Leslie Neely

Training paraprofessionals to implement interventions for people autism spectrum disorders: A systematic review

Objective: This review summarizes studies in which paraprofessionals were trained to implement interventions for people with autism spectrum disorders (ASD) in school and rehabilitation settings. Methods: Systematic searches identified 12 studies meeting inclusion criteria. These studies were evaluated in terms of: (a) participant characteristics, (b) intervention implemented, (c) training procedures, (d) outcomes and (e) certainty of evidence. Results: Across the 12 studies intervention was provided to a total of 39 paraprofessionals including teacher aides and rehabilitation staff. Paraprofessionals were trained to implement: social stories, prompting, Picture Exchange Communication System (PECS), Discrete Trial Training (DTT), Pivotal Response Training (PRT), incidental teaching or activity schedules. Training procedures included written and verbal explanations, modelling, video demonstrations, role playing and feedback. Positive outcomes were reported in 92% of the included studies. Conclusion: Although the literature base is limited, this review highlights promising training procedures and areas in need of further research.

Effects of antecedent exercise on academic engagement and stereotypy during instruction

Antecedent physical exercise has emerged as a potentially promising treatment for reducing challenging behavior and increasing academic behavior in individuals with autism spectrum disorder (ASD). The purpose of this study was to evaluate the effects of physical exercise conducted prior to instructional sessions (antecedent physical exercise) on academic engagement and stereotypy during instructional sessions for two children diagnosed with ASD. Functional analysis results suggested stereotypy was maintained by automatic reinforcement for both participants. A multielement design was employed to evaluate academic engagement and stereotypy during instructional sessions following randomly sequenced conditions involving either (a) no antecedent exercise, (b) brief durations of antecedent exercise, or (c) antecedent exercise that continued until the participant engaged in a systematically determined behavioral indicator of satiation. Both participants demonstrated higher levels of academic engagement and reduced levels of stereotypy during the instructional sessions which followed antecedent physical exercise that continued until behavioral indicators of satiation occurred. This study replicates previous research suggesting that individuals with ASD may benefit from physical exercise prior to academic instruction and further suggests that the duration of antecedent exercise may be optimally individualized based on behavioral indicators of satiation.

Pre-Session Satiation as a Treatment for Stereotypy During Group Activities

Individuals with developmental disabilities may engage in automatically reinforced behaviors that may interfere with learning opportunities. Manipulation of motivating operations has been shown to reduce automatically maintained behavior in some individuals. Considering behavioral indicators of satiation may assist in identifying the point at which an abolishing operation has begun to effect behavior. The purpose of this study was to evaluate the effects of pre-session satiation of automatic reinforcement on subsequent levels of stereotypy and activity engagement during group activities for three males ages 5 to 13 years with developmental disabilities. Following functional analyses with analogue conditions, an alternating treatment design compared a pre-session access to stereotypy condition with a no-pre-session access condition prior to group activity sessions. Results indicated that pre-session satiation of the putative reinforcer produced by stereotypy was effective in decreasing stereotypy and increasing activity engagement during subsequent group activities for all participants. These findings add to the literature supporting the effectiveness of abolishing operations to decrease automatically maintained stereotypy.

The effects of video modeling in teaching functional living skills to persons with ASD: A meta-analysis of single-case studies.

BACKGROUND Many individuals with autism spectrum disorders (ASD) show deficits in functional living skills, leading to low independence, limited community involvement, and poor quality of life. With development of mobile devices, utilizing video modeling has become more feasible for educators to promote functional living skills of individuals with ASD. AIMS This article aims to review the single-case experimental literature and aggregate results across studies involving the use of video modeling to improve functional living skills of individuals with ASD. METHODS AND PROCEDURES The authors extracted data from single-case experimental studies and evaluated them using the Tau-U effect size measure. Effects were also differentiated by categories of potential moderators and other variables, including age of participants, concomitant diagnoses, types of video modeling, and outcome measures. OUTCOMES AND RESULTS Results indicate that video modeling interventions are overall moderately effective with this population and dependent measures. While significant differences were not found between categories of moderators and other variables, effects were found to be at least moderate for most of them. CONCLUSIONS AND IMPLICATIONS It is apparent that more single-case experiments are needed in this area, particularly with preschool and secondary-school aged participants, participants with ASD-only and those with high-functioning ASD, and for video modeling interventions addressing community access skills.

An Evaluation of the Quality of Research on Evidence-Based Practices for Daily Living Skills for Individuals with Autism Spectrum Disorder

This study presents a literature review of interventions for improving daily living skills of individuals with ASD. This review investigated the quality of the design and evidence of the literature base and determined the state of the evidence base related to interventions for improving daily living skills of individuals with ASD. Included studies were evaluated to determine the overall quality of the evidence for each design within each article, based on the What Works Clearinghouse standards for single-case experimental design (Kratochwill et al. 2010), adapted by Maggin et al. (Remedial Spec Educ 34(1):44–58, 2013. doi:10.1177/0741932511435176). As a result, video modeling was found to be an evidence-based practice. Limitations and implications for future research and for practitioners are discussed.

Addressing Bullying of Students with Autism: Suggestions for Families and Educators

Bullying or any aggressive behavior of a more powerful person or group toward a less powerful person is a widespread problem in the U.S. educational system. While bullying is a significant problem for all students, students with an autism spectrum disorder (ASD) have a particularly high incidence rate of becoming victims of bullying. The social and communication deficits characteristic of students with ASD provide significant challenges in teaching and preparing these students for bullying situations. Cooperative work between teachers and parents, analyzing an individual student’s needs, educating the student about bullying, teaching how to cope with and reporting it in both controlled settings and natural environments, and developing a monitoring system are key components of preventing the students with ASD from being bullied. An illustrative example and practical suggestions and approaches are provided.

A comparison of general and explicit delay cues to reinforcement for tangible-maintained challenging behaviour

Abstract Objectives: This compares effects of explicit delay cue to reinforcement to general delay cue to reinforcement when attempting to decrease tangible-maintained challenging behaviours of children with autism spectrum disorder (ASD). Methods: Two school-age children with ASD participated in this study. In order to evaluate the effects of a general cue versus an explicit cue on the participants’ tangibly maintained challenging behaviours, a multiple baseline design across settings with an embedded alternating treatments design was used. Results: Results suggested that both types of delay cue to reinforcement demonstrated effectiveness on decreasing tangible-maintained behaviours of the participant. For both participants, an explicit delay cue demonstrated slightly better effects on the participants’ challenging behaviours then a general delay cue. Conclusions: This study adds an evidence to support that delayed reinforcement can be used as an effective strategy to reduce both escape and tangible-maintained challenging behaviours of children with ASD across multiple settings.

Systematic Review of Differential Reinforcement of Alternative Behavior Without Extinction for Individuals With Autism

The purpose of this article is to review the literature on differential reinforcement of alternative behavior procedures without extinction for individuals with autism. Using predetermined inclusion criteria, a total of 10 studies were included and summarized in terms of the following: (a) participant characteristics (e.g., sex, age, and diagnosis), (b) treatment setting, (c) problem behavior, (d) function, (e) alternative behavior, (f) intervention, (g) outcomes, and (h) conclusiveness of evidence. Of the 10 studies, nine demonstrated positive effects and one mixed effects. Five studies successfully reduced problem behavior by manipulating different reinforcement parameters (magnitude, immediacy, and quality) and four manipulated the schedule of reinforcement. One study had mixed results with two of the three participants requiring extinction. The findings of this review suggest that variations of differential reinforcement of alternative behavior interventions without an extinction component may be considered promising practices for the treatment of challenging behavior in individuals with autism.

Generalization and maintenance of functional communication training for individuals with developmental disabilities: A systematic and quality review

BACKGROUND Functional communication training (FCT) is considered an evidence-based practice for treating problem behavior in individuals with developmental disabilities (e.g. autism, intellectual disabilities, down syndrome, etc.). However, there is little known on how to sustain behavioral change following FCT interventions. This systematic and quality review synthesizes the current literature base evaluating the maintenance and generalization of behavioral effects following FCT. METHOD A systematic review identified 37 studies that met the pre-set inclusion criteria. Those studies were summarized in terms of: (a) generalization dimension, (b) generalization assessment design, (c) maintenance assessment design, (d) maintenance and generalization teaching strategy, and (e) latency to maintenance probes. All studies employed single-case research designs and were evaluated using the What Works Clearinghouse pilot single-case research standards (Kratochwill et al., 2013) as adapted by Maggin, Briesch, and Chafouleas (2013). Maintenance and generalization data were evaluated using a researcher-developed rubric based on the WWC standards. RESULTS AND DISCUSSION Results indicate that 30 studies met standards or met standards with reservations while only six studies also met all of the maintenance and generalization standards. Of the six studies, five did not implement any additional strategies beyond the contacting natural contingencies that is inherent in the FCT intervention. Implications for future research and practice are discussed.

Tablet-based interventions for individuals with ASD: Evidence of generalization and maintenance effects.

BACKGROUND Despite positive effects of and established empirical evidence for tablet-based interventions for individuals with autism spectrum disorder (ASD), it is not known whether such findings can be applicable to maintenance and generalization effects of those interventions. AIMS This systematic review evaluated peer-reviewed single-case experimental design (SCED) studies concerning evidence of generalization and maintenance effects of tablet-based interventions for individuals with ASD. METHODS To evaluate the methodological rigor of the literature in terms of generalization and maintenance effects, the authors adopted four of the basic design standards developed by What Works Clearinghouse (WWC; Kratochwill et al., 2010/2014). In addition, the authors used Tau-U effect size measure and attempted to calculate effect sizes differentiated by the type of generalization and maintenance teaching strategies. RESULTS A total of 21 studies assessed generalization and/or maintenance effects. In the first evaluation of evidence of generalization and maintenance effects, it was found that more than half of the studies included in this review collected interobserver agreement (IOA) on at least 20% of sessions across all generalization and maintenance conditions and met the minimum quality thresholds of IOA. Meanwhile, less than one third of the studies included more than three data points in each generalization and maintenance condition. With regard to maintenance of effects, about half of the reviewed studies did not report the latency to the maintenance measure, which may hamper the assessment of the clinical and practical significance of the effect of the tablet-based intervention. In the second evaluation, the omnibus Tau-U effect size for baseline to generalization comparisons resulted in a moderate effect. For the contrasts between intervention and generalization comparisons resulted in a small effect. The omnibus Tau-U effect size for baseline and maintenance comparisons resulted in a strong effect. For the contrasts between intervention to maintenance comparisons, the omnibus Tau-U effect size resulted in a small effect. CONCLUSIONS AND IMPLICATION Findings in this review suggest that efforts should be made to establish a system for appraising generalization and maintenance procedures in SCED studies. In addition, future studies should investigate if tablet-based interventions are truly effective in creating sustainable behavioral change in individuals with ASD.