenters will need to take into account cultural differences and be re spectful of different socioeconomic statuses. There was also a limit on the amount of time spent in baseline for each family. Although it would have been preferable to wait until stabilizat ion of data occurred for all phases before starting a new phase, there were some slight upward trends at the end of baseline befor e parent training. While this may seem to take away from the data, most of the baseline data for Skill 3 remained


47 variable until Parent B started teaching the child Skill 3. Also, there were significant increases in performance for both parents and children only after receiving parent training. A likely explanation for the upward trends is that the mother s in this study are very intelligent women. During baseline if they did something that resulted in a better response from their child, they w ould remember it and try it again. They would slowly add to their repertoire of behaviors because t hey had been told to “try and teach your son this skill.” The result was a slightly upward trend for two of the three mothers who were trying to teach their sons skills. This also happened with Parent 2B for the second child. Regardless, their performance and their children’s performance did not si gnificantly increase until after receiving training from the experimenter. Parents are quite capable of working with their own children. When given the necessary training and support syst em, they can continue an in-home Applied Behavior Analysis curri culum for their children. This study only lasted for 25 sessions, which was significantly le ss than expected. The Discrete Trial Training and Incidental Teaching techni ques were acquired quickly by the parents and applied immediatel y. The parents in th is study showed high motivation and a great desire to help their children learn new skills. Two of the families shared with the experimenter how they are already applying what they learned to teach new skills to their children on their own. These parents of children with Autism represent the thousa nds of parents in our society who want the best for their children. Parents want their children to su cceed and they want


48 to help their children reach their goals whether they are getting dressed by themselves or communicating with their par ents. There is no known cure for Pervasive Developmental Disorders or Au tism, but an incredible set of tools in Applied Behavior Analysis exists that can be shared with parents to help them and their children.


49 References Brookman-Frazee, L., Stahm er, A., Baker-Ericzen, M. & Tsai, K. (2006). Parenting interventions for children with autism spectrum and disruptive behavior disorders: opportuniti es for cross-fertilization, Clinical Child and Family Psychology Review, 9, 181-200. Carr, J., Nicolson, A., & Higbee, T. (2000) Evaluation of a brie f multiple-stimulus preference assessment in a naturalistic context, Journal of Applied Behavior Analysis, 33, 353-357.Charlop-Christy, M. & Carpenter, M. (2000). Modified incidental teacing sessions: a procedure for parents to increase s pontaneous speech in their children with autism, Journal of Positive Behavior Interventions, 2, 98-112. Crockett, L., Fleming, R., Doepke, K., & Stevens, J. (2005) Pa rent training: acquisition and generalization of discrete trials teaching skills with parents of children with autism, Research in Developmental Disabilities, 28, 23-26. Frost, L. & Bondy, A. (2003). Pyramid Approach to Education: Training Workshop Newark, DE. Gallimore, R., Weisner, T., Bernheimer L., Guthrie, D. & Nihira, K. (1993).Family responses to young ch ildren with develop mental delays: Accommodation activity in ecological and cultural context, American Journal on Mental Retardation, 98, 333-350.


50 Hart, B., & Risley, T. (1975). Incidental teaching of language in the preschool, Journal of Applied Behavior Analysis, 8, 411-420. Hart, B., & Risley, T. (1978). Promoti ng productive language through incidental teaching, Education and Urban Society, 10, 407-429. Ingersoll, B. & Dvortcsak, A. (2006). Including parent training in the early childhood special education curriculum fo r children with autism spectrum disorders, Journal of Positive Behavior Interventions, 8, 79-87. Kaiser, A., Hester P., Albert, C.,& Whiteman, B. (1995). Preparing parent trainers: an experimental analysis of effects on trainers, parents, and children, Topics in Early Childhood Special Education, 15, 385-414. Koegel, R., Glahn, T. & Nieminen, G. (1978) Genera lization of parent-training results, Journal of Applied Behavior Analysis, 11, 95-109. Koegel, R., Russo, D., & Rincover, A. ( 1977) Assessing and training teachers in the generalized use of behavior modifi cation with autistic children, Journal of Applied Behavior Analysis, 10, 197-205. Latham, G. (1994). The Power of Positive Parenti ng : A Wonderful Way to Raise Children, P & T Ink. Lerman, D., Swiezy, N., Perkins-Parks, S., & Roane, H. (2000). Skill acquisiton in parents of children with developmental disabilities: interaction between skill type and instructional format, Research in Developmental Disabilities, 21, 183-196. Lovaas, O. (1987). Behavioral treatment and normal educational and intellectual


51 functioning in young autistic children, Journal of Consulting and Clinical Psychology, 55, 3-9. Lovaas, O., Ackerman, A., Alexander, D., Fi restone, P.,Perkins, J., & Young, D. (1981). Teaching developmentally disabl ed children: The me book. Austin, TX: Pro-Ed. Lovaas, O., Koegel, R., Simmons, J. & Long, J. (1973). Some generalization and follow-up measured on autistic ch ildren in behavior therapy, Journal of Applied Behavior Analysis, 6, 131-165. Mahoney, G. & Perales, F. (2005). A compar ison of the impact of relationshipfocused ntervention on young chil dren with Pervasive Developmental Disorders and other disabilities. Journal of Developmental and Behavioral Pediatrics 26, 77-85. McGee, G., Krantz, P., Mason, D., & McClannahan, L. (1983). A modified incidental-teaching procedure fo r autistic youth: acquisition and generalization of rec eptive object labels, Journal of Applied Behavior Analysis, 16, 329-338. Mirande-Linde, F., & Melin, F. (1992). Acquisition, generalization, and spontaneous use of color adjectives: a comparison of incidental teaching and traditional discrete-trial proc edures for children with autism, Research in Developmental Disabilities, 13, 191-210. Moes, D. & Frea, W. (2002). Contex tualized behavioral support in early intervention for children with autism and their families, Journal of Autism and Developmental Disorders, 32, 519-533.


52 Naik-Polan, A. & Budd, K. (2009). Stimulus Generalizati on of Parenting Skills During Parent-Child Interaction Therapy, Journal of Early and Intensive Behavior Intervention, 5, 71-92. Seung, H., Ashwell, S., Elder, J. & Valc ante, G. (2006) Verbal communication outcomes in children with autism a fter in-home father training, Journal of Intellectual Disability Research, 50, 139-150. Sheinkopf, S., & Siegel, B. (1998). Home based behavioral treatment of young children with autism, Journal of Autism and Deve lopmental Disorders, 28, 15-23. Smith, T., Buch, G. & Gamb y, T. (2000). Parent-direc ted, intensive early intervention for children with perva sive developmental disorder, Research in Developmental Disabilities, 21, 297-309. Smith, T. & Lovaas, O. (1998). Intens ive and early behavior intervention with autism: the UCLA Young Autism Project, Infants and Young Children, 10, 67-78. Stahmer, A. (1995). Teaching symbolic play skills to children with autism using Pivotal Response Training, Journa l of Autism and Developmental Disorders, 25, 123-141. Stahmer, A. & Gist, K. (2001). The effe cts of an accelerated parent education program on technique mastery and child outcome, Journal of Positive Behavior Interventions, 3, 75-82. Steege, M., Mace, F., Perry, L. & Longenec ker, H. (2007). Applied behavior


53 analysis: beyond discrete trial teaching, Psychology in the Schools, 44, 91-99. Stokes, T., & Baer, D. (1977). An implicit tec hnology of generalization, Journal of Applied Behavior Analysis, 10, 349-367. Stokes, T., Baer, D., & Jackson, R. ( 1974). Programming the gener alization of a greeting response in four autistic children, Journal of Applied Behavior Analysis, 7, 599-610. Stokes, T., & Osnes, P. (1989). An operant pursuit of generalization, Behavior Therapy, 20, 337-355. Symon, J. (2005). Expanding interventions for children with autism: parents as trainers, Journal of Positive Beha vior Interventions, 7, 159-173. Wieder, S., & Greenspan, S. (2003). Climbi ng the symbolic ladder in the DIR model through Floor Time/Interactive Play, Autism, 7, 425-435.


54 Appendices


55 Appendix A: Data Collection: DTT Name: Time Start: Date: Time Finish: Trial # Skill SD given ResponseF, P, V, I SR Error Correction M P S R ITI Ignore Div./Disruptive Behavior Redirection Prompt Key: F: full physical P: partial physical V: verbal I: independent Error Correction Key: M: model P: prompt S: switch R: repeat


56 Appendix B: Data Collection: IT Name: Time Start: Date: Time Finish: Trial # Skill Environment Ready SD given Response F, P, V, I SR Error Correction Ignore Diversion Behavior Redirection Prompt Key: F: full physical P: partia l physical V: Verbal I: independent Error Correction Key: M: model P: prompt S: switch R: repeat


57 Appendix C: Data Collect ion: Parent Training Name: Time Start: Date: Time Finish: DTT Read Examples RP IT Read Examples RP EC Read Examples RP Both Read Examples RP Positive R. Read Examples RP Preference Ass. Read Examples RP Motivating Read Examples RP Ignoring Junk Behavior Read Examples RP Skills Read Examples RP EC: Error Correction RP: role play


58 Appendix D: Social Validi ty Questionnaire for Parents Name________________________ Date: _________________________ Appropriateness of Procedures Question for Parent to Answer Agree Somewhat Agree Neutral Somewhat Disagree Disagree Appropriateness of Procedures 5 4 3 2 1 1. The Parent Training Manual was easy to read and understand 2. My coach understood and communicated procedures and techniques effectively. 3. The two interventions were easy to use. Social Significance of Goals 5 4 3 2 1 4. I would recommend a similar intervention to other parents. 5. It is important to learn therapeutic interventions to teach my child skills. Social Importance of the Effects 5 4 3 2 1 6. The skills learned by my child were beneficial to their development. 7. I will continue to use these interventions with my child when a new skill needs to be taught. 8. My child learned the skills effectively.


59 Appendix E: Informed Consent













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A parent training program combining discrete trial training and incidental teaching in the home environment
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ABSTRACT: This study examined the effects of a parent training program teaching discrete trial teaching (DTT) and incidental teaching (IT) methods using a parent training manual. Three families with children between the ages of 5-6 diagnosed with Autism Spectrum Disorder (ASD) participated. Both parents received parent training although Parent A received training from the experimenter and Parent B received training from Parent A. The parents taught their children one skill each from three categories: communication, self-care routines and a household expectation. This study sought to expand upon the literature in the realm of combining DTT and IT as well as adding the dimensions of training in home environments in a short period of time and examined the role of one parent training the other. Results showed that all of the Parent As were able to learn and apply DTT and IT in teaching their children. All Parent A's were then able to teach Parent B's how to use DTT and IT without additional training from the experimenter. The generalization effects of learning skills in multiple environments with different people was also examined and discussed.
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