the journal of speech and language pathology - applied ... › 7928 › 872e0244c289... · the...

The Journal of Speech and Language Pathology - Applied Behavior Analysis

Volume Number 1 Winter, 2006 Issue Number 1

ISSN Pending

Table of Contents

: Welcome Readers of SLP-ABA! - Joseph Cautilli, Ph.D., BCBA and Mareile Koenig, Ph.D., CCC-SLP, BCBA

Page 2: ABA-SLP: Collaborating to Support Individuals with Communication Impairments - Mareile Koenig and Joanne Gerenser Page 11: Behavioral Improvements Associated with Computer-Assisted Instruction for Children with Developmental Disabilities - Christina Whalen, Lars Liden, Brooke Ingersoll, Eric Dallaire, and Sven Liden

Page 27: Equivalence Relations, The Assessment of Basic Learning Abilities and Language: A Synthesis of Behavioral Research and its Implications for Children With Autism - Marianne Jackson, W. Larry Williams, and Jeremy Biesbrouck

Page 43: Rule-Governance, Correspondence Training, and Discrimination Learning: A Developmental Analysis of Covert Conduct Problems - James Snyder, Amber McEachern, Lynn Schrepferman, Robert Zettle, Kassy Johnson, Nathan Swink, and Cecile McAlpine

Page 56: Operant Conditioning and Programmed Instruction in Aphasia Rehabilitation - Robert Goldfarb, Ph. D. Page 66: An Orton-based Operant Program for Auditory Language Learning Disorders - Leslie Dalton, Ph.D., CCC-SLP/ABA

Page 81: Validation of the Verbal Behavior Package: Old Wine New Bottle- A Reply to Carr & Firth (2005) - Joseph Cautilli, Ph.D.


VOLUME NO. 1, ISSUE NO. 1

ISSN: Pending

Published: March 15, 2006 Publisher’s Statement

The Journal of Speech-Language Pathology and Applied Behavior Analysis (JSLP-ABA) is published by Dr. Joseph Cautilli. It is a peer-reviewed, electronic journal intended for circulation in the scientific community. The mission of this journal is to provide a forum for SLP and ABA professionals to exchange information on topics of mutual interest. These topics may include, but are not necessarily limited to support for disorders of prelinguistic communication, speech perception/production, oral language and literacy, speech fluency, and voice. They may also address issues pertaining to accent reduction, culturally-based language variations, and augmentative-alternative communication. JSLP-ABA welcomes articles describing assessment and treatment efficacy research based on detailed case studies, single -subject designs, and group designs. Also encouraged are literature reviews that synthesize a body of information, highlight areas in need of further research, or reconsider previous information in a new light. Additionally, this journal welcomes papers describing theoretical frameworks and papers that address issues pertaining to SLP-ABA collaboration. All materials, articles, and information published in JSLP-ABA are peer-reviewed by the review board of JSLP-ABA for informational purposes only. The information contained in this journal is not intended to create any type of patient-therapist relationship or representation whatsoever. To receive a free subscription to JSLP-ABA, please send an e-mail to [email protected]. Include your name and the e-mail address in the body of your e-mail; and type “subscribe-SLP-ABA” in the subject field. When your e-mail is received, your name will be added to the subscription list. You will then automatically receive notice of publication of each new issue through an e-mail containing a hyperlink to the latest issue.

ADVERTISING IN THE JOURNAL OF SPEECH AND LANGUAGE PATHOLOGY - APPLIED BEHAVIOR ANALYSIS

The prices for advertising in one issue are as follows:

1/4 Page: $50.00 1/2 Page: $100.00 vertical or horizontal Full Page: $200.00

If you wish to run the same ad in multiple issues for the year, you are eligible for the following discount:

1/4 Pg.: $40 - per issue 1/2 Pg.: $75 - per issue -vertical or horizontal

Full Page: $150.00-per issue

An additional one time layout/composition fee of $25.00 is applicable

For more information, or place an ad, contact Halina Dziewolska by phone at (215) 462-6737 or e-mail at: [email protected]


ISSN: Pending

Mission Statement

The mission of the Journal of Speech-Language Pathology and Applied Behavior Analysis (JSLP-ABA) is to provide a forum for SLP and ABA professionals to exchange information on topics of mutual interest. These topics may include (but are not necessarily limited to) support for disorders of prelinguistic communication, speech perception/production, oral language and literacy, speech fluency, and voice. They may also address issues related to accent reduction, culturally-based language variations and augmentative-alternative communication. JSLP-ABA welcomes articles describing assessment and treatment efficacy data based on detailed case studie s, single-subject research design, and group designs. Also encouraged are literature reviews that synthesize a body of information, highlight areas in need of further research, or reconsider previous information in a new light. Additionally, this journal welcomes papers describing theoretical frameworks and papers that address issues pertaining to SLP-ABA collaboration. JSLP-ABA is viewed as a primary source of information for speech-language pathology (SLP) professionals and professionals in applied behavior analysis (ABA) who support individuals of all ages with communicative disorders. The contents of this journal are intended to meet the interest of these professionals for information to support evidence-based practice. JSLP-ABA is also intended to serve as a vehicle to encourage collaboration between these SLP and ABA professionals.

Submissions Authors who wish to submit papers for publication in JSLP-ABA must submit a signed Assignment of Rights (AOR) from with their article. The AOR form can be downloaded from the JSLP-ABA website’s submission page. The JSLP-ABA is wholly owned by Joseph Cautilli. Contributions may be invited by the Lead Editor or the Associate Editors only. All submissions are peer-reviewed. After acceptance, all articles are copyedited. Peer Review: All submitted manuscripts are reviewed initially by a JSLP-ABA editor. Manuscripts with insufficient priority for publication will be rejected promptly. Other manuscripts will be sent to expert consultants for peer review. Information from submitted manuscripts may be collected and analyzed systematically as part of research to improve the quality of the editorial or peer review process. Identifying information will remain confidential. Manuscripts: Manuscripts must be submitted in RTF format via e-mail to Dr. Joseph Cautilli ([email protected]). A Word about Abstracts In order to ensure that SLP-ABA will be accepted in the major psych databases, there are certain guidelines that must be followed for abstracts relating to our article and the Journal. The following guidelines are straight from the PsycINFO website: http://www.apa.org/psycinfo/about/covinfo.html

General Guidelines for Writing Effective Abstracts For use in PsycINFO and other databases, an abstract should not exceed 960 characters and spaces (approximately 120 words). Characters may be conserved by: • using digits for numbers (except at the beginning of sentences) • using well-known abbreviations • using the active voice Begin with the most important information, but don't waste space by repeating the title. Include in the abstract only the four or five most important concepts, findings, or implications. Embed as many key words and phrases in the abstract as possible; this will enhance the user's ability to find the citation for your article in a computer search. Include in the abstract only information that appears in the body of the paper. Style: Remember that not all people who read your abstract will have a high level of psychological knowledge. Define all acronyms and abbreviations, except those for measurements. • Spell out names of tests • Use generic names for drugs (when possible) • Define unique terms Use the present tense to describe results with continuing applicability or conclusions drawn and the past tense to describe variables manipulated or tests applied. As much as possible, use the third person, rather than the first person. Abstracts for Empirical Studies: Abstracts of an empirical study are generally about 100––120 words. Include the following information: • problem under investigation (in one sentence) • pertinent characteristics of subjects (number, type, age, sex, and genus and species) • experimental method, including apparatus, data-gathering procedures, complete test • names, and complete generic names and the dosage and routes of administration of any drugs (particularly if the drugs are novel or important to the study) • findings, including statistical significance levels • conclusions and implications or applications

Abstracts for Review/Theoretical Articles Abstracts for review or theoretical articles are generally about 75––100 words. Include the following information: • the topic in one sentence • purpose, thesis, or organizing construct and the scope (comprehensive or selective) of the article • sources used (e.g., personal observation, published literature) • conclusions Editing Accepted manuscripts are copy edited according to APA format and returned to the author for approval. Authors are responsible for all statements made in their work, including changes made by the copy editor and authorized by the corresponding author. Please adhere to APA format and use "Times New Roman" font in 11 pt., single spaced throughout. In references, however, please italicize the places where APA format would have you underline. Additional requirements: To be published in any of the BAO journals, we have additional requirements that authors must adhere to. Our requirements supercede any requirements that conflict with APA requirements. * All articles must be created as one continuous document - no documents that are created in sections or sub documents. * Authors must not insert their own headers, footers, or pagination. * Graphics, figures, tables, etc., must be in jpg or bmp format. Graphics, figures, tables, etc., may be embedded in the text body of the article by the author. No Excel graphs will be accepted. If graphical materials are submitted as separate Word documents, they should be in portrait format and should be full page, or one half page or less only. Graphical materials larger than one page cause serious layout problems. If graphical materials are not inserted into the text portion of the article by the author, indicators must be placed in the text body so we know where the graphical materials belong. * All articles should be single spaced, with one inch margins all around. * All abstracts must contain keywords. * Full author contact information must be included in the article. Thank you! The Behavior Analyst Online Journals Department


ISSN: Pending

Editorial Staff Editor In Chief

Joe Cautilli, Ph.D., BCBA

Senior Associate Editor

Mareile Koenig, Ph.D., CCC-SLP, BCBA

Associate Editors Leslie Cohen, Ph.D. Joanne Gerenser, Ph.D., CCC-SLP Caio Miguel, Ph.D.

Editorial Board

Jenn Cronin, M.Ed. James Luiselli, Ph.D.

Anntonette Falco, M.Ed. Pat Mirenda, Ph.D., BCBA

Lori Frost, MS, CCC/SLP Pete Peterson, Ph.D.

Cheryl Gunter, Ph.D., CCC-SLP Anna I. Petursdottir, M.A.

James Halle, Ph.D. Bill Potter, Ph.D.

Giri Hegde, Ph.D., CCC-SLP David Sidener, Ph.D.

Anne Holmes, Ph.D., CCC-SLP, BCBA Francois Tonneau, Ph.D.

Laura Hutt, M.S., SLP-CCC, BCBA Ray Weitzman, Ph.D., CCC-SLP

SLP-ABA Volume 1, No. 1 Winter, 2006

1

Welcome Readers of SLP-ABA! Joseph Cautilli, Ph.D., BCBA and Mareile Koenig, Ph.D., CCC-SLP, BCBA

We welcome you to the first issue of the first volume of the Journal of Speech andLanguage Pathology-Applied Behavior Analysis (JSLP-ABA)! The mission of this journal is to provide a forum for professionals from the fields of applied behavior analysis (ABA) and speech-language pathology (SLP) to exchange information of mutual interest. This first issue includes six papers that reflect a diversity of interests shared by professionals in each field; and the papers are written by representatives of each field. First, Koenig and Gerenser summarize the history of SLP-ABA collaboration, advantages of collaboration, and suggestions for strengthening collaboration in the service of individuals with communication impairments. The second paper, by Whalen, et al., describes two studies that assessed the ability of TeachTown (a computer assisted instruction program) to improve the communication skills of eight children (four with autism and four with other developmental disabilities). Next, a paper by Cautilli analyses what’s new and what’s traditional about the verbal behavior package for treating children with autism. Further, Jackson et al present a review and synthesis of recent literature on conditional discrimination processes and relational responding in humans. They discuss a possible hierarchy of discriminations based on the ABLA (Assessment of Basic Learning Abilities) literature, and they summarize the implications of this research for language acquisition by persons with autism and related disabilities. In another paper, Goldfarb reviews the importance of considering behavioral strategies for supporting adults with aphasia, and he presents a systematic framework for designing treatment programs. A final paper by Dalton describes an Orton-based operant program to support individuals with auditory language learning disorders. This diverse set of papers presents something for almost everyone, and we hope you enjoy them. We encourage our readers to participate in the process of information exchange by submitting papers for publication in JSLP-ABA. We are especially interested in treatment efficacy research based on detailed case studies, single -subject designs, or group designs. We welcome literature reviews that synthesize a body of information, highlight areas in need of further research, or reconsider previous information in a new light. We also invite papers describing theoretical frameworks, and papers on all aspects of SLP-ABA collaboration. If you have any questions, please contact us. Author contact information: Joseph Cautilli, Ph.D., BCBA Lead Editor ([email protected]) Mareile Koenig, Ph.D. CCC-SLP, BCBA Senior Associate Editor ([email protected])


2

SLP- ABA: Collaborating to Support Individuals with Communication Impairments

Mareile Koenig and Joanne Gerenser

Abstract

This paper addresses collaboration between professionals in the fields of speech-language

pathology and applied behavior analysis (SLP and ABA). Although the fields of SLP and ABA each address a wide range of different concerns, they share an interest in supporting individuals with communication impairments. However, despite this significant area of overlap, the history of collaboration between these professionals has varied markedly over the past 50 years. This paper provides (a) a historical sketch of events that have led to renewed interest in collaboration among professionals within these fields. (b) the advantages of collaboration, and (c) suggestions for ways to strengthen current levels of collaboration in the service of individuals with communication impairments. Keywords: Applied Behavior Analysis, Speech-Language Pathology, Scope of Practice, Collaboration, History.

Introduction

The fields of applied behavior analysis (ABA) and speech-language pathology (SLP) each have a unique but overlapping range of interests. ABA professionals offer support for a wide variety of problems that challenge individuals and organizations in the performance of socially-valued verbal and nonverbal behaviors (e.g., BACB, no date). The scope of practice for SLP professionals is limited to communicative enhancement, although the types of problems requiring intervention are as diverse as the communication system itself (e.g., developmental and acquired language disorders, speech production impairments, voice and fluency problems, augmentative and alternative communication needs, dysphagia, and others) (ASHA, 2001). An overlap between ABA and SLP professionals involves support for the needs of individuals with communication impairments, including the reduction of problem behaviors that stem from inadequate communication skills. Despite this significant overlap, the history of collaboration between professionals in these fields has varied over the years. The purpose of this paper is to provide a brief historical sketch of the relationship between the professions of ABA and SLP; to discuss current avenues and benefits of collaboration; and to suggest ways of strengthening this collaboration in the service of individuals with communication impairments.

A Brief Historical Sketch Many changes have occurred over the past 50 years in the practices of ABA and SLP. This is not at all surprising for at least three reasons. First, each profession has a relatively short history and a complex range of interests as noted above. Second, the context of service delivery, including evolving theoretical frameworks and consumer demands, has influenced the work of professionals in each field. Third, each profession has a commitment to evidence-based practice, which forces change in response to new findings. Changes in theoretical frameworks have had considerable impact on the practice of SLP. Some of these changes widened the gap between the fields of SLP and ABA while others had the opposite effect. For example, in the period between 1950 and 1975, the application of behavioral techniques to clinical practice was frequently reported in the SLP literature and in other literature consumed by SLP professionals. Some of the earliest articles refer to stimulus presentation and reinforcement (e.g., Enquist & Wagner, 1950), as well as response shaping and modeling (e.g., Backus & Beasley, 1951; Bloodstein,


3

1950). Moreover, behavioral techniques were used to treat a variety of speech-language problems, including disorders of articulation (e.g., McReynolds, 1966; Sommers et al., 1966), fluency (e.g., Brookshire & Martin, 1967; Brutten & Shoemaker, 1967), voice (e.g., Shriberg, 1971), and language (e.g., Baer & Guess, 1971; Holland & Harris, 1968; Sailor & Tackman, 1972). An excellent review of details regarding the integration of behavioral techniques within the profession of SLP is provided by Ogletree & Oren (2001). In the late 1970s and 1980s, the field of SLP became increasingly influenced by models of generative grammar and generative semantics (e.g., Chomsky, 1957; Bloom, 1970; Brown, 1973). These models relied heavily on concepts from theoretical linguistics and cognitive psychology – far from the roots of applied behavior analysis. The idea that language behaviors were a manifestation of a more basic, underlying, abstract rule-system suggested different methods of management. The appropriateness of using behavioral techniques for teaching a generative language system was questioned (e.g., Prizant, 1982), and SLP professionals became “…facilitator of the language-learning process who did not strictly control stimuli and responses in treatment but [rather] worked in natural, non-intrusive ways” (Ogletree, 2001, p 104). In addition, some of the heat resulting from Chomsky’s (1959) review of Skinner’s (1957) Verbal Behavior trickled down to ABA and SLP practitioners, thereby creating a considerable rift between many members of the two professions (e.g., MacCorquodale, 1970; Palmer, 1986). By the late 1980s, however, limitations of generative language models, combined with new potential offered by the pragmatics framework (e.g., Bates, 1976; Halliday, 1975; Bruner, 1981), began to bring SLP professionals as a group back to a closer alignment with ABA. Specifically, the pragmatics framework focused the attention of SLP professionals on the importance of communicative functions (and other aspects of social interaction) to natural and assisted language learning. From that point to about 1990, the fields of ABA and SLP continued on a relatively parallel course with regard to the practice of communicative enhancement. With few exceptions (e.g., Fey, 1986; Ogletree, 2001), there appears to have been little exchange of substantive information. For example, articles on language instruction in behavioral journals rarely cited literature produced by professionals in SLP or psycholinguistics and vice versa. Each profession appeared to be operating in a parallel universe despite important common interests (Koenig & Gerenser, 2000). Several events in the 1990s contributed toward significant changes in the degree of substantive information exchanged between ABA and SLP professionals. All were related in one way or another to a dramatic increase in the incidence of autism. Perhaps one of the most significant events was the publication in 1993 of Catherine Maurice’s book Let me Hear Your Voice, which described the diagnosis and recovery of two children with autism spectrum disorders (ASD) from a parent’s perspective. Included was a description of the many challenges that Maurice faced in finding appropriate treatments for her children and the nature of the therapies that she ultimately attributed to both children’s recovery. Included among the latter were ABA and (to a lesser extent) SLP. In summarizing the scientific evidence supporting behavioral interventions, Maurice (1993) referred to O. Ivar Lovaas’ (1987) research, which compared the treatment outcomes of children with autism in an experimental group receiving early, intensive, long-term behavioral intervention with the outcomes of children in two control groups, who received either less intensive behavioral intervention or a variety of non-behavioral interventions. The best outcomes were obtained by 9 (47%) of the 19 participants in the experimental group. By the end of the study, these children were characterized as “indistinguishable from same-age peers” in an academic setting. As noted by Green (1996), other studies provided similar patterns of support (e.g., Anderson et al., 1994; Birnbauer & Leach, 1993; Sheinkopf & Siegel, 1998).


4

Since no other treatment approaches offered efficacy data of this nature, it is not surprising that early intensive behavioral intervention (EIBI) soon became the treatment of choice for many families of children with ASD, and a momentum began to build. EIBI programs began to surface across the USA and internationally. In the best case scenario, these programs were led by experienced ABA professionals, and many included SLP professionals as team members. Workshops began to be offered around the country on the use of behavioral interventions for children with autism (e.g., Lovaas, 1995); and several manuals were published to support home-based programs (e.g., Fovel, 2002; Maurice, Green, & Luce, 1996; Leaf & McEachin, 1999; Sundberg & Partington, 1998). The availability of internet listservs enabled families to network with each other rapidly at regional, national, and international levels about the challenges and successes of behavioral (and other) interventions. The need for behavioral intervention options was also eventually communicated to public school systems by families whose children had made progress with this approach in home-based EIBI programs. Of relevance to this discussion is the fact that a large proportion of the EIBI curriculum for children with autism targeted language and pre-language skills (e.g., imitation, play, vocal production, etc.) (e.g., Lovaas, 1981; Freeman & Dake, 1997; Harris & Weiss, 1998; Taylor & McDonough, 1986; Leaf & McEachin, 1999; Maurice, Green, & Foxx, 2001; Partington & Sundberg, Taylor & McDonough, 1986). In deed, one recent manifestation of behavioral intervention (Sundberg & Partington, 1998) has come to be known (with some reservation among its proponents) as “Verbal Behavior” because it targets the verbal behavior functions described by Skinner (1957). Given the emphasis of EIBI programs on social-communicative enhancement, and given the evidence of treatment efficacy associated with behavioral methods, it is not surprising, that SLP professionals became increasingly interested in a reconsideration of the behavioral framework. Those who had participated on home-based early intervention teams had observed the impact of behavioral interventions directly; and those who worked in schools were becoming increasingly exposed to behavioral interventions through in-service programs. For example, the Pennsylvania Training and Technical Assistance Network (PaTTAN) has offered a large-scale annual “Autism Conference” for teachers, related service providers (including ABA and SLP professionals), and families of children with autism since 1998; and a major portion of this conference offers information on behavioral approaches to communicative enhancement. To date, the interest among SLP Professionals in behavioral approaches to communicative enhancement has had several tangible results. First, since 2001, a growing number of SLP professionals have expanded their post-graduate education to earn certification in ABA through the Behavior Analysis Certification Board (see http://www.bacb.com/). Second, a listserv was established in 2001 for professionals in ABA and SLP who wish to dialogue about issues of mutual interest (see http://health.groups.yahoo.com/group/SLP_ABA/). Third, the Association for Behavior Analysis developed a special interest group in 2005 for SLP professionals who attend the ABA convention (see http://behavioralspeech.com/). In recent years there has also been an increase in the number of SLP professionals presenting papers at annual ABA conventions and (slowly but surely) in the number of behavioral papers presented at annual ASHA (American Speech-Language and Hearing Association) conventions. Clearly, there is an interest in collaboration among members of each profession.

Benefits to Collaboration In this discussion, the word collaboration refers to a variety of activities involving the contribution of each profession towards evidence-based practices that can improve the services for individuals with communication impairments. Collaboration can occur in team work during clinical practice, in the pursuit of research, in reading the literature of each profession, in dialogue on listservs, in


5

participation at conferences and in any other context where professionals from both fields can have an impact on advancing evidence-based services to support people with communication impairments. The benefits of collaboration are clear to ABA and SLP professionals who are already engaged in the process. One example can be seen in the creation of evidence-based therapeutic approaches and practices by individuals with combined expertise in ABA and SLP (e.g., Dyer & Kohland, 1991; Frost & Bondy, 2001; Gerenser, 2005; Koegel & Koegel, 1996; Mirenda, 1997; Reichle & Wacker, 1993). Another important benefit to collaboration may be its ability to improve the integration of support provided by SLP and ABA professionals as participants on home-, school-, and center-based intervention teams. Areas where improvement is needed can be illustrated by examples of situations where problems have been observed. For example, in the context of our own clinical experiences, we have spoken with families who were confused about how to integrate recommendations from their ABA consultant for verbal behavior targets with seemingly conflicting recommendations from their SLP consultant for language intervention targets. Additionally, differing technical terms used by ABA and SLP professionals for referring to similar strategies are also sometimes a source of confusion. For example, SLPs may talk to families about “communicative temptations” while ABA professionals talk to them about “motivating operations.” Further, the precise technical definitions of various behavioral procedures (e.g., DRA, DRO, DRI, functional assessment, functional analysis) are sometimes poorly understood by SLP professionals, while the complexities of oral speech and language development are sometimes poorly understood by ABA professionals. In both cases, this can result in programmatic problems. Moreover, the concept of “verbal behavior” itself is often grossly misunderstood by consumers as well as many SLP professionals as referring to something other than evidence-based behavioral methodology for supporting communication development. With better collaboration, professionals from both disciplines may learn to present clearer information to consumers. Another benefit of collaboration may be a reduction in the number of reinvented wheels. In the SLP and psycholinguistic literature there is quite a history of research demonstrating that adult-directed techniques (e.g., discrete trials) are effective for establishing skills that are not already within repertoire while child-oriented and hybrid techniques (e.g., natural environmental training, or NET) are more effective in promoting generalization (e.g., Fey, 1986; Paul, 2001). Despite this fact, EIBI programs based on the Lovaas (1981) model appeared to emphasize discrete trial instruction without much attention to child-oriented or hybrid techniques. In fact, for a period of time, “ABA” became (incorrectly) synonymous with “discrete trial teaching” in the minds of many consumers, public school administrators, and non-ABA professionals. Moreover, the inclusion of NET was cited by Carr & Firth (2005) as an innovation associated with the most recently documented manifestation of EIBI (e.g., Sundberg & Partington, 1998). For further evidence of how the fields of ABA and SLP have reinvented the wheel while operating in relatively parallel universes, please see Prizant and Wetherby (1998). The fact that some of the same principles have been identified independently by professionals in two different fields tends to supports the validity of those principles. At the same time, however, some consumers are not provided with optimal services when professionals in the field that has not yet discovered the principle are using less effective teaching strategies. Finally, while the desire for stronger collaboration may have been prompted by the communication needs of individuals with autism, the benefits of stronger collaboration between ABA and SLP professionals would extend beyond the needs of this population. As indicated earlier, other communication needs frequently addressed by both ABA and SLP professionals include fluency disorders, aphasia, voice, and phonological disorders. However, despite this overlap in treatment interests, there is limited overlap in research, publications, or presentations. Stronger collaboration could reduce


6

these limitations. For all of the above reasons, it seems obvious that better collaboration between ABA and SLP professionals could result in a higher quality of service delivery for individuals with communication impairments.

Recommendations for Continued Collaboration As indicated previously, the work of ABA and SLP professionals overlaps with respect to supporting individuals with communication impairments. Any collaborative activity that enhances the quality of services provided to these consumers is worthy of consideration. Below are some suggestions:

1. Share treatme nt efficacy data. This can be accomplished at various levels. The Journal of Applied Behavior Analysis and Speech-Language Pathology (JSLP-ABA) welcomes data-based articles involving case studies, single subject designs, and group designs. Data-based research can also be shared in the form of presentations at national and regional conferences for ABA and SLP professionals. Information can be shared informally on the SLP-ABA Listserv.

2. Share innovative teaching procedures. This can be done informally on the SLP-ABA listserv

and at special interest group meetings. Before a procedure’s efficacy can be assessed, it needs to be defined. The advantage of sharing such ideas within a mixed forum (e.g., SLP-ABA listserv) is that the contributor has the potential to receive helpful feedback relatively quickly from other professionals with similar interests.

3. Share basic information. If you work in an applied context where information about your area

of expertise (ABA or SLP) is repeatedly misunderstood by professionals from the other area (SLP or ABA), consider sharing a clear summary of the targeted information with readers of JSLP-ABA. Chances are that your experience is not unique, and that an article on the topic may serve to clarify issues at a broader level.

4. Share your experience of successful collaboration within an applied environment. As with the

previous two suggestions, this can be done in the form of an article in JSLP-ABA, a presentation at a professional conference, or even on the SLP-ABA listserv. Given the various ways in which collaboration sometimes fails, models of effective collaboration have the potential to improve systems in other locations.

5. Read articles in journals associated with the other profession. If you are an ABA professional,

consider reading some of the articles in the American Journal of Speech-Language Pathology; Language, Speech, and Hearing Services in the Schools; and the Journal of Speech and Language Research. If you are an SLP professional, consider reading some of the articles in the Journal of Applied Behavior Analysis; The Analysis of Verbal Behavior; Behavior Analysis Today; the Journal of Early Intensive Behavioral Intervention, or The Journal of Precision Teaching. By reading the literature of the other profession, you will learn the vocabulary and gain a better understanding of where overlaps do and do not exist between the professions. Even if you completely disagree with the concept, philosophy or theory behind the material you are reading, the process of constructive professional disagreement can go a long way to inspire new and even better interventions.

6. Share your concerns about collaboration breakdowns. If you experience a collaboration

breakdown, it may be helpful to share (in general terms) what happened and how it may be resolved. Chances are the same problem may be brewing elsewhere, and your experience may help others solve it more easily.


7

7. Share lunch: If you’re an ABA professional, take an SLP professional to lunch. If you’re an SLP professional, take an ABA professional to lunch. Discuss the ways in which your roles overlap. You may discover that the individual resources which each of you bring to the table can be combined in helpful ways to improve the services for individuals with communication impairments.

References Anderson, S. R., Avery, D. L, Dipietro, E. K. Edwards, G. L. and Christian, W. P. (1987) Intensive home-

based early intervention with autistic children. Education and Treatment of Children, 10, 352-366.

ASHA (American Speech-Language and Hearing Association) (2001) Scope of Practice for Speech-

Language Pathologists. ASHA Desk Reference 2002: Cardinal Documents of the Association. BACB (Behavior Analysis Certification Board) (no date) Defining the field of behavior analysis.

Retrieved from http://www.bacb.com/cues/frame_about.html on 3/12/06. Backus, O., & Beasley, J. (1951) Speech therapy with children. Boston: Mifflin. Baer, D.M., & Guess, D. (1971). Receptive training of adjectivel inflection in mental retardates. Journal

of Applied Behavior Analysis. 4, 129-140. Bates, E. (1976) Language in context: Studies in the acquisition of pragmatics. New York: Academic

Press. Bloodstein, O. (1950) Hypothetical conditions under which stuttering is reduced or absent. Journal of

Speech and Hearing Disorders.15, 147-153. Bloom, L. (1970) Language development: Form and function in emerging grammars. Cambridge, MA:

MIT Press. Brookshire, R., & Martin, R.R. (1967) The differential effects of three verbal punishers on the

dysfluencies of normal speakers. Journal of Speech and Hearing Research. 10, 496-505. Brown, R. (1973) A first language. Cambridge, MA: Harvard University Press. Brutten, J. & Shoemaker, D. (1967) The modification of stuttering. Englewood Cliffs, NJ: Prentice-Hall. Bruner, J. (1981) The social context of language acquisition. Language and communication. 1, 155-178. Carr, J.E. & Firth, A.M. (2005). The verbal behavior approach to early and intensive behavioral

intervention for autism: A call for additional empirical support. Journal of Early and Intensive Behavioral Intervention, 2 (1), 18-26.

Chomsky, N. (1957) Syntactic structures. The Hague: Mouton. Chomsky, N. (1959) Review of Verbal Behavior by B.F. Skinner. Language, 35, 26-58.


8

Dyer, K. & Kohland, K. (1991) Communication training at the May Center’s Integrated Preschool: Assessment, Structured Teaching, and Naturalistic Generalization Strategies. In Cipani (Ed) A guide for developing language competence in preschool children with severe and moderate handicaps. Springfield, Ill.: Charles C. Thomas Publishing Co.

Enquist, L.E. & Wagner, C.F. (1950) Flannel chart techniques for the rehabilitation of speech and hearing

disorders. Journal of Speech and Hearing Disorders. 15, 338-341. Fovel, J.T. (2002) The ABA program companion, organizing quality programs for children with autism

and PDD. New York: DRL Books, Inc. Fey, M. (1986) Language intervention with young children. San Diego: College Hill Press. Freeman, S., & Dake, L (1996) Teach me language: A language manual for children with autism,

asperger’s syndrome and related developmental disorders. Langley, British Columbia: SKF Books. (Phone: 604-534-6956).

Frost, L. & Bondy, A. (2001) The picture exchange communication system (PECS): 2nd Edition. Newark,

DE: Pyramid Educational Products. Gerenser, J.E. (2005). Promoting speech and language in children with autism: From Theory to Practice.

Workshop, Association for Behavior Analysis Conference, Chicago, Ill. Green, G. (1996) Early behavioral intervention for children with autism: What does research tell us? In C.

Maurice, G. Green, & S. Luce (Eds.) Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed.

Halliday, M.(1975) Learning how to mean: Explorations in the development of language. New York:

Arnold. Harris, S.L. & Weiss, M.J/ (1998) Right from the start. Behavioral intervention for young children with

autism: A guide for parents and professionals. Bethesda, MD: Woodbine House. Holland, A., & Harris, A. B. (1968) Aphasia rehabilitation using programmed instruction: an intensive

case history. In H. Sloane & B. MacAuley (Eds.) Operant procedures in remedial speech and language training. Boston: Houghton Mifflin, 197-216.

Koegel, R. L. & Koegel, L. K. (1996) Teaching children with autism: Strategies for initiating positive

interactions and improving learning opportunities. Baltimore: Paul Brookes Publishing Co. Koenig, M., & Gerenser, J. (2000) Treating children with autism: SLP-ABA Collaboration. Mini

Seminar. ASHA Convention, Washington, D.C. Leaf, R., & McEachin, J. (1999) A work in progress: Behavior management strategies and a curriculum

for intensive behavioral treatment of autism. New York: DRL Books. Lovaas, I. (1981) Teaching developmentally disabled children: The ME book . Austin, Texas: Pro-Ed. Lovaas, O.I. (1995) Early Intervention Conference, Los Angeles, CA, January 27-28.


9

Lovaas, O. I. (1987) (1995).Behavioral treatment and normal education and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology. 55. 3-9.

Maurice, C. (1993) Let me hear your voice. New York: Fawcett Columbine. Maurice, C., Green, G., & Foxx, R. (2001) Making a difference: Behavioral intervention for autism.

Austin, TX: Pro-Ed. Maurice, C., Green, G., & Luce, S. (1996) Behavioral intervention for young children with autism: A

manual for parents and professionals. Austin, TX: Pro-Ed. MacCorquodale, K. (1970). On Chomsky's review of Skinner's Verbal Behavior. Journal of the

Experimental Analysis of Behavior, 13, 83-99. McReynolds, L. V. (1966) Operant conditioning for investigating speech sound discrimination in aphasic

children. Journal of Speech and Hearing Research. 9, 519-528. Mirenda, P. (1997) Functional communication training and augmentative communication: A research

review. Augmentative and Alternative Communication. 13, 207-225. Ogletree, B. T. & Oren, T. (2001) Application of ABA principles to general communication instruction.

Focus on Autism and Other Developmental Disabilities. 16, (2), 102-109. Paul, R. (2001) Language disorders from infancy through adolescence. Philadelphia: Mosby. Prizant, B. (1982) Speech-language pathologists and autistic children. What is our role. ASHA, 24, 463-

468. Palmer, D. C. (1986). Chomsky’s nativism: A critical review. In P. N. Chase & L. J. Parrott (Eds.),

Psychological aspects of language (pp. 44-60). Springfield, IL: Charles C Thomas. Partington, J., & Sundberg, Mark (1988) The Assessment of basic language and learning skills (ABLLS):

An assessment, curriculum guide, and skills tracking system for children with autism or other developmental disabilities. Pleasant Hill, CA: Behavior Analysts, Inc.

Prizant, B., & Wetherby, A. (1998) Understanding the continuum of discrete trial traditional behavioral to

social-pragmatic developmental approaches in communication enhancement for young children with autism. Seminars in Speech and Language. Volume 19, No. 4., pages. 329-352

Reichle, J. & & Wacker, D. P. (1993) Communicative alternatives to challenging behavior: Integrating

functional assessment and intervention strategies. Baltimore: Paul Brookes Publishing Company. Sailor, W., & Tackman, T. (1972) Stimulus factors in the training of prepositional usage in three autistic

children. Journal of Applied Behavior Analysis, 5, 183-192. Sheinkopf, S., & Siegel, B. (1998) Home-based behavioral treatment for young autistic children. Journal

of Autism and Developmental Disorders. 28, 15-23. Shriberg, J.D. (1971) A system for monitoring and conditioning modal fundamental frequency of speech.

Journal of Applied Behavior Analysis. 4, 565-568.


10

Skinner, B. F. (1957) Verbal behavior. MA: Copley Publishing Co. Sundberg, M. L. & Partington, J. W. (1998) Teaching language to children with autism or other

developmental disabilities. Danville, California: Behavior Analysts, Inc. Taylor, B., & McDonough, A. (1996) Selecting teaching programs. In C. Maurice, G. Green, & S. Luce

(Eds.) Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed.

Authors’ contact information: Mareile Koenig, Ph.D., CCC-SLP, BCBA Department of Communicative Disorders West Chester University West Chester, PA 19383 Phone: 610-458-5364 E-mail: [email protected] Joanne Gerenser, Ph.D., CCC-SLP Eden II Programs 150 Granite Ave. Staten Island, New York 10303 Phone: 718-816-1422 Ext. 115 E-mail: [email protected]


11

Behavioral Improvements Associated with Computer-Assisted Instruction for Children with Developmental Disabilities

Christina Whalen, Lars Liden, Brooke Ingersoll, Eric Dallaire, and Sven Liden

ABSTRACT TeachTown is a new computer-assisted instruction (CAI) program that utilizes best-practices ABA to teach

a variety of skills to young children. Study 1 investigated the effect of the software on the acquisition of receptive language, cognitive, and social skills by 4 children with autism and 4 children with other developmental delays using a pre-test/post-test design. Social validity with parents, teachers, and clinicians was also assessed. Study 2 used a multiple-baseline design across the 4 children with autism to investigate whether CAI impeded the children’s spontaneous use of language and social behaviors. Results suggested that the computer-assisted instruction actually enhanced social-communication and decreased inappropriate behaviors. Results are discussed in terms of the potential of using CAI programs for children with autism. Keywords: Computer, Autism, Social-Communication, Language, Discrete Trial Training, Pivotal Response Training

Introduction

Children with autism and other developmental disorders exhibit significant difficulties learning through traditional teaching methods. One method that has had substantial effectiveness in the education of these young children is applied behavior analysis (ABA). ABA encompasses a variety of teaching strategies which are drawn from the learning literature and includes both highly-structured and more naturalistic teaching approaches (Schreibman & Ingersoll, 2005). ABA has been shown to be particularly effective in the education of children with autism who, due to social, attentional, and motivational deficits, have difficulty learning though traditional methods (National Research Council, 2001; Schreibman & Ingersoll, 2005). Most ABA teaching techniques involve intensive, one-to-one instruction. Although ABA has been shown to be extremely effective for teaching new skills to young children with autism, it is often prohibitively expensive due to the significant amount of teacher time and materials need to implement it effectively.

With recent advances in computer technology, there has been a strong interest in the use of computer-assisted instruction (CAI) in the education of children with disabilities. There are several reasons to be excited about the possibility of using computers to implement ABA interventions with young children with autism. First, using computers may help to reduce the number of staff and staff training saving families and school districts substantial amounts of money. Second, it can be implemented with a high degree of fidelity. ABA instruction requires significant staff training to be implemented effectively. A computer program which uses ABA principles can be designed to always provide appropriate prompts and reinforcement consistently. Third, programs that automatically collect data on the child’s performance may provide more accuracy and more comprehensive data than personal instruction. Fourth, computer instruction may be implemented by untrained providers, increasing the number of hours of intervention. Fifth, it is highly motivating for many children as has been demonstrated by the very profitable computer game industry for young children. This may be particularly true for young children with autism who have often been described as visual learners (Sherer, Pierce, Parades, Kisacky, Ingersoll, & Schreibman, 2001; Schreibman, Whalen, & Stahmer, 2000). If computers are more motivating for children with autism and they are able to attend longer, many skills can be taught with reduced behavior problems and increased learning time. Finally, because computers can store great


12

amounts of information, more exemplars of concepts can be presented which will reduce the cost of materials for treatment and potentially increase generalization. Research that has examined the effectiveness of CAI for teaching children with autism and other developmental disorders has been promising (Bernard-Opitz, Sriram, & Nakhoda-Sapuan, 2001; Bosseler, & Massaro, 2003; Coleman-Martin, Wolff Hellar, Cihak, & Irvine, 2005; Kinney, Vidora, & Stromer, 2003; Moore, & Calvert, 2000; Simpson, Langone, & Ayers, 2004; Williams, Wright, Callaghan, Coughlan, 2002). In fact, current research is beginning to suggest that CAI may be more effective for teaching certain skills than direct instruction provided by a trained teacher. For example, Williams et al. (2002) compared CAI and teacher implemented instruction for teaching sight word reading to eight children with autism in a cross over design. The children learned significantly more sight words in the computer condition than the direct instruction condition. Additionally, it was found that the children attended significantly more during CAI than direct instruction, suggesting that CAI was more motivating to the children with autism. In a similar study, Moore and Calvert (2000) compared CAI and teacher instruction for teaching basic vocabulary skills. The children in the CAI condition learned significantly more vocabulary words than the children in the direct instruction condition. In addition, the children in the CAI condition attended more and were more motivated than the children in the direction instruction condition. Across children, the amount of time on task was positively correlated to the number of words learned. Despite the promise of CAI for children with developmental delays, there is a legitimate concern that CAI may impede the development of spontaneous language and result in increased social withdrawal, particularly for children with autism (Bernard-Opitz, Ross, & Tuttas, 1990). To date, little research has examined this possibility. One study comparing the effect of CAI to direct instruction by a teacher noted that the participants with autism used more spontaneous gestures and verbal requests for help in the CAI condition compared to direct instruction condition. While this finding is promising, due to the small number of subjects in each condition, an empirical analysis of the results was not conducted (Williams et al., 2002). An additional concern is that skills learned on the computer may not generalize to other activities. Previous research has not adequately examined whether skills learned during CAI were used spontaneously in non-computer-based activities. The goal of this research was to assess whether computer-assisted instruction impedes the use of language and social interaction in children with autism. In the first study, the effectiveness of TeachTown, an ABA-based, computer-assisted intervention program designed for use by preschool-aged children with developmental disabilities, was examined with eight children with autism and other developmental disabilities. In the second study, the four children with autism were observed during baseline play sessions and computer-assisted instruction with their parents. Language, social, and inappropriate behaviors were observed to determine whether the use of the computer led to decreased language use and/or social withdrawal. In addition, children were observed during generalization play sessions with their parents after treatment was begun to determine whether the use of CAI would have an effect language and social interaction outside of the treatment environment (computer).

Method – Study 1

Participants Participants included four children with an autism spectrum diagnosis (ASD) and four children

with other developmental disabilities (DD), including three with Down Syndrome and one with Soto’s Syndrome. Two children (one with ASD and one with DD) also participated during baseline but were unable to complete the study for personal and health reasons. Their data were not included in this report.

The average chronological age was 3 years, 9 months for the children with ASD and 4 years, 6 months for the children with DD. The average language-age equivalent for both groups was 1 year, 8


13

months using the MacArthur Communicative Development Inventory (CDI) (Fenson, et al., 1993). All participants with autism met criteria using the Childhood Autism Rating Scale (CARS) (Schopler, Reichler, DeVellis, & Daly, 1980) with an average score of 38. Additionally, these children had all received a diagnosis of autism or another autistic spectrum disorder from an outside physician or psychologist using DSM-IV-TR criteria (American Psychiatric Association, 2000). Table 1 summarizes the specific characteristics of each participant. All participants were recruited on a first-come, first-serve basis locally from parent groups, professional referrals, and the company website.

Table 1: Participant characteristics at intake

Participant Diagnosis Chronological

Age a CARS b CDI Gesturesa

CDI Languagea

Damon Cameron

Bailey Aaron Ellen

Frankie George Heather

Autism Autism Autism Autism

Down Syndrome Down Syndrome Soto’s Syndrome Down Syndrome

3-11 4-3 3-4 4-0 5-10 4-3 4-4 4-0

39 40.5 40 32 20 25 32 23

> 1-4 1-3 1-2

> 1-4 1-3

> 1-4 > 1-4 1-3

1-8 2-4 1-5 1-9 1-11 1-11 1-9 1-5

aChronological Age (CA) and MacArthur Childhood Developmental Index (CDI) age shown in years-months.

bRange of autism severity on the Childhood Autism Rating Scale (CARS): 15-29=non-autistic, 30-36=mildly-moderately autistic, 37-60=severely autistic

Design A pre-test/post-test design was used to determine acquisition of the targeted concepts using the

computer software for all eight participants. Acquisition was assessed using pre- and post-tests administered by the computer. These tests used novel stimuli that were not included in the training sessions to ensure that the children learned the concepts rather than simply recognizing the training stimuli. Setting and Materials

The research was conducted in the homes of each participant. Each child used a computer supplied by the family, or if the family did not have one, a computer was provided during the child’s participation in the study. Some participants used touch screen monitors which were either provided by the child’s family or by the research team. Software

The TeachTown software was designed based on best-practices from applied behavior analysis presented within a developmental framework. The software includes a comprehensive curriculum for children with developmental disorders and teaches receptive language, social understanding, self-help, attention, memory, auditory processing, and early academic skills. The program uses an intermittent reinforcement schedule and the child chooses the reinforcers and the order of activities. The reinforcers are designed by professional video game designers to be attractive to children with a wide range of interests and abilities. Each concept is introduced using errorless discrimination training where distracters are gradually faded in as the child progresses through the lesson. The software automatically adjusts to the child’s performance by providing prompts when the child’s performance decreases and fading prompts as the child’s performance improves.


14

To enhance generalization, the program uses a la rge variety of images for every concept and varies the verbal instructions for each trial. The software also includes a complete data tracking system that provides the adult with information about the child’s progress including prompts, errors, correct responses, and other valuable data.

Following baseline, each participant was asked to use the TeachTown software for three 15-minute sessions a week over an eight-week period. Data was collected automatically by the software regarding the amount of time the child used the software and on the child’s performance using the program. Dependent Measures Receptive identification of animals, food, clothing, transportation, toys, playground equipment, classroom objects, household objects, actions, people (boy, girl, mother, father, etc.), and occupations were targeted by the software program. In addition, matching identical and non-identical objects was taught. Social understanding was targeted using emotion identification and a unique eye gaze lesson. This lesson taught children to attend to eyes using a shaping paradigm that began with identifying where an arrow was pointing and gradually adding features that looked more and more like a face to identify where the eyes were looking. Pre-tests were used to assess each concept. If a child performed at less than 80% correct, they began drills for those concepts. The drills used errorless learning and gradually introduced distracters until the child identified the concept without prompting at 80% accuracy or better. When this occurred, the child completed the post-test for that lesson. The pre-tests and post-tests contained a completely different set of stimuli than the training drills (i.e. lessons) in order to assess generalization and ensure that the child had learned the concepts and not simply memorized stimuli. Social Validity

The social validity of this CAI protocol was assessed by having parents and professionals view a demonstration of the TeachTown software and rate the program on a five-point, Likert-type scale. Fifteen adults participated, including five parents of children with autism, five special education teachers, and five clinicians. The five clinicians included two speech-language pathologists, two psychologists, and one occupational therapist. Table 2 (below) summarizes the mean responses of these individuals to 6 social validity questions.

Results - Study 1

The pre and post-test scores of all eight participants were automatically generated using the TeachTown software. There was no difference in performance for the children with autism vs. the children with other developmental delays. Across all participants, there was a significant change in the percent correct using the TeachTown software from the pre-tests (M = 60.23, SD = 22.60) to the post-tests (M = 92.38, SD = 8.00), t(7) = -4.06, p < .01 Specific results are summarized in Figure 1, next page:


15

0

10

20

30

40

50

60

70

80

90

100

Pre-Test Avg. Post-Test Avg.

Per

cent

Cor

rect

t(7)=-4.07, p<.01

Figure 1: Average performance in percent correct from pre to post-tests for participants in Study 1. Error bars represent standard error.

Following the social validity demonstration, most parents, teachers, and clinicians gave the program high ratings in terms of the quality of the program, the appropriateness of the targeted goals and the appropriateness of the program for teaching needed skills. Parents and teachers indicated a strong interest in purchasing the program and clinicians indicated an average interest (see Table 2). Table 2: Social Validity Ratings* Following TeachTown Demonstration

Parent Teacher Clinician Do you like the general aesthetic and look of the interface? 4.6 4.8 4.8 Do you think the program generated appropriate goals? 4.8 4.8 4.3

What is your overall impression of the software? 5.0 4.8 4.6

How appropriate is this type of program for your child? 4.8 4.6 3.5

Do you feel like the supplementary activities and computer program are a good package for treating symptoms of the child’s disorder?

4.5 4.6 5.0

How likely would you be to purchase this type of program for the child?

4.5 4.6 3.4

*Rating Scale: 1 = did not like at all; 5 = extremely enthusiastic

Method – Study 2 Participants The participants in study 2 were the same four children with ASD who participated in Study 1 (See Table 1).

Design A single subject, multiple baseline design across participants was implemented (Kazdin, 1973). Parent-child dyads were videotaped for 15-minutes during baseline, CAI, and generalization. Baseline


16

sessions were conducted once a week for one to five weeks. Data from the computer-assisted instruction were collected during the first treatment session, after one month of intervention, and after two months of intervention. Data from generalization sessions were collected on the same days as the CAI. Setting and Materials

All session were conducted in the child’s home. Materials for parent-child play interactions were toys and activities that the family already owned and participants were not given any instructions for purchasing any special materials for this study.

Baseline During baseline, parents were told to “play” with their child and no other instructions were given. Play materials were provided by the parents and varied depending on what activities the parents chose to do with their child. Following baseline, each family was given a copy of the TeachTown early learning software and a binder with printed supplementary activities. The supplementary activities included suggestions of play activities that parents could engage in to help generalize concepts targeted during the CAI. Treatment During treatment, each child was observed with their parent while receiving computer-assisted instruction using the TeachTown computer software. Generalization During generalization, parents were told to play with their child, as they were in baseline. Most parents chose to engage in some of the supplementary activities with their child. As in baseline play, materials were provided by the parents, and varied depending on what activities the parents chose to do with their child. Dependent Measures

Each child’s inappropriate language (e.g. verbal self-stimulation, making comments out-of-context); spontaneous commenting (i.e. making comments to adult with purpose of sharing interest, not requesting or imitating); length of sentences; inappropriate behavior (e.g. avoidance of adult, self-stimulation, tantrums, and mild self-injury); positive affect (i.e. toward the adult in a social context); and looking toward the adult were coded via videotapes using interval recording.

More than 75% of tapes were coded by a trained rater blind to the purpose of this study and to

the diagnosis of the child. The remaining 25% of sessions, as well as interobserver reliability, was coded by the primary investigator in this study. Interobserver Reliability

Interobserver reliability was assessed for 33% of all sessions evenly across participants (autism and developmental disorders) and across session types (play and computer sessions). Kappa statistic was utilized to assess reliability. All kappa statistics were between 79% and 91%. The advantage of using this statistic is that chance agreement is removed.


17

Results – Study 2 Language

During baseline, 3 of the participants (Bailey, Cameron, and Damon) exhibited low rates of spontaneous commenting and high rates of inappropriate language, with Bailey making no comments at all. One participant (Aaron) used higher rates of spontaneous commenting and relatively low rates of inappropriate language.

During treatment sessions, Aaron exhibited an increase in his use of spontaneous commenting but

made no changes in his use of inappropriate language. Bailey exhibited a small amount of spontaneous commenting during the second treatment session, but this did not extend to other treatment sessions. He also exhibited a substantial decrease in his inappropriate language during the treatment sessions. Cameron and Damon both exhibited substantial increases in their use of spontaneous commenting and concurrent decreases in their inappropriate language during treatment sessions.

During the generalization sessions, Cameron and Damon continued to exhibit higher rates of

spontaneous commenting and lower rates of inappropriate language. Bailey and Aaron did not exhibit changes in their spontaneous commenting. Bailey’s decrease in inappropriate language extended to the first generalization session but not the second. Aaron had a slight increase in his inappropriate language during the first generalization session but not the second (See Figure 2).

FIGURE 2, NEXT PAGE


18

Overall, the children showed more spontaneous commenting and less inappropriate language in treatment sessions than during either baseline or generalization play sessions (See Figure 3). They used slightly more spontaneous commenting during generalization play sessions than in baseline play sessions. In addition, less inappropriate language was also observed in generalization compared to baseline play sessions. The children with autism also used more words per sentence during treatment (M=2.14, SE=.61) than baseline (M=1.41, SE=.73) or generalization sessions (M=1.83, SE=.81).


19

0

20

40

60

80

100

SpontaneousCommenting

InappropriateLanguage

Looking toAdult

PositiveAffect

InappropriateBehaviors

Behaviors

Per

cen

t o

f In

terv

als

Ob

serv

ed Baseline

Treatment

Generalization

Figure 3: Average use of language, social, and inappropriate behaviors for children during baseline, treatment, and generalization in Study 2. Error bars represent standard error.

Social Behaviors

During baseline, Bailey, Cameron, and Damon had low rates of looking to the adult (i.e. parent or caregiver), with Aaron exhibiting a slightly higher rate. Bailey also exhibited low rates of positive affect, while the other boys exhibited moderate rates.

During treatment, Bailey, Cameron, and Damon’s rates of looking to the adult increased. Aaron

exhibited a higher rate by the final treatment session. Bailey showed much more positive affect toward the adult while using the computer than during baseline (See Figure 4, below). Although Aaron exhibited a slight decrease in positive affect at the beginning of treatment, by the last treatment session he exhibited more positive affect than during baseline. Only a slight increase in positive affect in the treatment sessions was observed for Damon, and this increase continued a rising trend during baseline. No changes in positive affect were observed for Cameron during the treatment sessions. During the generalization sessions, none of the children maintained their positive changes in looking to the adult and only Bailey maintained a modest increase in his positive affect.

Overall, more looking and positive affect toward the adult were observed in children with autism,

while on the computer than during play sessions (See Figure 3). No real differences between baseline and generalization play sessions were observed for these behaviors. Inappropriate Behavior

During baseline, Bailey, Cameron, and Damon all exhibited high rates of inappropriate behavior. With treatment, these children all showed a decrease in their inappropriate behavior. These changes were not maintained during generalization sessions for Bailey, but Cameron and Damon showed much less inappropriate behavior in generalization sessions than in baseline (See Figure 5). Surprisingly, Aaron exhibited a small increase in inappropriate behavior during the first generalization session, but it returned to baseline levels by the final generalization session. Overall, the children exhibited fewer inappropriate behaviors after treatment was implemented than during baseline (See Figure 3).


20


21

Discussion


22

This study demonstrated that children with autism and other developmental disorders were able to

learn receptive language, social, and cognitive skills via CAI using the TeachTown software program. These data are consistent with previous studies indicating that CAI is effective for teaching receptive language skills (Moore & Calvert, 2000) and extends this research by demonstrating that CAI can be used to target additional social and cognitive skills in preschool-aged children with developmental disorders. Because the pre- and post-tests in the TeachTown program used different stimuli than the training lessons, our findings suggest that the children indeed learned generalized concepts, an issue that previous research has not adequately addressed. Given that there was no difference in performance between the children with autism and children with developmental delay in this study, CAI may be appropriate for children with developmental disabilities more broadly.

Parents, special education teachers, and clinicians who work with children with developmental

disorders rated the program highly overall. They indicated that the TeachTown program identifies appropriate teaching goals for young children with developmental disorders and provides an effective way to teach these skills. In addition, parents and teachers reported strong interest in purchasing and using this program with their children with disabilities. These findings suggest that computer-assisted instruction using TeachTown software is perceived as an appropriate method of instruction by relevant consumers and is likely to be easily disseminated.

The concern that the use of computers may inhibit spontaneous language and social interaction in

children with autism was not supported by this research. In fact, the children increased their use of spontaneous commenting, looks to the parent, and positive affect while on the computer and decreased their inappropriate language and behavior compared to baseline play sessions. This pattern of increased expressive language and social skills during CAI compared to play differs from typically developing preschoolers, who have been found to use similar levels of expressive language during computer activities as during other learning centers in a preschool environment (Kelly & Schorger, 2001). This finding may suggest that the skills targeted by the TeachTown software facilitate more language and social interaction than computer games designed for typically developing preschool-aged children. Alternatively, it may suggest that children with autism, unlike typically developing children, are more motivated during computer activities than play, thus making CAI a particularly effective strategy for teaching social communication. More research is needed on the collateral effects of using computers for this population including not only comparing computer time to play time as was done in this study, but comparing children with autism to typically developing children and children with other special needs and comparing software-implemented intervention to other teaching approaches (e.g. table top DTT).

The concern that children with autism would not generalize skills to non-computer-based

activities was also not supported. In the generalization play sessions, half of the children increased their spontaneous commenting and decreased their inappropriate language and behavior. Social skills did not generalize to play settings with the parent, however. This finding is not surprising given the extreme social deficits seen in this population and the fact that no parent training was provided to help parents elicit social skills from their children. It is anticipated that providing parents with some type of social skill training in addition to the TeachTown software would result in improved social interactions between the parent and child. Future research is needed to address this issue.

While these findings are encouraging, it is unclear what role the CAI played in these

improvements. One possibility is that the children used the skills they learned during CAI in the generalization sessions with the parents. If so, it would indicate that CAI can lead to changes in skills outside of the computer environment and that receptive language generalized to expressive use. This finding would be especially exciting given that research on the generalization from receptive learning to expressive language in teacher-implemented discrete trial training is encouraging, with many children


23

generalizing from receptive to expressive language (Wynn & Smith, 2003). However, since the use of specific language targets taught via CAI was not measured, it is premature to draw this conclusion. Future research examining this possibility will be particularly important when using computers for treatment as skills learned on the computer tend to be mostly receptive.

A second possibility is that the computer program may have increased pivotal skills such as

motivation and attention, which lead to improvements in language and other behaviors outside of the computer task. Motivation and attention to multiple cues are thought to affect a wide variety of other skills or behaviors and are a key element of naturalistic ABA programs such as Pivotal Response Training (Koegel & Koegel, 2006). The TeachTown program emphasizes multiple cues throughout the software program and increased motivation was observed while using the program for all participants. Several other studies examining CAI for children with autism have also reported increased motivation and attention during computer tasks (Chen & Bernard-Opitz, 1993). More research is needed to determine whether or not the use of CAI teaches pivotal skills which lead to wide-ranging improvements in skills not necessarily targeted by the software.

A third possibility is that the changes in the children’s behavior during generalization sessions

were due to the parents’ use of the supplementary activities rather than the CAI per se. Although this possibility would limit the interpretation of the generalization findings, it would suggest that the supplementary activities are an important and effective component of the intervention. Future research should examine the role of supplementary, play-based activities in combination with CAI on child outcome. It is also important to look at which treatment programs may work best with the TeachTown program including ABA, education, communication, and developmental treatment models.

Although this research has important implications for the research and treatment of children with autism and other developmental disorders, there were several limitations. First, although this study showed efficacy of the software for 8 children, only a small portion of the curriculum was assessed, limited time in the treatment program was provided, and only a small number of children participated. Future research should look at the efficacy of this program for a longer period of time, for more hours each week, and with more children using a clinical trial group design. Second, although some social-communication and behavior generalized from computer to play situations, it is not clear how much the content learned in the software generalized to the natural environment. It is also not clear how much receptive skills generalized to expressive skills. Research is currently underway looking at some of these issues. Third, it is unclear whether or not the software, the supplementary activities, or the combination of both was responsible for the positive changes observed. Studies comparing the 3 possible conditions would help to unravel which aspects of the program are most effective. Finally, this research did not look at a diverse group of children and so it not clear what prerequisites are necessary for using the TeachTown program. Age of the child, developmental level, diagnosis, behaviors, etc. may all contribute to the ability to use this program. Research is needed which looks at the child characteristics that may predict which types of children may be best suited for the TeachTown program.

In sum, computer-assisted instruction for children with developmental disorders looks to be a promising and effective option, especially for ABA treatment. TeachTown is the first program to provide a comprehensive ABA program using software and play-based (i.e. generalization) activities. The program was designed with the intent to increase the accessibility of treatment to parents, schools, and clinics and to reduce the cost associated with providing treatment. Future research will assess whether this and other CAI programs are able to successfully meet these goals. In addition, future studies are needed that will assess how this technology may be used for other age groups, other skills, other treatment approaches, and other populations. The use of computers has become so prevalent in homes, schools, clinics, and community settings and computers are able to offer so many possibilities, it is crucial that researchers continue to investigate the benefits and limitations of this promising treatment.


24

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders-text revision (4th ed.). Washington, D.C.: Author.

Bernard-Opitz, V., Ross, K., & Tuttas, M. L., (1990). Computer assisted instruction for children with

autism. Annals of the Academy of Medicine, 19, 611-616. Bernard-Opitz, V., Sriram, N. & Nakhoda-Sapuan, S. (2001). Enhancing social problem solving in

children with autism and normal children with computer-assisted instruction. Journal of Autism and Developmental Disorder, 31, 377-384.

Bosseler, A. & Massaro, D. W., (2003). Development and evaluation of a computer-animated tutor for

vocabulary and language learning in children with autism. Journal of Autism and Developmental Disorders, 33, 653-672.

Chen, S.H. & Bernard-Opitz, V. (1993). Comparison of personal and computer-assisted instruction for

children with autism. Mental Retardation, 31(6), 368-376. Coleman-Martin, M., Wolff Hellar, K., Cihak, D. F., & Irvine, K. L. (2005). Using computer-assisted

instruction and the non-verbal word learning approach to teach word identification. Focus on Autism and Other Developmental Disabilities, 20, 80-90.

Fenson, L., Dale, P.S., Reznick, J.S., Thal, D., Bates, E., Hartung, J.P., Pethick, S., & Reilly J.S. (1993).

MacArthur Communicative Development Inventories. San Diego, CA: Singular Publishing Group, Inc.

Kazdin, A.E. (1973). Methodological and assessment considerations in evaluating reinforcement

programs in applied settings. Journal of Applied Behavior Analysis, 6, 517-531. Kelly, K.L. & Schorger, J.R. (2001). “Let’s play ‘puters”: Expressive language use at the computer

center. Information Technology in Childhood Education Annual, 125-138. Koegel, R.L. & Koegel, L.K. (2006). Pivotal Response Treatments for Autism: Communication, Social,

and Academic Development. Baltimore, Maryland: Paul H. Brookes Publishing Co. Kinney, E. M., Vidora, J., & Stromer, R. (2003). Computer presented video models to teach generative

spelling to a child with an autism spectrum disorder. Journal of Positive Behavior Interventions, 5, 22-29.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young

autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9. McGee, G., Morrier, M., & Daly, T. (1999). An incidental teaching approach to early intervention for

toddlers with autism. The Journal of the Association for Persons with Severe Handicaps, 24(3), 133-146.

Moore, M. & Calvert, S. (2000). Brief report: Vocabulary acquisition for children with autism: Teacher

or computer instruction. Journal of Autism and Developmental Disorders, 30, 359-362.


25

National Research Council (2001). Educating children with autism. Committee on Educational interventions for children with autism. Division of Behavioral and Social Sciences and Education. D.C. National Academy Press.

Schopler, E.R., Reichler, R.F., DeVellis, & Daly, K. (1980). Toward object classifciation of childhood

autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10, 91-103.

Sherer, M., Pierce, K., Parades, S., Kisacky, K., Ingersoll, B., & Schreibman, L. (2001). Enhancing

conversation skills in children with autism via video technology: Which is better, "self" or "other" as a model?. Behavior Modification, 25, 140-158.

Schreibman, L. & Ingersoll, B. (2005). Behavioral interventions to promote learning in individuals with

autism. In F. Volkmar, A., Klin, R. Paul, & D. Cohen (Eds.), Handbook of Autism and Pervasive Developmental Disorders, Volume 2, Assessment, Interventions, and Policy (pp. 882-896). New York, NY: Wiley.

Schreibman, L., Whalen, C., and Stahmer, A. (2000). The use of video priming to reduce disruptive

behavior in children with autism. Journal of Positive Behavioral Interventions, 2 (1), 3-11. Simpson, A., Langone, J., & Ayers, K. M. (2004). Embedded video and computer based instruction to

improve social skills for students with autism. Education and Training for Children with Developmental Disabilities, 39, 240-252.

Smith, T. (1993). Autism. In T.R. Giles (Ed.), Effective Psychotherapies (pp. 107-133). New York:

Plenum. Williams, C., Wright, B., Callaghan, G., Coughlan, B. (2002). Do children with autism learn to read

more readily by computer assisted instruction or traditional book methods?: A pilot study. Autism, 6, 71-91.

Wynn, J.W. & Smith, T. (2003). Generalization between receptive and expressive language in young

children with autism. Behavioral Interventions, 18(4), 245-266.

Author’s Note

This research was supported in part by a Department of Education SBIR grant number R305S040161. TeachTown would like to thank Richard Fade and Western Research Foundation for their professional and financial support. We would also like to thank Amy McCormick for her assistance in this research and the parents, teachers, clinicians, and children who participated in this study. Author Contact Information: Address correspondence to: Christina Whalen, Ph.D., BCBA


26

TeachTown 2815 Eastlake Avenue E., Suite 300 Seattle, WA 98102 (206) 336-5585 [email protected] Lars Liden, PhD TeachTown 2815 Eastlake Avenue E., Suite 300 Seattle, WA 98102 (206) 336-5585 [email protected] Brooke Ingersoll, Ph.D., BCBA Department of Psychology Lewis & Clark College 0615 SW Palatine Hill Rd. Portland, OR 97219 Phone: 503-768-7647 [email protected] Eric Dallaire TeachTown 2815 Eastlake Avenue E., Suite 300 Seattle, WA 98102 (206) 336-5585 [email protected] Sven Liden TeachTown 2815 Eastlake Avenue E., Suite 300 Seattle, WA 98102 (206) 336-5585 [email protected]


27

Equivalence Relations, The Assessment of Basic Learning Abilities and Language: A Synthesis of Behavioral Research and its Implications

for Children With Autism

Marianne Jackson, W. Larry Williams, and Jeremy Biesbrouck University of Nevada, Reno

Abstract Assessment and intervention in Autism and related disorders has become a major application

area for the field of Behavior Analysis. However, basic behavioral research and research in other applied areas have recently provided new insights into the nature of language and other complex human behavior that although directly relevant to autism may not be widely known due to the volume of currently available literatures. This paper provides a review and synthesis of recent research on conditional discrimination processes and relational responding in humans, research on a possible hierarchy of discriminations as described by the literature on the Assessment of Basic Learning Abilities (ABLA), and the implications of this research for language acquisition in person with autism and related disabilities. Keywords: Conditional discrimination, Equivalence, Relational Frame Theory, Language, Autism.

A common challenge in most clinical and research endeavors is the problem of gaining an awareness and synthesis of the available literature. The recent past and current applications of Behavior Analysis in the area of Autism Spectrum Disorder have gained significant attention from clinicians and researchers alike. Typically however, most publications and professional presentations are limited to specific assessments, analyses or interventions that contribute or advance specific clinical or research knowledge. The purpose of the present article is to provide the reader with an overview of relevant developments in three areas of research and clinical activity that have relevance to behavioral analytical progress in the area of Autism.

These areas, are equivalent relations, conditional discrimination processes from the

perspective of the literature concerning the Assessment of Basic Learning Abilities (ABLA), and assessment and intervention for language acquisition in persons with Autism and related syndromes. It is hoped that this review will stimulate clinical and research discussion and activity that may not have been otherwise undertaken without an awareness of the three chosen knowledge areas.

Sidman (1971) described the phenomenon of Stimulus Equivalence. Since then he and many other investigators have researched a variety of characteristics of this phenomenon. One of the most widely debated topics in the Stimulus Equivalence literature involves the nature of the relations that form and the involvement or necessity of language (Horne & Lowe, 1996; Sidman, 1994, 2000). In general, studies show that verbally able subjects successfully demonstrate equivalence relations, whereas subjects who lack basic language abilities have typically not shown such emergent relations (e.g. Devany, Hayes & Nelson, 1986). These findings have led some researchers to conclude that language is necessary for the formation of such equivalence classes. Some theorize that language is a mediating variable in a process in which an equivalence relation is the outcome (e.g. Horne & Lowe, 1996). Others state that the formation of equivalence relations requires no such mediation and that the formation of these classes plays a role in the development of language (Sidman, 1994), (see Fields & Nevin, 1993; Hayes, 1989;

28

Horne & Lowe, 1996, 1997; and Sidman 1994 for reviews of this literature from differing viewpoints). Sidman (1994), suggested that “Such subjects [who cannot name stimuli] may well be limited in more ways than just their inability to name stimuli; they may also suffer other deficits that are incompatible with equivalence relations.” p.306.

The Assessment of Basic Learning Abilities (ABLA) (Martin, Yu & Vause, 2004) may point to some of those deficits. The ABLA purports to measure, among other things, the ability of individuals to make conditional discriminations and the relative ease with which they can learn new discriminations. The use of conditional discrimination abilities and procedures is fundamental to the equivalence literature, (e.g. Sidman & Tailby, 1982), and so these discrimination abilities, as measured by the ABLA, may be of some relevance to the discussion of stimulus equivalence.

Research on the ABLA

The Assessment of Basic Learning Abilities (ABLA) was developed by Kerr, Meyerson and Flora in 1977, and was originally called the Auditory Visual Combined Discrimination Test (AVC). It is intended to provide a short test to determine the ease or difficulty with which individuals with severe developmental disabilities can perform one simple imitative and five two choice discrimination tasks. This test also provides information that allows some inferences to be drawn regarding individuals’ previous histories with such tasks. These inferences can be drawn on the basis that the tests are short, providing few learning opportunities, and some research showing that failed levels are very difficult for individuals to learn and require a large number of trials (e.g., Meyerson, 1977).

ABLA Procedures and Materials: The materials used in the ABLA are a large yellow can, approximately 15 cm in diameter and 17 cm in height, a large red box of approximately 14 cm X 14 cm X 10 cm, a small yellow cylinder of approximately 4 cm in diameter 7 cm in height, a small red box with approximate dimensions of 5 cm X 5 cm X 5 cm and a small grey piece of foam of approximately 5 cm in diameter. Level 1 requires that the individual respond to the tester by placing a small piece of foam into either of two containers presented on any trial after the tester has modeled this same response. Level 2 requires that the individual place a small piece of foam into a stationary yellow can, with a red box also present on the table as a distracter. This level tests the ability of the individual to learn a positional discrimination. Level 3 is the same as level 2 except that the position of the yellow can and red box are randomly altered on each trial and this tests the ability of the individual to make a simple discrimination. Level 4 requires that the individual place a red cube into the red box or a yellow cylinder into the yellow can and positions of the yellow can and red box alternate randomly. This assesses the individual’s ability to make a visual conditional discrimination and may be described as a quasi-identity-match-to-sample task. Level 5 requires that the individual place a piece of foam into either the stationary yellow can or red box following a vocal request from the tester, while the red box and yellow can remain in the same position for each trial. This assesses the individual’s ability to learn a simple auditory visual discrimination. Level 6 is the same as level 5 except that the positions of the yellow can and red box are randomly alternated over trials. This assesses the individual’s ability to make an auditory-visual conditional discrimination and is an example of an arbitrary match-to-sample task. Each level begins with a demonstration trial, a guided trial and a practice trial, and reinforcement is provided for every independent correct response. The passing criterion for each level is eight consecutive independent correct responses and the failing criterion is eight cumulative errors on a given level.

29

Hierarchical nature of abilities: A large number of research projects arose out of Kerr, Meyerson, and Flora (1977) that began to investigate the nature of these learning abilities and the practical implications of them (see Martin and Yu, 2000 for a review). One of the earliest findings of ABLA research was that the test levels were hierarchically ordered in difficulty. Kerr et al (1977) found that for 111 of the 117 individuals who participated in their study, passing a level of discrimination ability passed lower levels, and those failing at a level did not pass any higher levels. This finding has since been replicated by other studies such as Martin, Yu, Quinn and Patterson (1983), as well as others (see Martin and Yu, 2000 for a review of this evidence). Furthermore, this hierarchical ordering of levels was found to hold for normally developing children (Casey & Kerr, 1977). Failed levels are difficult to teach: Another finding from Kerr et al (1977) was that failed levels are very difficult to teach. In this study, 97% of participants passed or failed a level within 30 trials or less. Further studies show that a failed level is difficult to teach using standard prompting and reinforcement procedures (i.e. a demonstration of the correct response after each error, and praise plus edibles for independent correct responses)( Witt & Wacker, 1981). Moreover, if successful teaching of failed levels occurs at all, it may require several hundreds of training trials (Meyerson, 1977; Yu and Martin 1986). ABLA is predictive of task performance: The learning and discrimination ability of a particular individual, as measured by the ABLA, is found to be highly predictive of success on educational, prevocational and vocational tasks (Stubbings & Martin, 1995, 1998; Tharinger, Schallert, & Kerr, 1977; Wacker, Kerr, & Carroll, 1983; Wacker, Steil, & Greenbaum, 1983). Furthermore, performance on the ABLA was found to be a more accurate predictor of success on a variety of training tasks than experienced staff with direct knowledge of that individual. Specifically, Stubbings and Martin (1998) compared ABLA predictions to those of two groups of teachers. One group were experienced teachers who had worked with the individual for more than eight months and the second group were experienced teachers who did not have a history with the individual but interacted with them before making a prediction. ABLA predictions about client performance on twelve tasks were more accurate than those of both experienced staff with a limited exposure to that individual, and those of experienced staff with extensive personal knowledge of those individuals. ABLA and language ability: Many studies have investigated the relationship between ABLA level and language ability (e.g. Barker-Collo, Jamieson, and Boo, 1995; Casey and Kerr, 1977; Vause, Martin, and Yu, 1998b; Ward, 1995; Ward and Yu, 2000). For example, Ward (1995) found that expressive communication skills were highly correlated with ABLA performance, with single words or signs occurring only in children who had achieved ABLA level 4, and expressive communication involving two or more words combined occurring only in children who had achieved ABLA levels 5 and 6. Furthermore, individuals with no formal communication ability only achieved ABLA level 2 or below.

More recently, Richards, Williams, and Follette (2002) reported significant positive correlations between the ABLA test and Vineland communication, daily living, and social skills subdomains (Sparrow, Balla, & Ceccetti, 1984). Moreover, they found that the Vineland and the Wechesler Adult Intelligence Scale -revised (WAIS-R) failed to differentiate individuals below ABLA Level 6 in that participants who scored below ABLA Level 6 were untestable on the WAIS-R and showed low age equivalent scores with limited range on the Vineland.

Marion et al (2003) investigated the relationship between individual’s ABLA

performance, performance on two auditory matching tests, and a test of echoics, mands and tacts

30

(Skinner, 1957) in persons with developmental disabilities. They found that ABLA performance was a better predictor of performance on these verbal operant assessments than level of functioning based on diagnosis. Furthermore, their results suggested that ABLA level 6 may be a prerequisite or bridging task for teaching such verbal operants.

VVNM as an addition to the ABLA: Many everyday tasks require the ability to match physically dissimilar stimuli and, as this is not assessed by the ABLA, Sakko, Martin, Vause, Martin and Yu (2004) investigated the relation between ABLA score and a visual-visual nonidentity matching task (VVNM). Their results suggest that this ability would fit into the hierarchy of ABLA abilities above level 4 (a visual-visual quasi-identity match-to-sample) but below level 6 (auditory-visual discrimination). They suggest that this may be a useful addition to the existing ABLA. ABLA performance and stimulus equivalence: One critical feature of the ABLA is that it differentiates individuals who are capable of making positional, simple and conditional visual discriminations. It also differentiates those individuals who are able to make auditory and auditory visual discriminations and those who are only currently attending to or able to discriminate visual stimuli in the environment. The widespread use of conditional discriminations in testing an individual’s ability to form equivalence relations (e.g. Sidman & Tailby, 1982; Sidman 1994) suggests that the ABLA test may have some utility as a predictor of individuals who will or will not form equivalence classes. Furthermore, the research showing that ABLA ability is predictive of language ability may lead to some further understanding of the relation between the ABLA, language ability and the formation of equivalence classes. Research on Equivalence Relations In 1971, Sidman demonstrated that match-to-sample procedures could be used to teach an individual with developmental disabilities to read and comprehend printed words. Although the individual was able to select the correct picture upon hearing the spoken word and could name the pictures before any training, he could not match the printed words to pictures or select the printed word upon hearing them spoken. During the study the individual was taught to select the corresponding printed word upon hearing the spoken word. He was then, without being directly taught, able to select the correct printed word on presentation of the corresponding picture and vice versa. Furthermore he named most of the printed words. This research demonstrated that individuals with developmental disabilities did not need to be taught every learned relation directly. In addition it showed potential, not only in teaching procedures that saved time and effort, but to explain this and other complex human behaviors. (Brady & McLean, 2000) A definition of equivalence:

The phenomenon of stimulus equivalence was distinguished from the unidirectional conditional discriminations that could serve as prerequisites for emergent relations, and was further defined and formalized by Sidman & Tailby (1982). During this study children were presented with four arbitrary matching tasks and were taught to match four sets of stimuli (A,B,C, & D) in a systematic sequence. The set of stimuli refer to stimuli that serve common experimenter-defined functions (i.e. samples or comparisons) and the class of stimuli (A1,B1,C1,D1) refers to the stimulus control relations demonstrated by the subject as a consequence of training (Lazar, Davis-Lang & Sanchez, 1984).

Sidman and Tailby (1982) defined equivalence in terms of the mathematical conceptualization of equivalence, which is a relation possessing the properties of reflexivity,

31

symmetry and transitivity. Reflexivity can be described as the ability to match a new stimulus to itself without differential reinforcement or other instructions. If R is some relation between stimuli, reflexivity would be represented as aRa. The demonstration of reflexivity is identity matching. Symmetry can be demonstrated by functional sample-comparison reversibility and proof of aRb symmetry would be the demonstration of bRa. To determine whether R is transitive requires a third stimulus c. Once aRb and bRc have been established transitivity requires aRc to emerge without differential reinforcement. Symmetrical and transitive relations can be seen in Figure one.

Figure 1. Diagram of all trainer relations (solid lines) and emergent symmetrical and transitive relations (dashed lines). The publication of this early study by Sidman and Tailby (1982) led to a rapid growth in research on equivalence relations. One of the most frequently addressed topics is the relation between language and equivalence relations. O’Donnell and Saunders (2003) state that “Although it is generally agreed that there is a close relation between equivalence relations and language, there is some disagreement as to the nature of this relation.” (p.132). The apparent correlations between language ability and the ability to form equivalence relations, has led some researchers to draw causal inferences regarding this relation. This research falls into three general viewpoints. The naming hypothesis: Horne and Lowe (1996) assert that naming is essential for the formation of equivalence classes. They state that, “because naming is evoked by, and itself evokes classes of events, it brings about new or emergent behavior such as that reported in studies of stimulus equivalence”. (p.185) This position holds that the emergence of equivalence relations is mediated by naming. Evidence presented in support of this view are studies showing that individuals with minimal or no language skills, have shown poor performance on equivalence tasks. Devany, Hayes and Nelson (1986) showed that young children who could speak and older children with developmental disabilities formed equivalence classes, whereas children with developmental disabilities who could not speak failed to show such emergent relations. Eikeseth and Smith (1992) also showed that participants, who were initially unable to demonstrate equivalence relations, were able to do so after being taught to say names for each of the stimuli.

Proponents of this language mediated view also cite research with nonhuman subjects, and their failure to show equivalence classes, as evidence in support of their position. Unsuccessful attempts have been made with pigeons, monkeys, baboons, and other primates. (See Eikeseth and Smith, 1992, for citations) Although some successes have been shown with

Symmetry Symmetry

Transitivity

EquivalenceA C

B

Symmetry Symmetry

Transitivity

EquivalenceA C

B

32

monkeys (McIntire, Cleary & Thompson, 1987), pigeons (Vaughan, 1988) and sea lions (Schusterman & Kastak, 1993), the validity of these reports has been disputed.

In particular the results obtained by Schusterman and Kastak (1993) have been widely

disputed. Horne and Lowe (1996) have argued that species specific variables may have been responsible for positive outcomes on equivalence tests, and that the direct teaching of one type of symmetrical relation may have negated the emergent characteristic of the equivalence relations. In a discussion of such arguments, Sidman (1994, pp.174-175), suggests that experience of multiple exemplars of symmetrical relations, may reduce or eliminate the salience of stimulus location as a controlling aspect of the stimuli. Schusterman and Kastak (1993) cited previous experience with such exemplars as the critical factor in their subject’s success with equivalence tests and suggest that establishing successful generalized identity matching may have facilitated subsequent performance on equivalence tests. Kastak, Schusterman and Kastak (2001) attempted to answer many of these criticisms by demonstrating the ability of two California sea lions to classify stimuli into functional classes using a simple discrimination reversal procedure. Following the formation of functional classes in this context, they showed transfer of the relations that emerged between class members to a matching-to-sample procedure. Next they showed that the functional classes could be expanded through traditionally defined equivalence relations. In these three experiments, appropriate within-class responding produced class-specific food reinforcers. The authors state that these findings show that sea lions can form equivalence classes in simple and conditional discrimination procedures. The demonstrations of equivalence in Californian sea lions by Schusterman & Kastak are often considered to be the most convincing evidence yet for stimulus equivalence in nonhumans (Sidman, 1994, p.173).

Relational Frame Theory (RFT): Another view of equivalence test performance suggests that success on equivalence tests is explained by the subject’s prior learning history of arbitrary relations (Hayes, 1991, 1994; Hayes and Hayes, 1989). Proponents of this view suggest that the action of relating arbitrary stimuli in equivalence tasks may be due to an overarching class of instrumental behavior which Hayes terms “equivalencing” (1994, p.110). According to Relational Frame Theory (RFT), equivalence emerges because the three properties of mutual entailment, combinatory entailment, and transformation of function, are directly trained, and that any subject with a relevant history with respect to these properties will derive the frame of coordination and show equivalence classes. Hayes suggests that relating arbitrary stimuli in equivalence tasks may be an overarching class of instrumental behavior and that this “equivalencing” (1994, p.110), is only one type of many possible types of relations that can be formed. The work of Schusterman and Kastak (1993) may also be used to support this view of equivalence as the sea lions did not initially show strong evidence of symmetry. After directly training symmetrical relations, however, symmetry was shown with respect to novel stimuli. This supports the view of relational frame theorists who suggest that a history of reinforcement of bidirectional relations is necessary for the demonstration of symmetry. Sidman’s Theory of Equivalence: According to Sidman, equivalence is a direct outcome of reinforcement contingencies and requires no new concepts beyond the familiar analytic units (Sidman, 2000). He suggests that equivalence represents a primary behavioral function not reducible to any other (Sidman, 1994). Importantly, Sidman argues that when operant conditioning is applied involving an antecedent stimulus, a response, and reinforcement, two phenomena occur: (1) the strengthening of the response with stimulus control increasing for the antecedent stimulus, and (2) formation of a relationship (equivalence) between the three elements as stimuli. This feature is generally overshadowed in the published research because the reinforcers are usually the same in a given study for a given participant, and the response is also usually the same, and is a choice response involved in matching. The resultant outcome is that we

33

observe the relationship predominantly between antecedent stimuli and the response and reinforcer equivalences are obscured. Sidman (1994) also suggests that equivalence performances are a critical part of the foundation for language. Therefore, the demonstration of equivalence relations in subjects who cannot name the stimuli would be consistent with this view. However, failures of subjects to name stimuli or to show equivalence may also be seen as supportive of this view. Sidman (1994) states that “Showing that subjects who cannot name stimuli fail to develop equivalence relations might seem definitive. Such subjects, however, may well be limited in more ways than just their inability to name stimuli; they may also suffer other deficits that are incompatible with equivalence relations.” (p.306)

Clayton and Hayes (1999) argued that all of these theories are able to adapt to encompass most of the existing literature, so presenting evidence to the contrary of any of these theories is extremely difficult. Demonstrations of equivalence in animals may appear to be convincing evidence that equivalence is not language driven; however, some authors have suggested that equivalence formation in nonhumans may not involve the same processes as it does in humans (Horne and Lowe, 1996). Failures to demonstrate equivalence in nonhumans may appear to support the naming hypothesis however, some have argued that species specific variables may be involved in this failure and that methodological refinements are required for these such as more ethologically valid stimuli. (Sidman, 1994, p.163)

One population of individuals studied in an attempt to prove one view is more coherent than another, is prenaming children. As suggested by O’Donnell and Saunders (2003) this population is problematic due to the rapid developmental changes that they undergo. Another population that shows some promise in this is persons with developmental disabilities. Some individuals with developmental disabilities can reach adulthood with little or no verbal repertoire. This population seems to solve problems of developmental changes and species specific variables and so seem to be a relevant group of individuals to study. In Sidman’s original (1971) study the participants were diagnosed with moderate to severe developmental disabilities yet the literature on individuals with developmental disabilities has grown slowly relative to that on normally developed individuals (O’Donnell & Saunders, 2003). This seems surprising as the study of individuals with developmental disabilities, language limitations and other skills deficits has the potential to make important theoretical and practical contributions to this area. Some Research on individuals with limited language skills and developmental disabilities:

Behaviorally oriented researchers have begun to report on the application of Equivalence and Relational Frame Theory to phenomena traditionally discussed from a cognitive perspective. For example Barnes-Holmes, McHugh & Barnes-Holmes (2004) have recently provided an RFT account of perspective taking and theory of mind. Roche & Barnes-Holmes (2002) have provided an RFT account of the complex responding involved in human sexual behavior. With respect to children diagnosed with developmental disabilities Holth (2005) has provided an operant interpretation of joint attention. Barnes-Holmes, Barnes-Holmes, & McHugh (2004) have demonstrated the establishment of relational responding in young children. An important feature of these articles is their demonstration of operant or relational responding as an explanation using more basic discrimination processes to account for complex phenomena previously dominated by traditional cognitive explanations. A major intent of the present review is to support this approach by describing the current known relationships between conditional discrimination abilities as described by the ABLA research and relational responding while examining methods of language acquisition in persons with developmental disabilities.

34

Research on the relationship between language and stimulus equivalence has began to investigate the abilities of developmentally disabled individuals to form equivalence relations. Devany, Hayes, and Nelson (1986) found that language able children were able to form such relations, whereas language disabled children were not. Although this study has been widely criticized on methodological issues it made an early and important step toward investigate this correlation. More recently, Brady and McLean (2000) investigated the formation of equivalence classes in three groups of individuals; the first group of four individuals was typically developing preschool children, the second group was four adults with developmental disabilities who were able to speak, and the third group was adults with developmental disabilities who were not able to speak. They investigate these participants’ ability to form equivalence classes across objects, spoken words and lexigrams. Two preschool children and five adults, three who could speak and two who could not, demonstrated transitivity and symmetry. The other two preschool children and three adults did not reach passing criteria on transitivity and symmetry tests. Some discussion of factors that may have contributed to the failure of some individuals to form equivalence classes, are provided by the authors. They include the composition of the lexigrams possibly leading to faulty stimulus control, the order of testing phases, the possibility that repeated testing may have led to delayed emergence, and the possibility of inadvertent cueing due to the use of table top training methods conducted by the experimenter. Thus, although language ability may be relevant for equivalence class formation, other procedural variables may also be involved. Carr, Wilkinson, Blackman and McIlvane (2000) investigated the formation of four member equivalence classes in individuals with severe developmental disability and minimal verbal repertoires. In their first experiment, they showed that three individuals achieved positive outcomes on tests for equivalence class formation using visual and auditory stimuli. All individuals had some form of functional communication (2 used manual signs, one used a picture based system) and extensive histories of making conditional discrimination across both auditory and visual modalities. In their second experiment, two participants demonstrated minimal verbal repertoires and only one of these individuals showed emergent equivalence relations. The authors discuss some procedural differences between their study, that demonstrated some positive results in people with minimal verbal skills, and other studies that have not. They suggest that one important factor may be a carefully controlled method of teaching the baseline discriminations. They used computer presentations of stimuli, responding on a touch screen, and the automatic dispensing of tokens as conditioned reinforcers. The authors argue that this method may produce more accurate stimulus control shaping.

Carr and colleagues (2000) suggest that their study required that the participants already had the ability to make auditory-visual conditional discriminations upon entry to the study. This not only insured that they would be able to make the baseline discriminations but also attempted to somewhat equate the previous histories with such tasks. This ability is comparable to level 6 of the Assessment of Basic Learning Abilities (ABLA) and suggests that achievement of this level of ability in making discriminations is an important variable in the emergence of equivalence relations.

One further difference between this study and some others (e.g. Brady & McLean, 2000)

that is not discussed by the authors is the structure of the baseline training. Brady and McLean, for example, use a linear method of training baseline discriminations. This structure can be seen in figure two. The present study (Carr, Wilkinson, Blackman and McIlvane, 2000) uses a comparison-as-node training structure.

35

Figure 2. Diagram of three common training structures.

Research has shown that comparison-as-node training structure is more likely to produce positive outcomes on equivalence tests, with preschool children and developmentally disabled individuals, than either a linear structure or a sample -as-node structure. (See Saunders and Green, 1999, for a review of this literature) These training structures can be seen in figure two. The training structure used may have facilitated the development of such equivalence relations.

The effect of one of these variables was investigated further by Vause, Martin, Yu, Marion, and Sakko (2005). They examined the formation of equivalence relations in individuals with minimal verbal repertoires. They asked whether the individual’s ability to make visual and auditory-visual discriminations was predictive of their ability to form equivalence relations. This study is interesting as it provides not only standard measures of language, but also a measure of functional use of speech developed by these authors and others in a previous study (Marion et al., 2003). The ABLA was used to assess the ability of the participants to learn to imitate, make positional discriminations, make simple discriminations, make visual conditional discriminations, simple auditory-visual discriminations, and auditory-visual conditional discriminations. They also assessed the ability to perform an arbitrary matching task using the recently proposed addition to the ABLA, the Visual-Visual Nonidentity Match (VVNM) described by Sakko, Martin, Vause, Martin and Yu (2004).

Vause et al., (2005) found that the two participants who passed ABLA level 6 and the

VVNM task, were able to form some equivalence relations whereas the three participants who only passed up to level four and did not pass the VVNM task, and did not demonstrate any equivalence relations. These findings are somewhat tentative as the emergent relations said to be shown by two participants were extremely variable, with performance on symmetry tests ranging from 28% to 83%, and performance on transitivity tests ranging from 17% to 89%. Although these results were across sets of post tests, they did not all show a consistent increase and so cannot be explained as a typical case of delayed emergence (Sidman, 1994).

Furthermore, the three participants who did not show any emergence of equivalence

relations, failed to meet mastery criterion for baseline conditional discriminations. This is consistent with previous research showing that failed levels of discrimination in the ABLA are difficult to train and often require several hundreds or even thousands of trials to do so. These participants have already failed the VVNM task and have not passed a level higher than four on the ABLA, demonstrating that they are not able to pass an arbitrary matching task and some of them may not have been able to pass level four that represents a quasi-identity match. Kastak, Schusterman and Kastak (2001) suggested that the ability to complete a generalized identity matching task may facilitate the formation of equivalence classes. As reflexive relations were not pretested and levels of ABLA passed below four were not given, we do not have the necessary information to address the role that generalized identity matching, and the ability to make visual

Comparison-as-node

A C

B

Sample-as-node

A C

B

Linear

A C

B

Comparison-as-node

A C

B

Sample-as-node

A C

B

Linear

A C

B

36

conditional discriminations, may have served with these participants. A further issue with this study, discussed by the authors, is the complexity of the stimuli. The stimuli used in this study have many components and some of these may have been similar for participants leading to the development of faulty stimulus control. The use of table top training methods may also have contributed to any faulty stimulus control problems (see Carr, Wilkinson, Blackman and McIlvane, 2000, for a discussion of this problem). In addition, their assessment of verbal abilities only assesses the use of speech. The authors discuss how the assessment of functional language may be adapted to include the use of signs or a picture system of communication. A final limitation of this study is the use of a linear structured procedure for training baseline discriminations. Previous research has shown that linear methods may be the least effective method to use with children and individuals with developmental disabilities, with comparison-as-node training being the most appropriate methods for such individuals (Saunders and Green, 1999). This may have prevented, or made more difficult, the formation of equivalence relations in these individuals.

Autism and Language Development. Arguably the most successful application area for behavior analysis has been that of Autism. Indeed many people working and studying in the area of Autism only know Behavior Analysis because of its methods and techniques as applied with children diagnosed with Autism (Maurice , Greene, & Luce 1996). Pioneered by Ivar Lovaas and other early applied behavior analysts (Lovass, 1966, 1977). An explosion of clinical research over the last 20 years based on the early developed behavioral teaching methods such as discrete trials training and discrimination learning (E.G., Lovass, Koegel & Schriebman, 1979) etc alternative communication methods such as the Picture exchange communication System (PECS) Bondy & Frost 1994) and more recent development of ways to implement Skinner’s (1957) behavioral analysis of language (E.G. Sundberg, 2004a, 2004b; Sundberg & Partington, 1998) have been associated with an impressive ability to transform many children with little or no social interaction or language skills into seemingly normal children who go on to develop normally. However, little discussed in this current sea of information and differing positions as to the most effective methods is the pivotal skill of vocal imitation for subsequent language development. Early behavioral researchers were firs t involved in developing methods for teaching basic concepts (Becker, Engleman & Thomas, 1971) ; kindergarten classroom skills (Martin, England, Kaprowy, Kilgour and Pilek, 1968); generalized Imitation (Baer, Peterson & Sherman, 1967) just to mention a few. Rarely discussed but widely disseminated among behavioral clinicians and researchers was the general method for the eventual teaching of language that started with establishing a generalized imitative motor repertoire (e.g., “clap your hands”), and then incorporating simple vocalizations from the teacher into chains of imitated motor behaviors (e.g., “do this”-clap your hands, touch your nose, say “Ah”). By this method, children could be taught to imitate vocalizations which could be expanded to words, and phrases and eventually transformed and developed into receptive and expressive language. Indeed we are not ware of any other way to begin vocal language training in children than through this sequence of skills. An alternative description of the skills involved in imitating a sound are the ability to vocally expressively produce a sound similar to a model’s sound under control of, or as part of an auditory identity conditional discrimination. That is, vocal imitation represents a form of auditory identity matching analogous or the same as ABLA level 4 visual quasi-identity matching. However, as has been discussed, even simple auditory discriminations (e.g., ABLA level 5) have been consistently shown to follow visual simple and identical or quasi-identical conditional discriminations (e.g. ABLA levels 3 & 4). It follows therefore, that even the simplest conditional auditory discrimination (that involving a nearly simultaneous identity match) would be observed to fall somewhere above ABLA level 5 (a presumed simple auditory discrimination)

37

and perhaps above or below ABLA level 6 (a conditional auditory-visual discrimination). Recall that this prediction is consistent with the previously described research by Sakko, Martin, Vause, Martin and Yu (2004) concerning the relation between ABLA score and a visual-visual nonidentity matching task (VVNM) as well as the demonstration that identity and arbitrary auditory discriminations fall above ABLA level6 ( Barker –Collo, Martin and Boo 1995). In one of the few reported studies concerning the ABLA and children with Autism, Cummings & Williams (2000) reported data on five children with autism or pervasive developmental disorder as they were taught different skills in different sessions every day in a multi-element design fashion.. Among other session types conducted with the children, of interest was there performance on a table top matching to sample task involving three dimensional objects, the establishment of a PECS (Bondy, 1994) ability to exchange pictures for reinforcers, and vocal imitation. They observed an interesting order of acquisition of these skills in the five children. The children who eventually demonstrated vocal imitation only did so after demonstrating the ability to match pictures of object to actual objects (PECS) which in turn was observed to occur only after acquisition of 3 dimensional object matching. Children who did not show vocal imitation failed at PECS training and children with difficulty at PECS training had difficulty with or were not able to perform 3 dimensional object matching. The authors suggested that perhaps there is a hierarchical relationship among these skills. The Cummings & Williams findings have been partially replicated in a study by Silva & Williams (in preparation) which found similar outcomes in four children diagnosed with autism. Children who could not acquire 3 dimensional matching did not acquire 2 dimensional to 3 dimensional matching (PECS), and vocal imitation was only observed in one child who acquired the PECS discriminations after the 3 dimensional matching skills. These findings, together with the body of ABLA research to date, support a visual and auditory discrimination and conditional discrimination hierarchy that places vocal imitation as a skill requiring visual conditional discrimination ability (identity visual matching) and simple auditory discrimination ( ABLA level 5). Whether discrimination ability that is not present at any given level, can be established through training of lower level discriminations is yet not known but appears to be the case for some subjects (e.g., Cummings & Williams, 2000; Silva & Williams, in preparation; Ward & Yu, 2000). Conclusions. The research on equivalence supports a position that cross modal (visual-auditory) equivalent relations can be established in humans and now even in some non-humans. Virtually all of the studies involving demonstrations of equivalence in person with developmental disabilities reveal in their descriptions of subjects, that those subjects appear to have “minimal language skills” or at least receptive language skills. However, such skills are indicative of ABLA level 6 or higher. The ABLA research literature supports a position that persons with ABLA skills at or below level 4 will not be able to demonstrate auditory or auditory-visual discriminations. It may therefore be that equivalence has not to do with language ability but rather the ability to make conditional discriminations, either within or across sensory modalities. If this were the case, we should find that persons who can make visual conditional discriminations only, might show equivalence relations within the visual modality but not across visual and auditory modalities. Similarly, persons would need to be able to make visual-auditory conditional discriminations in order to be able to make auditory-auditory discriminations and conditional discriminations such as those involved in vocal imitation. These questions and the relationship of other sensory discrimination processes (e.g., tactile, olfactory) to the demonstrated visual-auditory hierarchy and the formation of equivalence relations within and across these modalities is yet to be demonstrated and is the focus of our current work.

38

References

Baer, D. M., Peterson, R.F., & Sherman, J.A. (1967). The development of imitation by reinforcing behavioral similarity to a model. Journal of the Experimental Analysis of Behavior, 10, 405-416. Barker-Collo, S., Jamieson, J., & Boo, F. (1995). Assessment of Basic Learning Abilities

Test: Prediction of communication ability in persons with developmental disabilities. International Journal of Practical Approaches to Disability, 19, 23-28.

Barnes-Holmes, Y., Barnes-Holmes, D., & McHugh, L. (2004). Teaching Derived Relational Responding to Young Children. Journal of Early and Intensive Behavioral Intervention 1, 1, 3-12. Barnes-Holmes, Y., McHugh, L., & Barnes-Holmes, D. (2004). Perspective Taking and Theory of Mind: A Relational Frame Account. The Behavior Analyst Today, 5, 1, 15-25. Becker, W. C., Engleman, S.E., and Thomas, D.R. (1971) Teaching: A course in applied Psychology. Chicago, Science Research Associates. Bondy, A. S., & Frost, L. S. (1994). The Picture Exchange Communication System. Focus on

autistic behavior, 9 ,3, 1 – 19. Brady, N.C., & McLean, L.K.S. (2000). Emergent symbolic relations in speakers and nonspeakers. Research in Developmental Disabilities, 21, 197-214. Carr, D., Wilkinson, K.M., Blackman, D., & McIlvane, W.J., (2000). Equivalence

classes in individuals with minimal verbal repertoires. Journal of the Experimental Analysis of Behavior, 74, 101-114.

Casey, L., & Kerr, N. (1977). Auditory-visual discrimination and language prediction. Rehabilitation Psychology, 24 (Monograph Issue), 137-155. Clayton, M. C., & Hayes, L. J. (1999). Conceptual differences in the analysis of stimulus

equivalence. The Psychological Record, 49, 145–161. Cummings, A. R. & Williams, L. W. (2000). Visual identity matching and vocal imitation

training with children with autism: A surprising find. Journal of Developmental Disabilities, 7, 2, 109 - 122.

Devany, J. M., Hayes, S. C., & Nelson, R. O. (1986). Equivalence class formation in

language-able and language-disabled children. Journal of the Experimental Analysis of Behavior, 46, 243–257.

Eikeseth, S. & Smith, T. (1992). The development of functional and equivalence classes

in high-functioning autistic children: The role of naming. Journal of the Experimental Analysis of Behavior, 58, 123-133.

Fields, L., & Nevin, J. A. (1993). Stimulus equivalence [special issue]. The Psychological Record, 43.

39

Hayes, S.C. (1994). Relational frame theory: A functional approach to verbal events. In S.C. Hayes & L.J. Hayes, Behavior Analysis of Language and Cognition. (pp.9-30) Reno, NV, US: Context Press.

Hayes, S. C. (1991). A relational control theory of stimulus equivalence. In L. J. Hayes &

P. N. Chase (Eds.), Dialogues on verbal behavior (pp. 19–40). Reno, NV: Context Press. Hayes, S. C. (1989). Nonhumans have not yet shown stimulus equivalence. Journal of the

Experimental Analysis of Behavior, 51, 385–392. Hayes, S.C., & Hayes, L. J. (1989). The verbal action of the listener as a basis for rule

governance. In Hayes, S.C. Rule-governed behavior: Cognition, contingencies, and instructional control. (pp.153-190) New York, NY: Plenum Press.

Holth, P. (2005). An Operant Analysis of Joint attention Skills. Journal of Early and Intensive Behavioral Intervention, 2, 3, 160-175. Horne, P. J., & Lowe, C. F. (1997). Toward a theory of verbal behavior. Journal of the Experimental Analysis of Behavior, 68, 271–296. Horne, P. J., & Lowe, C. F. (1996). On the origins of naming and other symbolic behavior. Journal of the Experimental Analysis of Behavior, 65, 185–241. Kastak, R.C., Schusterman, R.J., & Kastak, D. (2001). Equivalence classification by

California sea lions using class-specific reinforcers. Journal of the Experimental Analysis of Behavior, 76, 131-158.

Kerr, N., Meyerson, L., & Flora, J. A. (1977). The measurement of motor, visual, and

auditory discrimination skills. Rehabilitation Psychology, 24 (Monograph issue), 95-112. Lazar, R. M., Davis-Lang, D., & Sanchez, L. (1984). The formation of visual equivalence

classes in children. Journal of the Experimental Analysis of Behavior, 41, 251-266. Lovaas, O.I. (1966). A program for the establishment of speech in psychotic children. In J.K. Wing (Ed.), Early Childhood Autism(pp.115-144). Elmsford, NY: Pergamon. Lovaas, O.I. (1977). The autistic child: Language development through behavior modification. New York: Irvington. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in

young autistic children. Journal of Consulting and Clinical Psychology , 55(1), 3-9. Lovaas, O. I, Koegel, R. L., & Schreibman L. (1979). Stimulus Overselectivity in Children With Autism: A Review of the Literature. Psychological Bulletin, 86, 6, 1236-1254. Marion, C., Vause, T., Harapiak, S., Martin, G. L., Yu, C.T., Sakko, G., & Walters, K.

(2003). The hierarchical relationship between several visual and auditory discriminations and three verbal operants among individuals with developmental disabilities. The Analysis of Verbal Behavior,19, 91-105.

40

Martin, G. L., England, G., Kaprowy, E., Kilgour, K., & Pilek, V. (1968). Operant conditioning of kindergarten class behavior in autistic children. Behavior Research & Therapy, 6, 281-294. Martin, G.L., & Yu, D. C. T. (2000) Overview of research on the Assessment of Basic

Learning Abilities Test. Journal on Developmental Disabilities. Special Issue: Recent research on the Assessment of Basic Learning Abilities Test., 7(2), 10-36.

Martin, G. L., Yu, D., Quinn, G., & Patterson, S. (1983). Measurement and training of

AVC discrimination skills: Independent confirmation and extension. Rehabilitation Psychology, 28, 231-237.

Martin, G. L., Yu, C.T., & Vause, P, (2004) Assessment of Basic Learning Abilities Test: Recent Research and Future Directions. In W. L. Williams (Ed.) Developmental Disabilities: Etiology, assessment, Intervention and Integration. Reno, NV. Context Press. Maurice, C., Greene, G., & Luce. S. (1996). Behavioral Interventions for young children with Autism: A manual for parents and professionals. Austin Tx., Pro-ed. McIntire, K.D., Cleary, J.P., & Thompson, T., (1987). Conditional relations by monkeys:

Reflexivity, symmetry and transitivity. Journal of the Experimental Analysis of Behavior, 47, 279-285.

Meyerson, L. (1977). AVC behavior and attempts to modify it. Rehabilitation

Psychology, 24 (Monograph Issue), 119-122. O’Donnell, J., & Saunders, K.J. (2003). Equivalence relations in individuals with

language limitations and mental retardation. Journal of the Experimental Analysis of Behavior, 80, 131-157.

Richards, D. F., Williams, W. L., & Follette, W. C. (2002). Two new empirically derived

reasons to use the Assessment of Basic Learning Abilities. American Journal on Mental Retardation, 107, 329-339.

Roche, B. & Barnes-Holmes, D. (2002). Human sexual Arousal: A Modern Behavioral Approach. The Behavior analyst Today, 3, 2, 145-154. Sakko, G., Martin, T. L., Vause, T., Martin, G. L., & Yu, C. T. (2004). A visual-visual

nonidentity matching assessment is a worthwhile addition to the Assessment of Basic Learning Abilities test. American Journal on Mental Retardation, 109, 45-52.

Saunders, R. R., & Green, G. (1999). A discrimination analysis of training-structure

effects on stimulus equivalence outcomes. Journal of the Experimental Analysis of Behavior, 72, 117–137.

Schusterman, R. J., & Kastak, D. (1993). A California sea lion (Zalophus californianus) is capable of forming equivalence relations. The Psychological Record, 43, 823–

839. Sidman, M. (2000). Equivalence relations and the reinforcement contingency. Journal of

41

the Experimental Analysis of Behavior, 74, 127–146. Sidman, M. (1994). Equivalence relations and behavior: A research story. Boston:

Authors Cooperative. Sidman, M. (1971). Reading and auditory-visual equivalences. Journal of Speech and

Hearing Research, 14, 5–13. Sidman, M., & Tailby, W. (1982). Conditional discrimination vs. matching to sample: An

expansion of the testing paradigm. Journal of the Experimental Analysis of Behavior, 37, 5–22.

Silva, J. & Williams, W. L. (in preparation). An Examination into the Relationship Between Visual Identity Matching and Vocal Imitation in Students with Autism Skinner, B. F. (1957). Verbal Behavior. East Norwalk, CT: Appleton-Century-Crofts.

Reprinted (1992) Cambridge, MA: B. F. Skinner Foundation. Sparrow, S., Balla, D., & Ceccetti, D. (1984). Vineland Adaptive Behavior Scales. Circle

Pines, MN: American Guidance Service. Stubbings, V., & Martin, G. L. (1998). Matching training tasks to abilities of people with

mental retardation: A learning test versus experienced staff. American Journal on Mental Retardation, 102, 473-484.

Stubbings, V., & Martin, G. L. (1995). The ABLA test for predicting performance of

developmentally disabled persons on prevocational training tasks. International Journal of Practical Approaches to Disability, 19, 12-17.

Sundberg, M. L. (2004a). The search for the etiology of Autism. Analysis of Verbal Behavior, 20,

3-4. Sundberg, M. L. (2004b). A Behavioral Analysis of Motivation and its Relation to Mand Training. In W. L. Williams (Ed.) Developmental Disabilities: Etiology, assessment, Intervention and Integration. Reno, NV. Context Press. Sunberg, M.L., & Partington, J.W. (1998). Teaching language to children with autism

and other developmental disabilities. Pleasant Hill CA: Behavior Analysts, Inc. Tharinger, D., Schallert, D., & Kerr, N. (1977). Use of AVC tasks to predict classroom learning in mentally retarded children. Rehabilitation Psychology, 24, 113-118. Wacker, D. P., Kerr, N. J., & Carroll, J. L. (1983). Discrimination skill as a predictor of

prevocational performance of institutionalized mentally retarded children. Rehabilitation Psychology, 28, 45-59.

Wacker, D. P., Steil, D. A., & Greenebaum, F. T. (1983). Assessment of discrimination

skills of multiply-handicapped preschoolers and prediction of classroom task performance. Journal of the Association for the Severely Handicapped, 8, 65-78.

42

Ward, R. (1995). Bridging the gap between visual and auditory discrimination learning in children with autism and severe developmental disabilities. Unpublished doctoral dissertation. University of Toronto, Canada.

Ward, R., & Yu, D. C. T. (2000). Bridging the gap between visual and auditory

discrimination learning in children with autism and severe developmental disabilities. Journal on Developmental Disabilities, 7(2), 142-155.

Vaughan, W., Jr. (1988). Formation of equivalence sets in pigeons. Journal of

Experimental Psychology: Animal Behavior Processes, 14, 36–42. Vause, T., Martin, G.L., Yu, C.T., Marion, C., & Sakko, G. (2005). Teaching

equivalence relations to individuals with minimal verbal repertoires: Are visual and auditory-visual discriminations predictive of stimulus equivalence? The Psychological Record, 55, 2, 197-218.

Witt, J. C., & Wacker, D. P. (1981). Teaching children to respond to auditory directives:

An evaluation of two procedures. Behavior Research of Severe Developmental Disabilities, 2, 175-189.

Yu, D., & Martin, G. L. (1986). Comparison of two procedures to teach visual

discriminations to severely handicapped persons. Journal of Practical Approaches to Developmental Handicap, 10, 7-12.

Author contact information: All authors can be reached at: Department of Psychology/296 University of Nevada, Reno 1664 North Virginia St. Reno NV 89557-0062 775-784 6828 775-784 1126 (fax) Marianne Jackson [email protected] W. Larry Williams Ph.D., B.C.B.A. [email protected] Jeremy Biesbrouck [email protected]


43

Rule-Governance, Correspondence Training, and Discrimination Learning:

A Developmental Analysis of Covert Conduct Problems

James Snyder, Amber McEachern, Lynn Schrepferman, Robert Zettle, Kassy Johnson, Nathan Swink, & Cecile McAlpine

Abstract

A developmental model of covert conduct problems is described. Three social processes increase risk for early covert conduct problems. First, parents and other social agents fail to reinforce children’s compliance to explicit commands and instructions. Second, there is a failure to transfer rule -giving and rule-following from external verbal stimuli and contingencies to children’s self-description of behavior-consequence relationships. Third, correspondence between children’s words and future (promise keeping) or past (truth-telling) behavior is inadequately established. Early covert conduct problems may also result from the acquisition and rehearsal of non-normative, deviant rules in family and peer settings. As such, covert conduct problems reflect acquisition of non-normative rules as a result of active deviancy training and deficits in rule governance and word-behavior correspondence. Key Words: Rule governed behavior, develop of conduct disorder, behavioral development and communication.

Introduction

Research in developmental psychopathology has identified several malleable social processes that increment risk for child and adolescent conduct problems. Identification of these processes, in turn, has powerfully informed the construction of efficacious family- and school-based preventive and clinical interventions for those problems (Reid, Patterson, & Snyder, 2002). Despite such advances, theoretical and empirical efforts to fully describe these processes and to translate relevant findings into concrete intervention tactics are incomplete. The primary focus of developmental and intervention research with younger children has been on what is commonly termed “overt” conduct problems, such as physical and verbal aggression, disruptive behavior, and defiance. A relative blind spot in this research concerns the evolution of “covert” conduct problems (e.g., lying, stealing, cheating) in earlier childhood, and the manner in which these problems can be systematically addressed in preventive and clinical interventions prior to adolescence.

The goal of this paper is to formulate a model of the social processes that facilitate the development of covert conduct problems during childhood, applying the notions of rule governance, language-behavior correspondence, and discrimination learning. Given the diverse backgrounds of readers of this new journal, a brief background is first provided in order to adequately contextualize these goals. Covert Conduct Problems Covert conduct problems refer to a complex class of behaviors that: (a) attain desired materials and reinforcing activities that are normatively sanctioned, and (b) are performed under discriminable environmental or behavioral conditions to minimize experience of those sanctions by proactive or retroactive concealment of the attaining behaviors. This behavioral class includes two generic, sequentially and functionally related sets, as represented in Figure 1. The first set entails behaviors that directly access proscribed materials and activities. Prototypes of “attaining” behaviors (see center portion of Figure 1) are stealing and cheating, but also include vandalism, fire setting and precocious/pseudo-mature activities (proscribed because of age) such as


44

alcohol/tobacco use and sexual behavior. The second set entails behaviors occurring in a chain either prior to or after performance of the attaining behaviors and whose function is to avoid or escape detection and social sanctions. Prototypes of these “surveillance avoidance” strategies are scanning the immediate environment for monitoring by social agents (see left portion of Figure 1), and lying (see right hand portion of Figure 1).

Previous developmental and intervention research has often not distinguished between covert and overt forms of conduct problems because they are highly inter-related, at least when measured concurrently. However, validity for this distinction can be inferred from several sources. Separate (though correlated) dimensions for overt and covert conduct problems have been repeatedly identified in factor analyses of parent- and teacher-reports and of behavioral observations of conduct problems (Achenbach & Rescorla, 2001; Frick, Lahey, Tannenbaum, et al., 1993; Hinshaw, Simmel, & Heller, 1995; Willoughby, Kupersmidt, & Bryant, 2001). Overt and covert conduct problems follow different developmental trajectories. The age of onset of overt conduct problems is earlier than that of covert conduct problems. The frequency of overt conduct problems and aggressive behavior normatively decreases during childhood whereas the frequency of covert conduct problems normatively increases during that same developmental period (Loeber, DeLamatre, Keenan, & Zhang, 1998; Snyder, 2005). The frequent display of covert conduct problems during early (Snyder, Schrepferman, McEachern, Johnson, Padilla, & Swink, 2005) as well as later childhood (Patterson & Yoerger, 1999) increments risk for persisting and increasingly serious antisocial behavior during adolescence and adulthood over the risk conferred by overt conduct problems alone.

Relative to overt conduct problems and aggression, few data are available concerning the developmental trajectories for child covert conduct problems prior to 10 years of age. In part, this is because many types of covert conduct problems do not occur during this developmental period (Patterson, Shaw, Snyder, & Yoerger, 2005) and those which do occur may be relatively infrequent, developmentally transient, and situation specific (Lahey & Loeber, 1994). The relative dearth of research on early covert conduct


45

problems limits ascertainment of the conditions under which such problems appear, persist and grow. It also curtails the development of preventive and clinical interventions targeting covert conduct problems during early childhood before they become increasingly persistent, serious and pervasive. Empirical attention to the social and psychological processes that increment risk for the appearance and growth of covert conduct problems during childhood has practical as well as theoretical value. Once “established,” covert conduct problems may be difficult to remediate because their continued performance is accompanied by their increasingly successful clandestine use. Remediation of covert conduct problems also becomes more challenging as a result of children’s increasing exposure to open social environments and reductions in adult tracking across the childhood and adolescent periods.

Although data about the developmental epidemiology of covert conduct problems are insufficient, there is an even larger deficit in behavioral theory and research on the social processes by which truth telling, promise keeping, and respect for property (or their opposites – lying, stealing and cheating) are established during early and middle childhood. The next several sections provide a description of the social conditions and processes by which these behaviors may be shaped and maintained. A Functional Assessment of Covert Conduct Problems A functional assessment provides a useful framework for describing the processes by which stealing, cheating, lying, concealment and other covert conduct problems are acquired, shaped and maintained (see Figure 1). Presumably, stealing, cheating, vandalism, fire setting, drug use and sexual behavior entail actions that lead to reinforcing materials and activities, or are intrinsically reinforcing. These behaviors may not be well concealed when they are initially performed, leading to punishment by parents, teachers and other social agents. However, given such punishment is intermittent or ineffective; a child may learn to discriminate the presence of the sanctioning agent. This discrimination learning may result in the shaping of proactive surveillance avoidance strategies, such as carefully scanning the environment for the presence of the sanctioning agent, making false promises or actively engaging in behaviors (being secretive, truancy, running away) that reduce the ability of social agents to monitor the child’s behavior. Proactive surveillance avoidance strategies are likely to be shaped and sustained by the non-occurrence of anticipated punishment for attaining behaviors - a negative reinforcement contingency.

Given that parents, teachers and other socialization agents cannot continuously monitor child behavior even under optimal circumstances, children are likely to engage in occasional stealing, cheating, property destruction, sexual behavior, and tobacco and alcohol use. After-the-fact indicators of these activities are often available to socialization agents who may then query or challenge the child concerning these behaviors. In response, the child may engage in retroactive surveillance avoidance strategies such as lying (fabrication and denial), feigning surprise or ignorance, blaming others, or claiming extenuating circumstances. In so far as these verbal behaviors are successful, they are negatively reinforced by escape from impending punishment. Rule-Governance and Word-Behavior Correspondence The proposed functional assessment model may have face validity and intuitive appeal, but it is too simple. Socialization does not rely solely on close parental monitoring and immediate consequences for child behavior. The contingency-shaped suppression of lying, stealing, cheating and other covert conduct problems by punishment is certainly an important ingredient in socialization. However, socialization is typically judged to be more fully “successful” when children can regulate their own behavior in the (relative) absence of ongoing monitoring and external contingencies by parents, teachers and other agents. The development of behavior self-regulation requires the shaping of word-behavior relations via two additional processes: rule governance and word-action correspondence.


46

A central aspect of socialization entails bringing external behavior under verbal control. This control occurs when verbal stimuli describing response-consequence contingencies influence subsequent response choices. This antecedent verbal control of behavior is referred to as rule -governance, and entails a specification of “if.... then….” contingency relationships (Hayes, Zettle, & Rosenfarb, 1989). Successful socialization can be conceptualized as the progressive shaping of children’s use of self-generated verbal stimuli to cue the performance of behaviors with remote and intermittent natural reinforcement contingencies, and to inhibit the performance of behaviors with powerful, immediate natural reinforcement contingencies. Verbal control of behavior, or rule-governance, gets established through several overlapping and iterative social processes during early childhood (see Figure 2). Three such processes are now described.

Process 1. Initial efforts at establishing rule -governance take the form of compliance training (right portion of Figure 2). In this training, parents and other social agents specify the behavior to be performed (“do” commands) or not to be performed (“don’t” commands) by the child, and then provide consequences for occurrence or non-occurrence of the behavior specified in the command. In more formal behavior analytic language, rule following (or com-pliance in the language of behavior analysis) develops because the behavior specified in the rule (com-mand in the language of behavior analysis) comes into reliable contact with socially-mediated consequences for correspondence between the rule and the relevant behavior (Hayes & Ju, 1998). Parents initiate compliance training in earnest when children are 1-2 years of age, partly because the increasing motor abilities of children evoke a press for behavior regulation. Compliance training is also facilitated because children’s rapid language development during this developmental period provides the capacity for rule -governance (e.g., Lowe, Beasty, & Bental, 1983). Given consistency and clarity in commands and contingencies, child compliance to parental commands, instructions and warnings is established and generalizes to instructional control by other social agents and to other social settings (Riegler & Baer, 1989).

The successful shaping of compliance to the verbal commands and instructions of social agents (external rules) is a critical step in child socialization. The social conditions and processes by which compliance becomes established in parent-child interaction has been the subject of substantial research over the past 25 years (Larzelere & Kuhn, 2005). The failure to teach children to be compliant substantially increases risk for subsequent overt (hitting) and covert (stealing and lying) forms of child conduct problems (Patterson, 1982). Child noncompliance and defiance are common parent complaints during the toddler and early childhood periods (Kalb & Loeber, 2003), and compliance is the central target of child behavior change in parent management training (Webster-Stratton & Reid, 2003).


47

Process 2. Basic compliance training (external verbal regulation of child behavior) is elaborated in several

ways to result in the emergence of two forms of self rule -governance. First, instruction following, itself, may become rule-governed as indicated by children’s generalized verbal endorsement (to themselves and to others) and behavioral propensity to “do what others tell you to do.” This generalized rule following is the result, in part, of consistent and contingent reinforcement for compliance and punishment for noncompliance.

Second, specific rule following (e.g., “say please and thank you”, “don’t steal,” “take turns and share,” “don’t

hit”) is also acquired and its control is transferred from externally-prompted commands and instructions to self-generated, unprompted verbal description of the rule (see bottom right portion of Figure 2). Children’s acquisition and use of self-prompting rules is often accompanied and facilitated by prompts and social reinforcement by external agents for rule statement by children (Parent: “What are you supposed to do?” Child: “Say please and thank you.” Parent: “Right!”). Children’s acquisition and use of self-prompting rules may also be facilitated when parents and other rule givers state reasons for rule following (i.e., specifying forthcoming consequences; this is known as induction in the child development literature).

Initial compliance training and children’s early self-generated rule -statement and rule following may be

primarily supported by consequences provided by external agents. These rules may be relatively arbitrary and be intended by parents as mands in that they will monitor and provide consequences for compliance. Children may also discriminate these as mands and comply because the form of the instruction indicates the parent will monitor and provide reinforcement for compliance. Rule following under such conditions is called pliance and the controlling verbal stimuli function as mands in behavior analytic languages. Rule-acquisition and rule-following also develop because behavior specified in a rule comes into contact with supporting natural environmental contingencies (in contrast to arbitrary consequences provided by rule givers). Children’s rule -governance and behavior self-regulation may be enhanced and sustained if the commands and rules given by parents and other socialization agents are also supported by naturally occurring contingencies (e.g., when children say “please,” they are much more likely to actually get what they ask for as well as getting parental praise for saying it). In the parent training literature, these contingencies are often called “natural and logical consequences.” Put more generally, parents’ instructions, commands and rules more effectively lead to sustained rule -governance of behavior by children when those commands, instructions and rules are context-sensitive or have real functional value in the natural environments experienced by children. Instructions and rules are internalized and sustained (self-generated and followed) as children experientially discover such instructions and rules are valid or accurate descriptions of behavior-reinforcement relationships in the natural environment.

Compliance to arbitrary rules (in the form of mands and pliance) is an important first step on the road to rule -

governance and behavior self-regulation. However, continued reliance on compliance controlled primarily by parental instructions, monitoring and consequences in the relative absence of congruent contingencies in the natural environment may lead to discriminated rule-following (pliance only in the presence of the rule giver), especially if rule-following is primarily supported by aversive parental consequences for non-compliance. As described previously and shown in Figure 1, such discriminated rule-following is a central feature of covert conduct problems, including active efforts at concealment or surveillance-avoidance. In the language of behavioral theory, rule-acquisition and rule following supported by natural contingencies rather than by contingencies by the rule-giver is referred to as tracking. The transfer of rule description and enforcement from external agents to the child, and the generalization of rule-governance over time and across settings (accompanied by reduced adult monitoring) are facilitated by parents’ use of instructions that take on a tracking function. Parents can foster the transfer from compliance to tracking forms of rule governance (being prepared for school) by making observations (“Is your backpack ready for school?”) about behaviors (putting relevant books in a backpack and taking the backpack to school) which cue the child to think about ensuing natural environmental contingencies for the behavior (teacher consequences for having the relevant materials).


48

Process 3. Compliance training occurs in repeated, discrete social exchanges. To initially establish compliance, parent’s state clear commands or instructions concerning the behavior to be performed by the child, observe whether the behavior specified in the command occurs, and then provide immediate reinforcement for compliance or punishment of noncompliance. Once “immediate compliance” is attained, shaping of what might be termed “distal compliance” is needed. Distal compliance refers to rule following that is temporally and contextually removed from the instruction or command and from the consequences provided by the rule -giving agent for child compliance or noncompliance (see top right hand portion of Figure 2).

Establishing distal compliance entails the addition of verbal bridging functions to command-compliance and

compliance-consequence social exchange sequences. These verbal bridging functions entail the establishment of word-behavior (saying ßà doing) correspondence, and are commonly called promise keeping and truth telling. The child’s rule-following behavior, which occurs temporally and contextually distal from the instruction or rule statement, can be shaped by obtaining a verbal indication by rule -followers of their acquiescence or intention to follow the rule (“I promise to….”). The function to be established is a verbal statement by the child indicating the rule or instruction will be followed, and a correspondence between that verbal statement and the child’s actual future performance of the behavior specified in the rule or instruction. Later in development, children may verbalize un-prompted promises. Parents and other socialization agents shape this verbal bridging function by after-the-fact monitoring and consequences for promise-behavior correspondence. In other words, socialization agents need to check whether the child kept the promise.

Distal compliance is also promoted by shaping a second verbal bridging function in which there is

correspondence between reports about past behavior and the actual performance of that behavior. Typically, this entails a query about the occurrence or non-occurrence of some behavior that was specified by the child as a promise (“Did you clean your room like you said you would?” “Did you get to school on time today?”) or that reflects a presumably already-established, self-generated “standing” rule (“Did you take money from my purse?” “Did you hit your brother?” “Did you brush your teeth?”). This verbal bridging function is truth-telling and its absence is lying. Establishing truth telling requires socialization agents have some independent manner by which to monitor the occurrence of the behavior being reported so the accuracy of the report can be tested and consequences can be applied for correspondence or non-correspondence between the child’s report about and actual previous performance of the behavior.

Word-behavior correspondence (promise-keeping and truth-telling) are shaped and established in small steps.

Initially, the focus is on rule following that is temporally and contextually more proximal (though not immediate) to the instruction or command, and on rule-following behaviors for which there is readily observable evidence for performance and for which relatively immediate consequences can be provided. Simultaneous shaping of both word-behavior correspondence and rule -following entails dual contingencies – for performance of the behavior specified in the promise, instruction or rule, and for correspondence between the verbal statements made about future (promise-keeping) or past (truth-telling) behavior and the actual occurrence of the behavior.

Managing these dual contingencies may be easier for promise keeping than for truth telling because word-

behavior correspondence and rule -following behavior (keeping a promise) coincide, and the lack of word-behavior correspondence and failure to engage in rule -following behavior (breaking a promise) also coincide. Reinforcement for promise-keeping simultaneously facilitates performance of both word-behavior correspondence and the behavior specified in the promise, whereas punishment for promise-breaking simultaneously inhibits non-correspondence between words and behavior and the failure to perform the behavior specified in the promise. Managing the dual contingencies for accurate reporting about behavior that has already occurred (truth-telling) is more complex because there can be a disjunction in the contingencies that support rule -following behavior and the accuracy of verbal reports about the actual performance of the behavior. Four combinations can occur: rule-following and accurate verbal reports, rule -following and inaccurate verbal reports, rule-violation and accurate verbal reports, and rule -violation and inaccurate verbal reports.


49

In the first combination, rule-following and accurate report, positive reinforcement contingencies by socialization agents simultaneously facilitate the child’s successful performance of a behavior specified in a rule and the child’s accurate verbal report about the performance of the behavior. The second combination is less frequent; children don’t typically lie to socialization agents about successfully performing a behavior specified in a normatively endorsed rule. In so far as this is the case, formulating contingencies for this disjunction is not an issue. However, children may lie to peers or parents about following a normative rule in order to gain approval and avoid status loss; this will be considered further in a later section on non-normative socialization.

The third combination in which a child violates a rule behaviorally and then admits to doing so presents a

quandary for socialization agents. The child’s rule -violation should be punished but the child’s admission of rule-breaking (word-behavior correspondence, or telling the truth about misbehavior) should be reinforced. The manner in which socialization agents can effectively implement these incompatible contingencies is not clear. The fourth combination in which the child violates a rule behaviorally and then tries to avoid punishment for the violation by denying it or by fabricating a cover story is also challenging. Punishment contingencies should be arranged to suppress both the rule -violating behavior and the inaccurate report (lack of word-behavior correspondence), and to do so with sufficient consistency and clarity so that intermittent avoidance of impending punishment by “successful” lying or concealment of the rule -violation is not negatively reinforced. Put differently, from the perspective of a child who has violated a rule, there may be little cost to lie or conceal if punishment for rule-violation is going to be forthcoming anyway. Socialization agents must, in some manner, make the cost greater for the combination of lying and rule -violation than for rule-violation alone.

Most children readily report that they “should keep their promises” and “should tell the truth” because

socialization agents and children frequently articulate these rules are reinforced for stating these rules (Hartshorne & May, 1928-1930). However, the statement of such rules by socialization agents and their (re) statement by children without contingencies that support actual word-behavior correspondence specified in the promise-keeping and truth-telling rules is clearly not sufficient. In fact, reinforcing children’s statement that they should keep their promises and should tell the truth in the absence of reinforcing actual truth telling and promise-keeping may actually be counter-productive in that such contingencies actually shape “talking the talk” but not “walking the walk.” At best, a failure to reinforce actual word-behavior correspondence as well as statement of rules about word-behavior correspondence is unlikely to result in distal compliance and rule following. At worst, this failure may lead to children’s more sophisticated verbal manipulation of rule-givers and successful avoidance of punishment for rule breaking. Children’s ability to state rules about being truthful and keeping promises may be confused with their actual likelihood of doing so.

Standard parent management training interventions targeting covert conduct problems like recurrent stealing

emphasize parents’ careful monitoring of rule -violating behavior, labeling the behavior as rule-violating (“That’s stealing.”), and punishing the behavior without queries (i.e., not testing word-behavior correspondence) to reduce children’s opportunity to deny or fabricate (Barth, 1987). However, relatively little empirical attention has been paid to the efficacy with which these parenting strategies reduce covert conduct problems (McMahon & Wells, 1998). The similarity of these strategies to those used by parents and other socialization agents to successfully inhibit covert conduct problems and to promote children’s promise keeping and truth telling in early development is unclear. Word-behavior correspondence by children certainly includes in-home behavior monitoring and contingency management by parents beginning in the toddler and preschool years (Dishion & McMahon, 1998). Proactive efforts to establish word-behavior correspondence by young children may be much easier than to remediate its absence in later childhood (Burton, 1963).

Word-behavior correspondence involves establishing distal compliance, but may also be shaped by less

pointed and more positively toned parent-child conversations about children’s behavior, activities and experiences at school and in the neighborhood. These conversations promote children’s accurate description of a range of behaviors, activities and experiences outside of the parents’ immediate purview. These conversations may serve as an early developmental template for parent solicitation and children’s disclosure of information about their out-


50

of-home activities and associates (Patrick, Snyder, Schrepferman, & Snyder, 2005) critical to effective monitoring in later childhood and adolescence (Stattin & Kerr, 2000).

While promise-keeping and truth-telling have been described as social acts, one can of course state intentions

(make promises) to oneself, and self-evaluate whether an intended behavior was actually performed. This is certainly another important function in the development of children’s capacity for behavior self-regulation. Covert Conduct Problems: Non-Normative Rather than Failed Socialization Conduct problems are often viewed as a deficit in rule -governance. Overt conduct problems such as defiance, threats and aggression, and covert conduct problems such as stealing, lying and cheating reflect failures to apply normative rules to regulate one’s own behavior. The immediate payoffs for rule -breaking behavior (Snyder & Patterson, 1995) often come at considerable long-term costs (Patterson, Forgatch, Yoerger, & Stoolmiller, 1998), implying that poor impulse control and deficient verbal ability may serve as core components of conduct problems (Lahey & Waldman, 2003).

However, consider the alternative hypothesis that most human behavior, whether labeled as healthy or pathological, is at least in part rule-governed – i.e., influenced by verbal statements about expected behavior-consequence relationships derived from observation or direct experience. In this formulation, children who display frequent, persistent and serious conduct problems may be no less adept at acquiring and extracting verbal rules about behavior-consequence relations and at using those rules to regulate their own behavior than are children without such problems. Rather than an absence of rule -governance, overt and, perhaps even more so, covert conduct problems may reflect the acquisition of a different, non-normative set of rules about behavior-consequence relations and the application of those rules in a manner that facilitates the performance of deviant behavior – even in the face of its intermittent, immediate punishment. Examples of deviancy-supporting verbal rules are: “Only do what you’re told when someone makes you.”, “Be aggressive if it gets what you want.”, “Lie to avoid punishment.”, “Take others’ property if you can get away with it.”, “Get even but don’t get caught.”, “Tell people what they want to hear.”, “Break the rules and defy authority when you can.” Note that these rules not only describe behavior-consequence relationships, but also contain elements specifying concealment and surveillance-discriminated performance of behavior.

The formulation that children are actively socialized into deviancy is not novel, and has been articulated in

prominent theories of delinquency over last 70 years (Sutherland, 1939; Hirschi, 1969). The central thesis is that persons acquire, espouse and engage in patterns of thinking and behavior congruent with the thinking and behavior of social agents with whom they have ongoing and regular contact. Affiliation with deviant peers during adolescence, for example, has been repeatedly found to powerfully predict delinquent behavior, early and persisting drug use, and precocious sexual behavior (Thornberry & Krohn, 1997). However, extant research on the influence of deviant peers (or other social agents who endorse deviant behavior) is limited in several ways. First, research has not detailed the social processes by which rules supporting deviant behavior are learned, maintained and elaborated, and about how such rules facilitate deviant behavior. These social processes are generically described as “deviancy training.” A clearer understanding of deviancy training processes is a key to the development of effective interventions other than simply limiting exposure to deviant individuals, settings and activities. Second, nearly all research on deviancy training has focused on deviant peer relationships in late childhood and adolescence (Patterson, Dishion & Yoerger, 2000). There is now reason to believe that deviancy-producing affiliations and social processes occur in peer groups as early as kindergarten (Snyder, Schrepferman, Oeser, Patterson, Stoolmiller, Johnson, & Snyder, 2005), and that similar processes occur in family as well as peer relationships (Snyder, Bank, & Burraston, in press).

A useful way to think about early deviancy training is in terms of “rehearsal.” Young children lack the ability

to be accomplished liars, stealers and cheaters, and have limited opportunities for extensive practice of these behaviors. They are not very adept at concealment, and are subject to fairly continuous monitoring even in high


51

risk family environments. However, children may frequently be exposed to deviant actions and hear verbal descriptions of deviant behavior by other individuals, including peers, siblings, parents and media models. Children also observe the reactions of others to such descriptions and the consequences for such deviant actions. Insofar as such deviant talk and behavior is observed to incur excitement, endorsement and approval, and leads to positive outcomes, children may derive verbal rules (values, norms) in which similar excitement, endorsement, approval and positive outcomes are expected for deviant behavior and its description. Exposure also provides children with detailed instructions about how, when and where to engage in such behaviors, including their concealment.

Young children also rehearse these deviant activities in their talk and play with peers, and such rehearsal is

further shaped and elaborated when it accrues social attention, is socially titillating, and is reciprocated (Snyder, Stoolmiller, Patterson, Schrepferman, Oeser, Johnson, & Soetaert, 2004). Based on the reactions of peers to deviant talk and role rehearsal, such talk and rehearsal serve as a means to locate similarly behaving peer affiliates. Interaction with similarly behaving affiliates, in turn, results in mutual shaping and elaboration of such talk and rehearsal, and initial collusion and collaboration in minor deviant activities (Snyder, Schrepferman, Oeser, et al., 2005). Deviant talk and rehearsal with peers (or siblings or parents) either as a listener and observer, or as a speaker and model, creates a relational word-action frame in which saying/listening and doing/observing become mutually entailed as they take on an equivalence function.

In summary, deviant talk and role rehearsal primes behavior and serves an advance organizing function, both

verbally and behaviorally, for involvement in more blatant and serious antisocial activities, and for successful concealment of those activities. Verbal representation of behavior-consequence relations derived from direct and vicarious experiences may be a central element in deviancy training processes. Such representations can serve as templates, which promote the performance of rule -breaking and socially proscribed behavior, as well as the performance of socially approved, normatively valued behavior. The exact nature of the behavior-consequence relations specified by rules depends on the kinds and function of rules in children’s vicarious and direct experiences. Contingencies for deviant talk and role rehearsal may facilitate the location of social niches compatible with a child’s emerging deviant verbal and behavioral repertoire or, alternatively, niches compatible with a child’s emerging prosocial verbal and behavioral repertoire.

Summary This paper is an initial effort to articulate a behavioral model of the social processes involved in the

development of covert conduct problems during early to middle childhood. As offered here, the model is incomplete in several ways. First, it focuses primarily on describing how environmental conditions and contingencies provided by socialization agents shape rule -governed behavior. The active and reciprocal contribution of child behavior on the social environment is inadequately represented. Second and in a related vein, the contribution of individual differences among children (resulting from some combination of maturation, genetic dispositions, and previous learning history) to ongoing socialization processes was given insufficient consideration. These individual differences may amplify or dampen (statistically moderate) the contribution of specific social experiences on the development of rule -governance, and risk for the development of covert conduct problems (Kochanska, Coy, & Murray, 2001). Third, some potentially important processes have been ignored in this account. For example, the contribution of emotion labeling, coaching, utilization and regulation in the development of rule-governance and covert conduct problems were not considered. The private experience and associated learned labels, and the social expression and behavior-behavior functions of guilt, shame and embarrassment on the one hand, and excitement and pride on the other, may play an integral role in rule-governance (Lewis, 2000). The application of a behavior analytic, functionalist perspective may contribute in substantial ways to the conceptually and methodologically messy area of emotion regulation.


52

It is also our hope that the model we have offered provides a framework that will advance research on the development of covert conduct problems during early and middle childhood. The model is comprised of a set of constructs that can be either directly observed or measured by relatively direct self-report. The model offers a set of testable hypotheses about the inter-related social, verbal, behavioral and environmental processes by which rule governance and word-behavior correspondence is established, either to support successful, normative socialization or to support deviant behavior and covert conduct problems. We have tried to link the model to previous empirical research where available, but the propositions offered here clearly need to be subjected to empirical testing in both correlational and experimental designs. Insofar as empirical support is forthcoming for this or revised accounts, the specification of the micro-social processes by which rule -governance, distal compliance and word-behavior correspondence is fostered during early childhood should lead to the formulation of more effective family- and peer-focused interventions, especially for young children who display early covert conduct problems.

References

Achenbach, T.M., & Rescorla, L.A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington,

VT: University of Vermont, Research Center for Children, Youth & Families. Barth, R.P. (1987). Assessment and treatment of stealing. In B.B. Lahey & A. Kazdin (Eds.), Advances in clinical

child psychology (Vol. 10, pp. 137-170). New York: Plenum Press. Burton, R.V. (1963). The generality of honesty reconsidered. Psychological Review, 70, 481-499. Dishion, T.J., & McMahon, R.J. (1998). Parental monitoring and the prevention of problem behavior: A

conceptual and empirical reformulation. Clinical Child and Family Psychology Review, 1, 61-75. Frick, P.J., Lahey, B.B., Loeber, R., Tannenbaum, L., Van Horn, Y., Christ, M.A.G., Hart, E.L., & Hanson, K.

(1993). Oppositional defiant disorder and conduct disorder: A meta-analytic review of factor analyses and cross-validation in a clinic sample. Clinical Psychology Review, 13 319-340.

Hartshorne, H., & May, M.A. (1928-1930). Moral studies in the nature of character: Studies in deceit (Vol.1);

Studies in self control (Vol. 2): Studies in the organization of character (Vol. 3). New York: Macmillan. Hayes, S.C., & Ju, W. (1998). Rule governed behavior. In W. O’Donohue (Ed.), Learning and behavior therapy

(pp. 374-391). Boston: Allyn & Bacon. Hayes, S.C. Zettle, R.D., & Rosenfarb, I. (1989). Rule following. In S.C. Hayes (Ed.), Rule-governed behavior:

Cognition, contingencies, and instructional control (pp. 191-220). New York: Plenum. Hinshaw, S.P., Simmel, C., & Heller, T.L. (1995). Multimethod assessment of covert antisocial behavior in

children: Laboratory observations, adult ratings, and child self report. Psychological Assessment, 7, 209-219. Hirschi, T. (1969). Causes of delinquency. Berkeley: University of California Press. Kalb, L.M., & Loeber, R. (2003). Child disobedience and noncompliance: A review. Pediatrics, 111, 641-652. Kochanska, G., Coy, K.C., & Murray, K.T. (2001). The development of self regulation in the first four years of

life. Child Development, 72, 1091-1111. Lahey, B.B., & Loeber, R. (1994). Framework for a developmental model of oppostional defiant disorder and

conduct disorder. In D.K. Routh (Ed.), Disruptive behavior disorders in childhood (pp. 139-180). New York: Plenum Press.


53

Lahey, B.B., & Waldman, I.D. (2003). A developmental propensity model of the origins of conduct problems

during childhood and adolescence. In B.B. Lahey, T.E. Moffitt, & A. Caspi (Eds.), Causes of conduct disorder and juvenile delinquency (pp. 76-117). New York: Guilford Press.

Larzelere, R.E., & Kuhn, B.R. (2005). Enhancing behavioral parent training with an extended discipline ladder.

Behavior Therapist, June, 105-108. Lewis, M. (2000).Self conscious emotions: Embarrassment, pride, shame, and guilt. IN M. Lewis & J.M.

Haviland-Jones (Eds.), Handbook of emotions (Second Edition, pp. 623-636). New York: Guilford Press. Loeber, R., DeLamatre, M.S., Keenan, K., & Zhang, Q. (1998). A prospective replication of developmental

pathways in disruptive and delinquent behavior. In R.D. Cairns, L.R. Bergman, & J. Kagan (Eds.), Methods and models for studying the individual (pp. 185-216). Thousand Oaks, CA: Sage.

Lowe, C.F., Beasty, A., & Bentall, R.P. (1983). The role of verbal behavior in human learning: Infant performance

on Fixed Interval schedules. Journal of the Experimental Analysis of Behavior, 39, 157-164. McMahon, R.J., & Wells, K.C. (1998). Conduct problems. In E.J. Mash & R. A. Barkley (Eds.), Treatment of

childhood disorders (Second Edition, pp. 111-207). New York: Guilford Press. Patrick, M.R., Snyder, J., Schrepferman, L.M., & Snyder, J.M. (2005). The joint contribution of early parental

warmth, communication, tracking, and early childhood conduct problems on monitoring in late childhood. Child Development, 76, 999-1014.

Patterson, G.R. (1982). Coercive family process. Eugene, Oregon: Castalia Publishing. Patterson, G.R., Dishion, T.J., & Yoerger, K. (2000). Adolescent growth in new forms of problem behaviors:

Macro- and micro-peer dynamics. Prevention Science, 1, 3-13. Patterson, G.R., Forgatch, M.S., Yoerger, K., & Stoolmiller, M. (1998). Variables that initiate and maintain an

early onset trajectory for juvenile offending. Development and Psychopathology, 10, 541-547. Patterson, G.R., Shaw, D.S., Snyder, J., & Yoerger, K. (2005). Changes in maternal ratings of children’s overt and

covert antisocial behavior. Aggressive Behavior, 31, 473-484. Patterson, G.R., & Yoerger, K. (1999). Intraindividual growth in covert antisocial behavior: A necessary precursor

to chronic and adult arrests? Criminal Behavior and Mental Health, 9, 86-100. Reid, J.B., Patterson, G.R., & Snyder, J. (2002). Antisocial behavior in children and adolescents: A developmental

analysis and model for intervention. Washington, D.C.: American Psychological Association. Riegler, H.C., & Baer, D.M. (1989). A developmental analysis of rule following. In H.W. Reese (Ed.), Advances

in Child Development (Vol. 21, pp. 191-219). New York: Academic Press. Snyder, J., (March, 2005). Advances and practical applications of structural equation modeling in psychological

research: Examples from the development of child conduct problems.” Invited presentation, annual meeting of the Southwestern Psychological Association, Memphis, TN.

Snyder, J., Bank, L., & Burraston, B. (in press). The consequences of antisocial behavior in older male siblings for

younger brothers and sisters. Journal of Family Psychology.


54

Snyder, J., & Patterson, G.R. (1995). Individual differences in social aggression: A test of a reinforcement model of

socialization in the natural environment. Behavior Therapy, 26, 371-391. Snyder, J., Schrepferman, L., McEachern, A., Johnson, K., Padilla, S. & Swink, N. (2005). Early Covert Conduct

Problems: Phenomenology, Prevalence, Persistence and Progression. Submitted for publication. Snyder, J., Schrepferman, L., Oeser, J., Patterson, G.R., Stoolmiller, M., Johnson, K., & Snyder, A. (2005).

Deviancy training and association with deviant peers in young children: Occurrence and contribution to early-onset conduct problems. Development and Psychopathology, 17, 397-413.

Snyder, J., Stoolmiller, M., Patterson, G.R., Schrepferman, L., Oeser, J., Johnson, K., & Soetaert, D. (2004). The

application of response allocation matching to understanding risk mechanisms in development: The case of young children’s deviant talk and play, and risk for early onset antisocial behavior. Behavior Analyst Today, 4, 335-343.

Stattin, H., & Kerr, M. (2000). What parents know, how they know it, and several forms of adolescent adjustment:

Further support for a reinterpretation of monitoring. Developmental Psychology, 36, 366-380. Sutherland, E.H. (1939). Principles of criminology. Philadelphia: Lippincott. Thornberry, T.P., & Krohn, M.D. (1997). Peers, drug use, and delinquency. In D.M. Stoff, J. Breiling, & J.D.

Maser (Eds.), Handbook of antisocial behavior (pp. 218-233). New York: John Wiley & Sons. Webster-Stratton, C., & Reid, M.J. (2003). The Incredible Years Parents, Teachers, and Children Training Series:

A multifaceted treatment approach for young children with conduct problems. In A.E. Kazdin & J.R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents. (pp. 224-240). New York: Guilford Press.

Willoughby, M., Kupersmidt, J., & Bryant, D. (2001). Overt and covert dimensions of antisocial behavior in early

childhood. Journal of Abnormal Child Psychology, 29, 177-187. Author Contact Information All authors may be reached at:

Wichita State University Department of Psychology Box 34 Wichita, Kansas 67260-3170

(316) 978-3170

James Snyder: [email protected]

Amber McEachern: [email protected]

Lynn Schrepferman: [email protected]

Rob Zettle: [email protected]


55

Kassy Johnson: [email protected]

Nathan Swink: [email protected]

Cecile McAlpine: [email protected]

ADVERTISING IN THE JOURNAL OF SPEECH AND LANGUAGE PATHOLOGY - APPLIED BEHAVIOR ANALYSIS

The prices for advertising in one issue are as follows:

1/4 Page: $50.00 1/2 Page: $100.00 vertical or horizontal Full Page: $200.00

If you wish to run the same ad in multiple issues for the year, you are eligible for the following discount:

1/4 Pg.: $40 - per issue 1/2 Pg.: $75 - per issue -vertical or horizontal

Full Page: $150.00-per issue

An additional one-time layout/composition fee of $25.00 is applicable

For more information, or place an ad, contact Halina Dziewolska by phone at (215) 462-6737 or e-mail at: [email protected]


56

Operant Conditioning and Programmed Instruction in Aphasia Rehabilitation

Robert Goldfarb, Ph. D.

Abstract

Behavior theory has fallen from favor as a foundation for aphasia rehabilitation. Once a robust

basis for experimental and clinical examination of communication disorders in adults, behavior modification has been largely absent in the literature of the past 25 years. This paper advocates a return to the application of a behavioral framework for the treatment of aphasia, with particular attention to the principles of reinforcement, and punishment, including overcorrection. It also advocates a return to such programs of instruction as melodic intonation therapy and to the application of contemporary alternate augmentative communication systems (AAC). The language of sets provides an overall framework for approaching aphasia therapy. Key Words: Programmed instruction, aphasia, rehabilitation, behavioral speech interventions

Introduction Behavior theory presents a set of principles by which a person’s performance can be observed, analyzed and modified to support the development of socially valued adaptive skills. These principles are rules or laws which describe behavior and its relationship to environmental consequences and motivating stimuli. It is important for speech-language pathologists (SLPs) to understand behavioral principles, because clinical treatment involves the modification of communicative behavior. When clinical treatment is effective, there is behavioral change. Principles of behavior modification have been described as they relate to aphasia rehabilitation (Brookshire, 1969; Goldfarb, 1981; Holland, 1970; Holland & Harris, 1968). These principles refer to a Skinnerian or operant model, not a Pavlovian or reflexive model. Systematic reinforcement of operant behaviors can lead to new responses that expand a person’s interactive repertoires communicatively, socially, and verbally. New reflexes cannot be learned, but operant procedures can be used to inhibit or shape infantile oral reflexes, such as suckling and biting, which may be exhibited following brain damage in adults.

While there was a flurry of activity in operant-based aphasia research more than 25 years ago (Albert, Sparks, & Helm, 1973; Brookshire, 1968; Goldfarb & Scharf, 1980; Keenan, 1966; Keith & Darley, 1967; Rosenberg & Edwards, 1965; Sarno, Silverman, & Sands, 1970; Tikofsky & Reynolds, 1962; 1963), there has been much less recent interest. One recent non-language study (Goldenberg, Hodges, Hershe, & Jinich, 1980) reported efficacy of operant conditioning in reducing fecal incontinence in 12 patients (ages 12-78 years) with medical and surgical conditions using biofeedback. An auditory language comprehension program for persons with severe aphasia (Bastiaanse, Nijboer, & Taconis, 1993) was applied in a case study involving a participant who learned to discriminate a target word from one, two, and then three distracters. Two other studies used filmed or videotaped programmed instruction to examine reading recognition and comprehension (Di Carlo, 1980) and comprehension of indirect requests such as “can” and “should” (Levey & Goldfarb, 2003) with participants who had aphasia. However, the generalizability of recent studies is limited due to the small number of subjects and low statistical power.


57

Consequences of Ignoring Behavioral Principles SLPs with a limited understanding of applied behavior analysis (ABA) are at risk for attempting to modify maladaptive communicative behavior ineffectively. Consider the following vignette: Several adults with aphasia are seated in a small group during a speech-language therapy session. One of the adult clients points to the door and says, “Go, go.” When this request is ignored by the SLP, the client repeats the gesture and the utterance with greater intensity. Without turning to the client, the SLP says, “Just a minute, I’m helping John now.” The client then unlocks his wheelchair and rolls back and forth, ramming the chairs of other group members. This continues until the SLP turns to the client, saying, “All right, I’m coming!” This vignette illustrates important limitations in the application of the principles of reinforcement. Specifically, the client demonstrates several forms of verbal and non-verbal behavior with the potential to gain social attention (e.g., pointing, vocalizing, chair-ramming). However, the SLP responds to the one form (chair- ramming) that is the least adaptive from a social-communicative perspective. Moreover, the SLP ignores (at least twice) two conventional forms (pointing, vocalizing) with the highest level of social acceptability. If the goal is to gain the SLP’s attention, then the client learns two lessons from the interaction: (1) conventional social signals are not reinforced in this context, and (2) antisocial behavior (chair-ramming) leads to reinforcement. Under these conditions, we can expect an increase in the frequency of maladaptive behavior for communication purposes. Another context in which limited knowledge of behavioral principles can lead to inappropriate practices involves the use of punishment. In an alternative version of the above vignette, the SLP may have considered chair-ramming to be an inappropriate behavior and may have chosen to consequate this behavior with some form of punishment. If so, two problems could have resulted. First, research indicates that punishment alone has only a temporary effect (at best) on reducing the frequency of an inappropriate behavior (Goldfarb, 1981; Rosenberg & Edwards, 1965). In fact, a more likely explanation for its frequent use is that a clinician may be reinforced by an immediate change in a client’s behavior. Secondly, if the SLP chose a punishment without first conducting a functional assessment of the maladaptive behavior, the consequence believed to be punishing may actually have been reinforcing. For example, in the absence of a functional assessment, the SLP might have decided to “punish” the client’s chair-ramming behavior by using “time out” (i.e., removing the client from the room). However, if chair-ramming was motivated by the client’s desire to “go” (i.e., to leave the group), then being removed from the room would actually have functioned as reinforcement rather than as punishment. Under these circumstances, an increase in chair-ramming could be expected. While an understanding of behavioral principles does not, alone, insure errorless clinical management, a failure to appreciate these basic principles can lead to counterproductive results. The above examples, illustrating ineffective use of reinforcement and punishment, are not atypical in situations where information about behavioral principles is not available to the clinician. Operant Conditioning: Overcorrection A contingency classified as punishment which may be useful with adults who have aphasia (Goldfarb, 1982) is overcorrection (Azrin & Foxx, 1971; Foxx & Azrin, 1972; 1973). This process is based on the assumptions that undesired behavior can be reduced or eliminated by


58

requiring a person to (1) correct the environmental consequences of an inappropriate act (restitution) and to (2) practice overly correct forms of an appropriate related behavior (positive practice) (Foxx & Azrin,, 1972). The overcorrection procedure must be directly related to the undesired behavior or it may become arbitrary or punitive. It is also necessary that overcorrection be instituted immediately after the undesired behavior has occurred, thereby preventing its reinforcement. The overcorrection procedure should also be lengthy, preventing the client from engaging in other activities which may be reinforcing. Therefore, overcorrection may be considered a time-out period. Azrin and Foxx (1971) successfully reduced incontinence in nine profoundly developmentally delayed adults by 90%, employing an intensive training program which included an overcorrection procedure. Whenever incontinence occurred, the patient was required to clean all traces of accidents, wash the soiled clothing, shower, and obtain fresh clothing. Several procedures have been used in an attempt to eliminate self-stimulatory behavior in persons with developmental delay (DD) and autism spectrum disorders (ASD), but none has been successful in eliminating the behavior totally (Lovaas, Schaeffer, & Simmons, 1965; Mulhern & Baumeister, 1969). Foxx and Azrin (1973) compared overcorrection with 4 other procedures for eliminating the behavior of hand-mouthing. The other procedures included (1) physical punishment by a slap, (2) positive reinforcement for non-self-stimulatory behavior, (3) a distasteful solution painted on the hand, and (4) free reinforcement. Overcorrection was found to be the most effective method, reducing the frequency of hand-mouthing from over 100 per hour to zero per hour. A verbal warning was paired with the overcorrection procedure. When overcorrection was eliminated, the verbal warning alone was sufficient to maintain the desired behavior. Overcorrection procedures have been used to reduce or eliminate stealing by institutionalized adults with developmental delay (Azrin & Wesolowski, 1974) and to reduce or eliminate drooling and tongue thrusting by children with language-impairment (Goldfarb & Guglielmo, 1977). Similar procedures have been used to increase eye contact by children with ASD and children with DD (Foxx, 1977). Generalization of overcorrection procedures has also been studied (Epstein, Doke, Salwaj, Sorrell, & Rimmer, 1974; Rusch, Close, Hops, & Agosta, 1976).

Clinical aphasiologists routinely observe client behaviors which may be reduced by overcorrection. Some of these behaviors involve speech. For example, swearing, or the use of deistic or taboo words and phrases is common in aphasia following stroke and left hemispherectomy (Van Lancker & Cummings, 1999). Also common are stereotypies, such as saying “I come over there” in response to any question or using the phrase, “I don’t know” in the presence of word retrieval difficulty. Inappropriate responses are also observed while people with aphasia are reading. Specifically, visual half-field neglect (i.e., failure to read words on the right side of the page) often accompany right homonymous hemianopia. Further, inappropriate responses can be observed when people with aphasia are writing. Problems may occur in size, shape, and spacing of letters produced in non-dominant left-handed writing. Additionally, visual half-field neglect also occurs in writing. Finally, maladaptive behaviors may be produced secondary to emotional incontinence. For example, people with aphasia may wipe their eyes and nose on their sleeve. They may drool. They may experience dysphagia. They may demonstrate incomplete or inadequate grooming, toileting, or other self-care.

Positive practice extends time out from reinforcement, which is part of overcorrection. It may be used effectively in modifying an individual's requests for action or information.


59

Impairments in naming and word finding are characteristic of virtually all types of aphasia. This symptom is called “anomia” and it should not be confused with the syndrome of anomic aphasia. It is characterized by the use of generic terms (e.g., "The thing with the stuff over there.") in place of substantive words (e.g., “the flower pot”). There are also phonemic paraphasias, where the word or phrase produced is similar in sound to the target (e.g., "corned beef and garbage"), and semantic paraphasias, where the word or phrase is similar in meaning to the target (e.g., using “driving range” to mean “parking lot”). A therapy goal for individuals with these problems may be to reduce the use of generic terms or paraphasias. Positive practice may require the individual with aphasia (IWA) to identify semantic features of form and function for the target word or phrase before the communication partner (CP) complies with the request. Consider the following exchange:

IWA: Paperskate. CP: What do you do with it? IWA: Write your name. CP: What does it look like? IWA: Ink. Pencil--pen. CP: Here you are.

The positive practice repertoire may also include gesture and pantomime to reduce use of generic terms and paraphasias. Programmed Instruction: Melodic Intonation Therapy Evidence used to support the efficacy of treatment programs can be classified at three levels (U.S. Department of Health and Human Services, 1995). The first level of evidence (Level A) consists of the results of at least two randomized clinical trials (RCT), with good internal and external validity. The second level (Level B) involves evidence similar to Level A, but includes only a single RCT, or RCTs that only indirectly address the question of interest, or two or more non-randomized clinical trials. The third level (Level C), consists of data generated by a single non-RCT, by studies using historical controls, or by quasi-experimental controls such as pre- and post-treatment comparisons. It may also involve expert opinion in the form of a strong consensus (90% or more expert reviewers agree) or as simple consensus (75-89% of expert reviewers agree). According to the U. S. Department of Health and Human Services (1995), the best evidence level of support for any aphasia therapy is Research Evidence Level C, with expert opinion = consensus. Included among these therapies are traditional stimulus-response modality-specific treatments and drills. Examples include (1) the Language Oriented Treatment (Shewan & Bandur, 1982) protocol, where the language behavior of individuals with non-fluent or Broca's aphasia is cued with the initial phoneme of the target word; (2) direct stimulus-response treatment (Wertz, Collins, Weiss, et al., 1981; Wertz, Weiss, Aten, et al., 1986), where individuals with aphasia are asked to complete a highly associative open-ended sentence about activities of daily living (e.g., "You wash your hands with soap and _____"); and (3) Melodic Intonation Therapy (MIT) (Albert, Sparks, & Helm, 1973). MIT rests on Level C evidence (pre- and post-treatment comparisons) with simple consensus (75-89% of expert reviewers agree). Further research involving randomized clinical trials might improve the level of evidence supporting this treatment. Behavioral strategies lend themselves to evaluation at higher levels of evidence because of the data collection and the pre-/post-training evaluations that are necessary aspects of clinical procedures. They are also reinforcing for clinicians, who can examine schedules of reinforcement, criterion levels, and response data to determine whether or not treatment is effective. As a shaping and fading procedure, MIT qualifies as a behavioral approach.


60

Melodic Intonation Therapy (MIT) can increase the expressive abilities of some aphasic patients for whom other clinical approaches have failed (Sparks & Holland, 1976), particularly those with moderate non-fluent (Broca’s) aphasia, whose level of language comprehension exceeds their level of language production. It is a programmed approach, originally designed with two levels of increasing difficulty, each level consisting of several steps (Albert, et al., 1973.) Short phrases or sentences are embedded in simple melody patterns that are not recognized as songs. As patients progress through the program the melodic aspect is faded. First, the target utterance is intoned, so that “I am hungry,” a four-syllable phrase with emphasis on the third syllable (/h??/), is sung in musical notes as low, low, high, low. Next, the patient is instructed to employ speech-song or sprechgesang, similar to the “hammy” delivery of a bad Shakespearean actor, so that “I am hungry,” while not sung, will have longer vowel durations, greater amplitude displacements, and more pitch variation than normal speech. Finally, the phrase is trained, in several steps, to be produced with normal speech prosody. The technique was based on common observation of the ability of aphasic patients to sing the lyrics of well-known songs learned premorbidly. Following extended clinical trials, MIT was expanded to include three levels of increasing difficulty (Sparks & Holland, 1976). This three-level treatment was designed to be administered intensively, with daily therapy in individual and group settings for at least three months. Goldfarb and Bader (1979) proposed that MIT might also be successful when used as a combined clinic and home training program. In Level I, all sentences are intoned. The clinician holds the patient’s left hand, presumably recruiting the prosodic abilities in the unimpaired right hemisphere of the patient’s brain, and provides assisted hand-tapping to accompany each production of a target utterance. Level II introduces a series of back-ups for the five steps learned in Level I, as well as instituting 6-second delays between stimulus and response at Steps 4 and 5. In Level III, melodic intonation is gradually faded through sprechgesang to normal speech prosody, while hand-tapping is discontinued. As in Level II, the back-up and delay strategies apply. The Language of Sets” A Model for Treatment In mathematics, the intersection of two sets consists of the elements the sets have in common. Santo Pietro and Goldfarb (1995) used this concept to help plan treatment for adults with aphasia. The concept may be applied in both general and specific ways. As a specific example, assume that Patient A and the patient’s Clinician B are asked, independently, to list five goals of language rehabilitation most important for Patient A. Patient A identifies these goals as improving the ability to: (1) recite hymns and prayers in church; (2) state bids while playing bridge games; (3) retrieve names and relationships of family members; (4) verbalize activities of daily living; and (5) speak and understand conversational speech on the telephone. Clinician B identifies appropriate goals as improving the ability to: (3) retrieve names and relationships of family members; (4) verbalize activities of daily living; (5) speak and understand conversational speech on the telephone; (6) read and understand the newspaper; and (7) write legibly with the left hand. Clinician B can make more appropriate choices by examining these two sets of goals arithmetically. As presented above, Set A = {1,2,3,4,5} and Set B = {3,4,5,6,7}. The intersection of these two sets of goals is {3,4,5} or Set C. Expressed in words, the intersection of Set A and Set B is Set C. The symbol for intersection is n , read “cap.” In symbols, A n B = C,


61

or {1,2,3,4,5} n {3,4,5,6,7} = {3,4,5}. These three goals, {3,4,5} might be expected to elicit maximum motivation and cooperation between Patient A and Clinician B. As a general concept, aphasia treatments (Santo Pietro & Goldfarb, 1995) may be grouped according to the intersections in the Venn diagram illustrated in Figure 1, below:

The diagram represents a person with language impairment (P) communicating with a communication partner (CP) within an environment (E). None of the component sets should be treated independently of the others. The clinician who treats to deficit, or chooses to rebuild skills lost as a result of the neurological impairment, notes that the set representing impairment {I} is contained completely within the set of the patient {P}, who is contained completely within an environment ({E}. The set {I} also intersects the communication {C} between the patient {P} and the communication partner {CP} as well as the communication partner him/herself. Rebuilding language skills will affect the patient, the patient’s communication partner, the communication between them, and their shared environment. Similarly, {P}, {CP}, {C}, and {E} will have a direct effect on the level of impairment {I} as a function of treatment. Aphasia rehabilitation should not be confined to the circle representing {I}; it must address all the other intersections in the diagram. For example, it should treat to strength or that section of {C} which is unimpaired; repair communicative acts between patients and their communication partners; educate and support the partners; repair the communication-impaired environment to provide opportunities for communication; and treat the whole person to reduce psychosocial handicap. Goals based on the model of sets described above are best realized using operant conditioning and programmed instruction techniques. In programmed instruction there is a built-in system of individualized training. Small training steps permit individuals to move from one clinical task to another at different rates. The clinician programs treatment so that communicative responsibility is increasingly assigned to the client (Bollinger & Stout, 1976; Stocker & Goldfarb, 1995).


62

New Directions: Alternative-Augmentative Communication Members of our research group (Lavi, Goldfarb, & Arroyo, 2005) are currently engaged in an intensive study of a case of possible in-utero CVA. The child, a female now age 4, presents with problems similar to some observed in adults who have suffered CVA. For example, the child’s stroke affected auditory comprehension areas of the brain, leading to an early misdiagnosis of deafness. She does show evidence of hearing loss, but the problem seems to be more central than peripheral. Similarly, both auditory comprehension deficits and hearing loss co-exist in many older adults with thromboembolic strokes. Operant audiometry continues to be the focus of research in testing hearing of young children through localization (Primus, 1987) and visual reinforcement strategies (Thompson, et al., 1989). Speech-language pathologists and audiologists need to interact to facilitate conditioning of the aphasic patient for a complete audiological evaluation, as well as to determine which aspects of the disorder respond to amplification or language intervention. The child in our study did not have vocal language, but had been trained to use some American Sign Language symbols. Her frustration with limited communicative ability was evidenced by frequent tantrums. Giving her a communicative strategy through a Picture Exchange Communication System (PECS) (Bondy & Frost, 1998; Charlop-Christy, et al., 2002) permitted non-vocal language production. She progressed to learning alternative-augmentative communication (AAC) with DynaMyte (DynaVox Systems, Inc., Pittsburgh, PA, U.S.A.), a portable electronic communication device. (Note that the product name has changed to Dyna-Mo, as sales representatives were not allowed to board airplanes carrying DynaMyte.) The current focus of therapy is to use AAC to facilitate development of vocal language. There are many new communication board sets and such communication software as Boardmaker (Assistive Technology, Inc., Dedham, MA, U.S.A.), which are useful to supplement and substitute for vocal language efforts of aphasic adults. They are telephone- and modem-ready, using Windows XP Home Edition as an operating system. Recent research suggests efficacy of AAC devices, such as the word-based TalksBac system for adults with non-fluent aphasia (Waller, et al., 1998) and using aided and unaided AAC for adults with severe aphasia (Jacobs, et al., 2004). Ideally, AAC devices will be employed by clinicians well versed in theories and applications of operant conditioning and programmed instruction principles.

References

Albert, M., Sparks, R., & Helm, N., (1973). Melodic intonation therapy for aphasia. Archives of Neurology, 29, 130-131.

Azrin, N., & Foxx, R., (1971). A rapid method of toilet training the institutionally retarded.

Journal of Applied Behavior Analysis, 4, 89-99. Azrin, N., & Wesolowski, M., (1974). Theft reversal: an overcorrection procedure for

eliminating stealing by retarded persons. Journal of Applied Behavior Analysis, 7, 577-581.

Bastiaanse, R., Nijboer, S., & Taconis, M., (1993). The auditory language comprehension

programme: a description and case study. European Journal of Disorders of Communication, 28, 415-433.


63

Bollinger, R., & Stout, C. (1976). Response-contingent small-step treatment: Performance-based communication intervention. Journal of Speech and Hearing Disorders, 41, 40-51.

Bondy, A., & Frost, L., (1998). The picture exchange communication system. Seminars in

Speech and Language, 19, 373-388. Brookshire, R., (1968). Visual discrimination and response reversal learning by aphasic subjects.

Journal of Speech and Hearing Research, 11, 677-692. Brookshire, R., (1969). Probability learning by aphasic subjects. Journal of Speech and Hearing

Research, 12, 857-864. Charlop-Christy, M., Carpenter, M., Le, L., LeBlanc, L., & Kellet, K., (2002). Using the picture

exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35, 213-231.

Di Carlo, L., (1980). Language recovery in aphasia: Effect of systematic filmed programmed

instruction. Archives of Physical Medicine and Rehabilitation, 61, 41-44. Epstein, L, Doke, L., Salwaj., T., Sorrell, S., & Rimmer, B., (1974). Generality and side effects

of overcorrection. Journal of Applied Behavior Analysis, 7, 385-390. Foxx, R., (1977). Attention training: The use of overcorrection avoidance to increase the eye

contact of autistic and retarded children. Journal of Applied Behavior Analysis, 10, 489-499.

Foxx, R., & Azrin, N., (1972). Restitution: A method of eliminating aggressive-disruptive

behavior of retarded and brain damaged patients. Behavior Research and Therapy, 10, 15-27.

Foxx, R., & Azrin, N., (1973). The elimination of autistic self-stimulatory behavior by

overcorrection. Journal of Applied Behavior Analysis, 6, 1-15. Goldenberg, D.A., Hodges, K., Hershe, T., & Jinich, H., (1980). Biofeedback therapy for fecal

incontinence. American Journal of Gastroenterology, 74, 342-345. Goldfarb, R., (1981). Operant conditioning and programmed instruction in aphasia rehabilitation.

In R. Chapey (Ed.), Language intervention strategies in adult aphasia . Baltimore: Williams & Wilkins, 249-263.

Goldfarb, R., (1982). Considering the use of overcorrection procedures in aphasia rehabilitation.

AAO Exchange, 2, 13-17. Goldfarb, R., & Bader, E., (1979). Espousing melodic intonation therapy in aphasia

rehabilitation. International Journal of Rehabilitation Research, 2, 333-342. Goldfarb, R., & Guglielmo H., (1977). The efficacy of an overcorrection procedure in the

management of tongue thrust and drooling behavior. Exceptional Children Education Resources, 9 (abstract).


64

Goldfarb, R., & Scharf, E., (1980). The effect of time-altered stimulation on an aphasic adult’s clustering ability. Aphasia-Apraxia-Agnosia, 2, 1-14.

Holland, A., (1970). Case studies in aphasia rehabilitation using programmed instruction.

Journal of Speech and Hearing Disorders, 35, 377-390. Holland, A., & Harris, A. B., (1968). Aphasia rehabilitation using programmed instruction: an

intensive case history. In H. Sloane & B. MacAulay (Eds.), Operant procedures in remedial speech and language training. Boston: Houghton Mifflin, 197-216.

Jacobs, B., Drew, R., Ogletree, B., & Pierce, K., (2004). Augmentative and alternative

communication (AAC) for adults with severe aphasia: where we stand and how we can go further. Disability and Rehabilitation, 26, 21-22.

Keenan, J., (1966). A method for eliciting naming behavior from aphasic patients. Journal of

Speech and Hearing Disorders, 31, 261-266. Keith, R., & Darley, F., (1967). The use of a specific electric board in rehabilitation of the

aphasic patient. Journal of Speech and Hearing Disorders, 32, 148-153. Lavi, D., Goldfarb, R., & Arroyo, C., (2005). PECS to AAC: Case study of possible in-utero

CVA. Presentation to the American Speech-Language-Hearing Association, San Diego, CA.

Levey, S., & Goldfarb, R., (2003). Comprehension of indirect requests by persons with fluent

aphasia. Perceptual and Motor Skills, 96, 245-256. Lovaas, O.I., Schaeffer, B., & Simmons, J., (1965). Building social behavior in autistic children

by use of electric shock. Journal of Experimental Research in Personality , 1, 99-109. Mulhern, T., & Baumeister, A., (1969). An experimental attempt to reduce stereotypy by

reinforcement procedures. American Journal of Mental Deficiency, 74, 69-74. Primus, M.A., (1987). Response and reinforcement in operant audiometry. Journal of Speech

and Hearing Disorders, 52, 294-299. Rosenberg, B., & Edwards, A., (1965). An automated multiple response alternative training

program for use with aphasics. Journal of Speech and Hearing Research, 8, 615-619. Rusch, F., Close, D., Hops, H., & Agosta, J., (1976). Overcorrection: generalization and

maintenance. Journal of Applied Behavior Analysis, 9, 498. Santo Pietro, M. J., & Goldfarb, R., (1995). Techniques for aphasia rehabilitation generating

effective treatment (TARGET). Vero Beach, FL: The Speech Bin. Sarno, M., Silverman, M., & Sands, E., (1970). Speech therapy and language recovery in severe

aphasia. Journal of Speech and Hearing Research, 13, 607-623. Shewan, C., & Bandur, D., (1982). Treatment of aphasia: a language-oriented approach. San

Diego, CA: College-Hill.


65

Sparks, R., & Holland, A., (1976). Method: Melodic intonation therapy for aphasia. Journal of Speech and Hearing Disorders, 41, 287-297.

Stocker, B., & Goldfarb, R. (1995) The Stocker probe for fluency and language (3rd ed.) Vero

Beach, FL: The Speech Bin. Thompson, M., Thompson, G., & Vethivelu, S., (1989). A comparison of audiometric test

methods for 2-year-old children. Journal of Speech and Hearing Disorders, 54, 174-179. Tikofsky, R., & Reynolds, G., (1962). Preliminary study: Nonverbal learning and aphasia.

Journal of Speech and Hearing Research, 5, 133-143. Tikofsky, R., & Reynolds, G., (1963). Further studies of non-verbal learning and aphasia.

Journal of Speech and Hearing Research, 6, 329-337. U.S. Department of Health and Human Services, (1995). Post-stroke rehabilitation. Rockville,

MD: Agency for Health Care Policy and Research. Van Lancker, D., & Cummings, J.L., (1999). Expletives: Neurolinguistic and neuro-behavioral

perspectives on swearing. Brain Research Reviews, 31, 83-104. Waller, A., Dennis, F., Brodie, J., & Cairns, A., (1998). Evaluating the use of TalksBac, a

predictive communication device for nonfluent adults with aphasia.International Journal of Language and Communication Disorders, 33, 45-70.

Wertz, R. T., Collins, M. J., Weiss, D., Kurtzke, J. F., Friden, T., Brookshire, R. H., Pierce, J.,

Holtzapple, P., Hubbard, D., J., Porch, B. E., West, J. A., Davis, L., Matovitch, V., Morley, G. K., & Resurreccion, E., (1981). Veterans Administration cooperative study on aphasia: A comparison of individual and group treatment. Journal of Speech and Hearing Research, 24, 580-594.

Wertz, R. T., Weiss, D. G., Aten, J. L., Brookshire, R. H., Garcia -Bunuel, L., Holland, A.,

Kurtzke, J. F., LaPointe, L. L., Milianti, F. L., Brannegan, R., et al., (1986). Comparison of clinic, home, and deferred language treatment for aphasia: A Veterans Administration cooperative study. Archives of Neurology, 43, 653-658.

Author Contact Information: Dr. Robert Goldfarb, Chair One South Avenue PO Box 701 Garden City, NY 11530-0701 Phone: (516) 877-4785 E-mail: [email protected]


66

An Orton-based Operant Program for Auditory Language Learning Disorders

Leslie Dalton, Ph.D., CCC-SLP/ABA

President and CEO of Sonido Educational Software Products. Retired Professor, Valdosta State University, Valdosta, Georgia

Abstract This paper describes an Orton/Gillingham-based remedial program focusing on the temporal aspects of auditory language learning disorders. The program utilizes a Skinnerian operant paradigm which generates S-R data under strict psychophysical and psychoacoustical controls. Cumulative baseline recordings are generated and used to relate multiple -component (dichotic, diotic, ipsilateral, etc.) auditory stimuli to a listener’s discrimination and synthesis of complex speech. The Dichonics™ methodology isolates temporal aspects of phonemic synthesis, discrimination and awareness. Comorbidity of ADHD, CAPD, apraxia, aphasia, dyslexia and autism is discussed. Keywords: Orton, operant conditioning, language disorders, dichotic, temporal auditory, phonemic synthesis and discrimination, CAPD, ADHD, apraxia, dyslexia, autism; Dichonics

Introduction

It can be argued that the treatment of language disorders should follow a strict behavioral protocol regardless of the etiology of the disorder (e.g., aphasia, apraxia, autism, ADHD, CAPD, etc.). However, this is rarely observed in practice. For example, a recent internet survey revealed that 111 different therapies were being provided to children with autism, including an average of seven different treatments per child (Green, Pituch, Itchon, Choi, O'reilly & Sigafoos, 2005). Speech therapy was found to be the most common intervention, followed by visual therapy, sensory integration, and applied behavioral analysis. Other therapies included medication (52%), special diets (27%), and vitamin supplements (43%).

According to Green, et al, (2005), professionals should address the treatment processes and outcomes rather than focusing on causation. Consistent with Green et al’s recommendation, this paper presents an integrated multi-component paradigm for measuring and modifying the operant behavior of persons who (regardless of etiology) demonstrate depressed auditory language learning skills. Presented is a rigid operant (instrumental) program of the type described by B. F. Skinner (1938). Operant “conditioning” depends on growth and character of baseline as a measure of quantity and quality of a stimulus-based response paradigm. This article addresses both therapy and “diagnosis” in that a well-controlled therapy program builds a baseline of performance that reveals concise diagnostic information. In a good operant therapy paradigm, diagnosis goes hand-in-hand with therapy. Baseline acquisition, under strict behavioral control, is a measure of learning ability (or disability) and of how the stimulus delivery must be manipulated in order to overcome failure to achieve baseline with “normal” patterns. The strength of operant conditioning is the control that can be manifested via the tight one-at-a-time manipulation of ongoing behavior so that the acquisition curve reveals ongoing information about ability. Dalton, Allen, Henton & Taylor (1969) used a Skinner box and the behavioral method of conditioned suppression (CS) to establish auditory thresholds in monkeys being employed as subjects in the early space program. CS occurs when the subject is shaped to associate key pressing with positive


67

reinforcement but ceases to lever-press in the presence of a discernable stimulus (in our case sound). Dalton & Allen (1969) applied those same techniques to measure auditory thresholds in the adolescent rhesus monkey with induced cerebral palsy. In that study the response mode (lever) had to be especially adapted to participants with no subsequent effect on the audiogram. The thresholds were accurate, easily replicated and sensitive to medical changes as validated by post mortem examination. In an effort to establish an operant-controlled phonemic discrimination task for human application, Dalton (1979) expanded the single lever response key to determine listening preference of the rhesus monkey. Two major findings came from that study. First, the participants appeared to find a preference to what they listened to; and second, reinforcement was a combination of the listening choice and food. The results were generalized to surmise that the choice of sound became a primary reinforcer and reduced food to a secondary role. The application for behavioral therapy in learning disabilities (LD) became immediately obvious. Learning Disabilities have become a major educational problem that grows according to the number of specialist involved. Each specialty has its own unique name for a syndrome, which to another specialist might bear a different name. Dyslexia, specific language dysfunction, specific learning dysfunction, attention deficit hyperactive dysfunction (ADHD), minimal brain damage (MBD), central auditory processing deficit (CAPD), aphasia, hyperactivity, apraxia, autism, Asbergers’s syndrome, and pervasive development disability (PPD) are but a few of the labels placed on children who may be unable to thrive in a public school environment. Each specialty is likely to offer its own diagnostic methodology including educational, psychological, psychiatric, neurological, behavioral, nutritional, genetic, and others, resulting in long lists of “symptoms,” all describing the same set of kids. The problem lies in that each child with LD may present a different set of symptoms. These symptoms then become the point of focus, resulting in a referral to a specific specialty that will then label the child according to the practices of that specialty. Levy & Hyman (2005) stated that in no area of developmental pediatric practice does more controversy exist than in the choice of treatment for individuals with autistic spectrum disorders. Dalton, McKenzie, Kolosseus & Barry, B. (1992) noted that dichotically evoked auditory brainstem potentials for children labeled ADHD, CAPD, dyslexia, and others consisted of the same temporal discontinuity suggesting a common root problem. Lilienfeld (2005) notes that although there exist substantial scientifically supported treatments for childhood psychiatric (speaking of PPD) disorders, many of the most popular are based on weak or nonexistent data. Language is crucial for communication and socialization. It should be assessed systematically and uniformly before any diagnosis is made that involves language as a part of the syndrome. Responsibility for this assessment typically falls to the speech-language pathologist (SLP) and often in a school-based setting. As such, some SLPs may be influenced by the referral source, consequently designing a diagnostic and therapy plan around the labeled disorder (i.e. autism) rather than around the strengths and weaknesses of the child’s language system. Too often inadequate vision and hearing testing precedes a speech and language exam as well (Wray, Silove & Knott, 2005). In these cases, the observation of Levy & Hyman (2005) holds true. Consistent with the framework of evidence-based practice, Lilienfeld (2005) suggests that the challenge for the future is to develop scientific validity to the treatment of childhood disorders.

Method The Orton-Gillingham (O-G) approach to phonics is, by far, the most adhered to (if not revered) phonics program ever conceived. However, there is an almost religious attachment to the “original” methodology. Many clinics, individuals, groups, and organizations are dedicated to the process. A Yahoo search for “self-contained computer-generated Orton-Gillingham applications” yields 103,000 “hits” consisting of mostly advertisements with no detailed description of the techniques used except to reiterate the O-G philosophy and/or to offer services/products for sale along with praise via testimonials.


68

A similar Entrez-PubMed search found two articles. Higgins & Raskind (2004) used computer software to present a speech recognition-based Program. No comparison to the classic O-G delivery system was made. One study, Guyer & Sabatino (1989), placed college students with LD on a “modified” O-G program and compared their progress to those exposed to a nonphonetic approach. Pre/post-test results were based on standardized tests such as the Wide Range Achievement Test-Revised and Woodcock Reading Mastery Tests. The O-G group was found to achieve statistically significant improvement in reading when compared to the group using the nonphonetic approach (or nothing). This study indicates that a modified O-G approach is useful in the teaching of reading to college students with LD. Oakland, Black, Stanford, Nussbaum & Balise (1998) conducted the only study that systematically compared face-to-face therapy with that provided artificially. They used the O-G methods and reported that students displaying dyslexia demonstrated significantly higher reading recognition and comprehension than a control group, even when presented by videotape. Dalton & Kolosseus (1983, unpublished data) compared a computerized Orton-based program to therapy provided by a tutor in a traditional O-G setting and found the instrumental program to be better received by the students and to result in more rapid changes in phonemic performance.

The O-G procedure is preformed using a deck of picture cards (available from many sources) for the visual stimulus and the voice of the tutor as the auditory carrier. Sounds are introduced systematically beginning with a vowel and several consonants such as ”ae” (as in “apple”), /p/, /s/, /f/, /m/ and /t/. The teacher produces the sounds in isolation while pointing to the card with a picture of an object whose name involves the target vowel sound. Next, the consonants are blended with the vowel. Additionally, the child imitates the model produced by the teacher and points to the picture. This is expanded letter-by-letter and sound-by-sound, until full blending takes place. All the time, the student is writing the letters and learning to blend them into words (Orton 1964).

Dalton & Cooper (1973) (see Dalton & Kolosseus, 1983) used that approach as a guide to a

computerized operant program (written in DOS 2) called Phonemic Gobble (PG). The stimulus phoneme (SP) was presented by the therapist (or produced by the student) with the computer keyboard serving as the response “lever.” Since the keyboard also served as the tactile interface the home keys (/f/ and /j/) were introduced first. Once baseline for the home keys was met, the Orton (1964) sequence was begun with special monitoring to ensure that the student used proper fingering on the keyboard. New SPs were added as baseline improved. Following a period of drill with the SP, a Pac Man-like game was introduced with the current SP (and home keys) being placed on a full screen X-Y matrix. The computer cursor moved in a straight line (the only choice at that time) until the student altered directions using the keypad arrows. Hazards were placed on the grid that would end the game if not detected by the student. Additionally, some letters were given the role of “bad guy” while others were “good guys.” For example, /b/ was a “bomb” that ended the game and /p/ was power that allowed temporary immunity from “bad guys.” The vowels were programmed to “jump” out of the way of the cursor thus always avoiding capture. The letters were paired according to usage reversal tendencies (/b/, /p/, /q/, /d/, etc.). Dalton and French (2002) obtained a trademark for a program called Dichonics™ more fitted to the rapidly changing computer technology.

The Stimuli

Spatial and Temporal Factors

The O-G program is one-dimensional. Dichonics addresses the role of temporal integration into the therapy while using the O-G approach as a linear template. The nature of temporal theory is far too complex to detail here, but, since it is integral to the Dichonics program, a brief discussion is presented.


69

The auditory neural system is interactive with each side contributing invaluably, and sometimes exclusively, to the other (Stecker & Hafter ,2000). Disturbing the dichotic interaction results in central auditory processing discontinuity, which interrupts the sensory integration systems involved with language acquisition and usage.1 Liegeois-Chauvel, de Graaf, Laguitton & Chauvel (1999) noted that speech perception requires cortical mechanisms capable of analyzing and encoding successive spectral (frequency) changes in the acoustic signal. A defect of this mechanism could account for hearing discrimination impairments associated with language disorders. Dalton (1971) and Boehm and Dalton (1971) described a non-linguistic stimulus (minimal auditory intensity differential, MAID) useful in the differential diagnosis of cochlear/retrocochlear hearing loss. Subsequent research placed the MAID stimulus in an adjustable dichotic arrangement (virtual image analysis, VIA) with the ability of leading (or lagging) one ear over the other in steps as small as eight microseconds. If there is no time delay between ears (diotic) the click will appear to be slightly off-center in about 80% of listeners. If the delay is changed one ear over the other, the stimulus will appear to move to the center, or further away from center depending on cerebral dominance. The wider the time gap the farther away from center the stimulus appears until, ultimately (about 1200microsec), the stimulus is perceived as being in a single ear only. Using participants at-hand, a modified method of adjustment was used to have the listeners adjust the time differential until the click appeared to be in the middle of their head. The outcome revealed that “normal” right handed listeners indicated a position slightly toward the right ear for center while left handed listeners placed the stimulus just the opposite.2 Extensive subsequent studies (Dalton & Kolosseus, 1996, 1995, 1991, 1986,1982, 1981; Dalton, McKenzie, Kolosseus & Barry, 1992 and Dalton and Cooper, 1985) showed the VIA to be useful as the stimulus for both behavioral and electrophysiological diagnostic procedures, and it is an important part of the Dichonics program.

Tallal and Stark (1981) used operant methodology to investigate discrimination of various

temporal and spectral cues. That near-classic study progressed into a study by Tallal, Merzenich, Miller and Jenkins (1998) that revealed that timing cues present in the acoustic waveform of speech provide critical information for the recognition and segmentation of the ongoing speech signal. They devised a therapy that depended on the reduction of temporal integration thresholds via a computer algorithm that expanded and enhanced the brief, rapidly changing acoustic segments within ongoing synthesized speech and used this to provide intensive speech and language training exercises. Oades (1998) discussee the importance of cross-hemispheric dialog with information supplied by the contralateral system. The presence of visual correlates in linguistic processing (Elias, Bulman-Fleming & McManus, 1999) offers additional evidence supporting the bottom-up influence on central processes as well as the use of one modality to strengthen another. They showed that low-level temporal asymmetries are related to asymmetries in linguistic processing using the Fused Dichotic Words Test and the Visual Inspection-time test. Spinelli and Mecacci (1990) provided information linking hemispheric asymmetry and pattern reversal visual-evoked potentials. They reported that eye dominance appeared to play a role in determining hemispheric asymmetry. Dalton, et al (1992) presented preliminary electrophysiological data on a population of children with LD plus ADHD, CAPD, dyslexia, and autism. Findings revealed abnormal auditory brainstem evoked responses (BSER) to a unique dichotic stimulus called Virtual Image Analysis (VIA) (Dalton and Cooper, 1985, United States Patent #4,5560601985) expanded the clinically

1 Spatial and temporal summation is a cross-modality phenomenon and is not particularly intensity sensitive. When two or more subthreshold stimuli of differing modalities are applied simultaneously, or within a short period, a neural response may occur. This information was available at the time Orton (1936) was introducing his multimodality therapy concept. A paper focusing on modality interaction (Dalton, in prep) will look at stimulus effects on clinical electrophysiological responses in LD children and the possible implications in comorbidity theory. 2 This relationship appears to change when measuring the stimulus effects electrophysiologically. In a behavioral response the Ss will point to the left side of midline when evoked potentials reveal more robust right activity. This would tend to confirm dominance for auditory processing (Dalton, et al, 1992).


70

established brainstem evoked response paradigm by adding a third dimension to the results. With standard BSER the results depend on the amplitude and latency of a series of waves evoked by a unilateral auditory click. In dichotic evoked BSER (VIA) the stimulus consists of two identical BSER clicks (Dalton, et al, 1985) manipulated in the time domain so that precise time/phase changes challenge the dichotic interaction of the auditory system. The results show a relationship between the wave latencies and amplitude to the lead/lag of the VIA dichotic stimulus. Auditory Intensity Calibration

There are several reasons for careful control of the auditory output of the CD ROM. One obvious

reason has to do with listener comparison (inter and intra). A basic rule of data collection should always be consistency of stimulus parameters. A second more exotic problem relates to over-amplification that may cause discrimination “rollover.” Rollover is seen in retrocochlear and/or central hearing problems and is manifested as a reduction in word discrimination ability as intensity is increased (Jerger & Hayes, 1977). Spatial and Temporal Summation, as previously discussed, are not bilaterally equal. The auditory pathway consists of many areas that have unique chores some dealing with loudness, others time or phase, while others look for specific frequencies all to be integrated at the central level into meaningful symbols of language. Since loss of word discrimination (intrinsic and extrinsic) is an integral part of central language dysfunction it is imperative to reduce any element that might add to the loss. Calibration assures inter-subject stimulus accuracy while at the same time reduces the possibility that rollover may be a factor in inter-session accuracy for a single participant. Dichonics provides two calibration options: I. Biologic: sets the loudness (a subjective human judgment) to a comfortable level for a “normal” listener and II. Electroacoustic: sets the intensity objective relating to a physical measure of volts or sound pressure level (SPL).

Biological Calibration (BC): The default option is called biological because the loudness (as

opposed to intensity) is subjectively judged to be at a comfortable level by a person with normal hearing. The BC can also be done using several listeners with the final calibration being a best fit of those listeners. BC is satisfactory for home use and individual use in schools where multiple computers might be used. This calibration level is then stored within the program and automatically sets the soundcard at that level every time the program is loaded. Hence, intersession or intersubject stimulation loudness remains constant.

Electronic Calibration Meter (Electroacoustic): When data are to be compared in any way, such

as with a control group, or to a “normal” population, then the second calibration method, is advised. Here an electronic comparator (Dalton & French, 2002), set to a fixed intensity, automatically adjusts the soundcard of any computer to a known, and constant, stimulus level delivered to the earphones. A single calibration tone (1kHz) is delivered via the PC soundcard to the meter that compares the intensity of the soundcard output to a known voltage in the meter. When the two voltages are equal the calibration level is stored within the program and automatically sets the soundcard at that level every time the program is loaded.3 The Speech Stimulus

3 Matched sets of earphones and the comparator were offered with the first issue of Dichonics and, unfortunately, most potential users rejected the need for such specific calibration. Even the necessity of matched earphones was ignored; some used speakers and complained that the program was not working.


71

The speech stimuli in Dichonics are never changed as to loudness or structure of the basic stimulus. Any modification is caused by changing the relationship of one ear over the other or by masking the constant stimulus. Therefore, the live speech recorded on the CD-ROM is constant in production and loudness. A female speaker of General American English with a contralto voice delivered live speech via microphone directly into speech processing software contained within the computer. The initial readings were monitored by a volume units (VU) meter and later normalized to be within a set range of loudness prior to calibration. Masking noises were spectrographically selected as pink, brown and white noise. All intensity levels were under computer control.

The VIA is a non-speech stimulus. It too, is set at a fixed intensity that remains unchanged

throughout. The only changing parameter is the time of arrival of each stimulus to the ears. Psychophysics (S-R)

Most educational/therapeutic programs measure progress using pre/post testing that do not

account for other uncontrolled influences such as readiness, supplemental training and, other intervening educational or non-educational factors. Operant conditioning measures the immediate present-response to a stimulus and compares it to the immediate-past response. A cumulative recording plots progress according to quickness and correctness (rate and accuracy) of the response. The building of a baseline depends on “shaping” incorrect or random behaviors into the desired and well-defined immediate acquisition curves reflected by the cumulative recording (baseline) all the while providing reinforcement for “correct” responses and repeat stimulation for incorrect responses.

The design of an instrumental conditioning program must carefully consider the nature and role

of the two major components—stimulus and response (S-R). Learning has not necessarily taken place when the startle reflex is triggered in a newborn to a loud sound. However, when the child begins to look toward that sound then learning has commenced. Later, the child can be taught to raise a hand in the presence of that same loud sound. Here the simple sound/response relationship ends. To proceed beyond this normally, cognition must convert complex sensory information into learned behavior. For this to happen, the individuals must have a viable peripheral sensory system (hearing, vision, touch, smell), an intact neurological system (cranial nerves, brainstem, etc.) to transmit, receive and process the external stimuli, and cognitive power to convert the neural information into meaning leading to a decision followed by an appropriate response. Whether all of these involved steps are occurring is revealed by baseline acquisition.

Therefore, five necessary components of the S-R design must be considered, including (1) the

cognitive level of the participant (entering behavior), (2) the sensory integrity of the participant, (3) the nature of the stimulus, (4) the method of the stimulus delivery, and (5) the method of responding. These five components are inextricability entwined but can be individually modified to allow progress in other areas. Figure one shows the flow chart of the Dichonics program.

FIGURE 1, NEXT PAGE


72

The program automatically determines the route to be followed using progress information

provided by baseline acquisition. It is the role of the therapist to carry out any shaping necessary to develop usage of the mouse or keyboard. The producers of the Dichonics program have also developed a series of companion CD-ROM therapies that are specifically designed for special functions. For example, a mouse-usage shaping program that is particularly useful with students who have autism begins with the presentation of a single door on the computer screen. The mouse must be positioned on the door and left there for the door to open in order for an animation to appear. The door then closes automatically, after which the mouse must be removed so that the task can be repeated. No “mouse clicks” are required at this stage. The program then progresses to two doors and then four doors until finally the left button of the mouse must be clicked to manually cause the doors to open. The pictures behind the doors begin with animals making their unique sounds. The students usually produce the sounds without prompting. Two


73

critical problems can occur, including superstitious behavior and perseveration. These must be carefully shaped-out by the therapist (Dalton, 1969). An example of superstitious behavior was observed in the case of a student with autism. This student circled the screen with the mouse before placing it on the door. Perseveration occurs when a student follows the exact pattern on every attempt to the extent that the introduction of new material becomes impossible.

Sample Data

Table 1 (below) shows the results from the Probe section of Dichonics for a single school

population of students who had been qualified for language therapy by an SLP. Of the 21 students, 16 were right handed (RH), four were left handed (LH), and one showed no dominance preference. Of the 16 RH students, nine yielded right dominant VIA scores. All of the LH students scored right dominant VIA scores. Two students (LB & BG, both RH) scored 100% on Word Discrimination (WD) and Phonemic Inventory (PI). LB scored high normal on MEM, and BG scored low normal.

Fig 2 shows the baseline (BL) acquisition curve for the Table 1 population. The horizontal line in

the Response Time panel is the mean response for students LB and BG.

FIGURE 2, NEXT PAGE


74

Figure 3 is a screen shot4 of the progress display for a “typical” student. Note that this student has

received three awards and has 20 points toward another. The SLP in this situation has a “Store” where the certificates could be used as money to buy any number of items from toys to school supplies.

Student EY is a 9 year old diagnosed5 with autism. His shaping occurred over a four-week period

with three attempts at introduction before BL began to take hold. Figure 4 reveals severe phonemic

4 A screen shot is an actual pictorial of the computer display representing stored data on the hard drive. A computer generated graphic from actual data collected from the therapy process 5 The term “diagnosis” is used here to express an existing condition determined by a licensed or certified specialist other than this writer or the SLP providing services. The student was qualified for therapy by an IEP committee including an SLP and educational psychologist.


75

problems. He scored 100% on phonemes occurring at the beginning of words and recognized none in the final position. Some progress began to show with the middle position being at 100% for the forth set of trials. The Response time was slow but within tolerance range. Figure 5 is BL progress for EY.

Figures 6, 7 and 8 show Dichonics data for Ashtin, a 6th grader, who had been qualified for language therapy with a diagnosis of Apraxia.


76


77

-----Insert Figures 6, 7 and 8 about here-----

Ashtin is an outgoing young lady who loves therapy. Her language skills belie her therapy data. She has progressed only to lesson two (all short vowels plus /p/ and /b/) at the 80% accuracy level. Her responses are erratic in all regards except for response time on Phonemic Memory. Phoneme Inventory shows no systematic understanding of initial, medial or final positioning. Figure 9 is a sample of Ashton’s writing.

Because of the failure to adapt to the BL activity, Ashtin was placed on the Dichonics Language Explorer Series, Nouns K-2nd Grade, and the Dichonics auditory-visual articulation (AVA) program. AVA uses real-time spectrographic analysis that allows the student to compare his/her sound production intra or inter subject. In Ashtin’s case, a side-by-side classmate was used for comparison of production. Also,


78

Ashtin wrote out every auditory stimulus or production. Ashtin’s experience is an example of how some programs seem to not work as designed. However, the BL paradigm in Dichonics does reveal hard data points of entry into future therapy and does, as suggested, provide a descriptive diagnosis that helps define a complex child.

Discussion Dichonics has its drawbacks particularly in the educational environment. First, educators prefer numbers that can be plugged into a formula that yields a range of data compared to a normal population. Dichonics is not normed for that purpose. Second, in IEP language, it is difficult to make a statement as to where a student is going to be at any given point in the future (e.g., Jane will be at lesson 3 by Christmas) since the Dichonics data are generated, not subjectively determined. Third, some therapists and parents are impatient. They want a quick fix or the promise of one; and they are unwilling to take part in the shaping process. A forth drawback is that Dichonics breaks with tradition; and, like any such program, it is viewed with skepticism. Finally, Dichonics is based on behavioral principles and it is subject to the fallout from the “behavioral controls” bad rap of several years ago.

Future

Dichonics is now under major revision. The first change is to address the more recent strong evidence that auditory problems are a factor of temporality. While the O-G therapy will continue as the template, the major emphasis will be on the “optimal listening condition” (OCD) rather than simple recognition. Extensive dichotic positioning will find BL for various temporal conditions and drill will look for BL improvement using the “best condition” performance.

A second major modification in Dichonics has to do with the continued rapid change in software development platforms. The predecessor to Dichonics (Dalton and Cooper, 1973) was written in DOS 2; subsequent versions were written in every Windows version produced from that basic platform. Because of the extensive automation of the Dichonics program, small changes in Windows mean severe changes in Dichonics. The original goal of Dichonics was to turn all (or at least most) of the decision processes over to the computer leaving the details as to when to move-on as a program function. The revised program will advise the user when to make changes but will not make them automatically. This has advantages in that it will allow far more options to be employed branching out to other specific drill not provided on the current disc.

References

Boehm, J.A. & Dalton, L.W. (1972) Electronic design of a test device to implement the MAID stimulus. Journal of the Acoustical Society of America, 51, 816-19.

Dalton, L.W. & French, B. (2002) Calibration and security device for PC auditory programs. United

States Patent # 6,654,652. Dalton, L.W. and Kolosseus, J.E. (1996) Multi-channel brain mapping to a unique auditory stimulus.

American Auditory Society, Salt Lake City, UT Dalton, L.W. & Kolosseus, J.E. (1995) BAER latency delays dependency to a non-speech dichotic

stimulus. American Auditory Society. Dallas, TX


79

Dalton, L.W., McKenzie, R.A, Kolosseus, J. E. & Barry, B. (1992) screening for central auditory dysfunction. Joint Session of Otolaryngology and Pediatrics, Southern Medical Association Scientific Conference, San Antonio, TX

Dalton, L.W. & Kolosseus, J.E. (1991) Dichotic auditory virtual image analysis: a non-linguistic central

processing test. International Symposium on Screening Children for Auditory Function. Vanderbilt University, Nashville, TN

Dalton, L.W. & Kolosseus, J.E. (1986) Cerebral dominance and dichotic listening. Pediatric Audiology

Up-date, Newport RI Dalton, L.W. & Cooper, W.C. (1985) Method and apparatus for measuring differential auditory system,

United States Patent #4,556060 Dalton, L.W. & Kolosseus, J.E. (1982) Virtual image perception as a technique for early identification of

learning disabilities. AACLD-CE Conference, Albuquerque, NM Dalton, L.W. & Kolosseus, J.E. (1981) The virtual image analysis (VIA) as a technique for measuring

dyslexia. The American Speech & Hearing Association, Colorado Springs, CO. Dalton, L.W. (1979) Listening preference in the rhesus monkey. The American Speech & Hearing

Association, Atlanta, GA Dalton, L.W. & Cooper, W.C. (1973) Phonemic Gobble. Copyright 1973. Dalton, L.W. An operant procedure for neonatal hearing testing. The American Speech & Hearing

Association, Chicago, IL, November 1971. Dalton, L.W. & Allen, J.A. (1969) A VI schedule for stimulus presentation in evoked response

audiometry for monkeys. The American Speech & Hearing Association, Chicago, IL Dalton, L.W., Allen, J.A., Henton, W. & Taylor, H. (1969) Auditory thresholds is the rhesus monkey

using a closed system helmet. Journal of Auditory Research. 9,178 Dalton, L.W. (1967) Operant conditioning as reflected in the conditioned suppression paradigm; a

primate-working model. Scientific Exhibit, The American Speech & Hearing Association, Chicago, IL

Elias, L.J., Bulman-Fleming, M.B. & McManus, I.C. (1999). Visual temporal asymmetries are related to

asymmetries in linguistic perception. Neuropsychologia . 37, 1243-9. Green, V.A., Pituch K.A., Itchon, J., Choi, A., O'reilly, M. & Sigafoos, J. (2005) Internet survey of

treatments used by parents of children with autism. Research in Developmental Disabilities. Guyer, B.P. & Sabatino, D. (1989) The effectiveness of a multisensory alphabetic phonetic approach with

college students who are learning disabled. Journal of Learning Disabilities. Aug-Sep; 22(7): 430-4.

Higgins, E.L. & Raskind, M.H. (2004) Speech recognition-based and automaticity programs to help

students with severe reading and spelling problems. Annals of Dyslexia . Dec; 54(2): 365-92.


80

Jerger, J. & Hayes, D. (1977) Diagnostic speech audiometry. Arch chives of Otolaryngology. Apr; 103(4): 216-22

Levy, S.E. & Hyman S.L. (2005) Novel treatments for autistic spectrum disorders. Mental Retardation

and Developmental Disabilities Research Review. 11(2): 131-42 Liegeois-Chauvel, C., de Graaf, J.B., Laguitton, V. & Chauvel, P. (1999) Specialization of left auditory

cortex for speech perception in man depends on temporal coding. Cerebral Cortex. Jul-Aug; 9(5): 484-96.

Lilienfeld, S.O. (2005) Scientifically unsupported and supported interventions for childhood

psychopathology: a summary. Pediatrics. Mar; 115(3): 761-4. Oakland, T., Black, J.L, Stanford, G., Nussbaum, N.L. & Balise, R.R. (1998) An evaluation of the

dyslexia training program: a multisensory method for promoting reading in students with reading disabilities. Journal of Learning Disabilities. Mar-Apr; 31(2): 140-7.

Oates, R.D. (1998). Frontal, temporal and liberalized brain function in children with attention-deficit

hyperactivity disorder; a psychophysiological and neuropsychological viewpoint on development. Behavioral Brain Research. 94, 83-95.

Orton, J.L. (1965) A guide to teaching phonics. Educators Publishing Service, 75 Moulton St.,

Cambridge, MA Skinner, B. F. (1938) The behavior of organisms. Annals of experimental analysis of behavior, New

York, Appleton Century Crofts. Stecker, G.C. & Hafter, E.R. (2000). An effect of temporal asymmetry on loudness. Journal of Acoustical

Society of America. 107, 3358-68. Spinelli, D. & Mecacci, L. (1999). Handedness and hemispheric asymmetry of pattern reversal visual-

evoked potentials. Brain and Cognition. 13, 193-201. Tallal, P., Merzenich, M., Miller, S. & Jenkins, W. (1998) Language learning impairment: integrating

research and remediation. Scandanavian Journal of Psychology. Sep; 39(3): 197-9. Tallal, P. & Stark, R.E. (1981) Speech acoustic -cue discrimination abilities of normally developing and

language-impaired children. Journal of the Acoustical Society of America. Feb; 69(2): 568-74. Wray, J, Silove N, & Knott H. (2005) Language disorders and autism. Medical Journal of Australia . Apr

4; 182(7): 354-60. Author contact information: Leslie Dalton, Ph.D., CCC-SLP/A RR 1, Box 537 Ava, MO 65608 (417) 683-4553 E-mail: [email protected]


81

Validation of the Verbal Behavior Package: Old Wine New Bottle- A reply to Carr & Firth (2005)

Joseph Cautilli, Ph.D. St. Joseph’s University

Abstract

A recent commentary by Carr and Firth (2005) called for case studies and controlled longitudinal research to validate the verbal behavior (VB) approach to early intensive behavioral intervention for children with autism and related developmental disabilities. They contrasted the verbal behavior (VB) approach (Sundberg & Partington, 1998) with the Lovaas approach (Lovaas, 1987) by highlighting two unique features of the VB approach, including (1) its reliance on Skinner’s (1957) functional analysis of language and (2) its use of natural environment training (NET) to target language. The current paper notes that neither of these features (functional language training or NET) is new to specialists in language intervention. More than 35 years of research from the fields of speech-language pathology and behavior analysis supports these practices. While validation is clearly needed to support the VB package as a whole, practitioners do have a rich history of literature to support the individual strategies within the package. Keywords: behavior analysis, verbal behavior, early intervention, language disabled populations, and autism

Introduction

Gilbert (1996) described a fundamental tension between scientists and engineers. He characterized scientists as humble individuals who focus on how little is known while portraying engineers as bolder spirits who argue that much is known while little is applied. This contrast comes to mind when reading Carr and Firth’s (2005) interesting commentary on the need for research to validate the verbal behavior1 (VB) approach to early intensive behavioral intervention (EIBI) for children with autism spectrum disorders (ASD) and other developmental disabilities (DD) (Sundberg & Partington, 1987). The need for treatment efficacy research cannot be denied in the interest of science and in a climate of evidence-based practice; however, it also bears mentioning that the VB model rests on a considerable history of practice and research. The purpose of this paper is to support and complement the observations of Carr and Firth (2005) by summarizing the theoretical and empirical literature pertaining to selected components of the VB model with emphasis on those pertaining to natural environmental training (NET).

Carr and Firth (2005) noted, appropriately, that support for the VB approach currently exists primarily in the form of studies on the training of single verbal operants to individuals with and without language disorders; and they noted the dearth of controlled, longitudinal outcome studies to assess the effectiveness of the VB program as a package. In considering the design of studies to address this need, perhaps of greatest interest would be an empirical study to determine whether the VB approach, if provided early in life, could significantly alter the course of a child’s development as s/he approached elementary school (similar to the study conducted by Warren, & Kaiser, 1986b). For a global intervention program to make this claim, the empirical evidence would need to meet the American Psychological Association’s criteria for a “well-established treatment.” Specifically, the evidence would

1 The VB approach is a well designed curriculum that (1) uses Skinner’s (1957) system of verbal classification (2) uses balanced teaching of both natural environment and discrete trial teaching methods to teach the items of the verbal classification system (see Sundberg & Partington, 1998)


82

need to include either (1) two randomized, controlled, group designs or (2) nine well-controlled single subject designs (Chamberless & Hollon, 1998).

The type of evidence currently available to support global ABA programs (e.g., discrete trial, VB) was recently reviewed by Brandsma and Hertbert (2001). These authors found that none of the current research meets the APA standard for demonstrating that exposure to the treatment could change the developmental course of the participants. Since empirical support for global EIBI programs does not yet meet the APA standard of empirical support, it is appropriate and ethical to look at evidence supporting the sub-components of global treatment packages. Therefore, this paper will examine the level of evidence supporting components of the VB package with particular emphasis on the milieu language-training component.

Historical Applications of Skinner’s Verbal Behavior Functions

Guess, Sailor and Baer made one of the earliest references to Skinner’s verbal operants in the language intervention literature in 1978. They noted that, “In 1957, B.F. Skinner asserted systematically and in detail that language might be a system of behavior, similar to other systems of behavior in its function…” (p 103). They also referred to “…several dozen [programs] in existence [based on Skinner’s approach]. Most of .. [which]…are intended to accomplish some major part of what may be imagined to be the total problem of language acquisition and usage by retarded children.” (p. 104). Clearly, programs designed around the functional features of verbal behavior have existed since at least the 1970s.

Not only were language intervention programs in the 1970s based on Skinner’s model, but they

addressed a number of the same specific functions (e.g., manding, tacting) as the current VB package. For example, in their description of milieu language training, Hart and Rodgers-Warren (1978) noted the importance of (1) arranging the environment; (2) assessing functional language; (3) defining the role of the milieu teacher; (4) building rate; (5) encouraging the use of language for requesting; and (6) encouraging the use of language for commenting. Note that their definitions of requesting and commenting were functionally equivalent to the mand and tact. Further, this section of their paper is approximately 18 pages in length, including seven pages about requesting and two pages about commenting. Thus targeting children’s use of language to request (manding) or comment (tacting) is not new to language intervention specialists; and these strategies were applied in programs for children with a wide range of DD including children with autism (e.g., Hancock and Kasier, 2002).

Use of Natural Environment Training (NET) Procedures Sundberg and Partington (1998) noted that the NET component of VB is based on three previously established frameworks: (1) the natural Language Paradigm (Koegel et al. 1987), (2) incidental teaching (Hart and Risley, 1975) and (3) the expanded program of milieu language training (Hart & Rogers-Warren, 1978). Evidence supporting these approaches is relevant to our discussion. To complement Carr and Firth’s (2005) statement about the availability of research to support verbal operants, the information below summarizes evidence for the milieu language approach and its components, which include incidental teaching, time delay, and mand-model. Milieu teaching within the context of other intervention approaches: To place the milieu approach within a therapeutic context, it helps to differentiate between three general approaches to language intervention, including adult-directed, child-led, and hybrid (Fey, 1986). Adult-directed techniques are characterized by the adult’s control over all aspects of the intervention program. The adult


83

chooses the target skills, the training context, the instructional materials, the number of response opportunities, and the reinforcement procedures. Discrete trial instruction is an example. Research shows that adult-directed approaches provide the highest density of response opportunities per unit of time (Paul, 2001) and are highly effective for establishing new skills within a learner’s repertoire. However, generalization will not occur spontaneously and must be planned as a follow-up training procedure. Child-led procedures are at the other extreme of the intervention continuum. The context, targets, frequency of response opportunities, and nature of reinforcement are dependent on the child’s spontaneous initiatives. Reactive language stimulation is an example. The child produces an utterance spontaneously in context (e.g., saying “that doggie” while looking at a dog). The caregiver reacts by expanding, extending, recasting, or otherwise acknowledging the child’s expressed meaning in a form that is slightly more advanced than the child’s original utterance (e.g., “Yes, that’s a dog!”). While this approach has been shown to stimulate the general growth and use of language, it cannot be used to target specific features of language systematically. Moreover, it is entirely dependent on a child’s spontaneous interest in developmentally appropriate objects and activities (Fey, 1986). Hybrid procedures represent a midpoint between adult-directed and child-oriented approaches. The teacher selects specific features of language to teach, sets up the natural environment in a way to establish motivation for the child to use those features of language (without specifically being asked to do so), and provides meaningful consequences (including social reinforcement) when the child produces the target utterance. Hybrid approaches combine the best features of adult-directed and child-oriented procedures; and milieu teaching is an example (Fey, 1986). The milieu-teaching package combines individual components of incidental teaching, time delay, and the mand-model procedure. These strategies have been used successfully to support children’s use of spontaneous language in the natural environment (Hart & Rogers-Warren, 1978; Alpert & Kaiser, 1992). Hart and Rogers-Warren (1978) coined the term “milieu language training” to reflect, in part, the multiple prompting procedures being used. Kaiser (1993) defined milieu language teaching as "a naturalistic, conversation-based teaching procedure in which the child's interest in the environment is used as a basis for eliciting elaborated child communicative responses" (p. 77). Increasingly, the milieu language approach has been viewed as the treatment of choice for children with disabilities or children at risk (Noonan & McCormick, 1993; Tannock & Girolametto, 1992). Milieu teaching as the treatment of choice: There are several reasons why the milieu treatment package has surfaced as the treatment of choice. First, evidence suggests that conversation-based strategies generate slightly higher levels of child interest and fewer negative child reactions than discrete trial instruction (Haley, Camarata, & Nelson, 1994). Haley and colleagues (1994) argued that if a child finds a procedure even mildly aversive, this could hinder his or her progress. At the other extreme, there are questions as to whether conversation- based approaches that are exclusively child-led could alone create a large enough number of response opportunities to help children with more severe language learning needs. As indicated above, the combination of naturalistic and adult-directed features in milieu language training represent a middle ground between these extreme adult-directed and child-led approaches (Fey, 1986). Second, milieu language teaching, unlike discrete trial instruction, appears to increase spontaneous speech and generalization. Milieu teaching is less tied to specific antecedents, which also makes it less susceptible to fostering prompt dependency. The natural context is arranged to motivate particular responses but not to specifically demand them; and target responses are reinforced whenever they occur. When prompting strategies are employed, they usually follow the least-to-most sequence (Hart, 1985; Cautilli, Hancock, Thomas, & TilIman, 2002; Peterson, 2004). Specifically, they begin with a time-delay. If necessary, they then move to the more restrictive prompt of “manding” the target, and (if


84

necessary) they then provide the child with a model. Further, while discrete trial programs rely on massed trials to encourage maintenance, milieu teaching relies on the generalization procedures described by Stokes and Baer (1977). In fact, the problems of generalization associated with massed trial instruction are what prompted Stokes and Baer (1977) to recommend these generalization strategies.2 The strategies include (1) training target skills in the natural context of use (emphasizing functional use), (2) using stimulus control strategies, (3) using modeling and reinforcement, and (4) using naturalistic intervention agents. Hart and Rogers-Warren (1978) noted that these procedures “[build] high rates of spontaneous language in natural settings (with a variety of persons), about objects and events, and … [they elaborate] the topography of language through imitation and differential reinforcement procedures.” (p. 219). Again, the goal of such programs is to generate “spontaneous speech.” Dyer (1989) demonstrated that that these procedures could be used successfully to encourage spontaneous requesting by children with autism when highly preferred reinforcers were available in the environment. Along a similar line, since milieu procedures explicitly continue the child’s course of conversation, they may be more likely to enhance social-conversational skills in general such as turn taking (Hart, 1985). Sundberg and Partington (1998) recognized that a number of common features are found among the components of the milieu approach (see their Table 13-1 on page 256). Kaiser, Yoder, and Keetz (1992, p. 9) and Rowland and Schweigert (1993) noted the following features: (a) language teaching that follows the child's lead or interest, (b) the use of multiple, naturally occurring examples, (c) explicitly prompting a child to use language, (d) the use of natural consequences to reinforce a child's verbal behavior, and (e) the involvement of natural caregivers in the including parents and extended family members. A third reason for the preference of milieu teaching over discrete trial instruction is evidence indicating that naturalistic teaching approaches are effective in promoting the generalization of language skills. This finding is clear and consistent with multiple replications (see, Alpert & Kaiser, 1992; Angelo & Goldstein, 1990;Cavallaro & Bambara, 1982; Charlop, Schreibman, & Thibodeau, 1985; Hart & Risley, 1975; Hemmeter & Kaiser, 1994; Hunt et al, 1986; Kaiser, Yoder, & Keetz, 1992; McGee, Krantz, & McClannahan, 1985; Oliver & Halle, 1982 Rogers-Warren & Warren, 1980; Warren, 1992; Warren & Bambara, 1989; Warren & Gazdag, 1990; Warren & Kaiser, 1986; Warren, McQuarter, & Rogers-Warren, 1984; Yoder, Kaiser, & Alpert, 1991). For example, Peterson (2004) reported that over 80% of the studies investigating the effects of milieu teaching measured maintenance, and over 90% found generalization. 3 In addition, and contrary to what might be expected, milieu procedures have been shown to be effective with children who present with greater impairments such as higher levels of mental retardation. Yoder, Kaiser, and Alpert (1991) compared milieu language training to the communication training approach. Their study included 40 preschool children who presented with either a greater than 20% developmental delay or scored more than 1.5 standard deviations below the mean in four of seven developmental areas. None of the children had a significant hearing impairment. Assignment to training 2 Discrete trial approaches were not the only approaches to have difficulty with generalization. Leonard (1981) and Frey (1986) found that most of the language learning strategies in the 1960s and 1970s failed to produce generalization. Leonard (1981) levied to very strong criticism of intensive language training approaches (1) the lack of evidence that trained forms for the child are used in “speaking situations that bear little resemblance to the training/testing situation” (p. 114) and (2) because “skills necessary for everyday communicative interactions such as conversational turn taking and the expression of a range of communicative intents, have not yet served as the focus of training studies…the case that language training enhances language impaired children’s ability to communicate in the world around them is still very much open” (p. 114). The argument about training shifts was echoed to some degree in Holland (1984) and Spradlin & Siegal (1982). 3 This is not intended to be a comprehensive review and for a more comprehensive review it is suggested that readers see Petersen (2004).


85

conditions was random. Results indicated no overall treatment effect differences. However, a strong interaction effect was found. Children who were more severely impaired performed better in the milieu condition while higher functioning children were more likely to benefit from the communication-training program. The results of this study contradicted the general wisdom of the time, which predicted the reverse would be true. The techniques have also been shown to have good preventative value (see Peterson, 2004 for a review of this literature).

A fourth reason for the preferences of milieu teaching is that the procedures are learned easily and used effectively by parents (Alpert & Kaiser, 1992). For example, Hester, Kaiser, Alpert, & Whiteman, (1995) found a facilitative effect by teaching parents the techniques. This basic finding was replicated in studies involving children with autism and their parents (Hancock & Kasier, 2002; Hemmerter, & Kaiser, 1994; Kaiser, Hancock, & Nietfeld, 2000). Further, peers of children with autism can also be taught to use milieu language procedures effectively (McGee, Almeida, Sultzer-Azaroff, & Feldman, 1992).

Critical features of milieu teaching: The question may be asked as to what it is about milieu

teaching that leads to communicative success. Some speculate that the use of multiple exemplars and a loose structure make the difference (Laski, Charlop, and Schreibman, 1988). Stokes and Baer (1977) identified both of these strategies as more likely to promote generalization. (Also see Osnes & Lieblein, 2003; Stokes & Osnes, 1987). However, much of the research on exemplar training is descriptive (e.g., Elbert, Powell, & Swartzlander, 1991). Two other strategies outline by Stokes and Bear (1977) are also incorporated, including (1) contextually-based language targets and (2) targets that are functional from the perspective of the child. These factors may also enhance generalization (Fey, 1986; Guess, Keogh, & Sailor, 1978).

Each component of the milieu teaching procedure has been studied individually, including incidental teaching, time delay, and mand-modeling techniques. The oldest and core technique of the milieu approach is incidental teaching. Originally, Hart and Risley (1968, 1974) explored this technique. Hart and Risely (1968) believed that children were more likely to initiate communication about things that are wants or needs or of interest. In their earliest study, Hart and Risley (1968) used incidental teaching to increase disadvantaged preschool children's use of adjective-noun combinations. The study looked at not just acquisition but generalization. In it, children were taught adjective-noun combinations in a group setting where the "spontaneous" use of these forms during free play resulted in access to desired classroom materials.

In a later study with disadvantaged children, Hart and Risley (1974) used incidental teaching procedures to shape preschool children’s use of compound sentences during free play periods. They used a three-step shaping procedure to help the children to progressively increase the complexity of their statements. Initially, the children were rewarded if they simply named the target objects. When this was achieved, they were rewarded for adding descriptive words. Finally, they needed to not only to name and describe the object but also to say (in a compound sentence) how they would use it. The results indicated that participants increased their use of all three targets: nouns, adjective-noun combinations, and compound sentences. These skills generalized to other non-training situations in the classroom as well.

While the above uses of incidental teaching produced immediate gains, they did not lead to long-term changes in the children’s intellectual functioning (see Hart & Risely, 1995). Still the studies with disadvantage children formed the basis of the procedure for changing and increasing language and social behavior. McGee, Krantz, and McClannahan (1985) later used incidental teaching (in addition to other procedures) successfully to encourage the use of preposition by children with autism. In sum, these studies provide some preliminary support for the use of incidental teaching as a component of milieu teaching.


86

The second component of the milieu teaching is the component of time delay procedure. Time delay is brief pause after the child speaks and originally was conceptualized as actually an extension of incidental teaching (See Hart & Warren, 1978). Procedurally, it involves delayed prompting (e.g., Halle, Baer, & Spradlin, 1981), and it can be seen as the least intrusive prompt in the least-to-most prompt hierarchy (Peterson, 2004). It is a pause procedure, which provides a child with an opportunity to respond. The pause serves as a prompt. In using this procedure, the teacher or caregiver identifies a situation in which the child demonstrates a desire for an object or assistance and then waits for the child to make a request. If the child does not initiate appropriately, another delay is usually instituted. If this is unsuccessful, the caregiver or teacher will then initiate the mand-model procedure (see below). Multiple studies support the use of the time delay procedure. Noonan and McCormick (1993) found time delay to be useful for teaching children to initiate verbal interaction and for increasing spontaneous speech (Noonan & McCormick, 1993). Taylor and Harris (1995) used the procedure to get an autistic child toask questions like “What are you doing?” or “What is this?” The time delay procedure is used to maximize response opportunities (Halle, Marshall, and Spradlin, 1979). Halle and colleagues (1979) observed two groups of children with mental retardation in an institution. Initially, the time delay procedure was used during mealtime by withholding meal trays for 15 seconds. However, this procedure did not result in spontaneous requesting by the first group of participants. In fact, only one of the three children in this group requested the meal tray appropriately, and requesting occurred only in limited contexts with limed frequency. For these reasons, Hall et al. added modeling of the correct response to the delay procedure. This resulted in an increase of request initiations by all of the children in the first group. The second group of three children, who had observed the contingencies implemented for the first three, then participated in the delay condition. In the second group all of the children responded appropriately to the delay contingencies. In addition, they generalized their use of requests across meal settings and servers. Halle and colleagues (1981) taught preschool teachers to identify opportunities in which time-delay procedures would be effective with their students. The intervention was effective in increasing children’s classroom responding. Further, many have successfully used time-delay to increase spontaneous speech by children with autism (e.g., Charlop, Schreibman, & Thibodeau, 1985; Ingenmey & Van Houten, 1991); and parents can use successfully to increase the use of words by their children with autism (Laski, Charlop, and Schreibman, 1988). Time delay can be enhanced if the child selects the activity (Coe, Matson, Fee, Fridley, & Love, 1990; Camarata & Nelson, 1992). The last procedure within the milieu package is the mand-model procedure. As with the procedures previously discussed, mand-modeling has considerable research support for language intervention. Rogers-Warren & Warren (1980) developed this procedure to enhance the incidental teaching strategy for children with more severe disabilities. Considerable evidence suggests that the procedure is effective. For example, Nye, Foster, and Seaman, (1987) conducted a meta-analysis of 43 research studies involving children with language impairments. All of the studies used group comparisons with controls. Findings suggested that the language intervention procedures were effective. Specifically, the performance of children who received language intervention changed to a level that ranked more than one standard deviation (e.g., from the 35th percentile to the 50th percentile). Many of the studies reviewed by Nye et al. involved the mand-model procedure. When the results were analyzed further, modeling, elicitation, imitation, and focused stimulation were included among the most powerful interventions. In this context, elicitation refers to the use of carrier phrases (e.g., "This is a ____"), which a child is then expected to complete. It also includes the question “What do you want?” Note that modeling and elicitation are both components of the mand-model procedure within in the milieu language package. As indicated above, the mand-model procedure (e.g., Rogers-Warren & Warren, 1980; Warren, McQuarter, & Rogers-Warren, 1984) is an extension of the incidental teaching model. It was developed


87

as part of the least-to-most prompting package strategy. The mand-model procedure requires the teacher or caregiver to model and/or mand (request) a response from the child. When modeling, the teacher or caregiver observes the focus of the child's interest (e.g., a toy train) and produces the word to represent the request. If the child produces the response, the teacher or caregiver then provides the requested item together with social reinforcement. Rogers-Warren and Rogers (1980) trained teachers to use the mand-model procedure and contingent praise to improve the language of a particular student. The results indicated that the student increased his general rates of verbalization, his use of novel words, and his use of novel word-combinations. In addition, Warren, McQuarter, and Rogers-Warren (1984) demonstrated the effectiveness of this procedure in promoting generalization and maintenance. As a package, researchers and interventions have compared milieu language training to other language intervention approaches. Research supports using milieu language teaching with a child’s mean length of utterance is less then 2.5 responses per interaction over a conversation based approach such as responsive interactions (Yoder, Kaiser, Goldstein et. al. 1995; Kaiser, Yoder, Keetz, 1992). It is important to note that these results reverse with children greater than 2.5 utterances with milieu teaching being less effective then responsive interactions for children (see Wilcox, Kouri, & Kaswell, 1991). As to age with children with autism spectrum disorders, incidental teaching provided before the age of three can have a greater impact then after the age of five (McGee, Morrier, & Daly, 1999). In training parents, Yoder and Warren (2001) conducted a randomized control study and found that mothers who were more responsive and educated produced greater outcomes with milieu procedures used prelinguistically with a child compared mothers with lower education. The lower educated group responded better to a condition, which seemed very similar to mand training.

Conclusion This paper began with a reference to Gilbert’s (1996) conceptualization of the differences between scientists and engineers. For scientists, the above information will not provide enough evidence of treatment efficacy. They will point out that some of the previous studies did not include children with autism, and that studies of individual strategies say nothing about the effect of a complete EIBI program based on the VB approach. Indeed, many questions remain to be addressed through the type of research recommended by Carr and Firth (2005). For engineers, the above information may settle some arguments. They may consider the individual techniques to be well supported by evidence with ample justification for use in teaching children with autism. The techniques are researched well enough to ensure that several of the mitigating factors such as child age are worked out. Rogers-Warren (1983) called this evidence a cumulative record of success, and it has become part of the engineering ethic of language intervention practitioners. Clearly, there is a rich body of literature on human language development, and (based on theoretical grounds) a well-supported subset of this information has been incorporated logically into the VB approach to EIBI. The individual pieces of this information constitute the old wine, and the conceptual framework constitutes the new bottle. Until the VB approach is validated as a complete package, engineers of language intervention programs for children with autism can honor the call to evidence-based practice (in part) by considering some of evidence summarized in this paper.

References

Alpert, C. L., & Kaiser, A. P. (1992). Training parents as milieu language teachers. Journal of Early

Intervention, 16, 31-52.


88

Angelo, D. H., & Goldstein, H. (1990). Effects of a pragmatic teaching strategy for requesting information by communication board users. Journal of Speech and Hearing Disorders, 55, 231-243.

Brandsma, L.L. & Herbert, J.D. (2001). Applied behavior analysis for childhood autism Does the emperor

have clothes? The Behavior Analyst Today, 3, 45-52. Camarata, S. & Nelson, K.(1992). Treatment efficancy as a function of target selection in the remediation

of child language disorders. Clinical Linguistics and Phonetics, 6, 167-178. Carr, J.E. & Firth, A.M. (2005). The verbal behavior approach to early and intensive behavioral

intervention for autism: A call for additional empirical support. Journal of Early and Intensive Behavioral Intervention, 2 (1), 18-26.

Cautilli, J.D., Hancock, M., Thomas, C., & TilIman, T.C. (2002) Behavior Therapy and Autism: Issues in Diagnosis and Treatment - The Behavior Analyst Today, 3 (2), 230 - 245

Cavallaro, C. C., & Bambara, L. M. (1982). Two strategies for teaching language during free play. Journal of the Association for Persons with Severe Handicaps, 7, 80-92.

Chamberless, D.L. & Hollon, S.D. (1998). Defining empirically supported therapies. Journal of

Consulting and Clinical Psychology, 66, 7-18. Charlop, M. E., Schreibman, L., & Thibodeau, M. G. (1985). Increasing spontaneous verbal responding in

autistic children using a time delay procedure. Journal of Applied Behavior Analysis, 18, 155-166.

Coe, D., Matson, J., Fee, V., Manikam, R., & Linarello, C.(1990). Training nonverbal and verbal play

skills to mentally retarded and autistic children. Journal of Autism and Developmental Disabilities, 20, 177-187.

Dyer, K. (1989). The effects of preference on spontaneous verbal requests in children with autism.

Journal of the Association for Persons with Severe Handicaps, 14, 184-189. Elbert, M., Powell, T.W., & Swartzlander, P. (1991). Toward a technology of generalization: How many

exemplars are sufficient? Journal of Speech and Hearing Research, 34, 81-87. Fey, M. E. (1986). Language intervention with young children. Austin, TX: PRO-ED. Gilbert, T. (1996). Human Competence: Engineering Worthy Performance. Tribute Edition. International Society for Performance Negineering. Guess, D., Keogh, W., & Sailor, W. (1978). Generalization of speech and language behavior. In R.

Schiefelbusch (Ed.), Bases of language intervention. Baltimore, MD: University Park Press. Guess, D., Sailor, W. & Baer, D. (1978). Children with limited language. In R.L. Schiefelbusch (Ed.),

Language intervention strategies. Baltimore: University Park Press. Haley, K.L., Camarata, S.M., & Nelson, K.E. (1994). Social valence in children with specific language

impairments during imitation-based and conversation-based language interventions. Journal of Speech and Hearing Research, 37, 378-388.


89

Halle, J., Baer, D., & Spradlin, J. (1981). Teachers' generalized use of delay as a stimulus control

procedure to increase language use in handicapped children. Journal of Applied Behavior Analysis, 14, 389- 409.

Halle, J. W., Marshall, A. M., & Spradlin, J. E. (1979). Time delay: A technique to increase language use

and generalization in retarded children. Journal of Applied Behavior Analysis, 12, 431-439. Hancock, T.B. & Kasier, A.P. (2002). The effects of trainer-implemented enhanced milieu teaching on

the social communication of children who have autism. Topics in Early Childhood Special Education, 22, 39-54.

Hart, B. (1985). Naturalistic language training techniques. In S.F. Warren & A. Rogers-Warren (Eds.)

Teaching functional language (pp. 63-88). Baltimore: University Park Press. Hart, B. M., & Risley, T. R. (1968). Establishing the use of descriptive adjectives in the spontaneous

speech of disadvantaged children. Journal of Applied Behavior Analysis, 1, 109-120. Hart, B. M., & Risley, T. R. (1974). Using preschool materials to modify the language of disadvantaged

children. Journal of Applied Behavior Analysis, 7, 243-256. Hart, B. M., & Risley, T. R. (1975). Incidental teaching of language in the preschool. Journal of Applied

Behavior Analysis, 8, 411-420. Hart, B. M., & Risley, T. R. (1980). In vivo language intervention: Unanticipated general effects. Journal

of Applied Behavior Analysis, 13, 243-256. Hart, B.M. & Risely, T.R. (1995). Meaningful Differences in the Everyday life ofAmerican Children.

Brookes/Cole Hart, B., & Rogers-Warren, A. (1978). A milieu approach to teaching language. In R. L. Schiefelbusch

(Ed.), Language intervention strategies (pp. 193-235). Baltimore: University Park Press. Hester, P.P., Kaiser, A.P., Alpert, C.L., & Whiteman, B. (1995). The generalized effects of training

trainers to teach parents to implement milieu teaching. Journal of Early Intervention, 20, 30-51. Hemmeter, M. L., & Kaiser, A. P. (1994). Enhanced milieu teaching: Effects of parent-implemented

language intervention. Journal of Early Intervention, 18, 269-289. Hemmerter, M.L. & Kaiser, A.P.(1994). Enhanced milieu teaching: effects of parent-implemented

language intervention. Journal of Early Intervention, 18, 269-289. Holland, A.(Ed.)(1984). Language disorders in children. San Diego: College-Hill Press. Hunt, P., Goetz, L., Alwell, M., & Sailor, W. (1986). Using an interrupted behavior chain strategy to

teach generalized communication responses. Journal of the Association for Persons with Severe Handicaps, 11, 196- 204.

Ingenmey, R., & Van Houten, R. (1991). Using time delay to promote spontaneous speech in an autistic child. Journal of Applied Behavior Analysis, 24, 591-596.


90

Kaiser, A. P. (1993). Parent-implemented language intervention: An environmental perspective. In A. P. Kaiser & D. B. Gray (Eds.), Enhancing children's communication: Research foundations for intervention (pp. 63-84). Baltimore, MD: Paul H. Brookes.

Kaiser, A. P., Yoder, P. J., & Keetz, A. (1992). The efficacy of milieu teaching. In S. F. Warren J.

Reichle (Eds.). Causes and effects in communication and language intervention (pp. 63-84). Baltimore, MD: Paul H. Brookes.

Kaiser, A.P., Hancock, T. B., & Nietfeld, J.P. (2000). The effects of parent-implemented enhanced milieu

teaching on the social communication of children who have autism. Journal of Early Education and Development, 4, 423-446.

Keogel, R.L., O’Dell, M.C. & Keogel, L.K.(1987). A natural language teaching approach for nonverbal autistic children. Journal of Autism and Developmental Disorders, 17, 187-200. Laski, K. E., Charlop, M. H., & Schreibman, L. (1988). Training parents to use the natural language

paradigm to increase their autistic children's speech. Journal of Applied Behavior Analysis, 21, 391-400.

Leonard, L.B.(1981). Facilitating linguistic skills in children with specific language impairments. Applied

Psycholinguistics, 2, 89-118. Lovaas, O. I. (1987) Behavioral treatment and normal educational and normal intellectual functioning in

young autistic children. Journal of Consulting and Clinical Psychology. 55, 3-9. McGee, G., Almeida, C., Sultzer-Azaroff, B., & Feldman, R.S. (1992). Promoting reciprocal interactions

via peer incidental teaching. Journal of Applied Behavior Analysis, 25, 117-126. McGee, G. G., Krantz, P. J., & McClannahan, L. E. (1985). The facilitative effects of incidental teaching

on preposition use by autistic children. Journal of Applied Behavior Analysis, 18, 17-31. McGee, G.G., Morrier, MJ, Daly, T.(1999). An incidental teaching approach to early intervention for

toddlers with autism. Journal of the Association for Persons with Severe Handicaps, 24(3), 133-146.

Noonan, M. J., & McCormick, L. (1993). Early intervention in natural environments: methods and

procedures. Pacific Grove, CA: Brooks/Cole. Nye, C., Foster, S.H., & Seaman, D. (1987). Effectiveness of language interventions with the language/learning disabled. Journal of Speech and Hearing Disorders, 52, 348-357. Oliver, C. B., & Halle, J. W. (1982). Language training in the everyday environment: Teaching

functional sign use to a retarded child. Journal of the Association for Persons with Severe Handicaps, 8, 50-62.

Osnes. P.G & Lieblein, J.A. (2003) An explicit technology of generalization. The Behavior Analyst

Today, 3 (4), 364-368. Paul, R. (2001) Language Disorders from Infancy Through Adolescence: Assessment and Intervention.

Philadelphia: Mosby.


91

Peterson, P (2004). Naturalistic language teaching procedures for children a risk for language delays. The Behavior Analyst Today, 5.(4), 404-414

Partington, J.W. & Sundberg, J.W. (1999). The assessment of Basic Language and Learning Skills.

Behavior Analyst Inc. Rogers-Warren, A.K. (1983). A cumulative record: The behavioral analysis of autism. Contemporary

Psychology 28(9), 725-726. Rogers-Warren, A., & Warren, S. F. (1980). Mands for verbalization. Behavior Modification, 4, 361-382. Rowland, C. & Schweigert, P.(1993). Analyzing the communication environment to increase functional

communication. Journal of the Association for Persons with Severe Handicaps, 18, 161-176. Skinner, B.F. (1957). Verbal Behavior. Appleton-Century-Croft. New York. Spradlin, J.E., & Siegal, G.M. (1982). Language training in natural and clinical environments. Journal of Speech and Hearing Disorders, 47, 2-6. Stokes, T.F. & Baer, D.M. (1977). An implicit technology of generalization. Journal of Applied Behavior

Analysis, 10, 349-367. Stokes, T.F. & Osnes, P.G. (1989). An operant pursuit of generalization. Behavior Therapy, 20, 337-355. Sundberg, M., & Partington, J. (1998) Teaching Language to Children with Autism and Other

Developmental Disabilities, Danville, CA: Behavior Analysts, Inc. Taylor, B.A. & Harris, S.L.(1995). Teaching children with autism to seekinformation: Acquisition of

novel information and generalization of responding. Journal of Applied Behavior Analysis, 28, 3-14.

Tannock, R., & Girolametto, L. (1992). Reassessing parent-focused language intervention programs. In S.

F. Warren & J. Reichle (Eds.), Causes and effects in communication and language intervention (pp.49-76). Baltimore, MD: Paul H. Brookes.

Warren, S. (1992). Facilitating basic vocabulary acquisition with milieu teaching procedures. Journal of

Early Intervention, 16, 235-251. Warren S. F., & Bambara, L. M. (1989). An experimental analysis of milieu language intervention:

Teaching an action-object form. Journal of Speech and Hearing Disorders, 54, 448-461. Warren, S. F., & Gazdag, G. (1990). Facilitating early language development with milieu intervention

procedures. Journal of Early Intervention, 14, 62-86. Warren, S. F. & Kaiser, A. P. (1986a). Incidental language teaching: A critical review. Journal of Speech

and Hearing Disorders, 51, 291-299. Warren, S. F., McQuarter, R. J., & Rogers-Warren, A. P. (1984). The effects of mands and models on the

speech of unresponsive language- delayed preschool children. Journal of Speech and Hearing Disorders, 49, 43-52.


92

Warren, S.F. & Kaiser, A. (1986b). Generalization of trained language by young language delayed children: A longitudinal analysis. Journal of Speech and Hearing Disorders, 51, 239-251.

Wilcox, M.J., Kouri, T., & Caswell, S.(1991). Early language intervention: A comparison of classroom

and individual treatment. American Journal of Speech-Language Pathology, 1, 49-62. Yoder, P.J., Kaiser, A.P., & Alpert, C.L. (1991). An exploratory study of the interaction between

language teaching methods and child characteristics. Journal of Speech and Hearing Research, 34, 155-167.

Yoder, P.J., Kaiser, A.P., Goldstein, H., Alper, C., Mousetis, L., Kaczarack, L. & Fischer, R. (1995). An

exploratory comparison of milieu teaching and responsive interactions in the classroom. Journal of Early Intervention, 19(3), 218-242.

Yoder, P.J. & Warren, S.F.(2001). Relative treatment effects of two prelinguistic communication

interventions on language development in toddlers with developmental delays vary by maternal characteristics. Journal of Speech, Language, and Hearing Research, 44, 224-237.

Author contact information: Joseph Cautilli, Ph.D., BCBA Children’s Crisis Treatment Center 1823 Callowhill St. Philadelphia, PA 19122 Tel: 215-496-0707 ext. 1166 E-mail: [email protected].