prospectus - final version

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RUNNING HEAD: Video Self Modeling for children with ASD

Video Self-Modeling and its Applications

For Intervention-Resistant Children with Autism

Nathan Missen

Duquesne University



Video Self Modeling for children with ASD

Abstract

Autism Spectrum Disorder (ASD) is associated with a number of developmental delays.

Such delays often manifested as unconventional and/or inappropriate behaviors. These

behaviors serve to frustrate teachers, educators and parents alike. The behavior targeted

for this study was personal boundary violations. Three participants, each with ASD, took

part in an intervention aimed to address such behaviors through Video Self-Modeling

(VSM). VSM was chosen as it is congruent with several common characteristics of the

ASD population as well as Bandura’s theory of modeling (1977) and self-efficacy (1997).

A multiple baseline across subject design was utilized to assess the effect of the

intervention. Results indicate that VSM was effective in changing targeted behaviors for

these participants. Limitations and notions for future research are also noted.




Video Self-Modeling and its Applications

For Intervention-Resistant Children with Autism

Nathan Missen

Duquesne University

Autism Spectrum Disorders are characterized by a predictable pattern of

deficiencies in several developmental areas. Paucities in language utilization, social

interaction and overall communication skills are among the most prominent noted

(Buggey, 2005; Coyle, 2004; Sherer, 2001). Weaknesses in attentional capacity

(Courchenese et al., 1994), greater variability in affect regulation and affective coping

skills (Konstantareas & Stewart, 2006) as well as motivation (Koegel, Koegel &

McNerney, 2001) have also been observed. Such weaknesses often manifest as atypical

or unconventional behaviors: inappropriate proxemics, bizarre verbalizations, impaired

pragmatics, etc. Such behaviors serve to frustrate educators, family members and mental

health service providers alike in their efforts to address the needs of this particular

population.

In order to ameliorate the disadvantages theses children are exposed to, and

facilitate normalization and mainstreaming into the typical population, various forms of

treatment have been generated and implemented. Medical treatments have been reported

as being only marginally effective (Graham, Turk & Verhulst, 1999), while physiology

based approaches – such as the Gluten Free/Casein Free (GF/CF) diet and vitamin

therapy – and sensory based approaches – for example, music therapy and sensory

integration therapy – have produced mixed results, yet still maintain loyal followings




(Buggey et al., 1999). The most efficacious approach at this point seems to be a

psychological paradigm with a strong behaviorist component (Buggey et al., 1999).

One of the most published and well-researched psychobehavioral methodologies

is the Lovaas method (now more commonly known as Discrete Trial Training, which

falls under the umbrella of Applied Behavior Analysis). The popularity of this method

stems from a study published by Lovaas (1987), in which three groups of pre-schoolers

were exposed to varying intensities of behavioral intervention over a two-year period.

Those who received more intensive services (40 hours per week) compared to less

intensive services (10 hours per week) showed more substantial behavioral progress. In

addition, forty-seven percent of the intensive group passed the first grade with normally

developing peers. Drawbacks of this methodology are the long term, intensive nature of

the treatment, as well as retrospective criticisms of Lovaas’s study (Gresham &

MacMiliar, 1998)

Thus, the search for an effective and efficient method of intervention continues. A

relatively recent genre to emerge is that of video modeling (VM), and in particular, video

self modeling (VSM). Briefly, VM and VSM are both techniques aimed at producing

positive adaptive behavioral change; children watch models (either “self” or “others”)

demonstrating only the desired behavior and then subsequently imitating it (Bellini &

Akullian, 2007; Charlop-Christy, Le & Freeman, 2000; Coyle & Cole, 2004). VSM and

VM have proven to be an efficacious treatment for a multitude of skills and behaviors,

ranging from math skills (Buggey et al., 1999) to athletic performance (Bellini &

Akullian, 2007) and even selective mutism (Charlop-Christy et al., 2000). A recent meta-

analysis of schools based social skills interventions for children and young adults with




Autism yielded a mean Percentage of non-overlapping points (PND) of 80%, indicating

that VSM/VM is an ‘effective’ treatment (Bellini et al, 2007)

Why should video modeling be effective for children with autism? As previously

noted, individuals on the autistic spectrum display not only the core deficiencies in

language, social interactions and overall communication skills, but also concomitant

difficulties in attention and regulation. A number of suggestions have been generated to

address this: 1) VSM, in comparison with other intervention treatments, demands

relatively minimal attention and language output – two areas in which ASD individuals

typically struggle (videos are usually short, and participants are not required to produce

specific verbal responses), 2) children are directed to a small spatial area (i.e. a television

screen) to maximize focus and minimize distractions 3) a significant portion of people

with ASD are visually oriented learners, and reap relatively higher benefits from

interventions presented in this modality. A quote from Grandin (1996), an adult with

autism, illuminates this:

I think in pictures. Words are like a second language to me. I translate both

spoken and written words into full color movies, complete with sound, which run like a

VCR tape in my head. When somebody speaks to me, his words are instantly translated

into pictures (p.1)

While not representative of typical individual with Autism, Grandin’s testimonial

does give some insight into the think process of those on the spectrum, and why VM and

VSM may be effective for such individuals.

These suggestions, while possibly true in whole or in part, are not sufficiently

detailed or researched to such a degree as to be discrete theoretical entities. One postulate




that is sufficiently detailed that is also applicable to VSM is Bandura’s Social Learning

theory (Bandura, 1977). Bandura observed that children could accurately imitate the

actions of others through viewing their behavior, rather than personal experience. Ina

addition, actions were sometimes performed in settings other than the original (i.e.

generalization). Bandura also noted that attention and motivation were essential for

effective modeling. Children are more likely to pay attention to models they a) perceive

as competent and b) are similar to themselves in some manner, according to Bandura.

Another important component of Social Learning theory is self-efficacy. Self

efficacy refers to “…people’s beliefs about their capabilities to produce designated levels

of performance that exercise influence over events that affect their lives. Self-efficacy

beliefs determine how people think, feel, motivate themselves and behave” (Bandura,

1997). Individuals can obtain and enhance beliefs about self-efficacy thorough external

aid and support, but the most resilient and potent reinforcement of self-efficacy spring

from observations of one’s own success.

Thus, VM and in particular VSM, contain the components for a high probability

of success in addressing behavioral needs for children with ASD. It does not demand a

high intensity of processing from the participants, it is provided in a (possibly) preferred

modality and enhances self-efficacy through effective modeling. Furthermore, there is

literature to suggest that it is effective in addressing behavioral needs, and it is more time

efficient and cost-effective than other treatments with comparable timeframes (Bellini &

Akullian, 2007).

Purpose

The purpose of this study was threefold: (a) to validate the existing research base




through replication (b) to ascertain if VSM could effectively address challenging

behaviors for across students whom have proven to be resistant to a number of

interventions and (c) evaluate if VSM could generalize behaviors across settings.

Method

Participants

Three male children who attended a suburban public middle school were the focus

of this study. All children in this study met the DSM criteria for ASD, and were receiving

special education services when this study was initiated. A medical professional had

diagnosed each child independent of the researchers. To confirm their diagnosis and

gauge the extent of their abilities, the Childhood Autism Rating Scale – 2 nd edition

(CARS-2) and the Gilliam Autism Rating Scale (GARS-2) were utilized. Since this study

was directed at improving a particular aspect of social skills, the Social Responsiveness

Scale (SRS) was also administered to teachers. All parents were offered to complete the

SRS but declined. Background information is summarized in Table 1.

Families of the children with ASD were contacted and invited to a meeting to

discuss the study. At this meeting, the VSM procedure was explained, and parents were

given the opportunity to ask questions and voice any concerns they had. Parents were

also asked open ended questions to determine what behaviors they would like to see

changed, which behaviors were the most important to change as well as what skills they

would like their children to learn. This was done in order to establish a degree of social

validity. Researchers also explained to the parents that generalization measures would be

carried in the home setting on a regular basis. Ultimately, all parents decided to consent

to participation in the study.




Christopher was a 12 year old white male who was diagnosed with Autism 2

years and 5 months of age by a psychologist under contract with a wraparound agency, as

well as Oppositional Defiance Disorder at age 5. His diagnosis was confirmed by a

CARS score of 35 and his GARS score of 98. Social skills deficit was exemplified in

Christopher’s SRS score of 91. Christopher was able to participate in the regular

education classroom setting with modified instruction and preferential seating. Behaviors

of concerns, according to teacher and parent responses, centre on inappropriate

proxemics; that is, Christopher violated personal boundaries. To be more specific, he

hugged without permission and often poked people repeatedly for attention. When

stressed, he ‘karate chopped’ teachers and students and headbutt them as well.

Christopher had received numerous interventions in the past, including peer monitoring

and contingent reinforcement. Interventions were discontinued after limited success. He

is currently on a Positive Behavior Support Plan (PBSP) and has an Individualized

Education Plan (IEP). Christopher also receives several hours a week of Therapeutic

Support Staff provided by a wraparound agency. Christopher lives with his mother and

younger brother.

Tanner was a 10 year old white male who was diagnosed with Pervasive

Developmental Disorder – Not Otherwise Specified (PDD-NOS) at 3 years, 7 months by

a pediatrician. Tanner was also diagnosed with Gastroesophageal reflux disease (GERD)

at 4 years. A CARS score of 33 combined with a GARS score of 84 confirmed his

diagnosis of PDD-NOS. An SRS score of 88 reflected Tanner’s social skill impairment.

Tanner was able to function in his classroom with variety of instructional and schedule

accommodations (e.g. regular sensory breaks and the use of a colored timer to assist in




waiting behaviors). Tanner’s area of concern was unsuitable touching behavior; in

particular, he would run his fingers through people’s hair as well as repeatedly stroke

clothing items made out of fur. Tanner has had numerous interventions in the past,

including behavior management focusing on appropriate replacement behavior (i.e. the

usage of a sensory fidget toy) as well as a contingent reinforcement system. Each

intervention met with limited success and was discontinued shortly thereafter. Tanner is

currently on a PBSP and has an IEP. He does not receive any services outside of school.

He lives with both of his parents as well as an older brother and younger sister.

Samuel was a 11 year old white male who was diagnosed with Asperger’s

Syndrome at age 4 years, 5 months by a hospital psychologist. He had carried a previous

diagnosis of PDD-NOS. Samuel also carried a diagnosis of Attention Deficit

Hyperactivity Disorder – Predominantly Inattentive type (ADHD-PI), which was given at

age 6. The diagnosis of Asperger’s was validated through a CARS score of 34 and a

GARS score of 95. Samuel’s lack of social skills was reflected in his SRS score of 89.

Samuel is able to participate in the general education classroom when provide with

behavioral and instructional modifications that specifically address his attentional

challenges. These interventions have met with continuing, but intermittent success.

However, there have been no interventions that have specifically targeted his undesirable

physical communication behaviors; such behaviors include squeezing, pinching, poking

as well as occasional punching. He has been referred to the office for squeezing a

female’s student breasts. No further disciplinary action was taken. Samuel is currently on

a PBSP and an IEP. Samuel lives at home with is father and older brother.




Student Primary

Exceptionality

Age Childhood

AutismRating

Scale

Gilliam

Autism RatingScale

Social

ResponsivenessScale

Christopher Autism 12 35 98 91

Tanner PDD-NOS 10 33 84 88

Samuel Asperger’s 11 34 95 89

Table 1: Summary of identifying information for participants

Setting

All sessions were conducted in the school setting, with the exception of the

generalization probes, which were administered in the home. The school was a large

suburban setting, in a moderate sized district. Physical classrooms varied in shape, but

general organizational patterns remain consistent (i.e. blackboard/smartboard at the front,

desks arranged in rows, resources, along the sides, etc). The number of students in each

classroom varied from 15-25. The mean percentage of special needs students was 7%.

The school was implementing a schoolwide PBSP, focusing on bullying prevention.

Design and Procedure.

For this piece of research, a multiple baseline across subjects design was utilized

to demonstrate functional relationship. Targeted behaviors were operationalized

according to each child’s particular manifestation, but all were considered violations of

personal boundaries. In the present study, such behaviors were defined as “unwanted

and/or non-permitted contact with another individuals’ body”. An example of a wanted

but non-permitted contact would be hugging whilst punching would be both unwanted

and non-permitted.

Baseline




During the baseline phase, observations were conducted on each student, five

times a week, until a consistent rate of behavior was determined and interrater reliability

established; this process took 2 weeks. 45 minute observations were carried out by the

researcher and a graduate student trained in observation methods. Data was collected in

the form of frequency counts, with parameters explicitly defined for each target behavior.

The setting for each student was their regular education classroom, as well as

lunchtime/recess. Interrater reliability was assessed by calculating percentage agreement;

dividing the total number of agreements by the total number of incidents. Interrater

reliability was assessed at the end of each week; a mean percentage of 95% was yielded.

Discrepancies were due to omission. Pre-generalization observations were also carried

out in the home setting twice a week; observation, duration and reliability procedures

were identical. An interrater reliability of 93% was found for home setting observations.

Video Production: Filming

The self as model tape was produced with the researchers and the participants. It

was decided to utilize a naturalistic, rather than scripted approach, as all the participants

were capable of producing the behaviors and that viewing themselves as models may be

more congruent with Bandura’s theory of self-efficacy. To desensitize the participants to

the video-making process, promotional videos of each class were made. All students from

each class were present in the videos. Approximately one week before the intervention

period, targeted recording procedures began, in which the researcher began filming the

child in the classroom and cafeteria settings. The aim of this was to capture enough

adaptive interactions bereft of personal boundary violations to produce a short film. All

filming was done using a Sony Digital Handicam.




Video Production: Post-Filming

After enough material was captured, the editing process began. All editing was

done using iMovie software on a MacBook Pro. Digital video material was edited so that

only adaptive, socially convention interactions were available for viewing; all target

behaviors were eliminated. The material was then further edited to give the appearance of

natural, smooth interactions. Finally, intertitles were added to the start and end of the

final version (e.g. “Let’s watch Christopher have a conversation” “Let’s see how Samuel

does at lunchtime” “Good Job, Tanner!”) along with flattering freeze-frames of each

student. Fading was used throughout the videos when an appropriate segue was not

filmed.

Intervention

After a 3 minute video was produced for each student, copies were distributed to

their teachers. The teacher and the student then viewed the video daily, in an empty

classroom, before the lessons started for the day. No other students were present during

the viewing. Initially, teachers drew attention to the student’s good behavior however,

this was discouraged so as not to endanger intervention reliability. Researchers were

present during 35% of Christopher’s interventions sessions, 37% for Tanner’s and 33%

for Samuel’s. Procedural integrity was calculated at 100%.

Intervention data was then collected three times a week. Data collection procedures were

identical to baseline. At the end of each week, the researcher as well as the graduate

student met to compare collection results. Interrater reliability was calculated with the

same method as in baseline; 96% agreement rate was yielded. Generalization data was

also collected in the home setting twice a week; interrater reliability was at 97%.




Discrepancies were resolved through discussion, and if not resolved satisfactorily, the

data point in question was eliminated. Maintenance data was collected for three sessions

after terminating the last participant’s treatment.

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Figure 1: Number of incidents per day for each participant.

Results

All participants substantial decreased the frequency of personal boundary

violations. A summary of these results is provided in Figure 1. Christopher had a mean of

11.7 undesirable behaviors during baseline. This decreased to 3.5 during the intervention

phase and maintained at 0.3 behaviors per day.

Tanner had 193 boundary violations during baseline, for a rate of 12.1 per day.

During the intervention phase, this dropped to 5.5 incidents per day. Throughout

maintenance phase, Tanner’s rate dropped again, to .43 incidents per day.

Samuel displayed an average of 10.8 boundary violations per day for the baseline

phase. Pursuant to the implementation of the intervention, Samuel’s mean dropped to 5.5

incidents per day. Samuel did not exhibit any targeted behaviors during the maintenance

phase.

Samuel




Discussion

The implementation of video self modeling intervention to reduce personal

boundary violations with participants diagnosed with ASD and who were resistant to

other form of treatment seemed to be successful across settings and participants. Changes

observed in the classroom mirrored changes displayed in the home. These results support

previous finding concerning VSM

A follow up semi-structured interview with teachers indicated that the procedure

was positive overall. All teachers reported satisfaction with the outcomes of the study.

One teacher in particular noted that her classroom “felt more manageable” and that the

student had become a “role model” for other children in the class. Each teacher replied

that they would implement the intervention again if given another opportunity to do so.

Follow-up procedures with parents indicated a similar level of satisfaction. Each

parent was happy with the results of the intervention, and felt that it was both effective

and appropriate. A parent indicated that the change in her child was “practically life-

changing”. Another parent requested instructions and materials on how to generate their

own video tape to address other behavioral concerns.

Several other positive features of VSM also became apparent in this study. The

procedure is relatively non-intrusive; students did not miss any academic instruction due

to the implementation of this intervention. In addition, VSM is easy to implement and

does not require a substantial amount of time to carry out. A final positive aspect is that it

can produce change in a relatively short amount of time.

However, this study does have several limitations. A constant threat to single-

subject designs are the small number of participants, as well as the characteristics of each




participant. Every child in this study, whilst being diagnosed with a form of ASD, did not

display similar manifestations of ASD. Furthermore, each child also had differing

comorbid conditions. While this may point to the robustness of the intervention, it can

also mean that each participant may have been more (or less) able to respond to the

intervention. Further experiments with more homogenous participants may resolve this

limitation.

There was also the possibility of contamination in this study. Even though

teachers were briefed about confidentiality and impartiality, the filming took place with

the indirect participation and knowledge of other students. This may have resulted in

students changing their behavior responses to the participants.

A final limitation with this study is a possible Hawthorne effect, particularly in

the home setting. While researchers may have been able to blend in somewhat in the

school setting, it was more apparent in the home setting. There is a very real possibility

that participants may have modified their behavior due to the effect o f being studied. To

avoid this, one solution would be to have researchers investigate if parents could be

trained in observation procedures. However, this does raise bias issues.

In the future, it would be useful to assess the viability of VSM with a broader

range of functionality; for example, children who are non-verbal and ASD. In addition,

carrying out this intervention with an older age group may be enlightening, considering

the effects of peers and peer group dynamics; it may prove that peers are a more

efficacious model at that age. Finally, other individuals (such as guidance counselors,

teacher assistants, etc) who are more familiar with the school system may be in a better

position to implement and oversee this intervention. In general, it is important to continue




to modify interventions to suit the needs of this unique and important population in the

schools.




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