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Effects of a Modified Milieu Therapy Intervention on the Social Communicative Behaviors of Young Children with Autism Sp...

Permanent Link: http://ufdc.ufl.edu/UFE0021147/00001

Material Information

Title: Effects of a Modified Milieu Therapy Intervention on the Social Communicative Behaviors of Young Children with Autism Spectrum Disorders
Physical Description: 1 online resource (162 p.)
Language: english
Creator: Mancil, Gregory R
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: aberrant, autism, behavior, communication, functional, milieu, therapy, training
Special Education -- Dissertations, Academic -- UF
Genre: Special Education thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Children with autism spectrum disorder (ASD) typically have difficulty speaking and communicating, with 40% of these individuals never developing speech. They also have social deficits, which are exacerbated by their communication problems. Concurrent with these deficits, individuals with ASD exhibit high levels of aberrant behaviors such as screaming, hitting, and biting, creating substantial obstacles for parents and other individuals charged with their education and well-being. In addition to these deficits, children with ASD have difficulty generalizing skills to natural settings. Children with ASD often learn skills in isolation and do not apply the skills to other settings such as their homes. Such issues with communication deficits, aberrant behaviors, and generalization difficulties, combined with the increase in the prevalence of autism demands that the field respond and provide effective practices to meet these individuals? needs at home and in educational settings (school). To address both the communication and behavioral needs of children with ASD, researchers have investigated the use of applied behavior analysis interventions such as functional communication training (FCT) and milieu therapy. The researchers typically have used FCT to address aberrant behaviors and milieu therapy to address communication skills. However, FCT researchers have not addressed generalization or overall improvement in communication. In a similar respect, milieu therapy researchers have not addressed aberrant behaviors. The purpose of the current study was to examine the effects of an intervention that combined FCT and milieu therapy for intervening with children's communication and aberrant behaviors in a natural setting (i.e., their home). The results suggest that the children increased unprompted communication, while aberrant behavior decreased to zero. These results also generalized to the teacher in the classroom and maintained in both settings. Future research should examine the effects of the intervention with peers and the effects on other behaviors such as the parent?s use of language. In addition, future research should extend the outcomes of the current study to a larger sample and other individuals with different characteristics on the autism spectrum.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Gregory R Mancil.
Thesis: Thesis (Ph.D.)--University of Florida, 2007.
Local: Adviser: Conroy, Maureen A.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021147:00001

Permanent Link: http://ufdc.ufl.edu/UFE0021147/00001

Material Information

Title: Effects of a Modified Milieu Therapy Intervention on the Social Communicative Behaviors of Young Children with Autism Spectrum Disorders
Physical Description: 1 online resource (162 p.)
Language: english
Creator: Mancil, Gregory R
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: aberrant, autism, behavior, communication, functional, milieu, therapy, training
Special Education -- Dissertations, Academic -- UF
Genre: Special Education thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Children with autism spectrum disorder (ASD) typically have difficulty speaking and communicating, with 40% of these individuals never developing speech. They also have social deficits, which are exacerbated by their communication problems. Concurrent with these deficits, individuals with ASD exhibit high levels of aberrant behaviors such as screaming, hitting, and biting, creating substantial obstacles for parents and other individuals charged with their education and well-being. In addition to these deficits, children with ASD have difficulty generalizing skills to natural settings. Children with ASD often learn skills in isolation and do not apply the skills to other settings such as their homes. Such issues with communication deficits, aberrant behaviors, and generalization difficulties, combined with the increase in the prevalence of autism demands that the field respond and provide effective practices to meet these individuals? needs at home and in educational settings (school). To address both the communication and behavioral needs of children with ASD, researchers have investigated the use of applied behavior analysis interventions such as functional communication training (FCT) and milieu therapy. The researchers typically have used FCT to address aberrant behaviors and milieu therapy to address communication skills. However, FCT researchers have not addressed generalization or overall improvement in communication. In a similar respect, milieu therapy researchers have not addressed aberrant behaviors. The purpose of the current study was to examine the effects of an intervention that combined FCT and milieu therapy for intervening with children's communication and aberrant behaviors in a natural setting (i.e., their home). The results suggest that the children increased unprompted communication, while aberrant behavior decreased to zero. These results also generalized to the teacher in the classroom and maintained in both settings. Future research should examine the effects of the intervention with peers and the effects on other behaviors such as the parent?s use of language. In addition, future research should extend the outcomes of the current study to a larger sample and other individuals with different characteristics on the autism spectrum.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Gregory R Mancil.
Thesis: Thesis (Ph.D.)--University of Florida, 2007.
Local: Adviser: Conroy, Maureen A.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021147:00001


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EFFECTS OF A MODIFIED MILIEU THERAPY INTERVENTION ON THE SOCIAL
COMMU7NICATIVE BEHAVIORS OF YOUNG CHILDREN WITH AUTISM SPECTRUM
DISORDERS


















By

GREGORY RICHMOND MANCIL


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY
OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
OF DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

2007




























O 2007 Gregory Richmond Mancil









ACKNOWLEDGEMENTS

How do I begin to thank each individual who in his or her own way played a part on this

portion of my j ourney in life, which has been one of the best paths I have decided to meander

down? Thanks, first and foremost, to all of the families of children with autism who I have had

the pleasure to work with and learn from over the years. Without their dedication and desire to

improve their children's lives, I never would have stayed on this trail. I thank Suzie for allowing

me to pursue my passion despite the emotional costs. I thank my children Vladimir and Melody

for all the smiles, kisses, and hugs at the end of a long day. Although my family provided a lot of

support, it was the support of my chair Maureen Conroy who guided me on this path and has

helped me obtain my goal. I have been lucky to have a chair who is a great mentor, colleague,

and friend. Maureen is one of the few people I have met who is a true educator in every sense of

the word. Maureen, I thank her for all the opportunities she has given that allowed me to become

a better researcher and scholar. I also thank her for developing a collegial relationship that will

surely last well beyond my doctoral program and modeling how a professor should treat

students. Finally, I thank her for "keeping my spirits up" during the times I doubted myself. If I

become just a mere shadow of her as a professor, I will consider myself successful. Each of the

other committee members, Terry Scott, Hazel Jones, James McLesky, and Mark Lewis, also has

contributed to my education. Terry taught me the importance of working with teachers, staying

grounded in reality, and choosing interventions that someone will actually implement. Hazel

taught me how to support graduate students. James taught me important lessons in the mechanics

of presenting and writing. Mark taught me the importance of looking at all the literature,

including the medical research. I owe a special thanks to Alex Jordan because he mentored me at









my first j ob working with children with autism. Without his support and guidance, I may have

chosen a different path.

In addition, I would like to thank all of my fellow doctoral students who have become

and will continue to be great friends and colleagues. I owe a special thanks to Brian Boyd,

Melissa Miller, and Todd Haydon. I thank Brian for teaching me the intricacies of the doctoral

program. I will never forget our first conference and our Saturday morning breakfast. I thank

Melissa for her support in everything she did and continues to do. I thank Todd for the j okes and

conversations on behavior. The music always will be great. I thank the office staff: Shaira Rivas-

Otero, Michell York, and Vicki Tucker, for every travel request completed, every office supply

given, and every joke told. I will miss everyone in the Department of Special Education at the

University of Florida.












TABLE OF CONTENTS


Page


ACKNOWLEDGEMENT S .........._.... ............... 3....___......


LIST OF TABLES........................ .......7


LI ST OF FIGURE S .........._.... ............... 8....___. ....


ABSTRACT .........._.... ............... 9....___......


CHAPTER


1 INTRODUCTION............... ............ 11


Overview of Autism Spectrum Disorders ........._._._..... .___ ......._..... 11
Functional Communication Training ........._._........___ .........._...... 15
M ilieu Therapy................. .... ... .. ......... 16
Summary of FCT and Milieu Therapy Procedures ........._........ .._.......... 17
Statement of the Problem ........._._._......._ ....___ ...........1
Significance of the Study ........._._.. _.....__ ............ 18...
Purpose of the Study. ........._._._......._ ............._ 18...

2 LITERATURE REVIEW ........._._._..... .___ ....___ ...........1


Overview of Autism Spectrum Disorders ........._._._..... .___ ......._..... 19
Functional Communication Training .............. ................... 24
M ilieu Therapy................. .... ... .. .. ....... 28
Summary of FCT and Milieu Therapy Procedures.........._._._.. ......._._._.... 32
Functional Communication Training Literature Review ........._..... ........._... 35
Milieu Therapy Literature Review.............. ................ 45
Discussion.............. .............. 52


3 M ETHOD .............. ................... 68


Participants.............. ... ... .............. 68
Settings, Change Agents, Materials .............. ................... 72
Dependent Measures ...................... ... ............. 74
Experimental Procedures and Study Design.............. ................ 77
Data Analysis ................ .................. 84
Interobserver Agreement .............. ......____ ....._ .. ...... ....8
Treatment Integrity and Social Validity ............_...... .__ ............. 90












4 RE SULT S .........._.._ ......... ............._. 94....


Pre-Intervention/ Assessment Phase .....__. ............... ........__. ...... 94
Intervention Results.............. ................ 96
Generalization Results ........._.._.._ ...._.._......_._ .. ...... 0
Treatment Integrity.............. .............. 108
Social Validity.............. ............... 109
Summary ........._.._.. ...._..._ .............. 111...


5 DISCUSSION ........._.._.. ...._... .............. 123...


Limitations ........._.._.. ...._..._ .............. 123...
Overview of Findings ........._.._.. ...._... .............. 125..
Explanation of Findings. ........._...... .. .... _._.._......_. ... ..... 2
Theoretical or Conceptual Implications of Findings ........._.._.. ......._...... 130
Implications for Future Research ....__. ...._.._.._ ......._.... ..........13
Implications for Practice. ........._._. ...._... ...._.._ ...........13
Summary ........._.._.. ...._..._ .............. 135...


LIST OF REFERENCES .............. .................... 137


APPENDIX


A FUNCTIONAL ANALYSIS PROTOCOL ...._.._.._ ...... ..... ........._.... 144


B MISCELLANEOUS VARIABLES DATA SHEETS ..........._.._ ........_.._.. 146


C BOARDMAKER CARDS.............. ................ 148


D CODING MANUAL ................ ................ 149........ ....


E DATA COLLECTION AND CODING SHEETS ................ ................... 153


F TRAINING MANUAL ................. ......... ......... ..........15


G SOCIAL VALIDITY FORMS ................ ......... ......... ..........15


BIOGRAPHICAL SKETCH.............. ................ 161











LIST OF TABLES


Table pagt



2-1 Characteristics of the study participants of FCT. ................ ................... 60

2-2 Characteristics of the environment of FCT ................. ...................... 61


2-3 Research designs and interventions of FCT ................. ...................... 62


2-4 Major findings ofFCT.............. ................. 63


2-5 Characteristics of the study participants of milieu therapy ................... ........ 64


2-6 Characteristics of the environment of milieu therapy ................. ............... 65


2-7 Research designs and interventions of milieu therapy ................. .............. 66


2-8 Maj or findings of milieu therapy ................. ................ 67......... ..


3-1 Participant characteristics ................ ................ 92......... ....


3-2 Mother' s survey results ................ ................ 92......... ...


3-3 Teacher survey results ................ ................ 92.............

3-4 Maintenance session items ................ ......... ......... ...........9


4-1 Preference assessment choices.............. .................113


4-2 Average (range) number of trials ................ ..............113 ..............


4-3 Spontaneous verbalizations.............. .............113


4-4 Parent training ................ ..............113 .......... ....


4-5 Teacher training ................. ..............113................


4-6 Treatment integrity data ................ ..............114 .......... ....










LIST OF FIGURES


figure pag<



3-1 Intervention procedures ................ ..............93. .......... ....

4-1 Scott' s rate of aberrant behavior during the functional analysis. .................. 115

4-2 David' s rate of aberrant behavior during the functional analysis ................. 116

4-3 Zeb's rate of aberrant behavior during the functional analysis ................... .117

4-4 Communication response percentages and rates.............. ...................118

4-5 Aberrant behavior rate ................ ..............119 .......... ....

4-6 Scott' s mean latency to respond unprompted ................ ................. ....120

4-7 David' s mean latency to respond unprompted ................. ................. ...121

4-8 Zeb's mean latency to respond unprompted ................ ................. .....122









Abstract of Dissertation Presented to the Graduate School of the University of Florida in
Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy

EFFECTS OF A MODIFIED MILIEU THERAPY INTERVENTION ON THE
SOCIAL COMMUNICATIVE BEHAVIORS OF YOUNG CHILDREN WITH
AUTISM SPECTRUM DISORDERS

By

Gregory Richmond Mancil

August 2007

Chair: Maureen A. Conroy
Major: Special Education

Children with autism spectrum disorder (ASD) typically have difficulty speaking

and communicating, with 40% of these individuals never developing speech. They also

have social deficits, which are exacerbated by their communication problems.

Concurrent with these deficits, individuals with ASD exhibit high levels of aberrant

behaviors such as screaming, hitting, and biting, creating substantial obstacles for parents

and other individuals charged with their education and well-being. In addition to these

deficits, children with ASD have difficulty generalizing skills to natural settings.

Children with ASD often learn skills in isolation and do not apply the skills to other

settings such as their homes. Such issues with communication deficits, aberrant

behaviors, and generalization difficulties, combined with the increase in the prevalence of

autism demands that the field respond and provide effective practices to meet these

individuals' needs at home and in educational settings (school).

To address both the communication and behavioral needs of children with ASD,

researchers have investigated the use of applied behavior analysis interventions such as

functional communication training (FCT) and milieu therapy. The researchers typically










have used FCT to address aberrant behaviors and milieu therapy to address

communication skills. However, FCT researchers have not addressed generalization or

overall improvement in communication. In a similar respect, milieu therapy researchers

have not addressed aberrant behaviors.

The purpose of the current study was to examine the effects of an intervention that

combined FCT and milieu therapy for intervening with children's communication and

aberrant behaviors in a natural setting (i.e., their home). The results suggest that the

children increased unprompted communication, while aberrant behavior decreased to

zero. These results also generalized to the teacher in the classroom and maintained in

both settings. Future research should examine the effects of the intervention with peers

and the effects on other behaviors such as the parent's use of language. In addition, future

research should extend the outcomes of the current study to a larger sample and other

individuals with different characteristics on the autism spectrum.









CHAPTER 1
INTTRODUCTION

The purpose of this chapter is to provide an introduction to the literature on the

communication and behavioral needs of children with autism spectrum disorders (ASD).

Additionally, a rationale for investigating the use of a combined intervention for students with

ASD incorporating the principles of functional communication training with milieu therapy in

natural environments will be discussed. An introduction of autism spectrum disorder (ASD)

initially is given with a description of the history, incidence, and characteristics associated with

ASD. Second, a description of applied behavior analysis (ABA), a conceptual approach adhered

to by many researchers to address needs of children with ASD is provided. Third, a brief

description of two evidence-based intervention practices that are based on ABA principles [i.e.,

functional communication training (FCT) and milieu therapy] and are used to address aberrant

behaviors and communicative behaviors, respectively, is provided. This chapter concludes with a

discussion of the contributions the current study makes to both research and practice.

Overview of Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) is a developmental disorder affecting the lives of

thousands of children. ASD was first described by Leo Kanner in 1943, who initially labeled the

disorder autism. He studied the case histories of 11 children and noted that their characteristics

differed significantly from children with schizophrenia. He suggested that a separate category

was needed to account for these unique characteristics. Since the initial autism description in

1943, the disorder has evolved into a spectrum disorder (i.e., ASD) with the number and

percentage of persons identified increasing each year (Center for Disease Control and

Prevention, 2005).









According to the Centers for Disease Control and Prevention (CDC), two to six per 1,000

children (ages 3 to 10 years of age) have ASD (CDC, 2005). The Autism Society of America

(Autism Society of America, 2006) suggests that ASD is even more prevalent, and reports that 1

in 150 children born today will develop this disorder. The Autism Society of America (ASA)

also notes that 1.5 million Americans including children and adults have ASD, while another 15

million Americans (e.g., family, educators, and health care workers) are affected by this disorder.

In sum, ASD incidence and prevalence rates indicate that millions are affected by the disorder.

Significant impairments in social interaction and communication skills and a highly

restricted area of activities and interests are the defining features of ASD (American Psychiatric

Association, 2000). Social interaction problems may be exhibited through an impairment in

nonverbal behaviors (e.g., eye to eye gaze, body postures, facial expressions) and/or failure to

create developmentally appropriate peer relationships. For example, a child with ASD may have

difficultly directly looking into a person's eyes, even though the child may appear to be staring

directly at the person.

Coinciding with impairments in social interaction, children with ASD have

communication skill deficits. These deficits often include a delay in or absence of spoken

language. Children that do develop speech may not initiate or sustain conversations with others.

Further, these children may develop stereotyped and repetitive use of language or idiosyncratic

language. For example, a child with ASD may repeat a phrase over and over, which can be used

in a functional (i.e., as a mand to get a preferred item) or nonfunctional manner (i.e., no apparent

connection to stimuli).

In addition to social interaction and communication problems, children with ASD may

exhibit restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. Often,










they demonstrate a preoccupation with idiosyncratic interests to a level considered abnormal in

intensity and focus. For example, a child may know every phone number in his or her local

telephone book, but not demonstrate understanding of basic arithmetic. They also may

demonstrate inflexible, nonfunctional rituals and routines (e.g., turning a doorknob over and over

in each direction before leaving their home). Further, many children with ASD have stereotyped

and repetitive motor mannerisms. For example, a child may engage in repeated hand flapping

with no apparent purpose during instructional times in the classroom or during free time alone.

Concurrent with the aforementioned features, many children with ASD exhibit high

levels of aberrant behaviors toward others or themselves that interfere with their learning, such

as screaming, hitting, and biting (Sigafoos, 2000). Some children will repeatedly pinch

themselves or they may aggress toward other children or adults (e.g., hit others). These aberrant

behaviors create substantial obstacles for individuals responsible for their education and care

(Durand & Merges, 2001).

Many parents experience stress when their children engage in aggression or tantrums.

Unlike others, parents of children with ASD usually cannot determine the reason for the tantrum

because of their child' s deficits in communication. The combination of these characteristics (i.e.,

social interaction impairments, communication deficits, repetitive behaviors, and aberrant

behaviors), the negative effects on the children and families, and the increase in the prevalence

of ASD present a critical demand for the field of special education to respond and provide

effective practices to meet these children's needs at home and in educational settings.

Several researchers have responded to this need by examining the relationship between

aberrant behaviors and communication abilities of children with ASD (e.g., see Bott, Farmer, &

Rhode, 1997; Chung, Jenner, Chamberlain, & Corbett, 1995; Sigafoos, 2000; Schroeder,









Schroeder, Smith, & Dalldorf, 1978). Chung et al. found an inverse relation between

communication ability and the display of aberrant behaviors such as self-injury and aggression in

children with ASD. Similarly, Bott et al. (1997) determined that individuals with more

developed speech skills exhibited a lower rate of aberrant behaviors than those with impaired

speech skills. In a more recent study, Sigafoos (2000) hypothesized that impaired

communication development in children with ASD and other developmental disabilities may

actually cause aberrant behaviors. When children lack the appropriate communication skills to

communicate, they may use aberrant behaviors for communication purposes.

To address both the communication and behavioral needs of children with ASD,

researchers have investigated the use of applied behavior analysis interventions (Durand & Carr,

1987; Wacker et al., 1990). Applied behavior analysis (ABA) addresses the events surrounding

behavior, both antecedent events (occurring prior to a behavior) and consequent events

(occurring after a behavior), in order to manipulate those variables and produce behavior change

(Baer, Wolf, & Risley, 1968).

ABA is based on several principles, two of which are particularly noteworthy for the

current study. First, behaviors are learned through an individual's interactions with his or her

environment via operant conditioning, which involves the relationship between stimulus-

response-consequences (Skinner, 1953). A discriminative stimulus is one type of antecedent

factor that sets the occasion for behavior to occur and signals the availability of a reinforcer (or

consequent event). The consequence that follows the behavior determines the probability of the

behavior reoccurring in the presence of the same or a similar stimulus. Therefore, the

individual's environment must be assessed to determine the antecedents and consequences

surrounding the target behavior in order to understand their effects on that behavior (Baer, Wolf,









& Risley, 1968)). Second, behavior analysis research should identify and investigate procedures

that reliably produce significant behavior change (Bailey & Burch, 2002). Two of the most

prominent ABA intervention strategies in the literature that are applicable to children with ASD

and address the areas of aberrant behavior and communication are: (a) functional communication

training (FCT), and (b) milieu therapy. An overview of each of these interventions strategies

follows.

Functional Communication Training

Functional communication training (FCT) is one intervention strategy that has been used

to address both the communication and aberrant behavioral needs of children with ASD (Carr &

Durand, 1985; Durand & Merges, 2001; Wacker et al., 1990). FCT involves assessing the

function (i.e., outcome, consequence) of a behavior (e.g., attention, escape, tangible, or sensory)

through analogue assessment methodology referred to as functional analysis, and then replacing

the aberrant behavior by teaching a communicative response that serves the same function

(Durand & Carr, 1987).

A number of researchers have demonstrated the positive effects of this intervention with

children with ASD and children with other developmental disabilities. In this body of research,

communicative responses effectively have replaced aberrant behaviors in each of the studies

reviewed. For example, Wacker et al. (2005) demonstrated FCT was an effective intervention

for addressing attention and escape functions for children with aggressive behaviors, self-

injurious behaviors, and destructive behaviors (e.g., destroying property). Despite these positive

findings, FCT research with children with ASD has not examined the generality of this

intervention to natural settings. For example, many of the researchers of the studies reviewed

have performed FCT interventions only in clinical settings without sufficiently analyzing









generalization to other people and settings and predominantly limiting change agents to

clinicians and researchers. In contrast, other behavioral intervention strategies focusing on

communication skills, such as milieu therapy, have expanded research into the natural

environment (e.g., home and school) with natural change agents (e.g., parents and teachers).

Milieu Therapy

Milieu therapy is another behavioral intervention with a plethora of studies demonstrating

that it has been effectively used with children with developmental disabilities and/or

communication disorders (e.g., Hester, 1995; Yoder & Warren, 2002) and children with ASD

(e.g., Hancock & Kaiser, 2002). In contrast to FCT, milieu therapy focuses on teaching children

new communication skills and behaviors within their natural environments (Kaiser, 1993). The

natural environment may refer to any setting, including the home, school, or an inclusive

educational setting where the child typically would spend time (Schwartz, 2003).

Researchers have used four basic milieu procedures [i.e., (a) modeling desired responses

and correcting responses, (b) providing a mand and then modeling/correcting if needed, (c) time

delay, and (d) incidental teaching] in the natural environment to demonstrate significant

increases in children's communication and language skills (Hancock & Kaiser, 2002).

Researchers have accomplished this by focusing research with parents and teachers as natural

change agents within the natural environment. Teaching communication skills in natural

environments has many advantages including: (a) increases in vocabulary (Yoder et al., 1995),

(b) generalization of communication skills (Hancock & Kaiser, 2002), (c) maintenance of

communication skills (Spradlin & Siegel, 1982), and (d) unprompted use of language (Yoder &

Warren, 2002). Milieu therapy is a behavioral practice that has been demonstrated to

successfully increase communication skills in children with ASD. In contrast to the FCT









literature reviewed, the focus of milieu therapy has been on teaching children new skills and

behaviors within their natural environments (e.g., home and school).

Summary of FCT and Milieu Therapy Procedures

Although both FCT and milieu therapy research have been demonstrated to be effective

in teaching communication skills to children with ASD, these techniques have focused on

different aspects of the development of communication skills. The maj ority of the FCT research

has focused on replacing aberrant behavior with a single communication response. In contrast,

milieu therapy research has focused on increasing communication within the child's natural

setting and has not focused on replacing aberrant behaviors with functional communication

skills.

Statement of the Problem

As previously mentioned, individuals with ASD typically have difficulty speaking and

communicating, with 40% of these individuals never developing speech (Sigafoos, Arthur-Kelly,

& Butterfield, 2006). They also have social deficits, which are exacerbated by their

communication problems. Concurrent with these deficits, individuals with ASD exhibit high

levels of aberrant behaviors such as screaming, hitting, and biting (Sigafoos, 2000), creating

substantial obstacles for parents and other individuals charged with their education and well

being (Durand & Merges, 2001). In addition to these deficits, children with ASD have difficulty

generalizing skills to natural settings. They often learn skills in isolation and do not apply the

skills to other settings such as their homes (Sigafoos et al., 2006). Such issues with

communication deficits, aberrant behaviors, and generalization difficulties, combined with the

increase in the prevalence of ASD demands that the Hield respond and provide effective practices

to meet these individuals' needs at home and in educational settings.









Significance of the Study

The current study examined the effectiveness of an intervention that combines FCT and

milieu therapy for intervening with children' s communication and aberrant behaviors in a natural

setting (i.e., their home). Additionally, this study examined generalization of newly acquired

skills to classroom settings. Finally, this study examined the maintenance of newly acquired

skills in home settings. These aspects of the research proj ect are particularly important; given the

difficulty children with ASD have generalizing skills across individuals and settings.

Purpose of the Study

The overall goal of this study was to examine a modified milieu therapy intervention (i.e.,

combined FCT and milieu therapy) toward teaching young individuals with ASD functional

communication skills. The following research questions were addressed:

(a) Does the implementation of a modified milieu therapy intervention increase
communication skills and decrease dependence on prompts in children with ASD in a natural
setting?


(b) Do newly acquired communication skills in children with ASD generalize to an
untrained setting?


(c) Do newly acquired communication skills in children with ASD maintain over
time?


(d) Does the implementation of a modified milieu therapy intervention result in a
decrease of aberrant behaviors in children with ASD in a natural setting?









CHAPTER 2
LITERATURE REVIEW


The purpose of this chapter is to provide an integrative literature review of the studies

examining the effectiveness of using functional communication training (FCT) or milieu therapy

with young children with ASD. First, an introduction of autism spectrum disorder (ASD) is given

with a description of the history, incidence, and characteristics associated with ASD. Second, a

description of applied behavior analysis (ABA), a conceptual approach used to address

behavioral skills deficits and excesses of children with ASD is provided. Third, a description of

two intervention practices based on ABA principles [i.e., functional communication training

(FCT) and milieu therapy] used to address aberrant behaviors and communicative behaviors,

respectively, is provided. Finally, the empirical literature in reference to functional

communication training and milieu therapy with children with ASD is reviewed. Emphasis is

placed on evaluating the research in regard to the environments and change agents involved in

the research and the effectiveness of FCT and milieu therapy with children who have a diagnosis

of ASD. Analyses of the characteristics of the participants, environment, research designs, target

behaviors, interventions, major Eindings, reliability, and treatment fidelity across studies are

provided. In addition, a critique of the Eindings to address strengths, limitations, and

implications for future researchers is provided.

Overview of Autism Spectrum Disorders

ASD is a developmental disorder affecting the lives of thousands of children. ASD was

first described by Leo Kanner in 1943 through the case histories of 11 children. Kanner observed

that the characteristics of these children differed significantly from other children; therefore, he

suggested a separate diagnosis entity was needed to describe their unique characteristics. Since

Kanner' s first description of autism, the disorder has evolved into a spectrum disorder (i.e.,










ASD) with the number and percentage of diagnoses increasing each year (Center for Disease

Control and Prevention, 2005).

According to the Centers for Disease Control and Prevention (CDC), two to six per 1,000

children (ages 3 to 10 years of age) have ASD (CDC, 2005). Whereas the Autism Society of

America (Autism Society of America, 2006) suggests it is more prevalent and reports that 1 in

150 children born today will eventually be diagnosed with ASD. The Autism Society of

America (ASA) also notes that 1.5 million Americans including children and adults have ASD,

while another 15 million Americans (e.g., family, educators, and health care workers) are

affected by this disorder. In sum, the incidence and prevalence rates of ASD appears to be

growing at alarming rates.

The essential features of ASD include significant impairments in social interaction and

communication skills and a highly restricted area of activities and interests (American

Psychiatric Association, 2000). Social interaction problems may be exhibited through an

impairment in nonverbal behaviors (e.g., eye to eye gaze, body postures, facial expressions)

and/or failure to create developmentally appropriate peer relationships. For example, a child

with ASD is less likely to initiate peer-related social interactions or respond to social bids from

peers.

In addition to social interaction problems, children with ASD have communication skill

deficits. Often, these deficits include a delay in or absence of spoken language (e.g., 40% never

obtain speech). Children that do develop speech may have difficulty initiating or sustaining

conversations with others. Further, these children may develop stereotyped and repetitive use of

language or idiosyncratic language (e.g., repeating nonfunctional phrases over and over).

Coinciding with impairments in social interaction and communication, children with ASD may









exhibit restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. They

often demonstrate a preoccupation with idiosyncratic interests to a level considered abnormal in

intensity and focus (American Psychiatric Association, 2000). For example, a child may know

every fact about the makes and models of cars and sustain conversations related to this topic for

hours, but remain unable to hold conversations about any other topic. They also may engage in

inflexible, nonfunctional rituals and routines such as turning a doorknob over and over in each

direction before leaving their home. Although these rituals and routines initially may appear to

decrease anxiety, the routines typically impede an individual's ability to socialize and function

properly within society (Heflin & Alaimo, 2006). Further, many children with ASD have

stereotyped and repetitive motor mannerisms (e.g., hand flapping). For example, a child may

engage in repeated hand flapping, for no apparent purpose. Concurrent with the aforementioned

features, many children with ASD exhibit high levels of aberrant behaviors toward others or

themselves that interfere with their learning, such as screaming, hitting, and biting (Sigafoos,

2000). For instance, some children may repeatedly bite themselves or they may aggress toward

other children or adults (e.g., scratch others). Aberrant behaviors such as biting create substantial

obstacles for individuals responsible with their education and care (Durand & Merges, 2001).

Many parents experience stress when their children engage in aggression or tantrums. Unlike

other parents, parents of children with ASD may have difficulty determining the reason for the

tantrum because of the child' s deficits in communication. It is difficult for an individual who

does not have any communication skills to explain what may be the cause of the tantrum. These

characteristics (i.e., social interaction impairments, communication deficits, repetitive behaviors,

and aberrant behaviors) and their negative effects on the children and families combined with the

increase in the prevalence of ASD present a critical demand for the Hield of special education to










respond and provide effective practices to meet these children's needs at home and in

educational settings.

One area of important research is investigating methods aimed at increasing

communication skills, decreasing aberrant behavior, and determining the relation between

communication abilities and aberrant behaviors. A number of researchers have responded by

examining the relation between aberrant behaviors and communication abilities of children with

ASD (e.g., see Bott, Farmer, & Rhode, 1997; Chung, Jenner, Chamberlain, & Corbett, 1995;

Sigafoos, 2000; Schroeder, Schroeder, Smith, & Dalldorf, 1978). Chung et al. found an inverse

relation between communication ability and the display of aberrant behaviors such as self-injury

and aggression in children with ASD. Similarly, Bott et al. (1997) determined that individuals

with more developed speech skills exhibited a lower rate of aberrant behaviors than those with

impaired speech skills. Further, Sigafoos hypothesized in a more recent study that impaired

communication development in children with ASD and other developmental disabilities may

actually cause aberrant behaviors. He suggested that when children lack the appropriate skills to

communicate, they might actually use aberrant behaviors for communication purposes.

To address both the communication and behavioral needs of children with ASD, several

researchers have developed intervention practices based on a framework of applied behavior

analysis (Durand & Carr, 1987; Wacker et al., 1990). The framework of applied behavior

analysis (ABA) involves analyzing the events surrounding behavior, both antecedent events

(occurring prior to a behavior) and consequence events (occurring after a behavior), and

manipulating those variables to produce behavior change in the desired direction (Baer, Wolf, &

Risley, 1968; 1987). ABA is comprised of several principles, two of which are particularly

noteworthy for the current study. First, most behaviors are learned through an individual's









interactions with his or her environment. Behavior typically is learned via operant conditioning,

which involves the stimulus-response-consequence relationship (Skinner, 1953). A

discriminative stimulus sets the occasion for behavior to occur and signals the availability of a

reinforcer. The consequence that follows the behavior determines the probability of the behavior

reoccurring in the presence of the same or a similar stimulus. If the subsequent event following a

behavior (i.e., consequence) is a reinforcer, the future probability of the behavior occurring

increases; however, if the subsequent event serves as a punisher, the behavior will decrease.

Therefore, the individual's environment must be assessed to determine behavioral effects of the

antecedent and consequences surrounding the target behavior (Baer, Wolf, & Risley, 1968;

1987). Second, the primary goal of applied behavior analysis research is to discover procedures

that can reliably produce clinically significant behavior change (Bailey & Burch, 2002).

An important component of examining behavior change is evaluating not only the

experimental significance, but the social significance of the change as well (Bailey & Burch,

2002). The decision of what constitutes a significant behavior change should also include the

participant' s input, rather than decided by the researcher alone (Schwartz, 2003). It seems

logical that the more involved the participant is in aspects of the intervention process, the greater

the likelihood the change in the behavior will be meaningful. Researchers could accomplish this

by consulting consumers about important problems to research, appropriateness of the

interventions, and effectiveness of the outcomes (Schwartz, 2003). Two of the most prominent

strategies based on ABA techniques in the literature that are applicable to children with ASD and

addresses the areas of aberrant behavior and communication are: (a) functional communication

training (FCT), and (b) milieu therapy. Each of these interventions employs different aspects of

ABA practices. A descriptive overview of each intervention practice follows.









Functional Communication Training

Functional communication training (FCT) is one ABA intervention strategy that has been

used to address both the communication and aberrant behavior problems of children with ASD

(Carr & Durand, 1985; Durand & Merges, 2001; Wacker et al., 1990). Developed in the mid-

1980s, FCT involves assessing the function (i.e., outcome, consequence) of a behavior (e.g.,

attention, escape, tangible, or sensory) through analogue assessment methodology referred to as

functional analysis and then replacing the aberrant behavior by teaching a communicative

response that serves the same function (Durand & Carr, 1987). Three steps typically are

followed in the FCT process. First, an assessment of the function of a behavior (e.g., attention,

escape, tangible, or sensory) through a functional analysis (FA) is conducted. Next, a

communicative response that matches the function is identified. Finally, an intervention plan

that replaces the aberrant behavior with a communicative response that serves the same function

is implemented.

Functional Analysis and Functional Behavior Assessment: Step One

To identify the function, researchers typically complete a FA by manipulating

consequences, such as escape from demands, obtaining attention, and or obtaining preferred

tangible items, contingent on the aberrant behavior to conclusively determine the function of the

behavior. One important component of FA is that the results of each of these probe conditions

must be compared to the other conditions as well as a control condition to determine the function

of the behavior (i.e., tangible, free play, alone, or escape). For example, if the aberrant behavior

increases more during the attention condition in comparison to the other conditions, the

researcher concludes the behavior is maintained by attention. The condition in which the

aberrant behavior occurs at the highest stable rate (i.e., escape, attention, tangible) determines the









function of the behavior. Prior to conducting a FA, some researchers use descriptive functional

behavioral assessments to hypothesize a function and help to inform the FA process (Mancil,

2006). These functional behavioral assessment components may include indirect assessments

and direct observations (Brady & Halle, 1997).

Indirect assessments. Indirect assessment instruments can be categorized into three

formats: (a) checklists, (b) questionnaires, and (c) interviews. Checklists typically contain items

related to functions of aberrant behavior that requires an adult (e.g., parent, teacher) familiar with

the child's behavior to respond to on a Likert scale. The parent and/or teacher must then score

the instrument, leading to a hypothesis of the function of the aberrant behavior. For example, the

Motivation Assessment Scale (MAS) (Durand & Crimmons, 1996) is a checklist commonly

completed by teachers and other professionals. For this checklist, a Likert scale of 0 to 6 is used,

with 0 being never and 6 being always. There are 16 questions with four questions related to

each possible function (i.e., sensory, escape, attention, and tangible), which are randomly

grouped. The points are totaled for each function and the one with the greater number of points

and highest relative ranking is the hypothesized function.

Many questionnaires contain similar content, but usually consist of open-ended questions.

For example, a question may be presented as "When does the child engage in the behavior?"

There then may be some additional stipulated follow-up questions about the context in which the

aberrant behavior occurs (e.g., Does the child engage in the behavior during an academic task or

mostly during transitions?).


In contrast, interviews generally involve initial questions that are vague and set the

occasion for the interviewer to probe for more detail and guide the process with specific follow-

up questions. For example, the interviewer may ask, "How often does the behavior occur?" If










the respondent answers, "The child screams all morning." the interviewer may follow-up by

asking "Does he scream often or for extended periods?" The interview provides more room for a

detailed assessment, but also requires both additional time and skill level of the interviewer.

After the interview is complete, the interviewer compiles the provided answers and hypothesizes

a function.


Direct observations. Unlike indirect assessments that are designed to gain information

through a third party (e.g., teacher, parent), direct observations consist of directly observing the

behavioral and communicative behaviors of the children in various settings such as the clinic,

classroom, and playground. For example, a researcher may observe a child and record what

occurs before (antecedent) and after (consequence) the aberrant behaviors. Both indirect

assessments (e.g., checklists, questionnaires, interviews) and direct observations aid in

developing a hypothesis of the behavior' s function (e.g., the interview and direct observation

may suggest that attention is the function because every time the aberrant behavior was

observed, the teacher or parent gives the child attention).

Identifying a Communicative Response: Step Two

After determining the behavioral function, the next step in the FCT process involves

identifying a communicative response that matches the identified function of the aberrant

behavior. This replacement communicative response may be in the form from one of the

following categories: verbal language, picture communication, gestures, or assistive technology

devices (Brady & Halle, 1997). The selection of this response is based on four criteria (Dunlap

& Duda, 2005; Horner & Day, 1991). First, change agents should consider the child's capability

of completing the response. For example, if the child lacks the verbal abilities to request a

desired tangible item, the researcher may choose picture communication or a gestural response to









teach the child to use in replacement of the aberrant behavior. Second, researchers, teachers, and

parents should consider the ease of teaching the response. If a child is non-verbal, it may be

dimfcult and time consuming to teach a verbal response; thus, another response such as picture

communication or gesture would be more effcient. Third, researchers, teachers, and parents

should consider whether or not others are able to understand and acknowledge the response. If no

individual in the child's life knows sign language, the researcher should choose a response

people could easily understand and acknowledge such as a picture or an assistive technology

device. Finally, researchers, teachers, and parents should further consider how effcient and

effective the response serves its function in the community at large. For example, if other

individuals in the child's environment (e.g., store) are unable to understand the response and/or

the child has dimfculty completing the communicative response, the response may not

necessarily serve its function.

Development of Treatment Plan: Step Three

After the functional communication response is selected, an intervention plan is designed

to teach the target child the response (Lalli, Casey, & Kates, 1995). Typically, discrete trial

procedures have been used to teach the target child the communicative replacement response.

Discrete trial procedures involve removing the target child from the natural routine and

providing direct and repeated trials over and over requiring the child to respond to the

researcher' s mand (i.e., request) with the trained communicative response until mastery criterion

is met. In this research literature, this criterion typically involves the child providing a correct

response 10 consecutive times. For example, a child may be taught to say, "help" or to perform

a gesture that represents the word, "help" to replace screaming as the method for obtaining

attention. Additionally, a child may be taught to hand a picture of a desired tangible item to









adults to replace aberrant behaviors such as hitting another individual to gain the tangible item.

The final component in FCT involves placing the aberrant behavior on extinction (i.e.,

withholding reinforcement for the behavior) and prompting and reinforcing the child' s use of the

functional communicative response that replaces the aberrant behavior (Lalli et al., 1995). For

example, if the target child engages in a tantrum to obtain a desired tangible item, the adult

ignores the tantrum, prompts the child to ask for the tangible item using the functional

communicative response and provides the child access to the tangible item following the

appropriate communicative response. A number of researchers have demonstrated that the FCT

treatment process successfully produces a decrease in aberrant behaviors, while increasing

appropriate functional communication skills (e.g., see Carr & Durand, 1985; Durand & Merges,

2001; Wacker et al., 1990).

In sum, FCT is one ABA intervention practice that has been demonstrated to effectively

increase functional communication skills in children with ASD and reduce aberrant behaviors.

Researchers have demonstrated FCT is effective with various functions and topographies of

aberrant behavior. Although FCT has many strengths, it is not the only approach used to

increase communication skills with children with ASD. In the next section, milieu therapy,

another successful approach, will be reviewed.

Milieu Therapy

Milieu therapy is a second strategy with a plethora of studies demonstrating that it has

been effectively used to teach communication skills to children with developmental disabilities

and/or communication disorders (e.g., Hester, 1995; Yoder & Warren, 2002) and to a lesser

extent, children with ASD (e.g., Hancock & Kaiser, 2002; Ross & Greer, 2003). In milieu

therapy, the focus is teaching children new skills and behaviors within their natural









environments (Kaiser, 1993). The natural environment may refer to any setting that the child

would naturally spend time regardless of his or her disability, including the home, school, or an

inclusive educational setting (Schwartz, 2003). As demonstrated in the literature, teaching

communication skills in natural environments has many advantages including: (a) increases in

vocabulary (Yoder et al., 1995), (b) generalization (Hancock & Kaiser, 2002), (c) maintenance

(Spradlin & Siegel, 1982), and (d) unprompted use of language (Yoder & Warren, 2002).

Milieu therapy includes the following basic procedures: (a) providing a model of desired

responses and correcting child responses, (b) providing a mand and then modeling/correcting if

needed, (c) using a time delay, and (d) employing incidental teaching strategies (Hancock &

Kaiser, 2002). One of the strategies used in milieu therapy to promote communication in natural

environments is modeling correct responses and correcting the target child's responses. This

involves modeling a target behavior and then providing correction to the child as necessary

(Alpert & Kaiser, 1992). For example, while outside on the playground, a child may tap on the

adult' s arm and look at the toy dump truck. The adult gains the child' s attention and provides a

verbal prompt that matches the child' s communication skill level, such as "Want truck? If the

child says, "Want truck," the adult provides praise, repeats the child's phrase (e.g., says, "yes,

want truck") and provides the child the toy dump truck. Otherwise, the adult provides a

corrective model repeatedly, "Want truck" until the target child correctly models the response.

However, if the child does not respond in a reasonable time frame (e.g., two to three seconds),

as predetermined by the researcher, parent, and/or teacher, the adult provides a model and gives

the obj ect to the child. The purpose of modeling and correcting responses is to provide the target

child the necessary prompts and instructions in natural situations to assist in skill development.









Another component of milieu therapy is the mand-model technique. The mand-model

technique involves giving a direct instruction (commonly referred to in the literature as a mand)

within a naturally occurring activity and context. The mand is a vocal operant that is maintained

by a reinforcer (e.g., obtaining a preferred item such as a toy car) and is evoked by the

discriminative stimuli for that reinforcer (Skinner, 1957). For example, if a child says, "Water

please" and receives the water, it is likely that this is a mand. Also, it is important to recognize

that responses are deemed mands based on their controlling variables and not on their

topography. Sign language and picture cards can function as mands the same as vocal responses

function as mands. When necessary, this mand would be followed by a model and a correction

similar to the description above. The mand-model is performed by first gaining the child's

attention and then providing a prompt for a target behavior. After the prompt, a guided model

(i.e., assisting the child in performing the target behavior) is provided when necessary. For

instance, a child is given apple juice for snack and reaches to pick it up with his hands. The

adult provides a response block (e.g., blocks his hands), obtains the child's attention, and says,

"Tell me what you want" (mand), places the communication card with the picture of juice on it

in the child's hand, and physically guides his hand to the adult who has the apple juice

(corrective model). If the child continues to ask for juice by using the picture card, the adult

provides the juice paired with positive praise (e.g., "Good j ob asking"). If the child attempts to

grab the juice again without using the communication card, the adult repeats the process. The

purpose of the mand/model strategy is to develop independent skills by providing the child with

a prompt and an example of performing the communicative response correctly. The adult

continues with this procedure until a performance criterion is met (e.g., child perform the task

correctly for two days).









Time delay is another procedure often used in milieu therapy that involves the adult

providing a stimulus and then waiting approximately 5 to 30 seconds, based on the child's

developmental and mental age, for a child-initiated response (Kaiser, 1993). Time delay

typically is combined with other techniques such as the mand-model. If the child does not

respond, the adult provides a mand-model. For example, a child may want his coat, but need

help getting it from the shelf. While attending to the child, the adult waits for a period of 5 to 30

seconds (depending on the child' s developmental level) for the child to request help. If the child

requests by using a communicative response such as a picture card or vocalization, the adult

provides immediate praise and a correct model, "You want your coat?" If the child does not

independently request help within the time delay, the adult provides a mand-model. The amount

of time delay chosen depends on the child' s level. The longer the wait period, the greater the

chance of losing the child's interest; therefore, care is needed in choosing the appropriate time

delay. The purpose of time delay is to decrease the child' s dependence on adult prompting,

instructions, and models; thus, promoting independent and spontaneous (i.e., unprompted)

communication.

Incidental teaching is another strategy often employed within the framework of milieu

therapy. Incidental teaching is a process where communication skills are learned in naturally

occurring interactions or interactions arranged in natural contexts, which may be the reason the

terms incidental teaching and milieu therapy have been used interchangeably at times. Hart and

Risley (1968; 1975) described incidental teaching as an interaction between an adult (e.g.,

parent) and a child during unstructured situations such as free play where the child controls the

incidences in which teaching occurs by signaling interest in the environment. For example,

while playing with toy cars, a child may point to a car and say, "ca". The adult reinforces this









behavior by providing positive praise and giving the child the toy car. Incidental teaching

typically is combined with the other procedures and is applied during situations when children

are requesting either vocally or non-vocally. Prompts are provided if necessary. Further, access

to desired obj ects are contingent upon correct responses, which are followed by behavior specific

praise. For example, an adult may create a situation by "accidentally" forgetting to give a child

her milk during snack (i.e., sabotaging the environment). The adult then would use the

aforementioned techniques to enhance communication by giving a prompt when needed, praising

the child for correct responses, and giving the child the milk (contingent access) for correct

responses. The purpose of incidental teaching is to promote fluency and expand skills of

children with delayed language skills, which may include children with ASD (e.g., see Hart &

Risley, 1975; MacDuff, Krantz, MacDuff, & McClannahan, 1988).


In sum, milieu therapy is one practice that researchers have used to successfully

demonstrate an increase in communication skills of children with ASD. In contrast to the FCT

literature reviewed, the focus in milieu therapy is teaching children new skills and behaviors

within their natural environments (e.g., home and school). This has been done using four basic

procedures (a) modeling desired responses and correcting responses (i.e., model/correct), (b)

providing a mand and then modeling/correcting if needed (i.e., mand/model/correct), (c) using

time delay, and (d) employing incidental teaching which has resulted in skills generalizing to

other settings and people.

Summary of FCT and Milieu Therapy Procedures

Although both FCT and milieu therapy research have been demonstrated to be effective

in teaching communication skills to children with ASD, these techniques have focused on

different aspects of the development of communication skills. The maj ority of the FCT research









has focused on identifying functions of aberrant behavior and replacing aberrant behavior with a

single communication response. In contrast, milieu therapy research has focused on increasing

communication within the child's natural setting and has not focused on replacing aberrant

behaviors with functional communication skills. Both techniques are empirically validated and

have their strengths and weaknesses. In the following section, a contrast between FCT and milieu

therapy will be provided to highlight their similarities and differences

Contrast of FCT and Milieu Therapy

As apparent from the aforementioned descriptions of FCT and milieu therapy, a direct

comparison of these two interventions reveals an array of similarities and differences. The

following sections provide a contrast between FCT and milieu therapy. First, similarities of the

two practices will be provided. Next, differences between the two practices will be highlighted.

Similarities. FCT and milieu therapy have similarities. First, both interventions partly

include changing antecedents to behavior as an intervention strategy. That is, both interventions

use prompts as an antecedent strategy to obtain the desired behavior (i.e., communication

response); however, these prompts differ in each approach. Also, both interventions apply

changes to consequences to increase appropriate communicative behavior. For FCT, the

consequence involves obtaining access to the identified function of the behavior (e.g., tangible

item, escape a situation) through skill instruction in a replacement behavior. In milieu therapy,

the consequence is obtaining the requested item, which may or may not serve as a functional

reinforcer. Finally, each addresses the communication deficit of children with ASD as previously

detailed.

Differences. In addition to similarities, FCT and milieu therapy have prominent

differences. As mentioned previously, prompt procedures are used within both FCT and milieu









therapy interventions. However, typical application of the prompts systematically differs

between the two approaches. Prompts in FCT typically are based on the occurrence of aberrant

behavior (Carr & Durand, 1985). A prompt often is given to the child to perform the

communication response when the child engages in aberrant behavior. Although time delay may

be used in FCT for prompts, there has not been a systematic description of the procedure in the

FCT literature (Bourret, Vollmer, and Rapp, 2001; Mancil, 2006). In contrast, prompts within

milieu therapy training are not based on aberrant behavior occurrences. Prompts are not given

only in response to aberrant behaviors. Typically, the prompts in milieu therapy are connected to

time delay procedures systematically (Hancock & Kaiser, 2002). For example, if a child does

not communicate within 10s, a prompt may be given.

Another difference between the two procedures, apparent from the aforementioned

descriptions, concerns the underlying purpose of the trained communication response. FCT

always connects the communication response to function (Carr & Durand, 1985). The

underlying purpose is to decrease aberrant behavior by replacing it with the communication

response. Communication responses taught in milieu therapy, in contrast, are not necessarily

tied to function systematically. If a child does not request an item, the child is given access to

the item after several prompts have occurred (Kaiser, 1993). This does not occur in FCT because

it may reinforce the inappropriate behavior.

Another difference is manipulation of the environment. Although FCT researchers may

alter the environment, this is not mentioned in the research studies as an essential feature. In

contrast, managing the environment is a prominent feature of milieu therapy (Kaiser, 1993). For

example, an essential feature of milieu therapy involves setting up the environment to enhance









communication. For example, Kaiser (1993) described how to place desirable objects in view

and out of reach of children; thus, increasing the likelihood from communication to occur.

A final difference between the two interventions, which requires emphasis, is that milieu

therapy is in vivo. The child leads, so if he or she chooses to abandon one item/task, they are

allowed to move on to another item. This is not the case with FCT. When using FCT

procedures, following a correct response, children typically are returned to the task at hand and

presented with another trial. However, as noted by Bourret, Vollmer, and Rapp (2001), many of

the studies on FCT do not report explicitly how mand procedures are selected or conducted.

Thus, a complete and confident comparison between FCT and milieu therapy cannot be

provided. In the following section, the literature base examining the use of FCT and milieu

therapy with children with ASD will be reviewed.


Functional Communication Training Literature Review

To identify relevant research studies, the FCT literature review consisted of a thorough

review of the ERIC, Education, PsyclNTFO, and Academic Search Premier data bases using

various combinations of the following terms: functional communication training, functional

equivalence training, autism, autism spectrum disorder, and communication. A hand search was

conducted of the following j ournals, covering the span of 1985 to the present: Focus on Autism

and Other Developmental Disabilities, Journal ofAutism and Developmental Disorders, Journal

ofApplied Behavior Analysis, and Journal of Positive Behavior Interventions. Next, after

reviewing the retrieved articles, an archival search was conducted. These searches produced 30

articles in which FCT was the primary intervention addressing aberrant behaviors and

communication deficits, of which eight included children with ASD. The following criteria were

used for inclusion in this review: (a) at least one participant of the study was a child with an









autism spectrum disorder diagnosis, (b) the function of the aberrant behavior was determined by

a functional behavior assessment, and (c) the primary intervention was functional

communication training.

Eight articles that met the criteria were reviewed to determine the effectiveness of FCT

with children with ASD. The studies were analyzed to determine the characteristics of the study

participants, research settings, behaviors, interventions, research designs, reliability, treatment

fidelity, and maj or findings across studies are provided.


Characteristics of Study Participants

A total number of 22 participants with ASD were investigated across all of the eight

studies. The maj ority of researchers reported gender along with chronological (CA),

language/communication levels (LA), and mental ages (MA). Eighteen (82%) of the participants

were male and four (18%) were female. Although this may at first seem overrepresented by

males, the ratio of males to females is representative of the overall population of individuals

diagnosed with ASD (Lotter, 1966; Volkmar, Szatmari, & Sparrow, 1993). As shown in Table

2.1, participants ranged in age from 2.7 to 13 years (M = 8.0 years). The language age (LA)

reported ranged from 1.8 to 13.3 years (M = 7.6 years), while the mental age reported ranged

from 2.4 to 7.9 years (M = 5.0 years). When comparing CA, MA, and LA levels, a participant

with a low chronological age could have a language and mental age higher than that of an older

participant. Also, while some participants had a mental age greater than their language age,

other participants' ages were opposite in correlation. For example, a participant may have a

mental age of 5 years old and a language age of 3 years old. In contrast, another participant may

have a mental age of 3 years old and a language age of 5 years old. There was no correlation

between which should be higher, MA or LA.









Participants differed in their levels of language prior to the studies and whether or not

they had concomitant diagnoses. Of the speech levels reported for 12 participants, five

participants (42%) spoke in complete sentences; however, their sentences were not always

functional. For example, some of the complete sentences were reported in the research as

echolalic (i.e., repeated phrase over and over), while others were bizarre (e.g., a child saying,

"the cat flew on a broom' without an apparent contextual reference). Also, of the participants

who spoke in complete sentences, only 1 (1/5, 20%) was reported to speak spontaneously. Two

participants (2/12, 16%) were nonverbal and did not communicate with signs or gestures. Of all

these participants, only six (6/22, 27%) were reported to have additional diagnoses, which

included communication disorders, seizure disorders, and severe/profound mental retardation.


Characteristics of Research Setting

The type of research environment the studies were conducted in was similar across most

of the studies. With a few exceptions and unlike participant characteristics, the trainers and

training sessions were removed from the natural environment and the research sessions were

conducted in a clinical setting.

Trainer. As shown in Table 2.2, researchers and research assistants implemented the

majority of the interventions (i.e., 6/8, 75%). Only one study (1/8, 12.5%) involved a teacher as

an implementer, but she was not the participant' s teacher. She was recruited by the researchers to

conduct the study and served more in the role of a research assistant (Wacker et al., 1990).

Further, only one study (1/8, 12.5%) used parents as trainers (Wacker et al., 2005).

Training sessions. The majority of trainers conducted training sessions in clinic rooms.

For example, the maj ority of training (i.e., 6/8 studies,75%) occurred in separate rooms that

usually contained only a table and chairs. These clinic rooms were not designed to mirror the









classroom. Two studies (2/8, 25%), however, were conducted in more natural environments

(e.g., classroom and home). For example, O'Neill and Sweetland-Baker (2001) conducted a

study in various locations of the participant' s classroom, while Wacker et al. (2005) conducted

training in designated rooms of the participant' s home.


Characteristics of Behaviors, Interventions, and Research Designs

The type of aberrant behaviors and their functions varied among participants.

Consequently, researchers implemented various interventions to address these functions.

Differences identified across the studies can be organized in the following categories: (a)

aberrant behaviors, (b) FBA procedures, (c) behavior functions, (d) communicative responses,

and (e) FCT research designs.

Aberrant behaviors. As shown in Table 2.3, researchers reported eight different

categories of aberrant behaviors, with many participants exhibiting more than one behavior. The

categories included aggression (e.g., hitting, hair pulling), self-injurious behavior (e.g., hand

biting), destroying property, tantrums (e.g., yelling), body rocking, hand flapping, oppositional

behavior (e.g., refuse to do work), and walking away. Fourteen participants out of 22 (64%)

exhibited aggression, self-injurious behavior, or destruction of property. Also, fourteen

participants (14/22, 64%) exhibited more than one aberrant behavior. For example, one

participant engaged in aggressive behavior, tantrums, self-injurious behavior, and property

destruction (Carr & Durand, 1985).


FBA procedures. Basic FBA procedures used to analyze the various behaviors, for the

most part, were similar across all studies. Each research team used a functional analysis (FA) as

the primary method to derive at a behavioral function. However, as shown in table 3, three

research teams (3 out of 8, 38%) also conducted FBA that included indirect assessments.









Prior to the FA, research teams in these three studies first collected information through

indirect assessments with teachers or parents. Indirect assessments used in various studies

differed in type and length. While some researchers reported interviews that were informal and

short (Carr & Durand, 1985; Durand & Carr, 1987), others reported indirect assessments that

were more formal and greater in length (Durand & Carr, 1992). Carr and Durand (1985) and

Durand and Carr (1987) simply interviewed teachers and asked which of their students engaged

in aberrant behavior and what supposed function the behavior served. Durand and Carr (1992)

had teachers complete a problem behavior checklist and the M~otivation Assessment Scale (MAS)

to help hypothesize a behavioral function.


As mentioned previously, each research team conducted a FA to determine the function.

Researchers used a traditional FA (i.e., analyzing consequences) with the exception of Carr and

Durand (1985) who incorporated antecedent events into their functional analysis. Designs used

and reported by the authors for the FA differed. As shown in Table 2.3, five studies (5/8, 63%)

used alternating treatment designs where the assessment conditions were systematically

alternated. For example, Carr and Durand alternated easy versus difficult tasks and a low (33%)

versus high (100%) attention condition. Similarly, Wacker et al. (1990) alternated escape,

tangible, alone, and social attention conditions. Durand and Carr (1987; 1992) used a reversal

design to examine effects of different conditions. Wacker et al. and others (2005) used a multi-

element design to compare assessment conditions (i.e., attention, escape, tangible, and free play)

by counterbalancing them across sessions. These differences may be more in name than actual

differences. For example, the multi-element and alternate treatment designs are derivatives of a

reversal design.









Behavior functions. After the completion of the FBA procedures, behavioral functions

definitively were identified in each study for all but one participant (Wacker et al., 2005) whose

behavioral function was determined to be undifferentiated. Across all the studies, 12 participants

(12/22, 55%) emitted aberrant behaviors to escape a task or situation, while eight participants

(8/22, 36%) displayed aberrant behaviors to gain attention. Only three participants (3/22, 14%)

engaged in aberrant behaviors to gain a tangible item. Also, of the 12 participants whose

behavioral function was escape, four of them (18%) also engaged in the behavior to gain

attention. Similarly, one participant (1/22, 5%) who engaged in aberrant behaviors did so to gain

attention and to gain access to a tangible item.


Communicative responses. With the knowledge of the behavioral functionss, trainers

taught an array of communicative responses to replace the aberrant behaviors, with equal success

regardless of the response category. Responses taught aligned with the identified function and fit

into one of the following categories: (a) verbal language, (b) sign language, (c) picture icon

based language, or (d) augmentative devices. As shown in Table 2.3, trainers in six studies

taught participants to verbally mand. For example, Durand and Carr (1987) taught participants

to verbally mand, "Help me" to replace body rocking and hand flapping that served to escape

aversive tasks and situations. Durand and Carr (1992) taught participants in another study to

verbally mand, "Am I doing good work?" to replace tantrums that served to gain attention.

Researchers in two studies taught children to use sign language for manding (Wacker et al.,

2005; Wacker et al., 1990). For example, to gain access to a tangible, Wacker and colleagues

(1990) taught participants to mand the sign, "please". In two studies, research teams taught

children to use icons to serve as the mand (Martin, Drasgow, Halle, & Brucker, 2005; Wacker et

al., 2005). For example, Martin et al. taught their participant to present an icon card with the










words "No Thank You" written upon it to replace tantrums, which served as an escape function.

Wacker et al. (2005) used an augmentative device to teach a participant to press a micro switch

that said, "Please". This response replaced self-injurious behavior, which was attention

maintained.


Across all studies, communication responses were taught in a similar fashion. For

example, when Durand and Carr (1992) taught participants to verbally mand, "Am I doing good

work?" the training sessions as described previously continued until the participants were able to

perform the task correctly 10 consecutive times. During the training sessions, the trainer sat

across the table from the participant and waited for the participant to respond to the mand.

Similarly, in the study conducted by Martin and colleagues (2005), participants were trained to

emit the communicative response without error. In summary, all participants in each of the

studies were taught one mand until they were able to respond correctly 10 consecutive times.


FCT research designs. After the communicative responses were taught, researchers

used one of the following two single subj ect research designs for evaluating the effectiveness of

FCT: (a) reversal, or (b) multiple baseline. As shown in Table 2.3, researchers used a reversal

design in four studies. For example, Carr and Durand (1985) alternated relevant and irrelevant

response phases with baseline. First, baseline data were collected on aberrant behaviors. Then,

participants were reinforced for relevant communicative responses by the trainer giving them

assistance. Following this phase, reinforcement was removed, thus, returning to baseline. Next,

participants were reinforced for irrelevant responses. These responses, however, were irrelevant

to the task at hand or the function. The sequence was then repeated; however, the phases (i.e.,

relevant and irrelevant) were counterbalanced. Also as shown in Table 2.3, four studies used a

multiple baseline design. For example, Durand and Carr (1992) implemented the procedures









with one participant as they continued to collect baseline data on the remaining participants.

After a few sessions, they implemented the procedures with the next participant as they

continued to implement the procedure with the first participant. This continued until the

procedure was implemented with every participant. Further, they conducted sessions with a

naive trainer (i.e., graduate psychology maj or) to test for generalization to other people. This

was the only study to check for generalization across persons or settings.


Reported Reliability

Reported research results would be compromised unless the aforementioned observations

were reliable and procedures were implemented with Eidelity. Researchers all reported high inter-

rater reliability (i.e., agreement of observed phenomenon) ranging from 79% to 100%. For

example, Carr and Durand (1985) reported reliability of 80% or greater for all categories.

Similarly, Wacker et al. (1990) had an average reliability of 92%, with 80% or more for each

category. Martin and colleagues (2005) reported greater reliability ranging from 97% to 99%.

Reported Treatment Fidelity

In addition to reliability, all research teams reported high treatment fidelity (i.e., consistence

of implementation of the methods and procedures of treatment) within their prospective studies.

They suggested treatment fidelity was high based on direct observations, but research teams

seldom reported a percentage of steps completed correctly. The researchers simply stated that the

treatments were implemented with high Eidelity without providing the treatment data.


Major FCT Findings

For each of these studies, research teams reported similar findings, in that all participants

learned functional communication responses matched to the functions of their aberrant










behaviors, with the exception of the one participant whose behavioral function was

undetermined. As shown in Table 2.4, the success of the intervention was demonstrated by a

decrease of aberrant behaviors with a corresponding increase in the trained communication

response. After implementation of FCT, research teams found a decrease in aberrant behavior

across all studies. For example, Wacker and colleagues (2005) found that FCT combined with

time-out resulted in hand biting decreasing to zero percent. Similarly, Carr and Durand (1985)

found aberrant behaviors to decrease to 0.5% upon the successful implementation of FCT. Also,

Wacker and colleagues found significant decreases in aberrant behavior for all but one

participant, whose behavior' s function was undifferentiated. Consequently, Wacker and

colleagues noted that the communication response must match the aberrant behavior' s function,

since no function was identified, no FCT could occur.

Akin to decreases in aberrant behavior results across studies, participants increased their

use of communication mands. However, these mands were limited in range. Only one mand was

taught to the participants. For example, Carr and Durand (1985) noted sustained rates of relevant

responses in the final phases of the study, but only one response was taught and measured. In a

later study, Durand and Carr (1992) also found an increase in unprompted communication, the

communication, however, was again limited to one type of mand. More recently, the participant

in Martin et al.'s (2005) study independently used his icon card to request an item 100% of the

time following training; similar to previous studies, they focused on one mand with no expansion

of communication.

Only one research team reported generalization to other people or settings (Durand and

Carr, 1992). Durand and Carr examined for generalization with another person or setting for

children with ASD. They conducted final sessions with a naive trainer (i.e., graduate psychology










maj or) to test for generalization to other people. The children who had received FCT training

maintained their appropriate replacement communicative response and low levels of aberrant

behavior.


Summary of FCT Literature

In summary, FCT is one approach researchers have employed to address the communication

and behavioral needs of children with ASD. The effectiveness of FCT was demonstrated in each

study. Researchers demonstrated that FCT resulted in aberrant behavior decreasing and the

trained communicative response increasing. Although the results are promising, the FCT

literature also presents a number of limitations, which are described below.

FCT has been demonstrated to be a successful strategy for decreasing problem behaviors and

increasing functional communicative responses, however, the maj ority of the research has been

conducted in clinical settings, rather than children's natural environments (e.g., children's

classrooms and homes). When implementing the procedures during initial development stages,

researchers produced positive behavioral and communication results. For example, Durand and

Carr (1987) indicated an increase in communication and a decrease in aberrant behaviors, but

this study occurred within a separate 5 x 10 meter classroom that excluded the child's teacher

and did not design the environment to look like the child's regular classroom.

Similarly, parents and teachers very seldom have been used as change agents. In the

majority of the studies, research assistants have served as therapists. Wacker and colleagues

(2005) were the only researchers to use parents as natural change agents. None of the research

studies have used a target child's teacher as the change agent.

In addition to training in clinical settings, researchers focused on only a single

communication mand. Researchers taught one communication response to each child and did









not attempt to expand the vocabulary, vocal or non-vocal, of any child. Finally, research studies

have failed to evaluate the generalization and maintenance of acquired communicative responses.

Only one study analyzed generalization across individuals (Durand & Carr, 1992). No study

evaluated generalization across settings or maintenance of acquired skills.

Clearly, the FCT has made a significant impact on children with ASD; however, there are a

number of areas within the literature that need further research and expansion. These will be

described in the final section of this chapter.


Milieu Therapy Literature Review

The literature review of research conducted in the area of milieu therapy began with

searches of ERIC, Education, PsyclNTFO, and Academic Search Premier electronic data bases

using various combinations of the following terms: milieu therapy, incidental teaching, time

delay, embedded instruction, autism, autism spectrum disorder, and communication. Following

the electronic data base search, a hand search was conducted of the following j ournals, covering

the span of 1968 to the present: Education and Training in Developmental Disabilities, Focus

on Autism and Other Developmental Disabilities, Journal ofApplied Behavior Analysis, Journal

ofEarly Intervention, Journal of Positive Behavior Intervention, and Topics in Early Childhood

Special Education. Finally, after reviewing the retrieved articles, an archival search was

conducted. These searches produced 28 articles in which components of milieu therapy were the

primary intervention for increasing communication in children, of which eight included children

with autism spectrum disorders. The following criteria were used for inclusion in this review: (a)

at least one participant of the study was a child with an autism spectrum disorder diagnosis, (b)

the training occurred in environments that mirrored the natural environment (e.g., clinic arranged

like a typical classroom), (c) the primary intervention involved at least one of the identified









milieu therapy techniques, and (d) the primary intervention was to increase communication in

children.

The eight articles that met the criteria were reviewed to determine the effectiveness of

milieu therapy with children with ASD. Particularly, the studies were analyzed to determine the

characteristics of the study participants, research setting, behavior, interventions, research

designs, reliability, treatment fidelity, and maj or Eindings across studies are provided.


Characteristics of Study Participants

The maj ority of researchers reported gender along with chronological and mental ages,

with only two research teams reporting language age. Twenty-Hyve out of 34 (74%) of the

participants were male; four (12%) were female, and the gender of Hyve participants (14%) (Ross

& Greer, 2003) were not reported. As shown in Table 2.5, participants ranged in age from 2.9 to

15.8 years, with the average age being 7.3 years. Mental age was not reported consistently across

studies. The authors of one study reported IQ scores with a range of <50 to 95, with an average

of 61 (Hancock & Kaiser, 2002). The authors of Hyve other studies reported a mental age score

with a range of 2.7 to 6.2 years, with an average of 3.9 years. Language/communication age was

reported for two studies with a range of 1.6 to 5.7, with an average of 2.8 years. Participants

differed in their language levels prior to the studies, with all participants reported to have

diagnoses of ASD. Of the prior speech levels reported for 20 participants, nine participants

(9/20, 45%) demonstrated echolalia (i.e., repeated phrase over and over), four participants (4,20,

20%) were nonverbal, and six participants (6/20, 30%) had limited speech (i.e., one to two word

phrases requesting basic needs such as food), one individual (1/20, 5%) had extensive speech and

spoke spontaneously.









Characteristics of Research Setting

The type of settings the studies were conducted in was similar across the maj ority of the

studies. Most studies were conducted in the child's natural environment (i.e., home and

community setting) and the change agents included individuals who naturally interact with the

target child (e.g., parents, teachers).

Trainers. As shown in Table 2.6, teachers, paraprofessionals, and parents implemented

the majority of milieu therapy training. Only one study (12.5%) involved a researcher as the sole

implementer, which was one of the earlier investigations with milieu therapy techniques

(Charlop, Schriebman, & Thibodeau, 1985).

Training sessions. The maj ority of trainers conducted training sessions in the natural

environment. For example, 75% (i.e., 6/8 studies) of the studies occurred in the target child' s

natural environment, that is, two studies were conducted in homes and four in classroom settings.

However, two studies (2/8, 25%) were conducted in settings that were not the child's natural

environment. For example, Charlop et al. conducted their study in clinic rooms arranged like

classrooms and partitioned areas of classrooms while Hancock and Kaiser (2002) conducted

sessions in a playroom in a university setting. However, Hancock and Kaiser then measured

generalization in the home and demonstrated that three out of four children generalized training

from the university's playroom to the children's respective homes.


Characteristics of Target Behavior, Interventions, and Research Designs

Researchers implemented various milieu therapy techniques to address the varied

communication skill deficits demonstrated by participants. Differences identified across the

studies can be organized in the following categories: (a) targeted communication skills taught

(i.e., behavior), (b) interventions (i.e., milieu procedures used), and (c) research designs.










Target behaviors. Since communication levels of participants varied, researchers taught

different communication responses (i.e., behavior) to various participants and focused on a

variety of communication skills across studies (see Table 2.7). These included basic need

phrases (e.g., "I want snack"); emotional phrases (e.g., "I like you"); descriptive phrases (e.g.,

"Block is big"); pairs of prepositions (e.g., "on, under"); questions (e.g., "What do you want?");

receptive labeling (e.g., handing correct food item to teacher); and increases in the mean length

of utterance (i.e., number of words spoken together in one phrase). As shown in Table 2.7, basic

need phrases were taught to a higher percentage of participants (62%, 21 participants), while

receptive labeling was taught to only two participants (6%). For example, Charlop et al. (1985)

taught seven participants to say, "I want cookie". Also, Ross and Greer (2003) taught five

participants to say, "cookie".

Interventions. Researchers used various milieu therapy techniques to address the

communication difficulties of the participants in their respective studies. Typically, one or more

of the following milieu techniques were used: (a) model/correct, (b) mand/model/correct, (c)

time delay, or (d) incidental teaching. The strategies varied across studies. However, the

maj ority of researchers used time delay and/or the mand/model/correct technique (i.e., 6/8, 75%).

As shown in Table 2.7, time delay was used to teach twenty-one participants (62%)

communication skills. For example, Charlop et al. (1985) used a 2s to 10s time delay and

Johnson, McDonnell, Holzwarth, and Hunter (2004) used a 4s time delay to teach

communication skills. Similarly, twenty-one participants (62%) were taught using the

mand/model/correct technique. Laski et al. (1988) used mand/model/correct to teach basic need

phrases, description phrases, and questions. Also, Charlop and Walsh (1986) used

mand/model/correct to teach emotional phrases. Further, time delay and mand/model/correct









were used simultaneously for 13 participants (38%). For example, Hancock and Kaiser (2002)

and Ross and Greer (2003 used both techniques to teach communication skills. In contrast, only

one participant (3%) was taught using the model/correct technique, which was done by Johnson

et al. (2004) simultaneously with a 4s time delay.

Research designs. In the studies reviewed, all researchers used a multiple baseline

single subj ect methodology to evaluate the effectiveness of the milieu therapy intervention. The

baseline phases in the studies were across participants, communication skills, and/or sets of

objects. As shown in Table 2.7, Hyve of eight (62.5%) research teams analyzed the intervention

using a multiple baseline across only participants, one (12.5%) research team analyzed the

intervention using a multiple baseline across only communication skills, one (12.5%) research

team analyzed the intervention using a multiple baseline across participants and communication

skills, and one (12.5) research team analyzed the interventions using a multiple baseline across

sets of obj ects (i.e., receptive language where children chose the correct obj ect).


Reported Reliability

Research results would be compromised unless observations were reliable. Fortunately, all

research teams reported high inter-rater reliability. For example, Charlop et al. (1985) reported

reliability of 98% or greater for all behavioral categories. Similarly, Johnson et al. (2004) had an

average reliability of 99%, with a range of 97 to 100%. The other studies had similar findings.

Reported Treatment Fidelity

In addition to reliability, all research teams with the exception of Laski, Charlop, and

Schreibman (1988) reported high treatment fidelity (i.e., consistence of implementation of the

methods and procedures of treatment) within their prospective studies. The research teams

reported that treatment fidelity was high based on direct observations. Similar to the FCT









literature reviewed, research teams for milieu therapy seldom reported a percentage of steps

completed correctly and simply stated that the treatments were implemented with high fidelity

without providing the treatment data.


Major Milieu Therapy Findings

Regardless of the milieu strategies used, research teams reported similar findings, in that

they were all successful in teaching children with ASD communication skills regardless of the

combination of techniques used or the communication skills targeted. Further, the maj ority of the

children with ASD participating in these studies generalized their communication skills across

people and/or settings.

As shown in Table 2.8, the success of milieu therapy was demonstrated by an increase in

targeted communication skills for all 34 participants. For example, Charlop et al. (1985) noted

that all 7 participants in their study achieved the targeted communication skills at 90% accuracy

or higher. In another study, Hancock and Kaiser (2002) noted that all 4 participants mean length

utterance (MLU) and diversity of words (i.e., nouns and verbs) increased following training.

Similarly, McGee, Krantz, and McClannahan (1985) noted that all three participants achieved

targeted communication skills. In addition to increasing targeted communication skills in the

training setting, several researchers noted that these skills generalized. For example, Charlop et

al. noted that 6 participants (86%) generalized communication skills to untrained obj ects and 2

participants (29%) generalized the communication skills to unfamiliar settings. Similar to the

Charlop et al. study, generalization to another setting occurred in a study conducted by Hancock

and Kaiser (2002). However, 3 participants (75%) generalized communication skills to another

setting as compared to only 29% for the Charlop et al. study. One explanation could be because

Hancock and Kaiser included the mand/model/correct technique in their study. Additionally, the










parent conducted the training (see Table 2.8). In addition, McGee, Krantz, and McClannahan

(1985) noted that all three participants achieved generalization to another classroom after

acquisition was achieved during teaching sessions.

Similarly, several researchers noted maintenance of targeted communication skills. For

example, Hancock and Kaiser (2002) demonstrated that increases in target language were

maintained for the four children in their study as indicated through follow-up observations

conducted six months after the study ended. Similarly, Ross and Greer (2003) demonstrated that

all participants in their study showed maintenance of vocalization skills during a follow-up probe

three months after the study was completed.


Summary of Milieu Therapy Literature

In summary, milieu therapy is one approach researchers have used to address the

communication needs of children with ASD. As researchers investigated the use of milieu

therapy with children with ASD, they provided interventions in natural environments where

teachers and parents conducted the majority of training. When implementing various milieu

therapy procedures across research studies, researchers demonstrated that children with ASD

improved their communication skills. Although Sigafoos (2000) has noted that poor

communication skills and aberrant behaviors in children with ASD are highly linked, this review

found no mention of aberrant behaviors in the milieu therapy literature. Thus, readers may

acknowledge that milieu therapy increases communication skills and for many individuals,

generalizes to other people and settings when training is conducted in the natural environment.

However, the effect milieu therapy has on aberrant behaviors has not been investigated in the

literature. Clearly, this is a logical extension of the literature and needs further investigation.









Discussion

Children with ASD have significant impairments that influence their daily functioning.

Two interrelated impairments typically exhibited are deficits in appropriate communication and

behavior. Children with ASD typically have deficits in appropriate use of functional

communication skills and often engage in aberrant behaviors that serve a communicative

function (Sigafoos, 2000). In an attempt to address communication and behavioral needs,

researchers independently have addressed one or both of these problems. Functional

communication training (FCT) is one area of research that has investigated the effectiveness of

teaching children with ASD functional communication skills to replace their aberrant behaviors.

Milieu therapy is another area of research that has focused on the development of

communication skills, without attention to behavioral challenges. Although both areas of

research have produced positive child outcomes, each area also has a number of limitations. The

strengths and limitations of each area of research will be discussed next.

Functional Communication Training

FCT is one-approach researchers have employed to primarily address the behavioral

needs of children with ASD (e.g., see Mancil, 2006). Researchers have investigated the effects

of teaching a replacement communicative response, which matches the function of the aberrant

behavior, has on the associated aberrant behavior. FCT interventions have been successfully

implemented primarily in clinical settings, rather than in natural communicative environments.

The FCT literature indicates a decrease in aberrant behavior and an increase in the replacement

communicative response for the participants with ASD, which is a strength of this intervention.

Strengths. As discussed in previous sections, FCT researchers have demonstrated

several strengths of this intervention. First, researchers have provided a plethora of evidence









demonstrating that FCT has a significant impact on aberrant behavior (Durand & Carr, 1992;

Wacker et al., 2005). Second, evidence provided by researchers consistently demonstrates that

children who receive FCT use the replacement communicative behavior in place of the aberrant

behavior during intervention sessions. Finally, the discrete trial procedures typically used by

FCT researchers have been shown to be most effective at initial acquisition of communication

skills when compared to such techniques as incidental teaching (Miranda-Linne & Melin, 1992).

Limitations. Despite the strengths demonstrated by FCT researchers, a few limitations

should be addressed. First, limited FCT research has been conducted in natural environments.

Only two studies (2 of 8, 25%) were identified that have conducted training in natural

environments (e.g., home). For example, O'Neill and Sweetland-Baker (2001) conducted their

study in various locations of the participant' s classroom, while Wacker et al. (2005) conducted

training in designated rooms of the participant' s home. Second, parents and teachers seldom

were included as the change agent. Only two studies used a teacher (Wacker et al., 1990) or a

parent (Wacker et al., 2005) as a change agent. Third, although researchers have demonstrated

that FCT results in an increase in communication, this has been limited to only one trained

communication mand. No studies have taught more than one communication mand to a child.

Finally, there has been a lack of emphasis on generalization and maintenance in the research.

Durand and Carr (1992) conducted the only study that evaluated and demonstrated generalization

of communication to another person. No studies have been conducted that examined the

generalization to other settings or maintenance across time.

Milieu Therapy

Milieu therapy is another approach researchers have used to improve communicative

functioning of children with ASD. Researchers in this area have focused primarily on increasing










targeted communication skills. They have investigated the effects that techniques such as time

delay and incidental teaching have on the communication of children with ASD. As researchers

examined milieu therapy, they successfully implemented the milieu intervention strategies in the

natural environment, which resulted in an increase in communication skills.

Strengths. Several strengths of milieu therapy are evident. First, various techniques such

as time delay (Johnson et al., 2004) and mand/model/correct (Ross & Greer, 2003) have

produced positive results such as increasing the response variation of children' s communicative

skills (Warren & Gazdag, 1990; Yoder & Warren, 2002). For example, Hancock and Kaiser

(2002) showed an increase in the MLU (complexity) and vocabulary (diversity) of children with

ASD. Second, the maj ority of the milieu therapy research has been conducted in the children' s

natural environment. Six out of 8 (75%) studies were conducted in a natural environment.

Third, parents and teachers have demonstrated the ability to be effective natural change agents

using milieu therapy (7 out of 8, 88%, research studies reviewed). For example, a mother

implemented milieu therapy interventions in a study conducted by Hancock and Kaiser (2002).

In a study conducted by Ross and Greer (2003), a teacher implemented the milieu therapy

interventions. Finally, researchers consistently have demonstrated that communication skills

taught to children with ASD using milieu therapy procedures generalize to other people and

settings (McGee et al., 1985) and have greater maintenance than discrete trial procedures

(Miranda-Linne & Melin, 1992).

Limitations. Although milieu therapy researchers have demonstrated numerous

strengths of this intervention, a few limitations should be addressed. First, researchers have not

evaluated milieu therapy's effects on aberrant behavior. Research consumers do not know if

improvements in aberrant behavior occurred, which may effect decisions of consumers who are









looking for comprehensive interventions. Second, there is a paucity of research involving

children with ASD. The few milieu therapy research studies that have included children with

ASD were not designed specifically for the ASD population; instead, they were designed for any

individual with communication deficits.

Future Research Directions

When considering the strengths and limitations described in the FCT and milieu therapy

literature, future research should address concerns to extend the literature of both areas of

research. A logical extension of the FCT research is to extend this literature by examining the

following: (a) the effectiveness of FCT strategies in natural environments, (b) the generality of

FCT across people (adults and peers) and settings (home, school, community), and (c) the

maintenance of skills acquired through FCT across time. As discussed previously, few FCT

research studies have been conducted in natural environments. Further, researchers have not

investigated the generalization or maintenance of acquired skills sufficiently. In addition,

researchers have not examined the use of parents and teachers as natural change agents

suffici ently.

Similarly, there are logical extensions of the milieu therapy research. Analysis of the

following: (a) the connection to behavioral problems, and (b) the design of studies specifically

for children with ASD would extend the current research base. As described previously, milieu

therapy researchers have not systematically analyzed the relation between acquisition of

communication skills and aberrant behavior. For example, one question for future researchers to

consider is whether aberrant behaviors continue to decrease across settings as the child's

communication repertoire increases? The Hield cannot conclude what influence if any that milieu

therapy has on children' s aberrant behavior, particularly for children with ASD. Also, studies









have not been designed for children with ASD. Rather, the studies have been designed for

children with language delays, which may or may not include children with ASD.

One logical extension of the literature is to combine the strengths in FCT and milieu

therapy. Each approach has strengths that would support the future research directions for the

other approach (e.g., milieu therapy is in natural environments and FCT decreases aberrant

behavior). Combining both areas of research may (a) increase the response variation (i.e., more

words and more complex words) of children' s communicative skills, (b) provide an analysis of

the relation between aberrant behaviors and communication, (c) facilitate generalization and

maintenance of communicative skills in natural environments that also replace aberrant behavior,

and (d) demonstrate that these skills can be taught by natural change agents.

As previously mentioned, researchers investigating milieu therapy consistently have

demonstrated that using procedures such as time delay and mand/model/correct in the natural

environment greatly increases the response variation of children' s communicative skills (Warren

& Gazdag, 1990; Yoder & Warren, 2002). Thus, combining both areas of research and following

the same milieu therapy procedures while implementing FCT should result in similar findings.

In addition to increasing response variation, simultaneously analyzing communication

and aberrant behaviors is particularly important because many researchers (Carr &Durand, 1985;

Sigafoos, 2000) have hypothesized a direct relationship between aberrant behaviors and

communication skills in children with ASD. Despite this hypothesis, the relationship beyond

one behavior and communication mand using FCT has not been investigated adequately. The

findings ofFCT research have shown that teaching a communicative response will decrease one

behavior; however, these studies have not investigated whether aberrant behaviors in various

settings continue to decrease as more communication mands are taught to children with ASD










(Mancil, 2006). In contrast, research in milieu therapy with children with ASD has not

addressed this relationship, because this research focuses primarily on the communication of

children with ASD. Combining both areas of research should address the relationship between

the two variables.

Another benefit of combining both research areas is that milieu therapy researchers have

an extensive history demonstrating the effectiveness of research in the natural environment

(Alpert & Kaiser, 1992; Halle, Baer, & Spradlin, 1981; Hart & Risley, 1975; Warren & Gazdag,

1990). As aforementioned, these methods have demonstrated generalization and maintenance of

communication skills in children with ASD and other disabilities such as speech disorders

(Miranda-Linne & Melin, 1992). By using milieu therapy procedures in the natural

environment, results may indicate similar generalization and maintenance of targeted

communication skills that replace the aberrant behavior.

In addition to training in natural environments, milieu therapy researchers have

demonstrated the success of training parents and teachers to implement the intervention. The

parents and teachers used the procedures with high Eidelity and results indicated an increase in

communication skills for all children. Combining milieu therapy with FCT may show similar

results for an increase in communication skills and a decrease in aberrant behavior with parents

as natural change agents.

Another reason to simultaneously analyze the diversity of communication mands and

aberrant behaviors is efficiency. As noted by Koegel and LaZebnik (2004), the key to any

treatment program is to start intervention at an early age. Koegel and LaZebnik further noted that

each moment deficits in children with ASD are not addressed; the chance the children will

function independently in society decreases significantly. However, children with ASD and their









families have a limited amount of time available for therapy, as do many individuals; thus,

combining two forms of intervention (i.e., FCT and milieu therapy) optimizes the use of time by

concurrently addressing more than one deficit area.

In summary, both FCT and milieu therapy have been used successfully to address the

needs of children with ASD. Functional communication training (FCT) has focused on teaching

children with ASD functional communication skills to replace aberrant behaviors. In contrast,

milieu therapy has focused on the development of communication skills, without attention to

behavioral challenges. Although both areas of research have produced positive child outcomes,

each area also has a number of limitations.

In conclusion, the combination of milieu therapy and FCT will extend current research by

addressing maintenance and generalization. Maintenance and generalization will be addressed by

using milieu therapy procedures embedded in the natural environment and by training parents in

homes and teachers in classrooms (i.e., natural environment) while collecting data across time,

settings, and people. This will help determine if the training of a child with ASD by his or her

parent in the home setting will maintain over time and/or generalize to a classroom setting.

Therefore, the purpose of this study was to determine the effectiveness of combining the

strengths of two effective strategies [i.e., milieu therapy and functional communication training

(FCT)] to replace aberrant behavior with functional communicative skills in the individual's

natural environments with parents as change agents. The following research questions will be

addressed:


(a) Does the implementation of a modified milieu therapy intervention increase
communication responses and decrease dependence on prompts in children with ASD in a
natural setting?









(b) Do newly acquired communication skills in children with ASD generalize to an
untrained setting?


(c) Do newly acquired communication skills in children with ASD maintain over time?


(d) Does the implementation of a modified milieu therapy intervention result in a
decrease of aberrant behaviors in children with ASD in a natural setting?


































not available; MR = mental retardation; func.


Table 2-1. Characteristics of the study participants of FCT


Study


N CA* LA*


MA* M F


Diagnosis

Auti sm
2- Autism;
2- PDD
Auti sm
Auti sm
Autism, MR


Prior speech level


Carr & Durand (1985)
Durand & Carr (1987)

Durand & Carr (1992)
Martin et al. (2005)
O'Neill & Sweetland-
Baker (2001)
Ross (2002)
Wacker et al. (1990)

Wacker et al. (2005)


13
7-13

3.8-4.9
10
6-15


N/A
3.3-7.7

1.8-3.8
N/A
N/A


3
3-7.9

2.4-4.4
N/A
N/A


Verbal (complete sentences)
Verbal (echolalia, complex
sentences, bizarre speech)
N/A
Nonverbal
Verbal (non-functional)

Verbal
None

N/A


1


2
1
2

1
1

6


9-14.8 7-13.3 N/A
7 N/A N/A


2 Autism
Autism, MR,
Seizure disorder
1 3- Autism,
4- PDD,
1- Seizure disorder
2- CD


7 2.7-6.5 N/A


N/A



m=4.1
(2.4-7.9)


Total
Range


22 m=8
(2.7-15)


m=5.7
(1.8-13.3)


18 4


Note. CA = chronological age; LA = language age; MA = mental age; N/A =
functional; M = male; F = female; m = mean; CD = communication disorder
*Age in years/months









Table 2-2. Characteristics of the environment of FCT


Study


FCT implementer

Researcher
Researcher/ Assistants
Research Assistants
Researcher
Researcher

Researcher
Therapist, graduate
students, 1 teacher
Children's parents


FCT training location

Separate class
Separate class
Separate class
Separate class
Various class locations

Separate class
Standard classroom/
therapy room
Room at home


Description of location


Carr & Durand (1985)
Durand & Carr (1987)
Durand & Carr (1992)
Martin et al. (2005)
O'Neill & Sweetland-
Baker (2001)
Ross (2002)
Wacker et al. (1990)

Wacker et al. (2005)


5 x 10-m classroom next door
Contained table, two chairs
Table, chairs for trainer, children
N/A
N/A

Table, bookshelf, 3 chairs
Therapy room had table, chairs

N/A


SNote. N/A = not available.










Table 2-3. Research Designs and Interventions


Study


FCT design


FBA procedures

I, FA Alt. Tx
I, FA Alt. Tx

I, FA Alt. Tx

FA Alt. Tx
FA Alt. Tx

FA Alt. Tx
FA Alt. Tx
FA multiple
Element design


Dependent measures

AG, TAN, SIB, DP
2-BR; 2-HF

2-DP; 2-OP; TAN

TAN, AG, W
2-W; 1-DP; 1-SIB

no or poor initiation
SIB
6-AG; 4-SIB; 3-DP


Function


Response


Carr & Durand (1985)
Durand & Carr (1987)

Durand & Carr (1992)

Martin et al. (2005)
O'Neill & Sweetland-
Baker (2001)
Ross (2002)
Wacker et al. (1990)
Wacker et al. (2005)


Reversal
Multiple
Baseline
Multiple
Baseline
Alt. Tx
Multiple
Baseline
Reversal
Reversal
Multiple
Baseline


Verbal
Verbal

Verbal


Picture card
Verbal

Verbal
Sign language
Signs,
Pictures,
Verbal,
Assi stive
technology


1-A, 1-E, 1-T


4-A & E;
1-A & T;
1- U


Note. AG = aggressive behavior; SIB = self-injurious behavior; DP = destroying property; OP = oppositional; TAN = tantrum; W =
walk away; FCT = functional communication training; FA = functional analysis; FBA = functional behavioral assessment; HF = hand
flapping; BR = body rocking; N/A = not available; I = interview; Alt. Tx = alternating treatment; A = attention; E = escape; T =
tangible; U = undifferentiated









Table 2-4. Maj or findings of FCT


Study


Tx F IR reliability

High 80% or higher

High 80% or higher


Behavioral results


Communication results


Gen. Maint.


Carr & Durand (1985)

Durand & Carr (1987)

Durand & Carr (1992)

Martin et al. (2005)
O'Neill & Sweetland-
Baker (2001)
Ross (2002)
Wacker et al. (1990)


Wacker et al. (2005)


DB decreased to 0.5%

Reduction in HF, BR
exhibited following training
Decreased, maintained
best in FCT/time-out
Bear hugging decreased
Disruptive behavior
decreased
N/A
FCT w/time-out
resulted in hand biting
decreasing to 0%
Behaviors decreased
for all participants ranging
from 66.25% to 100%
reduction


Relevant responses N
maintained
Communication increased N

Unprompted communication Y

Independently after A phase N
Stimulus generalization N
occurred across some tasks
Faulty responses decreased N
Signing was maintained N


Manding increased Y


N


High

High
High

High
High


N/A


97-99%
87-99%


88-100%
92% average


High 90-100%


N


Note. Tx = treatment; HF = hand flapping; BR = body rocking; N/A = not available; FCT = functional communication training; Db
disruptive behavior; Tx F= treatment fidelity; Gen. = generalization; Maint. = maintenance; IR = inter rater; N = no; Y = yes










Table 2-5. Characteristics of the study participants of milieu therapy


Study


N CA*


LA*


MA* M F


Diagnosis Prior Speech Level


Charlop, Schriebman,
& Thibodeau (1985)
Charlop & Walsh (1986)


Hancock & Kaiser (2002)
Johnson, McDonnell,
Holzwarth, & Hunter (2004)
Laski, Charlop, &
Schriebman (1988)
McGee, Krantz, Mason &
SMcClannahan (1985)
McGee, Krantz, &
McClannahan (1985)
Ross & Greer (2003)
Total
Range


7 5.1-10.9

4 6-8.8


N/A

N/A


1.7-2.2
N/A

N/A

N/A


U- 6.1 7

3.6-6.2 4


Auti sm

Auti sm


Auti sm
Auti sm

Auti sm

Auti sm

Auti sm

Auti sm


2- Nonverbal;
5- Echolalic
2- Echolalic
1- Limited speech
1- Extensive speech
Limited speech
Limited speech

4- Nonverbal
4- Echolalic
Limited speech

Limited speech, often
echolalic
Limited speech


2.9-4.5
8


N/A
N/A


3 1
1


8 5-9.6

2 12.6-15.8


1.7-3.1 7 1


5-5.7


1 1


3 6-9


3.0-5.7 2.2-5.3 3


5.5-6.9
m=7.3
(2.9-15.8)


N/A
m=2.8
(1.6-5.7)


N/A
m=3.9
(2.7-6.2)


N/A
25


Note. CA = chronological age; LA = language age; MA = mental age; N/A = not available; U= untestable; func. = functional; M
male; F = female; m= mean
*age in years










Table 2-6. Characteristics of the environment of milieu therapy


Study


Therapy implementer

Researcher

Researcher/ Parent

Parent
Paraprofessional
Primary caretaker*
Teacher
Teacher
Teacher


Therapy training location


Description of location


Charlop et al. (1985)

Charlop & Walsh (1986)

Hancock & Kaiser (2002)
Johnson et al. (2004)
Laski et al. (1988)
McGee et al. (1983)
McGee et al. (1985)
Ross & Greer (2003)


Separate class

Typical play area

Separate class
Classroom
Home
Group Home
Classroom
Classroom


Partitioned area of classroom and
clinic room
Play room w/toys, outside in grass
area
Clinic room
N/A
Various rooms of typical home
Various rooms of typical home
Typical classroom
Typical classroom


SNote. N/A = not available.
Primary caretaker is a resident home parent









Table 2-7. Research Designs and Interventions of Milieu Therapy


Study


Research design


Milieu procedures Dependent measures


Communication skill

Basic needs
(e.g., "I want _")
Emotion phrase
(i.e., "I like you")


Charlop et al. (1985)

Charlop & Walsh (1986)


Hancock & Kaiser (2002)

Johnson et al. (2004)



Laski et al. (1988)






McGee et al. (1983)

McGee et al. (1985)



Ross & Greer (2003)


Multiple baseline
Across participants
Multiple baseline
Across participants

Multiple baseline
Across participants
Multiple baseline
Across CS


Multiple baseline
Across participants




Multiple baseline
Across sets of obj ects
Multiple baseline
Across participants
and pairs of prepositions

Multiple baseline
Across participants


Time delay (2s-10s)

Time delay (2s-10s),
Model/Correct, and
Mand/Model/Correct
Time delay (N/A),
Mand/Model/Correct
Time delay (4s),
Model/Correct


Mand/Model/Correct






Incidental teaching

Incidental teaching



Time delay (5s),
Mand/Model/Correct


MLU


Basic needs (Use of
device to request
help, break, and
snack)
Basic needs (i.e.,
"I want car");
Description (i.e.,
"Block is big"); and
Questions (i.e., "What
do you want?")
Receptive labeling of
obj ects
Pairs of prepositions
(on/under, inside/next
to, and in front of/
in back of)
Basic needs/
Vocal imitations


Note. MLU= mean length of utterance; N/A = not available; CS= communication skill









Table 2-8. Maj or findings of milieu therapy

Study Tx F IR reliability

Charlop et al. (1985) High 98%

Charlop & Walsh (1986) High 100%


How reported Results

By trial and blocks of 10 All acquired CS within
60 trials
# of correct responses 2- CS quickly increased to
per day criteria level
2-met criteria after time
delay procedure
% of opportunities, MLU % of opportunities w/ correct
diversity, and PPVT-R response increased, MLU
increased
% of correct responses Help (100%), break and
snack (80-100%)
% of intervals All children increased % of
intervals in which vocalized
% of correct responses 75-100% for all sets of
obj ects for both participants
% of correct responses 90-100%
% of correct responses 20-100% range, all increased
dramatically from baseline

treatment fidelity; IR = interrater; Gen. = generalization; Main,


Gen.

Y

Y


Main.

Y

Y


Hancock & Kaiser (2002)


Johnson et al. (2004)

SLaski et al. (1988)

McGee et al. (1983)

McGee et al. (1985)
Ross & Greer (2003)


Note. Tx = treatment; CS=
maintenance; Y = yes; N =


High N/A


Y Y


High

Low

High

High
High


97-100%

79-98%

94-100%

87-100%
89-100%


communication skills; TxF =
no









CHAPTER 3
IVETHOD S

The purpose of this chapter is to describe the methods that were used to conduct the

study. First, criteria for selecting the participants, the setting in which the study was conducted,

and the change agents and materials needed to carry out the study are reviewed. Second, the

dependent measures, coding definitions, experimental procedures, study design, and data

analysis methods are described. Finally, strategies to ensure interobserver agreement, treatment

integrity, and social validity are summarized.

Participants

The purpose of this study was to determine the effectiveness of modified milieu therapy

intervention [i.e., combined functional communication training (FCT) and milieu therapy]

implemented in the natural environment of children with ASD by their parents or other guardian.

The participants for the study included three preschool or elementary aged children with ASD

who were between the ages of four and eight. They were recruited with the help of a local

agency for individuals with ASD.

Prior to participating in the study, Institutional Review Board (IRB) approval was

obtained from the University of Florida. Upon IRB approval, parents and teachers of the target

children signed consent forms for their children to participate in the study, and for the study to

occur in the homes and classrooms of the target children. The target children had a diagnosis of

ASD obtained independently from a physician, licensed psychologist, or diagnostic center. In

addition, the Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003) and the

Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, DiLavore, & Risi, 1999) were

administered to obtain additional standardized scores indicating a diagnosis of autism.









The selection criteria for the targeted children included (a) enrolled in a pre-school or

elementary school, (b) nonverbal or limited language, (c) a mental age of at least 28 months

(McFee, McCrimmon, & Bebko, 2006), (d) autism diagnosis according to the ADI-R, and (e)

display of aberrant behavior used for communication to obtain a tangible item. Initially, parent

and teacher interviews determined if the target children met the aforementioned criteria. After

the interviews were concluded, direct observations and formal testing were conducted to confirm

that each child met the latter three inclusion and exclusion criteria. The third and fourth criteria

(i.e., diagnosis of autism and mental age of at least 28 months) were confirmed based on data

obtained from the ADI-R (LeCouteur, Lord, & Rutter, 2003), SCQ (Rutter, et al., 2003), and

Mullen Scales of Early Learning (Mullen, 1992). These were given by the primary experimenter

who was clinically trained to administer the ADI-R and other instruments. In addition, the Einal

criterion (i.e., tangible function of behavior) was confirmed by conducting a functional analysis

(see Appendix A for the functional analysis protocol).

Scott

Scott, a Caucasian male, was 7 years and 11 months at the start of the study (see Table

3.1). He participated in a private school for children with autism and related disabilities. Scott

was diagnosed with Autism at the age of three by a psychiatrist (no specific diagnostic measure

was reported). According to teacher and parent interviews, his socio-communicative skills

included the ability to initiate and respond through gestures and verbal language (2-3 word

utterances). However, they noted he had to be prompted to communicate the maj ority of time. He

demonstrated a low rate of social initiations to peers and adults. Scott' s overall mental age was

49 months as indicated by the Mullen Scales of Early Learning. His SCQ score was 25, well

above the cut off score of 15; thus, indicating autism and a need for further testing. Further,









Scott' s ADI-R scores for the three domains were 26 for reciprocal social interaction (cutoff =

10), 22 for communication (cutoff = 8), and 10 for repetitive behavior (cutoff = 3), which were

all well above their respective cutoff scores; indicating a diagnosis of autism. In addition,

tangible function for aberrant behavior was determined by a functional analysis to maintain his

aberrant behavior (i.e., hitting and pinching others).

Scott' s mother, the natural change agent for this study, has two children of which Scott is

the youngest (see Table 3.2). She has a Bachelor' s degree and has participated in several

research studies prior to this study. In addition, she indicated having received training in Applied

Behavior Analysis and the Picture Exchange Communication System (PECS) from a workshop

hosted by the Center for Autism and Related Disabilities.

Scott' s teacher had a Bachelors degree in education (see Table 3.3). She had six years

teaching experience and was ABA trained. In addition to Scott, she had 4 other students in her

classroom (i.e., a total of 5 students).

David

David, a Caucasian male, was 4 years and 1 month at the start of the study (see Table

3.1). He participated in a public school special education classroom for children with varying

disabilities. David was diagnosed with Autism at the age of two by a neurologist (no specific

diagnostic measure was reported). According to teacher and parent interviews, his socio-

communicative skills included the ability to initiate and respond through gestures and verbal

language (2-3 word utterances). However, they noted he had to be prompted to communicate the

maj ority of time. He demonstrated low rates of social initiations to peers and adults. David' s

overall mental age was 29 months as indicated by the Mullen Scales of Early Learning. His SCQ

score was 24, well above the cut off score of 15; thus, indicating autism and a need for additional









testing. Further, David's ADI-R scores for the three domains were 26 for reciprocal social

interaction (cutoff = 10), 14 for communication (cutoff = 7), and 10 for repetitive behavior

(cutoff = 3), which were all well above their respective cutoff scores; indicating a diagnosis of

autism. In addition, tangible function for aberrant behavior was determined by a functional

analysis to maintain his aberrant behavior (i.e., hitting and biting self).

David' s mother, the natural change agent for this study, has two children of which David

is the oldest (see Table 3.2). She has a Bachelor' s degree in Nursing and has not participated in

research studies prior to this study. In addition, she did not indicate having received training in

such techniques as Applied Behavior Analysis.

David's teacher had a Masters degree in education (see Table 3.3). She had twelve years

teaching experience and was not ABA trained. In addition to David, she had eight other students

in her classroom (i.e., a total of 9 students).

Zeb

Zeb, a Caucasian male, was 4 years and 10 months at the start of the study (see Table

3.1). He participated in a public school special education classroom for children with varying

disabilities. Zeb was diagnosed with autism at the age of two by a neurologist (no specific

diagnostic measure was reported). According to teacher and parent interviews, his socio-

communicative skills included the ability to initiate and respond through gestures and verbal

language (2-3 word utterances). However, they noted he had to be prompted to communicate the

maj ority of time. He demonstrated low rates of social initiations to peers and adults. Zeb's

overall mental age was 32 months as indicated by the Mullen Scales of Early Learning. His SCQ

score was 27, well above the cut off score of 15; thus, indicating autism and a need for further

testing. Further, Zeb's ADI-R scores for the three domains were 26 for reciprocal social









interaction (cutoff = 10), 16 for communication (cutoff = 7), and 10 for repetitive behavior

(cutoff = 3), which were all well above their respective cutoff scores; indicating a diagnosis of

autism. In addition, tangible function for aberrant behavior was determined by a functional

analysis to maintain his aberrant behavior (i.e., tantrums- screaming).

Zeb's mother, the natural change agent for this study, has two children of which Zeb is

the oldest (see Table 3.2). She has a high school diploma and has not participated in research

studies prior to this study. In addition, she did not indicate having ever received training in such

techniques as Applied Behavior Analysis.

Zeb's teacher had a Masters degree in education (see Table 3.3). She had fifteen years

teaching experience and was not ABA trained. In addition to Zeb, she had five other students in

her classroom (i.e., a total of 6 students).

Settings, Change Agents, and Materials

This section describes the settings in which each phase of the study was conducted, the

change agents who conducted the experimental procedures and collected data during each phase,

and the materials used to conduct the study.

Settings

All four phases of the study were conducted in the natural environments of the

participants (i.e., home and school). The phases included: (a) pre-intervention/assessment, (b)

baseline, (c) intervention, and (d) maintenance. Additionally, generalization was examined

throughout the study. For the pre-intervention phase, baseline phase, and intervention phase, data

were collected in the home of each participant (e.g., living room or other area where

communication typically occurred). Training of the child participants and parents occurred in

the home of each respective participant. Additionally, generalization data were collected in the










participants' classrooms during the baseline, intervention, and maintenance phases in the home

setting. The location of the study within the home and classroom were selected by the parents

and teachers and represented locations where the communication skills typically occurred (e.g.,

playground, snack time). In addition, the maintenance phase occurred in the home and classroom

in the same location as the previous phases.

Change agents

The primary experimenter, who conducted the pre-intervention/assessment phases, has

several years experience working with children with ASD. The primary experimenter has

several publications related to ASD and his research currently focuses on communication and

social behaviors of children with ASD. Parents served as the change agents for the baseline,

intervention, and maintenance phases. All parents spoke English and were literate. In addition,

information on their education, expertise, and experience was obtained to account for any

potential differences based on implementer characteristics (see Appendix B for data sheet). For

example, one parent participated in previous communication studies. Teachers also spoke

English. Similar to the parent characteristics, data was collected on the teachers' education,

expertise, and experience (see Table 3.3).

Materials

During each of the phases, materials were used to provide interventions and to collect,

code, and analyze data. These included picture cards, preferred items, training videos, a digital

video camera, a laptop computer, and data collection sheets. The picture cards (created using the

computer program Board Maker) were used during intervention, generalization, and maintenance

sessions (see Appendix C for sample cards). In addition, along with the training videos, the cards










were used to train parents. Preferred items (e.g., toys) identified during preference assessments

were used during all three phases. A digital camera was used to video all phases of the study.

Dependent Measures

This section outlines the primary and secondary dependent measures. Definitions of the

primary dependent measures that were collected on the participants' aberrant and communication

behaviors during the study's four phases are provided. In addition, definitions of the secondary

dependent measures that were collected on the participants' play behaviors and adults'

prompting behaviors are provided. The specific definitions used to operationally define each

behavior are described (see Appendix D for coding manual) and have been adapted from

previous researchers (Lalli, Casey, & Kates, 1995; Wacker et al., 2005).

Pre-Intervention Measures

Two experimental pre-assessments were conducted. First, an evaluation of target

individual's preference for tangible items were assessed through a preference assessment (Roane

et al., 1998). Data were collected in vivo on the duration of play with tangible items during the

preference assessment. Play consisted of the participant engaged with an item for a period of two

or more seconds in which the participant also made eye contact with the item. For example, if a

child picked up a toy car (i.e., tangible item), briefly looked at the item, and held it for at least

two seconds, play was coded. In contrast, if a child picked up a toy car, never looked at it, and

walked around the room with the car in his hand for four seconds, play was not coded.

Duration of play with tangible items was recorded with a stopwatch using a paper and

pencil recording system while viewing the video (see Appendix E for data sheets). The observer

used a stopwatch to record the duration of time the target child was engaged with the tangible

and then recorded the time on a data collection sheet.









Second, identification of the function (or communicative outcome) of aberrant behavior

was determined through a functional analysis. Aberrant behavior was defined broadly as

behavior that negatively impacted target child learning and independence and ranged from mild

(e.g., throws a toy on the floor once) to severe behavior (e.g., tantrums for an hour or bangs head

on the wall) (Bailey and Burch, 2002). Individual definitions of aberrant behavior varied and

were adjusted based on each target child's form of the behavior. These behaviors were

operationally defined in observable and measurable terms (Bailey and Burch, 2002).

For each participant, the targeted aberrant behavior was identified from data obtained

through parent and teacher interviews (i.e., informal interview questions) and direct

observations. The parents and teachers first identified the most prevalent aberrant behavior for

each child. The parent and teacher agreed on the same target behavior of each respective target

child. The primary experimenter then observed the child for one hour (Kazdin, 1982) in the

home and classroom to confirm that the target behavior occurred. The primary experimenter

recorded each occurrence of the target behavior using paper and pencil (see Appendix E for data

sheets). After the aberrant behavior was defined, an FA was conducted. To evaluate the relative

differences of various FA conditions, data were collected on responses per minute of aberrant

behavior in each condition (see Appendix A for protocol).

Intervention, Generalization, and Maintenance Measures

During the intervention, generalization, and maintenance phases of the study, data were

taken in vivo on five dependent measures: (a) frequency of aberrant behavior, (b) frequency of

unprompted and prompted communication responses, (c) latency of unprompted communication

responses in the training setting, (d) frequency of adult verbal, verbal/gestural, and physical

prompts (which also serves as a treatment integrity measure), and (e) number and diversity (i.e.,









verbs, nouns) of unprompted verbalizations. Each of these behaviors was recorded using a paper

and pencil data collection system while viewing the video (see Appendix E for data sheets). The

primary experimenter viewed the videotapes and recorded the first four measures initially.

Following this observation period, the videotape was viewed a second time. During this time,

the number and diversity of words was recorded. The definitions for these measures follow (see

Appendix D for detailed coding manual).

Aberrant behavior. Aberrant behavior definitions varied and were adjusted based on

each target child's form of the behavior. Some participants engaged in tantrums and others

engaged in property destruction or aggression toward others.

Unprompted communication response. Unprompted communication responses were

defined as handing picture communication cards to the trainer involved in the session without

any prompts.

Prompted communication response. Prompted communication responses were defined

as handing picture communication cards to the trainer involved in the session following a

prompt. This consisted of one of the following prompts: (a) physical, verbal, or verbal/gestural.

Prompts. Prompts, a secondary dependent measure, consisted of adults providing

verbal, verbal/gestural, or physical prompts, from least to most intrusive, respectively. Verbal

prompts consisted of verbal cue (e.g., "Tell me what you want."). Verbal/ gestural prompts

consisted of a combined verbal and visual cue (e.g., parent holds hand out with palm up in

anticipation of receiving a card while saying "Tell me what you want."). Physical prompts

consisted of hand over hand exchanges (e.g., parent leading a child's hand to a card).










Spontaneous verbalizations. Spontaneous verbalizations, a secondary dependent

measure, were defined as verbal words emitted by participants that were not echolalic in nature

or imitative of adult words. These varied in number and diversity (e.g., nouns, verbs).

Experimental Procedures and Study Design

The experimental procedures section outlines the steps that were followed to conduct

each phase of the study, and the study design section describes the single subj ect design used to

evaluate treatment effects. Four phases were conducted (a) pre-intervention/assessment

(functional analysis and preference assessment), (b) baseline, (c) intervention, and (d)

maintenance. Additionally, generalization was collected throughout the study.

Pre-intervention/Assessment Phase

Two assessments were conducted: (1) preference assessment, and (2) functional analysis.

Preference assessment. A preference assessment was conducted based on procedures

described by Roane and colleagues (1998). First, parent interviews were conducted to provide

insight into target children's interests and behavioral functions. Item interests obtained in the

caregiver interview were used for the preference assessment. From this list of items, the top

seven were chosen for the preference assessment. This set of seven items was arranged in a

circle in the specified location, chosen by the parent, at the home. The primary experimenter

walked the child to the center of the circle, which was equidistance from all items. The child was

told to choose a toy. Each target child was allowed to choose any item he wanted to interact with,

including multiple items. For a period of Hyve minutes, the observer recorded the duration the

target child played with each item. The item the target child played with for the longest duration

was used as the first item of interest in the intervention phase.










After the first preference assessment was conducted, the item the target child engaged

with for the longest time period was removed. Following this, another preference assessment

was conducted minus the original preferred item. This was repeated until three items were

identified, which were chosen as the items used to teach each communication mand to the target

child. The first assessment determined the first item to use for the mand and the next two

preference assessments determined the subsequent items to use for mand training.

Functional analysis. The functional analysis was conducted to determine the function of

the aberrant behavior. As stated, only children who displayed a tangible function were chosen for

inclusion in this study. Tangible functions were chosen because of the inherent design of the

intervention techniques, such as incidental teaching (i.e., to request items), and to avoid exposing

a child to aversive stimuli that elicits escape behavior. A functional analysis was conducted in

the participants' home settings using the procedures outlined by Iwata, Dorsey, Slifer, Bauman,

and Richman (1982/1994) with the addition of a tangible condition.

The functional analysis (FA) was conducted by manipulating consequences such as

escape from demands, contingent attention, and contingent tangible items to determine the

function of the behavior. To identify a primary function, the relative effects of contingent

reinforcement were compared to the other conditions (i.e., tangible, free play, escape) (see

Appendix A for FA protocol). After completing the FA, a tangible function was identified for

each participant.

Baseline and Intervention Phases

The baseline and intervention phases consisted of baseline, training, and the intervention.

Baseline. Prior to beginning baseline, the primary experimenter interviewed parents and

teachers and conducted direct observations in the home and classroom in locations training









occurred. During the interviews, the primary experimenter asked the parents and teachers to

identify routines during which the target children typically had access to the preferred items.

After obtaining the aforementioned data, baseline observations occurred during typical home and

classroom routines, which were identified and held constant for each target child. Baseline

consisted of direct observation of all dependent measures. During baseline, the target child was

given access to the first preferred item for 30s. The parent then removed the item and interacted

with the first preferred item for 30s. After interacting with the preferred item, the parent returned

the item to the target child for another 30s access period. This interaction cycle continued for the

5min session. During this time, the target child had access (i.e., card was on the floor next to the

target child) to the picture card of the first preferred item. These procedures were repeated

throughout each 5min session.

Training. Before initiating the intervention, parents were taught the procedures for

teaching their child to communicate using the modified milieu therapy intervention. This skill

was taught through viewing videos of the experimenter conducting an intervention with a child

with autism and through role-play training sessions. As outlined in Appendix F, parents first read

the training manual. The primary experimenter clarified any questions about coding definitions.

Then, the primary experimenter and parents viewed videos and identified and recorded

intervention procedures. They used paper and pencil to record and classify (e.g., verbal,

physical) each prompt given to the child in the video. In addition, the primary experimenter and

parents wrote each response from the child and recorded whether the response was prompted or

unprompted, classifying the prompt. This was done until the parents achieved 90% interobserver

agreement (IOA) with the primary experimenter. Finally, parents role-played the intervention

procedures with the primary experimenter. The parent practiced taking an item and playing with









the item, and giving verbal, verbal/gestural, and physical prompts with the primary experimenter

until they were able to perform the skills correctly 10 consecutive trials (see Appendix F for

detailed training manual).

For purposes of generalization, in contrast, teachers were taught a single skill. They were

taught to place highly preferred items in view, but out of reach of the child. Additionally, the

teachers were instructed to give the highly preferred items to the child when the child gave them

a picture card. The teachers practiced these skills through role-play with the primary

experimenter until they were able to complete this skill successfully as evaluated and defined by

parents and teachers performing the procedures correctly 10 consecutive trials (see Appendix F

for training manual and worksheets).

Intervention. Following baseline and completion of adult training, the intervention

began (see Figure 3.11 for visual of the intervention procedures). The intervention phase

consisted of three conditions (i.e., each tangible item was a new condition). The intervention

sessions initially occurred in an area of the home predetermined in the interviews during the pre-

intervention/assessment phase. However, if the child initiated communication and then began to

play in other locations (e.g., bedroom floor, kitchen table), the parent followed the child and

conducted the intervention in the new location.

During the intervention, a time delay of 5 seconds was used prior to prompting the child

for the tangible items. If the child asked for the item at any time, the child was allowed access to

the preferred item for 30 seconds and then the primary experimenter prompted the parent to take

the item and play with the item. An access time of 30 seconds was used because this time period

has been identified as enough time to keep a child's interest but not satiate (O'Neill &

Sweetland-Baker, 2001).









The intervention began by allowing the child access to the preferred item for 30 seconds

and then performing a two-step modeling procedure. The first step of the modeling procedure

consisted of the primary experimenter giving the parent a visual prompt (i.e., index card with

"Provide Model" written on it), the parent then said, "I want the _", gave the picture card to

the child, and then took the preferred item. The parent then played with the item of interest in the

home for 30 seconds without immediately providing another prompt If the child did not use the

picture card, the second step of the modeling procedure consisted of the primary experimenter

providing a visual prompt (i.e., index card with the words "Physical prompt" written on it) for

the parent to provide a physical prompt (i.e., hand over hand assistance) and then allow access to

the preferred item for 30 seconds. This two-step model procedure was done with each target

child and was not recorded as communication responses.

After the two-step modeling procedure, the primary experimenter provided a visual

prompt (i.e., index card with "Take Toy" written on it), the parent took the item and played with

the item of interest in the home without immediately providing a verbal mand. If the child did

not ask for the item within the defined time delay for the tangible item, the primary experimenter

provided a visual prompt (i.e., index card with the words "Verbal prompt" written on it)

indicating to the parent to provide a verbal prompt. The parent would then say, "Tell me what

you want." If the child did not initiate communication within the 5s time delay for the tangible

item, the primary experimenter provided a visual prompt (i.e., index card with the words

"Verbal/gestural" written on it) for the parent to provide a combined verbal/gestural prompt. If

the child still did not respond within the 5s time delay, the primary experimenter provided a

visual prompt (i.e., index card with the words "Physical prompt" written on it) for the parent to










provide a physical prompt (i.e., hand over hand assistance) and then allow access to the preferred

item for 30 seconds.

This condition for the intervention phase was continued two to three times a week until

the latency of the child' s response occurred consistently within the allotted 5s time delay for the

tangible item and decreased levels of aberrant behaviors were indicated. When the child

displayed the communicative response following the mand for the first item consistently within 5

seconds, for at least 75% of the prompts, and at least 20% of the communication responses in the

last three sessions were unprompted, the same procedures were followed to teach two additional

mands for preferred items. In each new condition of the intervention phase (i.e., condition two

and three), the child had access to the new card indicating a new item and the card(s) from the

previous conditions) of the intervention phase.

Maintenance Phase

The purpose of the maintenance phase was to determine if unprompted communication

trained in the home maintained over time. Two weeks following the conclusion of the

intervention phase, the primary experimenter and graduate assistant videotaped sessions in the

home until a stable trend in data was observed. During these sessions, the primary experimenter

did not provide any prompts to the parents. Parents continued to provide the intervention as

previously implemented during the last condition of the intervention phase without any

assistance from the primary experimenter. During this phase, the target child had access to all

three picture cards. In addition, the parent randomly interacted with each preferred item across

sessions. Each preferred item was interacted with for at least one entire session (see Table 3.4).









Generalization

The purpose of the generalization probes was to determine if and when communication

trained in the home environment generalized to the classroom environment. Generalization data

were collected simultaneously while the intervention phase of the study was being implemented.

The data were collected during typical classroom routines and activities as identified through the

pre-assessment interviews (e.g., snack, playtime, center time). The routines targeted depended on

the item of interest and when the item was typically available to the target child. For example, if

the preferred item was a toy car that the target child would play with during playtime and center

time, then data were collected during those periods. During these routines, the target child had

access to the picture cards. When data stabilized in each phase at home, at least three

generalization probes were conducted in the classroom (Kennedy, 2005).

The primary experimenter videotaped generalization sessions in the classroom that

corresponded to sessions in each child's home. After a few sessions in the home setting,

generalization data were collected in the classroom for at least a four to one ratio. That is, for

every four sessions in the home, at least one generalization data session was conducted.

During the generalization sessions, the teachers did not provide any prompts. Each target

child's respective preferred items were in view, but not accessible without requesting the item.

As aforementioned, each target child had access to the picture cards that indicated his respective

preferred items. The picture cards accessible to each target child mirrored those accessible in the

corresponding condition of the intervention phase. If the target child requested the preferred item

using the picture card, he was given 30s access to the item.












Experimental Design

A concurrent multiple baseline design across participants was used to evaluate the

effectiveness of the modified milieu therapy intervention on decreasing aberrant behaviors and

increasing communication behavior. While parents implemented the intervention in the home,

the primary experimenter videotaped the child in the classroom to determine if skills generalized

to the classroom and teacher. Effects of multiple baseline designs are demonstrated by

introducing the intervention to different participants at different times (Kazdin, 1982). Using

visual analysis, if changes in the dependent variables occur following the introduction of the

intervention, then this change can be attributed to the intervention.

Data Analysis

The data analysis section outlines the procedures used to analyze and evaluate the coded

data. The interobserver agreement section will describe the steps taken to ensure the reliability

of the data collected.

Data Collection, Coding, and Analysis

Sessions across all phases were videotaped using a Panasonic mini-DV digital camcorder

and subsequently coded using real time data collection sheets (see Appendix E). The data were

transferred to an ibook G4 laptop computer for data analysis using movie and Quicktime Pro

software. Each session was conducted for 5 minutes.

During each session, the primary experimenter recorded the frequency of aberrant

behaviors, frequency of prompted and unprompted communication responses, latency to respond

to prompts, frequency of types of prompts, and diversity and number of unprompted

verbalizations. The frequency of the aberrant behavior was recorded in real time (i.e., every









aberrant behavior was recorded). Responses per minute were calculated by taking the frequency

of aberrant behaviors during the session and dividing by the total amount of time of the session

(Hyve minutes).

Latency data were collected on the time between the adult taking the preferred item from

the target child and the target child requesting the item spontaneously. The average latency to

respond per session was calculated by adding the latency to respond with unprompted

communication during the Hyve-minute session and dividing by the total number of unprompted

communication responses.

Concurrently, the number and types of prompts provided by parents were counted.

Further, the primary experimenter viewed the videotapes a second time to collect the diversity

and number of unprompted verbalizations by recording the occurrence of each verbalization on a

data collection sheet (see Appendix E for data sheet). Every verbal word spoken during each

Hyve-minute session was recorded.

Each of the dependent measures were graphed and analyzed visually following

procedures outlined by Kennedy (2005) to determine the effects of the intervention on the

dependent variables. All phases were conducted until visual inspection of the graphed data

revealed at least three consecutive and stable data points. The primary experimenter used the

Microsoft Excel software program to graph the data. Line graphs were drawn for the frequency

data (converted to responses per minute or percentage of session data). Bar graphs were drawn

for the latency data (converted to mean latency) and verbalizations data (mean rate per

condition).

Kennedy (2005) recommended the examination of three aspects of line graphs, which

were used for the primary dependent measures in this study, to determine the influence of the









intervention (a) level of the dependent variable, (b) trend of the data (slope and magnitude), and

(c) variability. He further recommends two aspects of line graphs to determine the influence of

the independent variable across conditions (a) immediacy of effect, that is, how quickly change

occurs between phases, and (b) overlap of data between phases. These procedures were followed

to visually analyze the data for determining phase changes.

Interobserver Agreement

Interobserver agreement (IOA) is the extent to which two or more observers agree that a

behavior occurred, and more specifically, when and how long a behavior occurred (Kazdin,

1982). It provides a measure of the reliability (consistency of scores overtime) of the observers.

Interobserver agreement should be assessed for three reasons: (a) to minimize observer biases

that may develop, (b) to control for inconsistency of observers as one source of variation in data

collection, and (c) to determine if the target behaviors are well defined (Kazdin, 1982).

Kazdin (1982) recommends that IOA be collected during at least 25% of all observations

across the different phases of the investigation. This research proj ect adhered to Kazdin' s

criterion. IOA was calculated on at least 25% of the sessions during each phase of the study.

For frequency measures (e.g., communication responses, prompts), total agreement was

calculated (Kennedy, 2005). To calculate IOA for frequency measures, the number of responses

recorded by the primary observer was totaled. Similarly, the number of responses recorded by

the secondary observer was totaled. Finally, the smaller total was divided by the larger total and

multiplied by 100. This gave the IOA total agreement for each frequency measure.

For latency (e.g., communication response) and duration (e.g., play) measures, the total

agreement approach was used (Kennedy, 2005). To calculate IOA for latency measures, the

latency recorded by the primary observer was totaled. Similarly, the latency recorded by the









secondary observer was totaled. Finally, the smaller total was divided by the larger total and

multiplied by 100. This gave the IOA total agreement for latency. To calculate IOA for duration

measures, the duration recorded by the primary observer was totaled. Similarly, the duration

recorded by the secondary observer was totaled. Finally, the smaller total was divided by the

larger total and multiplied by 100. This gave the IOA total agreement for duration.

The primary experimenter was the primary data collector during each phase of the study

and a trained graduate student assisted with IOA. Agreement on at least 80% of all observations

must occur for observers to achieve acceptable interrater agreement. For this to occur the

observers must be well trained and the behaviors must be clearly defined. Prior to the collection

of data, all data collectors were at least 80% reliable across three consecutive sessions on the

coding system used for each phase of the study by coding videotapes of children with ASD

whom have similar characteristics as the actual participants. The primary experimenter and

graduate student independently watched videotapes of the intervention being performed with a

child with ASD. Both data collectors used the coding system to code frequency and latency

measures. IOA then was calculated between the measures recorded by the primary experimenter

and the graduate student. The IOA obtained was an average of 92% (range of 80% to 100%).

The aforementioned IOA procedures were used for the preference assessments,

functional analyses, baseline, intervention, and generalization sessions for each dependent

measure. First, IOA for the preference assessments will be provided. Second, IOA for the

functional analyses will be reported. Finally, IOA for baseline, intervention, maintenance, and

generalization sessions will be reported for each participant on the dependent measures that

include communication responses, prompts, aberrant behavior, latency to respond, and

verbalizations.









Preference Assessment

For the preference assessments, agreement on the duration of time each participant

physically touched an item was 100%. Reliability was calculated for 100% of the sessions for

each child.

Functional Analysis

For the functional analysis sessions, agreement on the frequency of aberrant behavior

during sessions for Scott averaged 95% (90%-100%), David averaged 96% (92%-100%), and

Zeb averaged 92% (89%-95%). Reliability was calculated for 40% of the sessions for each child.

Communication Responses

Agreement on Scott' s communication responses averaged 96% with a range of 88% to

100%. As for David, agreement on his communication responses average 95% with a range of

87% to 100%. IOA on Zeb's communication responses averaged 97% with a range of 87% to

100%. Reliability was calculated for approximately 50% to 100% of all baseline, intervention,

maintenance, and generalization sessions for each child on communication responses.

Prompts

Scott. Agreement on total prompts for Scott averaged 93% (86%-100%). Of the total

prompts for Scott, agreement on verbal prompts averaged 91% (80%-100%), verbal/ gestural

prompts averaged 94% (84%-100%), and physical prompts averaged 100%.

David. Agreement on total prompts for David averaged 96% (86%-100%). Of the total

prompts for David, agreement on verbal prompts averaged 94% (87%-100%), verbal/ gestural

prompts averaged 95% (88%-100%), and physical prompts averaged 100%.

Zeb. Agreement on total prompts for Zeb averaged 91% (84%-100%). Of the total

prompts for Zeb, agreement on verbal prompts averaged 88% (80%-97%), verbal/ gestural










prompts averaged 92% (87%-100%), and physical prompts averaged 100%. Reliability was

calculated for approximately 50% to 100% of all baseline, intervention, maintenance, and

generalization sessions for each child on prompts.

Aberrant Behavior

Agreement on Scott' s aberrant behavior averaged 96% with a range of 85% to 100%. As

for David, agreement on his aberrant behavior average 97% with a range of 89% to 100%. IOA

on Zeb's aberrant behavior averaged 95% with a range of 87% to 100%. Reliability was

calculated for approximately 50% to 100% of all baseline, intervention, maintenance, and

generalization sessions for each child on aberrant behavior.

Latency

Agreement on Scott' s latency to respond averaged 91% with a range of 83% to 100%. As

for David, agreement on his latency to respond average 92% with a range of 88% to 100%. IOA

on Zeb's latency to respond averaged 92% with a range of 85% to 100%. Reliability was

calculated for approximately 50% to 100% of all baseline, intervention, maintenance, and

generalization sessions for each child on latency to respond.

Verbalizations

Agreement on Scott' s verbalizations averaged 94% with a range of 80% to 100%. As for

David, agreement on his verbalizations averaged 99% with a range of 97% to 100%. IOA on

Zeb's verbalizations averaged 97% with a range of 84% to 100%. Reliability was calculated for

approximately 50% to 100% of all baseline, intervention, maintenance, and generalization

sessions for each child on verbalizations.









Treatment Integrity and Social Validity

Despite the importance of treatment integrity and social validity, seldom is either

collected in single subject studies targeting young children with ASD (Odom et al., 2003). This

section will describe how treatment integrity and social validity were collected for the current

study .

Treatment Integrity

Data on treatment integrity were gathered by viewing the videotapes from the baseline,

intervention, maintenance, and generalization sessions. Data were gathered during baseline to

ensure that the intervention was not being implemented. Data collectors viewed the videos and

recorded any adult prompts provided by the parents and teachers (i.e., recorded any prompts

because the parents and teachers were instructed to make no prompts). In addition, data were

gathered on the intervention in the home setting to ensure that the intervention procedures were

implemented consistently across participants. Data also were gathered during the maintenance

phase to ensure that the intervention procedures were implemented consistently across

participants. Finally, data were gathered during generalization sessions to ensure that the teachers

were following instructions and the modified milieu therapy intervention was not being

implemented in the classroom.

A data collector viewed the videos and compared the procedures viewed with those

outlined in the experimental procedures section. For example, treatment integrity data were

collected on the percentage of times the caregivers and teachers provided the highly preferred

item to the child when the item was requested. For each procedure implemented, the data

collector and expert marked a "yes" if this step was done correctly and a "no" if this step was









done incorrectly (see Appendix G for treatment integrity data sheet). The total correct

procedures were divided by the total number of procedures to be implemented.

Although there is not a consensus on a particular criterion level (Kazdin, 1982), a criteria

level of 80% was used to determine if high treatment integrity existed. The 80% criterion level

enabled the primary experimenter to make more precise conclusions about the interrelation

between the intervention and the dependent variables.

In addition, data were gathered during the generalization phase within the classroom to

ensure the teacher implemented the generalization procedures correctly and did not provide

unintentional prompts. Data collectors viewed the videos and recorded the number of

unintentional prompts provided by the teacher (i.e., recorded any prompts because the teacher

will be instructed to make no prompts).

Social Validity

Social validity data were collected on the intervention and outcomes. Caregivers and

teachers were asked to complete rating scales concerning the invasiveness and friendliness of the

procedures (see Appendix G) to determine the social validity of the process. In addition,

videotape analyses by one expert in the field of ASD were used to determine therapeutic

outcomes of the participants' social-communicative behaviors. The expert was chosen from the

University of Florida and had several years experience working with children with ASD and

their parents and teachers. The expert was asked to view 10-minute video clips of randomly

selected footage of the participants during the baseline and intervention sessions. The expert

completed a Likert scale to indicate the degree of appropriate social-communicative behavior

displayed by the participant on the video clips (see Appendix G).









Table 3-1. Participant characteristics
ADI-R Participant Topography Function of
Participant Age Diagnosis S-C-R SCQ MA of Behavior Behavior
Scott 7-11 Auti sm 26-22- 10 25 49 months Hit, pinch Tangible
David 4-1 Auti sm 26- 14- 10 24 29 months Hit, bite self Tangible
Zeb 4-10 Auti sm 26- 16- 10 27 32 months Tantrum Tangible
Note. Age in years-months; MA = mental age; S-C-R = Reciprocal social interaction,
communication, repetitive behaviors.

Table 3-2. Mother's survey results
Participant # of children Birth order Other studies Education ABA trained
Scott 2 Youngest Yes Bachelors Yes
David 2 Oldest No Bachelors No
Zeb 2 Oldest No High school No

Table 3-3. Teachers' survey results
Participant # of students Other studies Education ABA trained Experience
Scott' s teacher 5 No Bachelors Yes 6 yrs
David's teacher 9 Yes Masters No 12 yrs
Zeb's teacher 6 No Masters No 15 yrs

Table 3-4. Maintenance session items
Participant Session 1 Session 2 Session 3 Session 4 Session 5
Scott Ball Computer Toy story Computer Ball
David Swing Train Toy story Toy story Swing
Zeb Swing Computer Toy story Computer Swing













































Hand-over-Hand Assistance


Figure 3-1. Intervention procedures









CHAPTER 4
RESULTS

The purpose of this study was to examine the effects of a modified milieu therapy

intervention on the communicative behaviors of young children with autism spectrum disorders.

The study was conducted across 4 phases: (a) pre-intervention/ assessment phase, (b) baseline,

(c) intervention, and (d) maintenance. The intervention phase consisted of three conditions, each

teaching a new communicative behavior. Additionally, generalization of communicative

behaviors across settings was examined throughout the study. Interobserver agreement was

conducted to assess the reliability of behavioral observations and the Eindings. Finally, treatment

integrity and social validity data were conducted.

Pre-Intervention/ Assessment Phase

Preference Assessment

As described in Chapter 3, the preference assessments were conducted according to

procedures outlined by Roane, Vollmer, Ringdahl, & Marcus (1998). The results of the

preference assessments for all three participants are found in Table 4. 1.

Scott. For the first preference assessment, Scott was presented with the following items:

a green ball, toy dinosaur, toy truck, computer, swing, favorite book, and favorite movie (i.e., toy

story). In the first session, Scott exclusively chose the green ball for the entire time of the

preference assessment session (i.e., 5 min). During the second preference assessment session, he

interacted with the computer for 3 min 45s and did not interact with any other item during the

remainder of the session. In the Einal preference assessment session, Scott engaged with the Toy

Story for 4 min 46s and did not interact with any other item during the session. Therefore, each

of these items, individually, was determined to be the preferred item for each of the 3

communication conditions, respectively.










David. For the first preference assessment, David was presented with the following

items: a toy truck, toy farm animals, swing, toy train, favorite movie (i.e., toy story), favorite

book, and toy jack in the box. In the first preference assessment session, David interacted with

the toy train for 4 min 3s and with the toy truck for 20s. During the second preference

assessment session, he chose Toy Story for 3 min 48s and interacted again with the toy truck for

35s. In the Einal preference assessment session, David engaged with the swing for 3 min 11s and

once again chose the toy truck for 1 min 2s. Therefore, each of these items, individually, was

determined to be the preferred item for each of the 3 communication conditions, respectively.

Zeb. For the first preference assessment, Zeb was presented with the following items: a

swing, toy dinosaur, toy truck, computer, puzzle, favorite book, and favorite movie (i.e., Toy

Story). In the first preference assessment session, Zeb exclusively chose the computer. During

the second preference assessment session, he interacted with the swing for 3 min 4 s and did not

interact with any other item. In the Einal preference assessment session, Zeb engaged with Toy

Story for 5 min and did not interact with any other item. Therefore, each of these items,

individually, was determined to be the preferred item for each of the 3 communication

conditions, respectively.

Functional Analysis

Functional analyses were conducted for all three participants to determine functions of

their aberrant behaviors (see Figures 4. 1 4.3).

Scott. Scott' s results of the functional analysis are depicted in Eigure 4. 1. The rate of

Scott' s aggressive behavior (i.e., pinching and hitting others) was higher in the tangible condition

(M~= 0.6/min, range 0.4-0.8/min), in contrast to the attention condition (M~= O/min), escape

condition (M~= 0.05, range 0-0.2/min), and free play condition (M~= 0). There was no overlap in










data between conditions, although the data during the tangible condition varied. Further, Scott

engaged in aggressive behavior in only one session outside of the tangible condition. These

results indicate that Scott' s aggressive behavior was maintained by access to tangible items of

interest.

David. David' s results of the functional analysis are depicted in figure 4.2. The rate of

David's self-injurious behavior (SIB; i.e., hitting and biting self) was the higher in the tangible

condition (M~= 2.0/min, range 1.6-2.6/min), in contrast to the attention condition (M~= 1.1/min,

range 0.8-1.6/min), escape condition (M~= 0.3, range 0.2-0.6/min), and free play condition(M~=

0). There was no overlap in the data between conditions. In addition, his data during the tangible

condition was mostly stable until the final session, which ended on an increasing trend. These

results indicate that David' s SIB was maintained by access to tangible items of interest.

Zeb. Zeb's results of the functional analysis are depicted in figure 4.3. The rate of Zeb's

tantrums (i.e., screaming and whining) was higher in the tangible condition (M~= 1.9/min, range

1.6-2.2/min), in contrast to the attention condition (M~= O/min), escape condition (M~= 0.35S/min,

range 0.2-0.6/min), and free play condition (M~= O/min). There was no overlap in data between

conditions. In addition, data during the tangible condition was stable and produced an increasing

trend. Further, Scott engaged in aggressive behavior in only one other condition (i.e., escape),

but response rates were much lower compared to the tangible condition. These results indicate

that Zeb's tantrum behavior was maintained by access to tangible items of interest.

Intervention Results

Following the pre-intervention phase of the study, baseline, intervention, and

maintenance phases were implemented for each participant (see Figures 4.4 and 4.5). Based on

each participant' s responses, the number of opportunities for communication differed across each










session (see Table 4.2). In addition, an assessment of generalization of skills across settings

during each of these phases was conducted. Data were collected across all phases of the study on

target children's communicative and aberrant behaviors. The results for each target behavior

follow.

Communication

Scott's baseline. Baseline data were collected on Scott' s total percentage of

communication responses (PCR). During baseline, no prompts were given to Scott. After the

data were stable during baseline in the primary training setting (i.e., the home) for all

participants, which stabilized at 0% with no celebration (see Figure 4.4), the first intervention

condition was implemented with Scott.

Scott's condition 1. Following the implementation of the first intervention condition

(condition 1), Scott's total PCR changed in level from the baseline phase to intervention phase

from 0% to 37%. During condition 1, his total PCR initially stabilized across six sessions and

then was elevated in session 12 and again stabilized with a slight acceleration trend. Across

condition 1, his total PCR ranged from 40% to 86%, with an average of 64%. A breakdown

shows that his prompted PCR averaged 56% (37% to 78%), while his unprompted PCR averaged

8% (0% to 29%). In addition, there was no overlap in the data between the baseline and

intervention phases. Further, during condition 1, his mean latency to respond with unprompted

communication responses was 2.87s (2.00s-4.50s; see Figure 4.6), which is consistent with the

latency to respond in typically developing children (Hart & Risley, 1999). Scott required

prompts for the maj ority of sessions during this condition, but at least 20% (M= 27%, range 20%

- 33%) of each of the last three sessions was unprompted communication responses (see Figure

4.4).










Scott's condition 2. After Scott's total PCR stabilized above 75% for at least 3

consecutive sessions in the first condition and at least 20% of each of the last three sessions did

not require prompts, the new communicative response card was introduced. During intervention

condition 2, his responses stabilized above 75% for the last three sessions with an acceleration

trend. Across condition 2, his total PCR ranged from 56% to 100%, with an average of 82%. A

breakdown shows that his prompted PCR averaged 64% (32% to 100%), while his unprompted

PCR averaged 18% (0% to 55%). Similar to condition 1, his mean latency to respond with

unprompted communication responses was consistent with typically developing children with an

average of 3.10s (2.40s 4.20s). Similar to condition 1, Scott continued to need prompts for the

maj ority of sessions. He used unprompted communication responses for his last three sessions of

condition 2 (M= 44%, range 28% 63%).

Scott's condition 3. After Scott's total PCR stabilized above 75% for at least 3

consecutive sessions in the second condition and at least 20% of each of the last three sessions

did not require prompts, a new communicative response card for condition 3 was introduced.

During this condition, Scott' s total PCR was constant throughout the condition at 100%. A

breakdown shows that his prompted PCR averaged 9% (0% to 33%), while his unprompted PCR

averaged 91% (67% to 100%). Similar to the other two conditions, his mean latency to respond

with unprompted communication responses remained consistent with that of typically developing

children at an average of 2.94s (2.71s 3.03 s). In contrast to the other conditions, Scott no

longer required any prompts to communicate for the maj ority of the sessions.

Scott's maintenance. Following the last session of condition 3 in the intervention phase,

no observations were conducted for 2 weeks. At the end of the two-week period, the

experimenter returned and collected maintenance data. During the maintenance phase, Scott' s









total PCR stabilized at 100% for three consecutive sessions (M= 80%, range 50% 100%). A

breakdown shows that his prompted PCR averaged 20% (0% to 50%), while his unprompted

PCR averaged 60% (0% to 100%). In addition, his communicative responses maintained and did

not return to baseline levels. Similar to the three conditions in the intervention phase, his mean

latency to respond with unprompted communication responses remained consistent with that of

typically developing children at an average of 2. 12s (2.00s 2.40s). He also did not require

prompts for the final three sessions.

David's baseline. After the intervention was implemented with Scott, the experimenter

continued to collect baseline data on David. As with Scott, no prompts were given during these

sessions. PCR remained at zero percent during the baseline phase.

David's condition 1. When data were at a stable trend in baseline for David and a

predictable accelerating trend in condition 1 for Scott, the first intervention condition was

implemented with David. Similar to Scott' s change of level from baseline to intervention,

David's total PCR changed in level from the baseline phase to intervention phase from 0% to

36%. During condition 1, David's total PCR had an accelerating trend, with his last four sessions

above 75% and zero celebration. Across condition 1, his total PCR ranged from 43% to 88% with

an average of 68%. A breakdown shows that his prompted PCR averaged 50% (28% to 73%),

while his unprompted PCR averaged 15% (0% to 32%). In addition, there was no overlap in the

data between the baseline and intervention phases. Further, during condition 1, David's mean

latency to respond with unprompted communication responses was 2.15s (2.00s 2.33s; see

Figure 4.7), which is consistent with typically developing children (Hart & Risley, 1999).

However, he required prompts for the maj ority of session time during this condition (see Figure










4.4). David's used unprompted communication for part of his last three sessions of condition 1

(M= 27%, range 25% 28%).

David's condition 2. When data were at a stable and predictable accelerating trend in

condition 2 for Scott, David's total PCR stabilized above 75% for at least 3 consecutive sessions

during condition 1, and at least 20% of each of the last three sessions did not require prompts, the

new card for condition 2 was implemented with David. During condition 2, David's total PCR

had an acceleration trend and stabilized with zero celebration at 100% for 3 consecutive sessions.

Across condition 2, his total PCR ranged from 71% to 100%, with an average of 89%. A

breakdown shows that his prompted PCR averaged 11% (0% to 60%), while his unprompted

PCR averaged 78% (11% to 100%). Similar to condition 1, his mean latency to respond with

unprompted communication responses was consistent with typically developing children with an

average of 3.08s (2.25s 4.42s). In contrast to condition 1, David did not require prompts for the

maj ority of sessions. He used unprompted communication for 100% of his last three sessions

during condition 2.

David's condition 3. When data were at a stable and predictable trend in condition 3 for

Scott, David's total PCR stabilized above 75% for at least 3 consecutive sessions during

condition 2, and at least 20% of each of the last three sessions did not require prompts, the new

card for condition 3 was implemented with David. During this condition, his total PCR averaged

98% (range 78% 100%), which was 100% for all but the first session. A breakdown shows that

his prompted PCR averaged 3% (0% to 25%), while his unprompted PCR averaged 95% (53% to

100%). Similar to the other two conditions, his mean latency to respond with unprompted

communication responses remained consistent with that of typically developing children at an

average of 3.53s (2.33s 4.88s). David also no longer required prompts to communicate for the










majority of the sessions. Similar to condition 2, he used unprompted communication for 100% of

his last three sessions during condition 3.

David's maintenance. Following the last session of condition 3, no data were collected

for 2 weeks. At the end of the two-week period, the experimenter returned and collected

maintenance data. During this phase, David' s total PCR stabilized at 100% for five consecutive

sessions (M = 100%). A breakdown shows that his prompted PCR averaged 0%, while his

unprompted PCR averaged 100%. In addition, his communicative responses maintained and did

not return to baseline levels. Similar to the other three conditions, his mean latency to respond

with unprompted communication responses remained consistent with that of typically developing

children at an average of 3.4s (2.50s 4.20s). He also did not require any prompts during

maintenance sessions.

Zeb's baseline. After the intervention was implemented with Scott and David, the

experimenter continued to collect baseline data on Zeb. As with Scott and David, no prompts

were given during these sessions. PCR remained zero during the baseline phase.

Zeb's condition 1. When data were at a stable and predictable accelerating trend in

condition 1 for David, the intervention was implemented with Zeb. Similar to Scott and David's

change of level from baseline to intervention, David's total PCR changed in level from 0% to

37%. During condition 1, Zeb's total PCR had an accelerating trend, with his last three sessions

constant at 100%. Across condition 1, his total PCR ranged from 31% to 100%, with an average

of 70%. A breakdown shows that his prompted PCR averaged 30% (0% to 59%), while his

unprompted PCR averaged 44% (0% to 100%). In addition, there was no overlap in the data

between the baseline and intervention phases. Further, during condition 1, Zeb's mean latency to

respond with unprompted communication responses was 2. 12s (2.00s 2.20s; see Figure 4.8),









which is consistent with typically developing children (Hart & Risley, 1999). Similar to David,

he required prompts for the maj ority of sessions during this condition (see Figure 4.4). However,

Zeb used unprompted communication for the maj ority of his last three sessions of condition 1

(M= 90%, range 83% 100%).

Zeb's condition 2. When data were at a stable and predictable accelerating trend in

condition 2 for David, Zeb's total PCR stabilized above 75% for at least 3 consecutive sessions

during condition 1, and at least 20% of each of the last three sessions did not require prompts, the

new communication response for condition 2 was implemented with Zeb. During condition 2,

Zeb's total PCR had an acceleration trend and stabilized with zero celebration at 100% for six

consecutive sessions. Across condition 2, his total PCR ranged from 63% to 100%, with an

average of 93%. A breakdown shows that his prompted PCR averaged 47% (0% to 80%), while

his unprompted PCR averaged 45% (0% to 100%). Similar to condition 1, his mean latency to

respond with unprompted communication responses was consistent with typically developing

children with an average of 2.10s (1.29s 2.33s). In contrast to condition 2, Zeb did not require

prompts for the maj ority of sessions. A portion of his last three sessions of condition 2 was

unprompted communication responses (M= 38%, range 20% 66%).

Zeb's condition 3. When data were at a stable and predictable trend in condition 3 for

David, Zeb's total PCR stabilized above 75% for at least 3 consecutive sessions during condition

2, and at least 20% of each of the last three sessions did not require prompts, the new

communication response for condition 3 was implemented with Zeb. During this condition, his

total PCR averaged 94% (range 67% 100%), which was 100% for the final three sessions. A

breakdown shows that his prompted PCR averaged 28% (0% to 83%), while his unprompted

PCR averaged 72% (17% to 100%). Similar to the other two conditions, his mean latency to










respond with unprompted communication responses remained consistent with that of typically

developing children at an average of 3.18s (1.57s 4.80s). Zeb also did not require prompts to

communicate for the maj ority of the sessions. Similar to condition 2, his last three sessions of

condition 3 each had removal prompts (M= 94%, range 83% 100%).

Zeb's maintenance. Following the last session of condition 3, no data were collected for

2 weeks. At the end of the two-week period, the experimenter returned and collected

maintenance data. During this phase, Zeb's total PCR stabilized at 100% for five consecutive

sessions (M= 100%). A breakdown shows that his prompted PCR averaged 11% (0% to 42%),

while his unprompted PCR averaged 89% (58% to 100%). In addition, his communicative

responses maintained and did not return to baseline levels. Similar to the other three conditions,

his mean latency to respond with unprompted communication responses remained consistent

with that of typically developing children at an average of 2. 10s (2.00s 2.20s). He also did not

require prompts during the maj ority of maintenance session time. A large percentage of Zeb's

communication during maintenance was unprompted (M= 89%, range 57% 100%).

Aberrant Behavior

Scott. During baseline, Scott' s aberrant behavior (hitting, pinching parent) rate averaged

1.44 responses per minute (RPM) with a range of 1.00 to 1.80 RPM (see Figure 4.5). During

condition 1, his aberrant behavior rate decreased and stabilized at zero (M = 0.45 RPM, range 0-

1.20 RPM), which corresponded with his increase in communication responses. His aberrant

behavior rate remained low and decreased to zero (M = 0.20 RPM, range 0-0.40 RPM) during

condition 2. During condition 3, his aberrant behavior rate was stable at zero (M = 0 RPM) for

the entire condition. Scott maintained low rates of aberrant behavior (M = 0.20 RPM, range 0-

0.80) during maintenance sessions, with the last three sessions at 0 RPM.









David. During baseline, his aberrant behavior (hitting, biting self) rate averaged 1.86

RPM with a range of 0.80 to 2.60 RPM (see Figure 4.5). During condition 1, his aberrant

behavior rate decreased to zero (M = 0.56 RPM, range 0-1.60 RPM), which corresponded with

his increase in communication responses. His aberrant behavior rate remained at zero (M = 0.04

RPM, range 0-0.40 RPM) for eight of 9 sessions during condition 2. During condition 3, his

aberrant behavior rate remained at zero (M = 0 RPM) for all sessions. In contrast to Scott,

David's aberrant behavior rate stabilized around 0.8 RPM (M = 0.72 RPM, range 0.60-0.80)

during maintenance even though his communication remained high. However, he did not return

to pre-intervention rates of aberrant behavior.

Zeb. During baseline, Zeb's aberrant behavior (tantrum) rate averaged 2. 11 RPM with a

range of 1.40 to 2.60 RPM. His aberrant behavior rate decreased to near zero (M = 0.56 RPM,

range 0-1.60 RPM) during condition 1, which corresponded with his increase in communication.

During condition 2, his aberrant behavior rate remained at zero (M = 0 RPM) for all sessions.

Similar to the prior condition, Zeb's aberrant behavior rate remained at zero (M = 0 RPM) for all

sessions. In contrast to David, Zeb maintained an aberrant behavior rate of 0 RPM (M = 0 RPM)

during all maintenance sessions.

Spontaneous Verbalizations

Scott. During baseline sessions Scott had a spontaneous verbalization rate of 1.24

responses per minute (RPM; see Table 4.3 for more detail). In condition 1 of the intervention

phase, Scott's spontaneous verbalization rate increased to 3.38 RPM. Scott's spontaneous

verbalization rate increased to 4.91 RPM during condition 2. His spontaneous verbalization rate

continued to increase during condition 3 to 6.7 RPM. Scott's spontaneous verbalizations

maintained during follow-up at a rate of 5.76 RPM.










David. In contrast to Scott, David did not produce spontaneous verbalizations as defined

in this study during any sessions.

Zeb. Similar to David, Zeb did not produce spontaneous verbalizations during baseline,

condition 1 or condition 2. However, he did produce spontaneous verbalizations during condition

3. It was noted that Zeb had a spontaneous verbalization rate of 0.05 RPM during condition 3.

During maintenance sessions, his spontaneous verbalizations maintained at a rate of 0.84 RPM.

Generalization Results

Communication

Scott. During baseline, Scott did not engage in unprompted communication. Scott' s

communication responses did not generalize to the classroom during condition 1 either. During

condition 2, his communication responses generalized from the training setting to the

generalization setting (i.e., classroom setting). For two sessions in the classroom, Scott had a

response rate of 0.40. Also, he demonstrated a generalized use of the new communication

response (i.e., the new picture card) for 3 sessions in the classroom during condition 3 where he

had an average response rate of 0.20 (range of 0 0.40). In addition, generalization of his

communication responses maintained with an average of 0.20 RPM (range 0.20 0.20).

David. David did not generalize his communication responses (unprompted) during

baseline or condition 1. Similar to Scott, his communication responses generalized from the

training setting to the generalization setting (i.e., classroom setting) during condition 2.

However, rather than the communication response taught in condition 2, David used the

communication response with the card from condition 1 during generalization. For three sessions

in the classroom, David had an average response rate of 0.23 (range 0 0.60). Also, he

generalized the use of the new communication response for seven of 8 sessions in the classroom










during condition 3 where he had an average response rate of 0.48 (range 0 0.60). In addition,

generalization of his communication responses maintained with an average of 0.30 RPM (range

0 0.80).

Zeb. Similar to Scott and David, Zeb initially did not generalize his communication

responses (unprompted) during baseline. Further, he only used the communication response once

during generalization sessions in condition 1. Similar to Scott and David, Zeb's communication

responses generalized from the training setting to the generalization setting (i.e., classroom

setting) for three consecutive sessions during condition 2. During generalization sessions in

condition 2 in the classroom, Zeb had an average response rate of 0.29 (range 0 0.6). Also, he

generalized the use of the new communication response for every session of condition 3 in the

classroom where he had an average response rate of 0.63 (range of 0.4 0.8). In addition,

generalization of his unprompted communication responses maintained with an average of 0.6

RPM (M= 0.6).

Aberrant Behavior

Scott. Scott' s aberrant behavior rate averaged 0.3 RPM with a range of 0.2 to 0.6 RPM

(see Figure 4.5) during baseline. His aberrant behavior rate decreased to 0.2 RPM (M = 0.05

RPM, range 0-0.2 RPM) during condition 1. During condition 2, his aberrant behavior rate

remained at 0 RPM (M = 0 RPM). His aberrant behavior rate remained low during condition 3

(M = 0. 16 RPM, range 0-0.6). His aberrant behavior rate remained low during maintenance (M =

0.13 RPM, range 0-0.4).

David. During baseline, David's aberrant behavior rate averaged 1.73 RPM with a range

of 1.5 to 2.0 RPM (see Figure 4.5). David's aberrant behavior rate remained high during

condition 1 generalization sessions (M = 1.95 RPM, range 1.8-2.2 RPM; see Figure 4.5). His









aberrant behavior rate decreased to 0 RPM (M = 0. 1 RPM, range 0-0.2 RPM) during condition 2.

His aberrant behavior rate remained at 0 RPM (M = 0 RPM) during condition 3. His aberrant

behavior rate remained at 0 RPM (M = 0 RPM) also during maintenance.

Zeb. Zeb's aberrant behavior rate averaged 0.55 RPM with a range of 0.4 to 0.8 RPM

(see Figure 4.5) during baseline. His aberrant behavior rate decreased during condition 1 (M =

0.18 RPM, range 0-0.4 RPM). His aberrant behavior rate decreased to 0 RPM (M = 0.1 RPM,

range 0-0.2 RPM) during condition 2. Similar to David, Zeb's aberrant behavior rate remained at

0 RPM (M = 0 RPM) during condition 3. His aberrant behavior rate also remained at 0 RPM (M

= 0 RPM) during maintenance.

Spontaneous Verbalizations

Scott. During baseline generalization sessions, Scott did not produce spontaneous

verbalizations (see Table 4.3). Scott did produce spontaneous verbalizations during condition 1-

generalization sessions, with a spontaneous verbalization rate of 0.95 RPM. It also was noted

that Scott had a spontaneous verbalization rate of 0.3 RPM during condition 2 generalization

sessions. His spontaneous verbalizations increased in condition 3 generalization sessions to a rate

of 1.56 RPM. During maintenance sessions, his spontaneous verbalizations maintained at a rate

of 2.73 RPM.

David. In contrast to Scott, David did not produce spontaneous verbalizations as defined

in this study during any generalization sessions.

Zeb. Similar to David, Zeb did not produce spontaneous verbalizations during baseline,

condition 1, or condition 2 generalization sessions (see Table 4.3). However, he did produce

spontaneous verbalizations during condition 3 generalization sessions. It was noted that Zeb had










a spontaneous verbalization rate of 0.27 RPM during condition 3. During maintenance sessions,

his spontaneous verbalizations increased and maintained at a rate of 2.07 RPM.

Treatment Integrity

Treatment integrity is reported for training and treatment sessions (i.e., baseline,

intervention, maintenance, and generalization sessions).

Training

Parent training. As aforementioned in Chapter 3, parents were trained to criterion. First,

they viewed videos of the intervention with the primary experimenter and identified procedures

until they achieved a 90% IOA. This step took an average of two hours and 30 minutes (see

Table 4.4). Second, the parents' role played procedures with the primary experimenter until they

performed each procedure correctly (i.e., 100% accuracy) ten consecutive times. Parents required

an average 51 trials that took an average of 1 hour and 25 minutes of role-play to reach criteria

(see Table 4.4).

Teacher training. As aforementioned in Chapter 3, teachers were trained to criterion on

giving the requested item to the target child upon display of unprompted communication. The

teachers role-played with the primary experimenter until they performed the procedure correctly

(i.e., 100% accuracy) ten consecutive times. Teachers required an average of 23 trials that took

an average of 15 minutes of role-play to reach criteria (see Table 4.5).

Treatment Sessions

Treatment integrity data for baseline, intervention, maintenance, and generalization

sessions include: (a) percentage of correct procedural prompts (i.e., verbal, verbal/gestural/, or

removal), (b) correct implementation of the time delay procedure, and (c) the percentage of times

the requested item was given to participant for the correct time (i.e., 30s access contingent on









communication response) when item was requested. As mentioned in Chapter 3, treatment

integrity for each aforementioned procedure was calculated by marking a "yes" if it was done

correctly and a "no" if it was done incorrectly. The total correct procedures were divided by the

total number of procedures. Mean percentages and ranges are reported for each treatment

integrity measure (see Table 4.6).

Procedural prompts. Across phases, treatment integrity for procedural prompts was

high for each participant in the intervention setting. The average integrity was 81.4% with a

range of 63% to 100%. Treatment integrity in the generalization setting for procedural prompts

averaged higher. The average integrity across participants was 98.7% with a range of 75% to

100%.

Time delay. Across phases, treatment integrity for the use of time delay was high for

each participant in the training setting. The average integrity was 87. 1% with a range of 73% to

100%. Treatment integrity in the generalization setting for time delay averaged higher. The

average integrity across participants was 100%.

Requested item procedures. Across phases, treatment integrity for requested item

procedures was high for each participant in the training setting. The average integrity was 87.7 %

with a range of 73% to 100%. Treatment integrity in the generalization setting for requested item

procedures averaged higher. The average integrity across participants was 100%.

Social Validity

The participants' parents, teachers, and an expert in the field of ASD completed Likert-

type rating scales to determine the social validity of the intervention process and outcomes,

respectively. For the expert rating scales, Likert values ranged from 1, typically indicating the

process and outcomes were not at all useful to 5, typically indicating the process and outcomes










were very useful to the teacher and or child. The likert values for the parent and teacher rating

scales were similar, except for question 1, for which a five indicated that the training was too

time consuming.

Parent Social Validity

Across participants, parent' s responded to questions in a similar manner. Parent

responses to question one, which inquired about how time consuming the interventions'

procedures were averaged 2.7 (range: 2-3). The mean response for question two concerning the

improvement of everyday routines in the home was 4.7 (range: 4-5). Responses to question three

averaged 4.3 (range: 3-5). This question addressed the how much increase did the parent observe

in the child's communication. The mean response for question four dealing with how much

increase in appropriate behavior did the parent observe in the child averaged 4.7 (range: 4-5).

Responses to question five averaged 5 (range: 5), the highest possible value. This question

addressed the willingness of the parent to use the intervention in the future.

Teacher Social Validity

Similar to parent social validity questionnaires, teachers responded similar across

participants. Teachers' responses to question one, which inquired about how time consuming the

intervention procedures were, averaged 1 (range: 1). The mean response for question two

concerning the improvement of everyday routines in the home was 3.3 (range: 3-4). Responses to

question three averaged 4.3 (range: 4-5). This question addressed the how much increase did the

teacher observe in the child's communication. The mean response for question four dealing with

how much increase in appropriate behavior did the teacher observe in the child averaged 4

(range: 4). Responses to question five averaged 4.7 (range: 4-5). This question addressed the

willingness of the teacher to use the intervention in the future.










Expert Social Validity

When the expert viewed the video of the children in the home and classroom setting for

the baseline, intervention, and maintenance phases, the expert' s response to question one that

inquired about the appropriateness of the target child's communication averaged 4 (range: 3-5)

when the expert viewed video of the children in the home and classroom setting for the baseline,

intervention, and maintenance phases. The average response to question two concerning the level

of aberrant behavior of the child averaged 2.6 (range: 2-4) when the expert viewed video of the

children in the home and classroom setting for baseline, intervention, and maintenance phases.

The expert' s mean response to question three that addressed the frequency of the child' s

communication averaged 4.6 (range: 4-6). The final question dealt with the target child's overall

improvement concerning communication and aberrant behavior. The expert' s mean response to

question four was 5 (range: 4-6).

Summary

Based on the data reported, conclusions can be drawn within and across the three

participants. Overall, target children's percentage of communication response increased, leveled,

and remained stable at or above 75% across the intervention conditions. In addition, this was

maintained at follow-up sessions conducted two weeks after the conclusion of the last

intervention condition. Further, communication skills generalized to the classroom setting (i.e.,

generalization setting) in conditions 2 and 3 for Scott and David and conditions 1, 2, and 3 for

Zeb. However, the communication response rates for generalization were the highest in condition

3 and maintenance sessions for each participant.

The participants' dependence on prompts decreased across all three intervention

conditions, with less prompts being required for condition 3 or maintenance sessions. During










condition 3 and maintenance sessions, 80% or greater of the participants communication

responses did not require a physical, verbal/gestural, or verbal prompt. Each participant

responded on average between 3 and 4s across all three intervention conditions; however, this

measure was slightly variable.

Similar to the percentage of communication response levels, aberrant behavior rate

decreased, leveled, and remained low across conditions and maintained at 0 RPM by condition 3.

In addition, aberrant behavior rate remained at zero during maintenance sessions for each

participant except David, whose rate remained well below baseline levels. Further, aberrant

behavior rates for each participant during generalization probes leveled and stabilized at zero.

Treatment integrity data revealed that the intervention was conducted with a high level of

integrity within and across participants. Finally, social validity data demonstrated that the

teachers, parents, and an expert in the filed of ASD found the study to be beneficial to the

participants.









Table 4-1. Preference assessment choices
Participant Condition 1 Item Condition 2 Item Condition 3 Item
Scott Ball (5 min) Computer (3 min 45s) Toy Story (4 min 46s)
David Train (4 min 3s) Toy Story (3 min 48s) Swing (3 min 11s)
Zeb Computer (5 min) Swing (3 min 4s) Toy Story (5 min)

Table 4-2. Average (range) number of trials
Participant Baseline Condition 1 Condition 2 Condition 3 Maintenance
Scott 5 15 (12-21) 13 (10-16) 9 (8-10) 10 (8-12)
David 5 14 (8-19) 10 (7-15) 9 (7-11) 9 (8-10)
Zeb 5 14 (8-21) 11 (8-13) 10 (8-13) 8 (8-9)

Table 4-3. Spontaneous verbalizations
Baseline Cl C2 C3 Maintenance
Scott' s Tx Setting 1.24 3.38 4.91 6.7 5.76
Scott' s Gen. Setting 0 0.95 0.3 1.56 2.73
David Tx Setting 0 0 0 0 0
David Gen. Setting 0 0 0 0 0
Zeb Tx Setting 0 0 0 0.05 0.84
Zeb Gen. Setting 0 0 0 0.27 2.07
Note. C1 = condition 1; C2 = condition 2; C3 = condition 3; Tx = Treatment; Gen.=
generalization.

Table 4-4. Parent training
Parent Video viewing Role-play
Scott' s mother 2 hours 45minutes 2 hours (72 trials)
David's mother 1 hour 15 minutes I hour (36 trials)
Zeb's mother 3 hours 30 minutes I hour 15 minutes (45 trials)


Table 4-5. Teacher training
Teacher Role-play
Scott' s teacher 11 minutes (20 trials)
David's teacher 23 minutes (32 trials)
Zeb's teacher 10 minutes (18 trials)











Table 4-6. Treatment Integrity Data
Baseline Condition 1
Procedure Child Training Gen. Training Gen.
Procedural Scott M = M = M = 82% M =
Prompts 100% 100% (80% 100%) 100%
David M = M = M = 80% M =
100% 100% (75% 100%) 100%
Zeb M = M = M = 83% M =
100% 100% (73% 100%) 100%
Time Scott M = M = M = 82% M =
Delay 100% 100% (80% 95%) 100%
David M = M = M = 83% M =
100% 100% (73% 100%) 100%
Zeb M = M = M = 85% M =
100% 100% (80% 100%) 100%

Requested Scott M = M = M = 95% M =
Item Time 100% 100% (92% 100%) 100%
David M = M = M = 90% M =
100% 100% (86% 100%) 100%
Zeb M = M = M = 95% M =
100% 100% (92% 100%) 100%

Note. M = mean; Gen. = generalization


Condition 2
Gen.
oM =
00%)
M =


oM =
00%)
oM =
00%)
% M =


oM =
00%)
% M =


% M =


% M =


Condition 3
Training Gen.
M =100% M =
100%
M =90% M =
(82% 100%) 100%
M =80% M =
(63% 100%) 100%
M =100% M =
100%
M =90% M =
(86% 100%) 100%
M =85% M =
(80% 100%) 100%
M =100% M =
100%
M =100% M =
100%

M =100% M =
100%


Maintenance
Training Gen.
M = 80% M = 80%
(75% 100%) (75% 100%)
M =100% M =100%


M = 100% M = 80%
(75% 100%)
M = 80% M = 100%
(73% 100%)
M =100% M =100%


M =100% M =100%


M =100% M =100%


M = 95% M = 100%
(92% 100%)
M = 90% M = 100%
(73% 100%)


Training
M = 86%
(82%- 1
M =1.0


M = 90%
(85%- 1
M = 86%
(82%- 1
M =100


M = 90%
(86%- 1
M =100


M =100


M =100


100%


100%


100%


100%


100%


100%


100%


100%


100%























0.8-


0.7-


0.6-





0.4-


0.3-


0.2-


0.1-




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Session Number
-A free play -5 tangible -0- escape -* attention


Figure 4-1. Scott' s rate of aberrant behavior per min during the functional analysis.


115



















2.5








m"1.5








0.5





1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Session Number

-* attention -5-I tangible -A free play -* escape

Figure 4-2. David' s rate of aberrant behavior per min during the functional analysis.


116





























$1




0.5-






12 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Session Number

-* attention -H- tangible -A free play -* escape

Figure 4-3. Zeb's rate of aberrant behavior per min during the functional analysis.


117
















Il'rl:llll III


Generailzation


SHome


Generalization

I3 5 7 9 11 12 14 16 IS 20 22 24 26 27 29 31 33 35 38 40 42 44
Session Number
I Response~ate PromptedCommunication Unpromped Communication
Figure 4-4. Communication response percentages and rat~es.


118


L


Baseline


08"




0.6
04
02o~


11 1Hom1


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~ I ~ -~ ~ ~I~I-~ 77-rr.------1 --------


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Maintenaice


Home


3i


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Generalization


IkCI


t~


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----~--I I------


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Generalization


3
25'


rHC


~p~"??


33 35 38 401 42 44 45 47 49


1 3 5 7 9 II 12 14 16 18 20 22 24 26 27 29 31
Stassion~rumber


Figure 4-5. Aberrant behavior rate.


1
15



i"


,.5


,.5s"
~ L_ .._


3]













16



14



12





10





6












Baseline Condition 1 Condition 2



Figure 4-6. Scott' s mean latency to respond unprompted.


Maintenance


Condition 3


120

















14



12
























Baseline Condition 1 Condition 2 Condition 3


Figure 4-7. David's mean latency to respond with unprompted.


Maintenance

















14



12
























Baseline Condition 1 Condition 2 Condition 3


Figure 4-7. Zeb's mean latency to respond unprompted.


Maintenance











CHAPTER 5
DISCUSSION

The purpose of this chapter is to expound upon the results of the current study. First, the

chapter begins with a discussion of the limitations of the current study. Next, both an overview

and interpretation of the Eindings is provided. In addition, this chapter addresses the contribution

of those Eindings to theory. Finally, the chapter concludes with a discussion of the implications

for future research and practice.

Limitations

Although the intervention was functionally related to an increase in communication

responses and a decrease in aberrant behaviors across all participants, a few limitations may limit

the outcomes. First, as with many single subject research studies, the small sample size limits the

external validity of this study (Kazdin, 1982). The three participants had a diagnosis of autism;

thus, it is unknown whether the study's findings could be replicated with children who have

differential diagnoses of ASD (i.e., PDDD-NOS or Asperger' s syndrome) or if the Eindings could

extend to a larger sample of children with autism. In addition, since the study only included

young children whose aberrant behavior was maintained by a tangible function, one cannot be

certain that the Eindings would extend to older children with other behavioral functions (e.g.,

attention or escape).

Second, the participants only had access to the first picture card during baseline. One

cannot determine conclusively whether the participants could use the other picture cards prior to

training. However, parents and teachers reported that the participants had never been trained to

use any of the picture cards and had not used these picture cards spontaneously in the past. In










addition, the participants initially did not use any of the picture cards as they were introduced

during generalization.

Third, due to the nature of the intervention, the number and type of prompts varied across

phases. Particularly, no prompts were given during the baseline phase of the study. However, by

the end of each condition of the intervention phase, the use of unprompted communication for at

least 20% of sessions were required for each participant to move to the next condition. Further,

the providing of prompts to elicit communicative responses was chosen as a part of the

intervention to prevent the escalation of aberrant behaviors and increase the ethical treatment of

the intervention for the children. In addition, the procedures for the system of prompts were

consistent across conditions within the intervention phase and resulted in completely fading the

use of prompts by the end of condition 3.

Fourth, the parents may have used the intervention when the primary experimenter was

not in the home, which could have affected the outcome of the study. A parent using the

intervention everyday for three hours would have a different result than a parent who never used

the intervention outside the intervention sessions.

Finally, the utility of the preferences may not have been constant for all participants

(Hanley, Iwata, & Roscoe, 2006). Preferences may change based on states of deprivation and

satiation. If an individual has access to an item for an extended time prior to treatment sessions,

the strength of the preference may decrease (Hanley, et al., 2006). However, the experimenter

attempted to control this by requesting parents and teachers to withhold access to the preferred

items on the day of the intervention, but not on other days. It is unknown if this may have

influenced the outcomes. In addition, participants may have had a longer access history to some

preference items in the school setting. The history of interaction with items may explain why









some items generalized more quickly at school in comparison to the intervention condition (Ono,

2004). For example, the swing was an item participants had used everyday at school and was a

part of their respective schedules, whereas playing with the train was not. This may partially

explain why the swing generalized at a higher rate, despite that it was not the first preferred item.

However, the experimenter interviewed the teachers to ensure that each item included in the

preference assessments had been available and used several times by the participants in the

school setting.

Overview of Findings

The target children all acquired the communication responses during each condition of

the intervention phase and responded at least 75% of the time for at least the last three sessions

of each condition. By the third condition, the maj ority of communication responses were

unprompted, while communication responses were maintained and generalized to the classroom

setting.

Corresponding with the increase in communication responses, the target children's

aberrant behaviors decreased and were stable at 0 RPM by the end of the intervention phase.

Aberrant behavior remained low during maintenance and the generalization settings (i.e.,

classroom setting) by the end of the intervention phases (i.e., condition 3).

Two of the three participants increased their use of spontaneous verbalizations from the

baseline to intervention phases, while the third target child (David) never exhibited spontaneous

verbalization during sessions. The two participants who used spontaneous verbalization

maintained these verbalizations and used them in the generalization setting (i.e., classroom

setting).


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Explanation of Findings

Although the study's findings relatively are straight forward, a few of the findings

deserve further explanation. These include: (a) generalization of preferred items, and (b) David's

maintenance data.

Generalization of Preferred Items

One of the purposes of this study was to examine the relationship between

communicative responses learned in one setting (i.e., home) and the generalization of these

responses to a second setting (i.e., school). As discussed in the results section, for the majority of

the participants, generalization of communicative responses began to occur in condition 2, with

the exception of Zeb, who requested the item only once during condition 1. Although

generalization of communication responses did occur, it is not clear why generalization did not

begin to occur until the second response was acquired. One plausible explanation may be

because during condition 2, unprompted communication responses increased for all participants.

Researchers have suggested that generalization that does not occur immediately may increase

over time when more exemplars have been presented. For example, Griffiths and Craighead

(1972) and Stokes and Baer (1977) referred to this phenomenon as training sufficient exemplars

(i.e., training multiple examples of a new skill). In addition, Stokes and Baer purported that

introducing individuals to natural contingencies may increase the chance of generalization. For

instance, a child asking for a preferred tangible item that he or she would have access to in the

natural setting and then receiving the item requested would be a natural contingency. Therefore,

the generalization occurring in this study may be attributed to all three, which include: (a) the

increase in the participants' unprompted communication, (b) training sufficient exemplars, and

(c) introducing to natural contingencies. Each of these will be further discussed.


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Unprompted communication. One possible explanation for the delayed generalization

of the communication responses is the emergence of unprompted communication in the training

setting. As aforementioned, for the most part, communication did not generalize to the untrained

setting (i.e., classroom) until each child began to use more unprompted communication in the

training setting (i.e., home), respectively. Dyches, Davis, Lucido, and Young (2002) found

similar results in a case study of an adolescent girl and her use of a voice output communication

aid (VOCA). In this study, the researchers found that the individual generalized her unprompted

use of the VOCA only after unprompted communication was achieved during training.

Sufficient exemplars. Another possible explanation in this study for the delayed

generalization of the communication responses is the training of sumfcient exemplars,

particularly since the communication responses generalized during condition 2. Stokes and Baer

(1977) suggested that training multiple exemplars until generalization occurs sufficiently in an

untrained setting might be one strategy for increasing generality of a newly learned skill. For

example, Grinfths and Craighead (1972) provided training in two settings, and then observed

generalization to a third untrained setting. They trained a 30-year old woman with mental

retardation correct articulation of words in a clinical setting. However, she did not generalize this

skill to the residential cottage. Finally, after she was trained in the residential cottage, she

generalized to a third setting (i.e., classroom).

Stokes and Baer suggested that two to three exemplars are suffcient for increasing the

generality of a newly acquired skill, such as that demonstrated in Grinfths and Craigheads'

study. In addition, Stokes and Baer noted that generalization across responses might be

accomplished by training a suffcient number of responses. For example, Laski, Charlop, and

Schreibman (1988) trained parents to use multiple exemplars in the home during an intervention


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and then observed to see if the children generalized the skills during free play in a different area

of the home. Laski and colleagues noted that the trained verbalizations did generalize, but did not

give the exact number of multiple exemplars required to accomplish the generalization. Similar

to previous research (Laski et al., 1988), the current study also accomplished generalization to a

new setting following the training of multiple exemplars, particularly, two exemplars.

Natural contingencies. One final possible explanation for the generalization of the

communication responses in this study may be the introduction of natural contingencies. Natural

contingencies are consequences that occur in the person's natural environment that maintain

specific behaviors (Stokes & Baer, 1977). Stokes and Baer (1977) suggest choosing behaviors to

teach that normally result in natural reinforcement after the teaching concludes. Individuals are

taught behaviors that solicit naturally reinforcing consequences. For example, Horner (1971)

taught a 5-year old boy with mental retardation to use crutches in an experimental setting. The

boy then generalized the skill to a new setting to obtain desired items. In this new setting, the

caretakers did not give him the items he desired. Rather, he had to use his crutches to obtain the

item .

Similarly, Charlop, Schreibman, and Thibodeau (1985) taught children with autism to

request an item in a training setting. After the children requested the item consistently in the

training setting, Charlop and colleagues presented the item to the child in the generalization

setting without providing any verbal prompts. Six of the seven children generalized the

communication requesting to the new setting. In the current study, parents taught participants to

request preferred items, which may have served as natural reinforcers in the generalization

setting. Similar to Charlop et al. (1985) and Horner (1971), caretakers in this study required the


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participants to use their new skill (i.e., use of picture card for communication) to obtain access to

a desired item in the generalization setting.

Maintenance Data

Generally, participants maintained high levels of communication and low levels of

aberrant behavior during maintenance sessions, with the exception of David. Similar to the other

two participants, David maintained high levels of communication, but he also engaged in

aberrant behavior during maintenance sessions.

There are several possible explanations that may be applied to David's occurrence of

problem behaviors during the maintenance condition, all related to potential setting events. One

plausible explanation may have been the occurrence of a temporally distant setting event for

David just prior to the maintenance phase of the study (i.e., change of routine and out of town

visit with his family). Additionally, David's parents noted that his sleep patterns were interrupted

(i.e., sleep deprived during sessions) during this out of town trip and continued to pose a problem

since returning home. Each of these potential setting events is related to personal contexts

(McGill, Teer, Rye, and Hughes, 2005). Personal contexts refer to events such as when someone

has been sleep deprived, ill, or had a change in routine. According to McGill and colleagues,

setting events in personal contexts, particularly the disturbance of sleep, are more likely to

contribute to the occurrence of problem behaviors than others such as physical setting or day of

the week. For example, Kennedy and Itkonen (1993) experimentally demonstrated that sleep

deprivation in an individual with moderate mental retardation and autistic-like symptoms was

differentially associated with increased levels of problem behavior.

In summary, generalization occurred for the most part beginning in condition 2 of the

intervention phase. This may be attributed to when unprompted communication occurred in the


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training setting, sufficient exemplars were trained, and participants were introduced to natural

contingencies. In addition to generalization, participants maintained their communication

responses, but David continued to engage in aberrant behavior. This may be explained by

personal context setting events (e.g., sleep deprivation), which researchers have demonstrated to

be differentially associated with increased levels of problem behavior (Kennedy & Itkonen,

1993).

Theoretical or Conceptual Implications of Findings

The Eindings of the current study have theoretical implications for FCT and milieu

therapy literature research. Researchers in the Hield of FCT have discussed the importance of

linking communication responses to behavioral function. In addition, milieu therapy researchers

have noted the importance of using more naturalistic procedures to enhance generalization and

maintenance of effects. This study has taken an initial step in furthering each of these lines of

research and merging the two research areas together.

In regard to FCT literature, the current study demonstrates the utility of teaching multiple

responses in decreasing dependence on prompts and increasing the likelihood of generalization.

Previous FCT research lacked an emphasis on either of these considerations (Mancil, 2006). Carr

and Durand (1985), Durand and Carr (1992), and Wacker and colleagues (1990) taught one

communication response to the participants of their respective studies. Further, the maj ority of

researchers for the FCT studies did not focus on generalization to other persons or settings. The

one research team who did test for generalization of the one communication response with a

graduate psychology major (Durand & Carr, 1992), not a natural change agent. This lack of

focus on generalization partially may be because they did not train sufficient exemplars, which

are used to promote generalization (Baer, Wolf, & Risley, 1968). In contrast, the results of the


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current study demonstrate that with sufficient exemplars, prompt dependence decreased and

generalization occurred in an untrained setting with an untrained person.

The current study also extends the milieu therapy literature by providing a direct,

functional connection between communication and abnormal behavior. Although a few milieu

therapy researchers in the past anecdotally mentioned decreases in aberrant behavior, these

behaviors were not experimentally analyzed (Yoder et al., 1995). They did not systematically

analyze aberrant behavior. For example, Charlop, Shriebman, and Thibodeau (1985), Hancock

and Kaiser (2002), Ross and Greer (2003) did not mention aberrant behavior. Further, Yoder et

al. (1995) noted that milieu procedures may decrease aberrant behavior, but did not empirically

demonstrate a relation between the intervention and the decrease in aberrant behavior. The

current study, however, provides a model for incorporating function of aberrant behavior and

teaching replacement communication responses while employing milieu therapy prompting

techniques in a natural environment.

In addition to contributing to the FCT and milieu therapy literature base, the current study

also contributes to the generalization literature. The findings of this study further support the

concept that training sufficient exemplars and targeting natural contingencies is needed for

generalization to occur. Similar to the studies by Griffiths and Craighead (1972) and Laski,

Charlop, and Schriebman (1988), participants in this study generalized after sufficient exemplars

were trained. Further, the use of natural contingencies may have contributed to the generalization

as it did in the study by Charlop, Thibodeau, and Schriebman (1985). In addition, the current

study demonstrated that unprompted communication may need to occur in one setting before it

generalizes to another setting.









In summary, the current study's findings have theoretical or conceptual implications for

the FCT, milieu therapy, and generalization literatures. The current study extends the FCT

literature by demonstrating the utility of having natural change agents teach multiple

communication responses in a natural environment. Similarly, the Eindings extend the milieu

therapy literature by providing a functional relationship between an intervention with milieu

procedures and the decrease of aberrant behavior. Finally, the study's findings extends the

generalization literature by demonstrating that using natural contingencies, training multiple

exemplars, and obtaining unprompted communication in one setting increases the chance of

generalization occurring.

Implications for Future Research

The primary experimenter found positive effects of the intervention on the social

communicative behaviors of young children with ASD. The results along with the limitations of

the current study provide implications for future research. First, the study's findings should be

replicated with a larger group of individuals with ASD, systematically accounting for diverse

characteristics (e.g., language level). These analyses may provide additional information for

individuals along the autism continuum with different diagnoses, age, and ability level. This may

assist researchers in identifying ASD subgroups that are the most responsive to the intervention.

For example, children with ASD who have social characteristics that are aloof (i.e., have an

absence of speech and poor social interaction, but seem to enj oy others) may respond better than

children who are socially passive (i.e., avoid eye contact and other social stimuli such as

touching). Further, children with ASD who have an average I.Q. and/or are considered high

functioning may demonstrate better responses to the intervention.









Second, the utility of the intervention with various trainers should be explored.

Researchers could examine whether similar results would occur when fathers, teachers, or peers

implement the intervention in comparison to mothers who were the implementers in the current

study. In addition, researchers should explore generalization with peers. Researchers may want

to determine if similar results would occur following training with an adult or if training would

need to occur with one peer before generalizing to another peer. Further, training may need to

occur with multiple peers before the communication responses generalize to other peers.

Third, the effects of using different items should be examined. For example, researchers

could examine the effectiveness of using items identified later in the sequence of preferences as

the first items trained. Some researchers have found using preferences identified in subsequent

preference assessments to have similar effects as the first preferences (Ciccone, Graff, & Ahearn,

2006). Further, DeLeon, Anders, Rodriguez-Catter, and Neidert (2000) found that rotating sets of

toys had a better effect on outcomes than using a single set of toys.

Fourth, researchers should examine generalization further. Researchers should examine

generalization to peers and siblings. For example, researchers should examine if communication

skills generalize to peers after training with an adult or if training should occur first with one

peer to increase the chance of generalization to another peer.

Finally, researchers should examine additional outcomes of the modified milieu therapy

intervention such as possible effects on the mother' s use of language. For example, the

experimenter and the expert, both, observed that the mothers began to speak more with

participants, similar to how they may interact with typically developing children. The mothers

began using speech that focused on "richly" describing obj ects. They talked about the colors,

shapes, and other properties of the items. This could possibly have an effect on the overall









outcomes with communication (Hart & Risley, 1999). Further, researchers should examine the

effects, if any, the intervention has on the amounts of eye gaze, social smiling, and/or otherwise

improve the deficits typically associated with ASD. For example, the increase in communication

may result in improvement in joint attention skills. Further, the reciprocity of communication

learned may transfer to other areas such as playing with peers.

In summary, future researchers should focus on five areas. First, the findings should be

replicated with a larger group of children with ASD who have diverse characteristics. Second,

the intervention should be examined with various change agents (i.e., teachers, peers). Third, the

effects of using different items should be analyzed. Fourth, generalization should be examined

further. Finally, future researchers should examine different outcomes of the modified milieu

intervention such as mother's use of language.

Implications for Practice

In addition to future research implications, the current study has implications for practice.

Researchers have demonstrated effectiveness of FCT (Wacker et al., 2005) and milieu therapy

(Hester et al., 1995) on addressing aberrant behavior and communication, respectively. However,

researchers of the FCT literature have not demonstrated effectiveness by natural change agents in

natural environments, nor have they demonstrated an increase in multiple communication

responses (Mancil, 2006). In addition, the researchers in the milieu therapy literature have not

demonstrated an empirical connection between an increase in communication response and a

decrease in aberrant behavior. This study provides some evidence that using milieu procedures in

the natural environment by natural change agents is effective in increasing unprompted

communication and decreasing aberrant behavior. This study also provides evidence that having

natural change agents use milieu procedures (i.e., prompts and time delay) in a natural









environment increase generalization and maintenance. The study by Hancock and Kaiser (2002)

provides related support that training in the natural environment increases generalization and

maintenance. Therefore, the current study has practical implications because it provides

additional evidence of the importance of interventions in the natural environment by natural

change agents (e.g., parents).

The other practical implication of this study is that it demonstrates that the milieu

procedures can have the same effect on aberrant behavior as traditional discrete trial training

typically used in FCT, but may be considered a more natural intervention for a classroom or

home setting (Miranda-Linne & Melin, 1992). The three participants increased their use of

unprompted communication and decreased their engagement in aberrant behavior. These

findings are consistent with the FCT literature in regards to the aberrant behavior (Carr &

Durand, 1985; Wacker et al., 2005) and the milieu therapy literature in regards to the

communication (Charlop, Schreibman, & Thibodeau, 1985; Hester, Kaiser, Alpert, & Whiteman,

1995), but with the added benefit of being one intervention.

Summary

Previous researchers have examined the effectiveness of FCT and milieu therapy with

children with ASD, but FCT researchers more so. FCT researchers have demonstrated positive

effects on aberrant behavior and milieu therapy researchers have demonstrated positive effects

with communication. The current study extended the outcomes and addressed the limitations of

the past studies. Similar to past FCT studies, the current study's results demonstrate that aberrant

behavior decreases when a communication skill is taught that serves the same function as the

aberrant behavior. This study extended the research by teaching multiple exemplars and

demonstrating generalization to an untrained setting with an untrained person. In contrast to the


135










maj ority of previous FCT studies, the experimenter of this study trained natural change agents in

the natural environment and achieved similar results as previous studies conducted in clinical

settings.

In addition to extending the FCT literature, the current study also extended the milieu

therapy literature. Similar to past milieu therapy studies, this study demonstrated the

effectiveness of milieu procedures on increasing communication. In contrast, the current study

demonstrated the utility of milieu therapy on decreasing aberrant behavior and provided a

functional relationship between milieu therapy procedures and aberrant behavior. The current

study also added to the milieu literature base by focusing on children with autism.

The current study contributes to research and practice because it adds to the FCT and

milieu therapy literature by demonstrating that a combined intervention decreases aberrant

behavior, increases unprompted communication, and promotes generalization to untrained

settings and persons. This contributes to practice because the study demonstrates the utility of the

intervention with individuals who have limited training (e.g., parents). In conclusion, the

implementation of the modified milieu therapy intervention by parents in the natural setting led

to an increase in unprompted communication, clinically significant decreases in aberrant

behavior, generalization to untrained settings and persons, and maintenance of these effects.


136











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APPENDIX A
FUNCTIONAL ANALYSIS PROTOCOL

Functional Analysis Protocol

Four conditions: Attention, Tangible, Escape, and Free Play (control)

1. Free Play
a. Home environment
-Environmental variables held constant (e.g., people, rooms, furniture,
noise levels)

b. Activity
-Child interacts with preferred items as determined by a preference
assessment

c. Researcher behavior
-Researcher provides noncontingent attention to the child
-No task demands are presented
-No programmed consequences are provided for problematic behavior

d. Assumption
-No problem behavior should occur in this condition


2. Attention
a. Home environment
-Environmental variables held constant (e.g., people, rooms, furniture,
noise levels)

b. Activity
-Child interacts with a neutral task as determined by the parent and
previous observations

c. Researcher behavior
-Researcher attends to the child's behavior each time it occurs by giving
the child attention and stating "Please don't do that"

d. Assumption
-If increased problem behavior occurs, conclude problem behavior is to
"gain" access to adult attention


3. Tangible
a. Home environment










-Environmental variables held constant (e.g., people, rooms, furniture,
noise levels)

b. Activity
-Child interacts with a preferred item determined previously by a
preference assessment

c. Researcher behavior
-No task demands are presented
-Researcher provides noncontingent attention to the child
-Researcher removes the preferred item after a short, set period of time of
appropriate behavior (30 seconds)

d. Assumption
-If increased problem behavior occurs, conclude problem behavior is to
"gain" access to tangible items


4. Escape
a. Home environment
-Environmental variables held constant (e.g., people, rooms, furniture,
noise levels)

b. Activity
-Child interacts with a demanding task as determined by the parent and
through observation

c. Researcher behavior
-Researcher provides noncontingent attention to the child
-Researcher repeatedly directs child to complete the demanding task (one
minute intervals)
-Researcher removes task each time problem behavior occurs for a set
period of time (30 seconds) and then returns the task when appropriate
behavior occurs

d. Assumption
-If increased problem behavior occurs, conclude problem behavior
functions to "escape" demands


145










APPENDIX B
MISCELLANEOUS VARIBLES DATA SHEETS

Adult Survey

Student: Date:
Adult: (e.g., Parent 1)

1. Education:
Please indicate your highest degree obtained.
O None.
O High School.
O Bachelors.
O Masters.
O Post Masters.

2. Experience:
Please indicate the number of research studies in which you have participated.
Number of Research Studies

3. Expertise:
Please indicate each type of training you have received. (Check all that apply).
O Applied Behavior Analysis
O Functional Communication Training
O Milieu Therapy.
O Other:
O None.


146













Date Time Sleep C Sleep P People Meals Weather Health Major Events Behavior of previous day


III


Session Variable Check


Major event = like death in family, etc.; Sleep P = parent's sleep; Sleep C = child's sleep
Meals = number of meals before session; Weather = hot, humid, rain, etc.


147





APPENDIX C
BOARDMAKER CARDS


music


play time


blocks


manipulatives


clean up


148









APPENDIX D
CODING MANUAL

Coding Manual


Aberrant behavior: Aberrant behavior is defined broadly as behavior that negatively impacts

target child learning and independence and can include mild behavior and severe behavior

(Bailey and Burch, 2002). The definition will vary and be adjusted based on each target child's

form of the behavior. Some participants may engage in tantrums and others may engage in

property destruction or aggression towards others. For example, screaming and hitting

classmates would be considered aberrant behavior. The behaviors will be operationally defined

in observable and measurable terms as outlined by Bailey and Burch (2002). For each

participant, the aberrant behavior to target will be determined from data obtained from parent

and teacher interviews and direct observations. A behavior must be over for three seconds before

another aberrant behavior can be counted. If a child tantrums, stops for 1 second, and resumes to

tantrum, the episode is counted as one behavior.

Aberrant behavior: Typically defined as tantrums, task refusal, self-injury, aggression, or

property destruction (Harding et al., 2001).

1. Examples:

A child lies on the floor, kicks his feet, and screams for a period equal
to or greater than 1 second (i.e., tantrum).

When asked to do a task, a child screams (i.e., tantrum, task refusal).

A child lies on the floor and begins banging his head (self-injury).

A child screams and hits an adult (aggression).

A child lies on the floor and kicks a hole in the wall (property
destruction).


149










2. Nonexamples:

A child lays on the floor and no task demand has been made.

A child falls and hits his head on the floor.

Communication response: Communication responses are defined as handing picture

communication cards to the trainer involved in the session with or without a prompt.

Prompted communication: Prompted communication response is defined as requesting an

item with a physical, verbal, or gestural prompt.

1. Examples:

*If a teacher tells a participant, "Tell me what you want" and the
participant then hands the picture card to the teacher, then prompted
communication has occurred.

2. Nonexamples:

*If a child hands a picture card to a teacher or other change agent
without any prompt, then unprompted communication has occurred.

Unprompted communication: Unprompted communication is defined as requesting an

item without a physical, verbal, or gestural prompt (i.e., unprompted communication).

1. Examples

*If a child hands a picture card to a teacher or other change agent
without any prompt, then unprompted communication has occurred.

2. Nonexamples:

*If a teacher tells a participant. "If you want the car, give me the card"
and the participant then hands the card to the teacher, then unprompted
communication has not occurred.

Prompts: Prompts consist of verbal, gestural, or physical prompts, least to most intrusive,

respectively.

Verbal prompts consist of verbal language (e.g., "Tell me what you want.").


150










1. Examples:

*The teacher says, "Tell me what you want."

2. Nonexamples:

*The teacher points to an obj ect and then holds her hand out.

Gestural prompts consist of visual cues (e.g., teacher holds hand out with palm up in

anticipation of receiving a card).

1. Examples:

The parent holds her hand out.

The parent holds her hand out and points to the object.

2. Nonexamples:

The parent says, "What do you want?'

The teacher touches the student' s hand.

Physical prompts consist of hand over hand exchanges (e.g., teacher leading a child's

hand to a card).

1. Examples:

*The parent grasps the child's hand and assists in picking up the card.

2. Nonexamples:

The teacher holds her hand out for the picture card.

The parent says, "Give me the card."

Play: Play consists of the participant engaged with a preferred item for a period of two or more

seconds in which the participant also makes eye contact with the preferred item.

1. Examples:

*If a child picks up a toy car (i.e., preferred item), briefly looks at the
item, and holds it for two seconds, play has occurred.










2. Nonexamples:

*If a child picks up a toy car, never looks at it, and walks around the
room with the car in his hand for four seconds, play has not occurred.

Verbalizations. Verbalizations may be imitative or unprompted.

Imitative verbalizations: Defined as imitating another's words such as the case with

echolalia.

1. Examples:

The parent says, "Tell me what you want." The child then says, "Tell
me."

The teacher says, "Do you want the car?" and the child says, "Car."

2. Nonexamples:

The child says, "Car" without an adult present saying the word.

The child says, "help" without an adult present saying the word.

Unprompted verbalizations: Defined as verbal words emitted by participants that are not

echolalic in nature. That is, adult words are not being imitated.

1. Examples:

The child says, "Car" without an adult present saying the word.

The child says, "help" without and adult present saying the word.

2. Nonexamples:

The parent says, "Tell me what you want." The child then says, "Tell
me."

The teacher says, "Do you want the car?" and the child says, "Car."































0:00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

1:00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

2:00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

3:00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

4:00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59


APPENDIX E
DATA COLLECTION AND CODING SHEETS


Real-time Data Collection Sheet


Time:


Date:
Primary Observer:
Session Number (s):
Highly Preferred Stimulus:


Name :
Secondary Observer:
Schedule:
Condition:


Results:











































Beh



Beh


Child Response: Y Nr lAbberant Behavior:




Instructions:
1. Record the adult prompt.
V== verbal prompt
V/G= verbal + gestural prompt
P= physical prompt
U= unprompted

2. Record latency to the prompt.
This will be 1 to 5 seconds. Recall that if it is more than 5 seconds,
another prompt is given.

3. Record the child response.
Y= yes, the child responded
N= no, the child dki not respond

4. Tally the number of aberrant behaviors
Note, there must be 3 seconds between the end of one
aberrant behavior, and the beginning of a new one.


Prompt: IV IV/Gi P U Latency:


Student: Date:
Mand Item: Sessoni Nurnber:

Prirnary Observer:

1. Mand
Prompt: |V |V/Gi P IU Latency:

Child Response: NY I Abberant

Prompt: IV IV/Gi P U Latency:

Child Response: NY I Abberant

Prompt: IV IV/Gi P U Latency:

Child Response: NY I Abberant

Prompt: IV IV/Gi P U Latency:

Child Response: NY I Abberant

Prompt: IV IV/Gi P U Latency:

Child Response: NY I Abberant

Prompt: IV IV/Gi P U Latency:

Child Response: Y Nr lAbberant

Prompt: IV IV/Gi P U Latency:

Child Response: Y Nr lAbberant

Prompt: IV IV/Gi P U Latency:

Child Response: Y Nr lAbberant

Prompt: IV IV/Gi P U Latency:

Child Response: Y Nr lAbberant


I1|2 3 4 5 6 7 8 9 10

Behavior:


| 1|2|3 41 51 6 71 81 9 101

awior:

1 2 3 4 5 6 7 8 9 10

awior:

1 2 3 4 5 6 7 8 9 10

awior:

1 2 3 4 5 6 7 8 9 10

awior:

1 2 3 4 5 6 7 8 9 10

avior:

1 2 3 4 5 6 7 8 9 10

avior:

1 2 3 4 5 6 7 8 9 10

awior:

1 2 3 4 5 6 7 8 9 10

awior:

1 2 3 4 5 6 7 8 9 10









APPENDIX F
TRAINING MANUAL

Training Manual

Introduction: The training will consist of training parents to teach their children

communication skills to replace aberrant behaviors.

Before initiating the intervention, parents will be taught the procedures for teaching their

child this skill through viewing videos and role-play training sessions, which will occur until

caregivers reach 90% accuracy. First, parents will read the coding manual. The primary

experimenter will clarify any questions about coding definitions. Then, parents will view videos

and must identify and record intervention procedures. Parents will use paper and pencil to record

and classify (e.g., verbal, physical) each prompt given to the child. In addition, the parent will

write each response from the child and record whether the response was prompted or

unprompted, classifying the prompt. Finally, parents will role-play the intervention procedures

with the primary experimenter. The parent will practice taking an item and playing with the

item, and giving verbal, verbal/gestural, and physical prompts with the primary experimenter

(see Appendix F for detailed training manual).

For purposes of generalization, in contrast, teachers will be taught a single skill.

Teachers will be taught to place highly preferred items in view, but out of reach of the child.

Additionally, the teachers will be instructed to give the highly preferred items to the child when

given a picture card. The teachers will practice this through role-play with the experimenter until

they are able to complete this skill successfully as evaluated and defined by caregivers and

teachers performing the procedures correctly 10 consecutive trials (see Appendix F for training

manual and worksheets).


155










Parents: Parents will be taught the procedures for teaching their child to communicate and

initiate communication through reading the coding and experimental manuals, viewing training

videos (videos of the primary experimenter performing the intervention), and role-play training

sessions, which will occur until they reach criterion level.

1. Parents will read the manuals and view videos and must identify and record intervention

procedures.

a. The parents will read the coding manual and experimental procedures
manual .

b. Using paper and pencil and the attached data sheet, the parents will
record and identify prompts used (verbal, gestural, and physical) in the
video clips.

c. The parents will identify play situations according to the definition in
the coding manual.

d. The parents will identify communication responses.

e. Given video clips, the parents will code the behaviors using the data
collection sheets in Appendix E. The parents' codes will be compared
to the primary experimenter. The parents must obtain 90% IOA.

f. If the parents are below 90% accuracy after viewing ten 1-minute video
clips, the primary experimenter will review the coding manual.

g. The parents will be given more video clips until the parents reach 90%
accuracy, which approximately will be four hours across two days.


156









Video Prompts Play Situations Communication Implementation

Clip Responses on Video Clip

Clip 1 Yes/No



Clip 2 Yes/No



Clip 3 Yes/No



Clip 4 Yes/No



Clip 5 Yes/No



Clip 6 Yes/No



Clip 7 Yes/No



Clip 8 Yes/No



Clip 9 Yes/No



Clip 10 Yes/No












2. During the role-play, parents must implement the intervention procedures with the

primary experimenter and/ or graduate assistant.

a. Parents will role-play the procedures with the primary experimenter.

b. The parents will practice the session using the procedures outlined in the
experimental procedures section.

c. After completing the session, parents will view the videos with the
primary experimenter and determine if the procedures were
implemented correctly.

d. This will continue until the parent performs the procedures correctly 10
consecutive times.


Teachers: Teachers will be taught to place highly preferred items in view, but out of reach of the

child. Also, the teachers will be instructed to give the highly preferred items to the child when

given a picture card.

1. Teachers will practice this through role-play with the experimenter.

2. This training will occur daily until parents and teachers perform the procedures correctly
10 consecutive trials (see Appendix E for training worksheet).










APPENDIX G
SOCIAL VALIDITY FORMS

INTERVENTION ACCEPTABILITY FORM

Date:
Caregiver:
School (if applicable):
Age of child: _years _months


SECTION I: Please complete the items below by circling the number under the question that
best fits how you feel about the intervention.

1. How time consuming was the training?
Not at all Somewhat Very
1 2 3 4 5

2. Did the intervention improve your everyday routines (e.g., dinner, etc.)?
Not at all Somewhat Very
1 2 3 4 5

3. How much increase did you see in your child's communication?
Not at all Somewhat Very
1 2 3 4 5

4. Did you see an increase in your child's appropriate behavior?
Not at all Somewhat Very
1 2 3 4 5

5. How likely is it that you will use the intervention in the future?
Not at all Somewhat Very
1 2 3 4 5

SECTION II: Please tell me about you and your family.

1. How many children do you have?
Children

2. What is your current level of education? Place a check next to your choice.
High school _some college bachelors graduate school

3. Have you participated in research studies in the past?


SECTION III: Thank you for completing this questionnaire. Your input is very appreciated. If
there is anything else you may like to share, please do so in the space provided below.






















After viewing the 10-minute video clip please use the likert scales below to indicate the child' s
display of social behavior. Please remember to base your answers on the social behavior of the
targeted child.

1. How appropriate was the child's communication?

Not at all Sometimes Ver
1 2 3 4 5 6

2. How inappropriate was the child's behavior?

Not at all Sometimes Ver
1 2 3 4 5 6

3. How often did the child communicate?

Not at all Sometimes Ver
1 2 3 4 5 6

4. Overall, do you think the child's communication and behavior improved?

Not at all Sometimes Ver
1 2 3 4 5 6


Expert Social Validity Form


Date:

Participant:
Name:


Scoring Code:


Comments :









BIOGRAPHICAL SKETCH

My decision to work in the Hield of special education was by happenstance. After

providing supports for a mother and her child who had bipolar disorder, I was offered a job at a

center for children with severe emotional behavior disorders and autism called the Cedarwood

program, which was a part of the Georgia Psychoeducational Network. Prior to this, I taught high

school mathematics, but was not satisfied with my job. I took the job and started teaching

children with autism in August of 1999.

The program employed me for Hyve years. During this time, I worked in the classroom for

four years directly with the students. The program sent me to numerous workshops including a

stint at Division TEACCH (treatment and education of autistic and communication-handicapped

children), a statewide organization in North Carolina for individuals with autism. In addition,

they sent me to visit with Temple Grandin, a famous individual with autism. From that point on,

I knew working with individuals with autism was my passion and would encompass my career.

My last year working for the Cedar wood Program was spend as the school liaison. I traveled to

various schools to conduct functional assessments and help teachers develop behavioral

programs for children with autism and behavior disorders. While working at Cedarwood, I

worked on a master' s degree in behavior disorders at Georgia Southern University and received

the degree in 2002.

After completing my master' s program, I continued working for the Cedarwood Program

and started teaching undergraduate and graduate courses at Georgia Southern University. That

experience coupled with those gained with the Cedarwood Program helped confirm my decision

to pursue a doctoral degree. My experiences with the Cedarwood Program gave me my desire to

work with children with autism, while the experiences I had at Georgia Southern University









kindled my desire to become part of academia. Keeping in mind my desire to work directly with

parents and their children, and acknowledging my growing aspiration to conduct research and

teach at the college level, I chose to pursue a doctoral degree in special education. With a

doctoral degree from the University of Florida, I plan to continue to carry out research in the

field of autism because it is my passion, and to help parents and teachers of these children better

understand and meet their unique needs.





PAGE 1

1 E F F E C T S O F A M O D I F I E D M I L I E U T H E R A P Y I N T E R V E N T I O N O N T H E S O C I A L C O M M U N I C A T I V E B E H A V I O R S O F Y O U N G C H I L D R E N W I T H A U T I S M S P E C T R U M D I S O R D E R S B y G R E G O R Y R I C H M O N D M A N C I L A D I S S E R T A T I O N P R E S E N T E D T O T H E G R A D U A T E S C H O O L O F T H E U N I V E R S I T Y O F F L O R I D A I N P A R T I A L F U L F I L L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F D O C T O R O F P H I L O S O P H Y U N I V E R S I T Y O F F L O R I D A 2007

PAGE 2

2 2007 G r e gor y R i c hm ond M a nc i l

PAGE 3

3 A C K N O W L E D G E M E N T S H ow do I be gi n t o t ha nk e a c h i ndi vi dua l w ho i n hi s or he r ow n w a y pl a ye d a pa r t on t hi s por t i on of m y j our ne y i n l i f e w hi c h ha s be e n one of t he be s t pa t hs I ha ve de c i de d t o m e a nde r dow n? T ha nks f i r s t a nd f or e m os t t o a l l of t he f a m i l i e s of c hi l dr e n w i t h a ut i s m w ho I ha ve ha d t he pl e a s ur e t o w or k w i t h a nd l e a r n f r om ove r t he ye a r s W i t hout t he i r de di c a t i on a nd de s i r e t o i m pr ove t he i r c hi l dr e n s l i ve s I ne ve r w oul d ha ve s t a ye d on t hi s t r a i l I t ha nk S uz i e f or a l l ow i ng m e t o pur s ue m y pa s s i on de s pi t e t he e m ot i ona l c os t s I t ha nk m y c hi l dr e n V l a di m i r a nd M e l ody f or a l l t he s m i l e s k i s s e s a nd hugs a t t he e nd of a l ong da y. A l t hough m y f a m i l y pr ovi de d a l ot o f s uppor t i t w a s t he s uppor t o f m y c ha i r M a ur e e n C onr oy w ho gui de d m e on t hi s pa t h a nd ha s he l pe d m e obt a i n m y goa l I ha ve be e n l uc ky t o ha ve a c ha i r w ho i s a gr e a t m e nt or c ol l e a gue a nd f r i e nd. M a ur e e n i s one o f t he f e w pe opl e I ha v e m e t w ho i s a t r ue e duc a t or i n e ve r y s e ns e of t he w or d. M a ur e e n, I t ha nk he r f o r a l l t he oppo r t un i t i e s s he ha s gi ve n t ha t a l l ow e d m e t o be c om e a be t t e r r e s e a r c he r a nd s c hol a r I a l s o t ha nk he r f o r de ve l opi ng a c ol l e gi a l r e l a t i ons hi p t ha t w i l l s ur e l y l a s t w e l l be yond m y doc t or a l pr ogr a m a nd m ode l i ng how a p r of e s s or s houl d t r e a t s t ude nt s F i na l l y, I t ha nk he r f or ke e pi ng m y s pi r i t s up dur i ng t he t i m e s I doubt e d m ys e l f I f I be c om e j us t a m e r e s ha dow of he r a s a pr of e s s or I w i l l c ons i de r m ys e l f s uc c e s s f ul E a c h of t he ot he r c om m i t t e e m e m be r s T e r r y S c ot t H a z e l J one s J a m e s M c L e s ky, a nd M a r k L e w i s a l s o ha s c ont r i but e d t o m y e duc a t i on. T e r r y t a ught m e t he i m por t a nc e of w o r ki ng w i t h t e a c he r s s t a yi ng gr ounde d i n r e a l i t y, a nd c hoos i ng i nt e r ve nt i ons t ha t s om e one w i l l a c t ua l l y i m pl e m e nt H a z e l t a ught m e how t o s uppor t gr a dua t e s t ude nt s J a m e s t a ught m e i m por t a nt l e s s ons i n t he m e c ha ni c s of pr e s e nt i ng a nd w r i t i ng M a r k t a ught m e t he i m p or t a nc e of l ooki ng a t a l l t he l i t e r a t ur e i nc l udi ng t he m e di c a l r e s e a r c h. I ow e a s pe c i a l t ha nks t o A l e x J or da n be c a us e he m e nt or e d m e a t

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4 m y f i r s t j ob w or k i ng w i t h c hi l dr e n w i t h a ut i s m W i t hout hi s s uppor t a nd gui da nc e I m a y ha ve c hos e n a di f f e r e nt pa t h I n a ddi t i on I w oul d l i ke t o t ha nk a l l of m y f e l l ow doc t or a l s t ude nt s w ho ha ve be c om e a nd w i l l c ont i nue t o be g r e a t f r i e nds a nd c ol l e a gue s I ow e a s pe c i a l t ha nks t o B r i a n B oyd, M e l i s s a M i l l e r a nd T odd H a ydon I t ha nk B r i a n f o r t e a c hi ng m e t he i nt r i c a c i e s of t he doc t o r a l pr ogr a m I w i l l ne ve r f or ge t our f i r s t c onf e r e nc e a n d our S a t ur da y m o r ni ng b r e a kf a s t I t ha nk M e l i s s a f or he r s uppor t i n e ve r yt hi ng s he di d a nd c ont i nue s t o do. I t ha nk T odd f o r t he j oke s a nd c onve r s a t i ons on be ha vi or T he m us i c a l w a ys w i l l be gr e a t I t ha nk t he of f i c e s t a f f : S ha i r a R i va s O t e r o, M i c he l l Y or k a nd V i c ki T uc ke r f or e ve r y t r a ve l r e que s t c om pl e t e d, e ve r y of f i c e s uppl y gi ve n, a nd e ve r y j oke t ol d I w i l l m i s s e ve r yone i n t he D e pa r t m e nt of S pe c i a l E duc a t i on a t t he U ni ve r s i t y of F l or i da

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5 T A B L E O F C O N T E N T S P a ge A C K N O W L E D G E M E N T S . . . . . . . . . . . . . . . . . . . . . 3 L I S T O F T A B L E S . . . . . . . . . . . . . . . . . . . . . . . . . 7 L I S T O F F I G U R E S . . . . . . . . . . . . . . . . . . . . . . . . 8 A B S T R A C T . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 C H A P T E R 1 I N T R O D U C T I O N . . . . . . . . . . . . . . . . . . . . . . 11 O ve r vi e w of A ut i s m S pe c t r um D i s or de r s . . . . . . . . . . . . . 11 F unc t i ona l C om m uni c a t i on T r a i ni ng . . . . . . . . . . . . . . . 15 M i l i e u T he r a py . . . . . . . . . . . . . . . . . . . . . . . 16 S um m a r y of F C T a nd M i l i e u T he r a py P r oc e dur e s . . . . . . . . . . 17 S t a t e m e nt of t he P r ob l e m . . . . . . . . . . . . . . . . . . . 17 S i gni f i c a nc e of t he S t udy . . . . . . . . . . . . . . . . . . . . 18 P ur pos e of t he S t udy . . . . . . . . . . . . . . . . . . . . . 18 2 L I T E R A T U R E R E V I E W . . . . . . . . . . . . . . . . . . . 19 O ve r vi e w of A ut i s m S pe c t r um D i s or de r s . . . . . . . . . . . . . 19 F unc t i ona l C om m uni c a t i on T r a i ni ng . . . . . . . . . . . . . . . 24 M i l i e u T he r a py . . . . . . . . . . . . . . . . . . . . . . . 28 S um m a r y of F C T a nd M i l i e u T he r a py P r oc e dur e s . . . . . . . . . . 32 F unc t i ona l C om m uni c a t i on T r a i ni ng L i t e r a t u r e R e vi e w . . . . . . . . 35 M i l i e u T he r a py L i t e r a t ur e R e vi e w . . . . . . . . . . . . . . . . 45 D i s c us s i on . . . . . . . . . . . . . . . . . . . . . . . . . 52 3 M E T H O D . . . . . . . . . . . . . . . . . . . . . . . . . 68 P a r t i c i pa nt s . . . . . . . . . . . . . . . . . . . . . . . . . 68 S e t t i ngs C ha nge A ge nt s M a t e r i a l s . . . . . . . . . . . . . . . . 72 D e pe nde nt M e a s ur e s . . . . . . . . . . . . . . . . . . . . . 74 E xpe r i m e nt a l P r oc e dur e s a nd S t udy D e s i gn . . . . . . . . . . . . . 77 D a t a A na l ys i s . . . . . . . . . . . . . . . . . . . . . . . . 84 I nt e r obs e r v e r A gr e e m e nt . . . . . . . . . . . . . . . . . . . . 86 T r e a t m e nt I n t e gr i t y a nd S oc i a l V a l i di t y . . . . . . . . . . . . . . 90

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6 4 RESULTS...................................................................................................... 94 Pre-Intervention/ Assessment Phase............................................................... 94 Intervention Results........................................................................................ 96 Generalization Results.................................................................................... 105 Treatment Integrity......................................................................................... 108 Social Validity................................................................................................ 109 Summary........................................................................................................ 111 5 DISCUSSION................................................................................................ 123 Limitations..................................................................................................... 123 Overview of Findings..................................................................................... 125 Explanation of Findings.................................................................................. 126 Theoretical or Conceptual Implications of Findings........................................ 130 Implications for Future Research.................................................................... 132 Implications for Practice................................................................................. 134 Summary........................................................................................................ 135 LIST OF REFERENCES .............................................................................................. 137 APPENDIX A FUNCTIONAL ANALYSIS PROTOCOL..................................................... 144 B MISCELLANEOUS VARIABLES DATA SHEETS..................................... 146 C BOARDMAKER CARDS.............................................................................. 148 D CODING MANUAL...................................................................................... 149 E DATA COLLECTION AND CODING SHEETS........................................... 153 F TRAINING MANUAL.................................................................................. 155 G SOCIAL VALIDITY FORMS....................................................................... 159 BIOGRAPHICAL SKETCH...................................................................................... 161

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7 L I S T O F T A B L E S T a bl e pa ge 2 1 C ha r a c t e r i s t i c s of t he s t udy pa r t i c i pa nt s o f F C T . . . . . . . . . . 60 2 2 C ha r a c t e r i s t i c s of t he e nvi r onm e nt of F C T . . . . . . . . . . . . 61 2 3 R e s e a r c h de s i gn s a nd i nt e r ve nt i ons of F C T . . . . . . . . . . . . 62 2 4 M a j or f i ndi ngs of F C T . . . . . . . . . . . . . . . . . . . . 63 2 5 C ha r a c t e r i s t i c s of t he s t udy pa r t i c i pa nt s o f m i l i e u t he r a py . . . . . . 64 2 6 C ha r a c t e r i s t i c s of t he e nvi r onm e nt of m i l i e u t he r a p y . . . . . . . . 65 2 7 R e s e a r c h de s i gn s a nd i nt e r ve nt i ons of m i l i e u t he r a py . . . . . . . . 66 2 8 M a j or f i ndi ngs o f m i l i e u t he r a py . . . . . . . . . . . . . . . . 67 3 1 P a r t i c i pa nt c ha r a c t e r i s t i c s . . . . . . . . . . . . . . . . . . . 92 3 2 M ot he r s s ur ve y r e s ul t s . . . . . . . . . . . . . . . . . . . 92 3 3 T e a c he r s ur ve y r e s ul t s . . . . . . . . . . . . . . . . . . . . 92 3 4 M a i nt e na nc e s e s s i on i t e m s . . . . . . . . . . . . . . . . . . 92 4 1 P r e f e r e nc e a s s e s s m e nt c hoi c e s . . . . . . . . . . . . . . . . . 113 4 2 A ve r a ge ( r a nge ) nu m be r o f t r i a l s . . . . . . . . . . . . . . . . 113 4 3 S pont a ne ous ve r ba l i z a t i ons . . . . . . . . . . . . . . . . . . 113 4 4 P a r e nt t r a i ni ng . . . . . . . . . . . . . . . . . . . . . . . 113 4 5 T e a c he r t r a i ni ng . . . . . . . . . . . . . . . . . . . . . . 113 4 6 T r e a t m e nt i nt e gr i t y da t a . . . . . . . . . . . . . . . . . . . 114

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8 L I S T O F F I G U R E S F i gur e pa ge 3 1 I nt e r ve nt i on p r oc e dur e s . . . . . . . . . . . . . . . . . . . . 93 4 1 S c ot t s r a t e o f a be r r a nt be ha vi or du r i ng t he f unc t i o na l a na l ys i s . . . . 115 4 2 D a vi d s r a t e of a be r r a nt be ha vi o r dur i ng t he f unc t i ona l a na l ys i s . . . . 116 4 3 Z e b s r a t e o f a be r r a nt be ha vi or du r i ng t he f unc t i on a l a na l ys i s . . . . . 117 4 4 C om m uni c a t i on r e s pons e pe r c e nt a ge s a nd r a t e s . . . . . . . . . . 118 4 5 A be r r a nt be ha vi or r a t e . . . . . . . . . . . . . . . . . . . . 119 4 6 S c ot t s m e a n l a t e n c y t o r e s pond unpr om pt e d . . . . . . . . . . . 120 4 7 D a vi d s m e a n l a t e nc y t o r e s pond unpr om pt e d . . . . . . . . . . . 121 4 8 Z e b s m e a n l a t e nc y t o r e s pond unpr om p t e d . . . . . . . . . . . . 122

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9 Abstract of Dissertation Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy EFFECTS OF A MODIFIED MILIEU THERAPY INTERVENTION ON THE SOCIAL COMMUNICATIVE BEHAVIOR S OF YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDERS By Gregory Richmond Mancil August 2007 Chair: Maureen A. Conroy Major: Special Education Children with autism spectrum disorder (A SD) typically have difficulty speaking and communicating, with 40% of these individu als never developing speech. They also have social deficits, which are exacerb ated by their communication problems. Concurrent with these deficits, individuals with ASD exhibit high levels of aberrant behaviors such as screaming, hitting, and biting, creating subs tantial obstacles for parents and other individuals charged with their ed ucation and well-being. In addition to these deficits, children with ASD have difficulty generalizing skills to natural settings. Children with ASD often learn skills in isol ation and do not apply the skills to other settings such as their homes. Such i ssues with communicati on deficits, aberrant behaviors, and generalization difficulties, combin ed with the increase in the prevalence of autism demands that the field respond and pr ovide effective practices to meet these individuals needs at home and in educational settings (school). To address both the communication and be havioral needs of children with ASD, researchers have investigated the use of applied behavior an alysis interventions such as functional communication traini ng (FCT) and milieu therapy. The researchers typically

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10 have used FCT to address aberrant behaviors and milieu therapy to address communication skills. However, FCT research ers have not addressed generalization or overall improvement in communication. In a similar respect, milieu therapy researchers have not addressed aberrant behaviors. The purpose of the current study was to exam ine the effects of an intervention that combined FCT and milieu therapy for intervening with childrens communication and aberrant behaviors in a natural setting (i.e., their home). The results suggest that the children increased unprompted communication, while aberrant beha vior decreased to zero. These results also generalized to the t eacher in the classroom and maintained in both settings. Future research should examine the effects of the intervention with peers and the effects on other behaviors such as the parents use of language. In addition, future research should extend the outcomes of the current study to a larger sample and other individuals with different char acteristics on the autism spectrum.

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11 C H A P T E R 1 I N T R O D U C T I O N T he pur pos e of t hi s c ha pt e r i s t o p r ovi de a n i nt r od uc t i on t o t he l i t e r a t ur e on t he c om m uni c a t i on a nd be ha vi or a l ne e ds of c hi l dr e n w i t h a ut i s m s pe c t r um di s or de r s ( A S D ) A ddi t i ona l l y, a r a t i ona l e f or i nve s t i ga t i ng t he us e o f a c om bi ne d i nt e r ve nt i on f or s t ude nt s w i t h A S D i nc or por a t i ng t he pr i nc i pl e s of f unc t i ona l c o m m uni c a t i on t r a i ni ng w i t h m i l i e u t he r a py i n na t ur a l e nvi r onm e nt s w i l l be di s c us s e d. A n i nt r od uc t i on of a ut i s m s pe c t r um di s or de r ( A S D ) i ni t i a l l y i s gi ve n w i t h a de s c r i pt i on of t he hi s t or y i nc i de nc e a nd c ha r a c t e r i s t i c s a s s oc i a t e d w i t h A S D S e c ond, a de s c r i pt i on of a ppl i e d be ha vi or a na l ys i s ( A B A ) a c onc e pt ua l a ppr oa c h a dhe r e d t o by m a ny r e s e a r c he r s t o a ddr e s s ne e ds of c hi l dr e n w i t h A S D i s pr ovi de d T hi r d, a br i e f de s c r i pt i on of t w o e vi de nc e ba s e d i nt e r ve nt i on pr a c t i c e s t ha t a r e ba s e d on A B A pr i nc i pl e s [ i e f unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) a nd m i l i e u t he r a py] a nd a r e us e d t o a ddr e s s a be r r a nt be ha vi or s a nd c om m uni c a t i ve be ha vi or s r e s pe c t i ve l y, i s pr o v i de d. T hi s c ha pt e r c onc l ude s w i t h a di s c us s i on of t he c ont r i but i ons t he c ur r e nt s t udy m a ke s t o bot h r e s e a r c h a nd p r a c t i c e O ve r vi e w of A u t i s m S p e c t r u m D i s or d e r s A ut i s m S pe c t r um D i s or de r s ( A S D ) i s a de ve l opm e nt a l di s or de r a f f e c t i ng t he l i ve s of t hous a nds of c hi l dr e n. A S D w a s f i r s t de s c r i be d by L e o K a nne r i n 1943, w ho i ni t i a l l y l a be l e d t he di s or de r a ut i s m H e s t udi e d t he c a s e hi s t or i e s of 1 1 c hi l dr e n a nd not e d t ha t t he i r c ha r a c t e r i s t i c s di f f e r e d s i gni f i c a nt l y f r o m c hi l d r e n w i t h s c hi z ophr e ni a H e s ugge s t e d t ha t a s e pa r a t e c a t e gor y w a s ne e de d t o a c c ount f or t he s e uni que c ha r a c t e r i s t i c s S i nc e t he i ni t i a l a ut i s m de s c r i pt i on i n 1943, t he d i s or de r ha s e vol ve d i nt o a s pe c t r um di s or de r ( i e A S D ) w i t h t he num be r a nd pe r c e nt a ge of pe r s ons i de nt i f i e d i nc r e a s i ng e a c h ye a r ( C e nt e r f or D i s e a s e C ont r ol a nd P r e ve nt i on, 2005 )

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12 A c c or di ng t o t he C e nt e r s f or D i s e a s e C ont r ol a nd P r e ve nt i on ( C D C ) t w o t o s i x pe r 1, 000 c hi l dr e n ( a ge s 3 t o 10 ye a r s o f a ge ) ha ve A S D ( C D C 2005) T he A ut i s m S oc i e t y of A m e r i c a ( A ut i s m S oc i e t y o f A m e r i c a 2006) s ugge s t s t ha t A S D i s e ve n m or e pr e va l e nt a nd r e por t s t ha t 1 i n 150 c hi l d r e n bor n t oda y w i l l de ve l op t hi s d i s or de r T he A ut i s m S oc i e t y o f A m e r i c a ( A S A ) a l s o not e s t ha t 1. 5 m i l l i on A m e r i c a ns i nc l udi ng c hi l dr e n a nd a dul t s ha ve A S D w hi l e a not h e r 15 m i l l i on A m e r i c a ns ( e g. f a m i l y, e duc a t or s a nd he a l t h c a r e w or ke r s ) a r e a f f e c t e d by t hi s d i s or de r I n s um A S D i nc i de nc e a nd p r e va l e nc e r a t e s i ndi c a t e t ha t m i l l i ons a r e a f f e c t e d by t he di s or de r S i gni f i c a nt i m pa i r m e nt s i n s oc i a l i nt e r a c t i on a nd c om m uni c a t i on s ki l l s a nd a hi ghl y r e s t r i c t e d a r e a of a c t i vi t i e s a nd i nt e r e s t s a r e t he de f i ni ng f e a t ur e s of A S D ( A m e r i c a n P s yc hi a t r i c A s s oc i a t i on, 2000) S oc i a l i n t e r a c t i on pr ob l e m s m a y be e xhi bi t e d t h r ough a n i m pa i r m e nt i n nonve r ba l be ha vi or s ( e g e ye t o e y e ga z e body p os t ur e s f a c i a l e xpr e s s i ons ) a nd/ or f a i l ur e t o c r e a t e de ve l opm e nt a l l y a ppr opr i a t e pe e r r e l a t i ons h i ps F o r e xa m pl e a c hi l d w i t h A S D m a y ha ve di f f i c ul t l y di r e c t l y l ook i ng i nt o a pe r s on s e ye s e v e n t hough t he c hi l d m a y a ppe a r t o be s t a r i ng di r e c t l y a t t he pe r s on. C oi nc i di ng w i t h i m pa i r m e nt s i n s oc i a l i nt e r a c t i on c hi l dr e n w i t h A S D ha ve c om m uni c a t i on s ki l l de f i c i t s T he s e de f i c i t s of t e n i nc l ude a de l a y i n or a bs e nc e of s poke n l a ngua ge C hi l dr e n t ha t do de ve l op s pe e c h m a y no t i ni t i a t e o r s us t a i n c onve r s a t i ons w i t h ot he r s F ur t he r t he s e c hi l dr e n m a y de ve l op s t e r e ot ype d a n d r e pe t i t i ve us e of l a ngua ge or i di os ync r a t i c l a ngua ge F o r e xa m pl e a c hi l d w i t h A S D m a y r e pe a t a phr a s e ove r a nd ove r w hi c h c a n be us e d i n a f unc t i ona l ( i e a s a m a nd t o ge t a pr e f e r r e d i t e m ) or nonf unc t i ona l m a nne r ( i e no a ppa r e nt c onne c t i on t o s t i m ul i ) I n a ddi t i on t o s oc i a l i nt e r a c t i on a nd c om m uni c a t i o n pr obl e m s c hi l d r e n w i t h A S D m a y e xhi bi t r e s t r i c t e d, r e pe t i t i ve a nd s t e r e ot ype d pa t t e r ns of be ha vi or i nt e r e s t s a nd a c t i vi t i e s O f t e n,

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13 t he y de m ons t r a t e a pr e oc c upa t i on w i t h i di os ync r a t i c i nt e r e s t s t o a l e ve l c ons i de r e d a bno r m a l i n i nt e ns i t y a nd f oc us F or e xa m pl e a c hi l d m a y kno w e ve r y phone num be r i n hi s or he r l oc a l t e l e phone book, but not de m ons t r a t e unde r s t a n di ng of ba s i c a r i t hm e t i c T he y a l s o m a y de m ons t r a t e i nf l e xi bl e nonf unc t i ona l r i t ua l s a nd r out i ne s ( e g. t u r ni ng a door knob ove r a nd ove r i n e a c h di r e c t i on be f or e l e a vi ng t he i r ho m e ) F u r t h e r m a ny c hi l dr e n w i t h A S D ha ve s t e r e ot ype d a nd r e pe t i t i ve m ot o r m a nne r i s m s F o r e xa m pl e a c hi l d m a y e nga ge i n r e pe a t e d ha nd f l a ppi ng w i t h no a ppa r e nt pur pos e dur i ng i ns t r uc t i ona l t i m e s i n t he c l a s s r oom or dur i ng f r e e t i m e a l one C onc ur r e nt w i t h t he a f or e m e nt i one d f e a t ur e s m a n y c hi l dr e n w i t h A S D e xhi bi t hi gh l e ve l s of a be r r a nt be ha vi o r s t ow a r d ot he r s or t he m s e l ve s t ha t i nt e r f e r e w i t h t he i r l e a r ni ng, s uc h a s s c r e a m i ng, hi t t i ng, a nd bi t i ng ( S i ga f oos 2000 ) S om e c hi l dr e n w i l l r e pe a t e dl y p i nc h t he m s e l ve s or t he y m a y a ggr e s s t ow a r d ot he r c hi l d r e n or a dul t s ( e g hi t ot h e r s ) T he s e a be r r a nt be ha vi or s c r e a t e s ubs t a nt i a l obs t a c l e s f or i ndi vi dua l s r e s pons i bl e f or t he i r e duc a t i on a nd c a r e ( D ur a nd & M e r ge s 2001) M a ny pa r e nt s e xpe r i e nc e s t r e s s w he n t he i r c hi l dr e n e nga ge i n a ggr e s s i on or t a nt r um s U nl i ke ot he r s pa r e nt s o f c hi l d r e n w i t h A S D us ua l l y c a nnot de t e r m i ne t he r e a s on f o r t he t a nt r um be c a us e of t he i r c hi l d s de f i c i t s i n c om m un i c a t i on. T he c om bi na t i on of t he s e c ha r a c t e r i s t i c s ( i e s oc i a l i nt e r a c t i on i m pa i r m e nt s c om m uni c a t i on de f i c i t s r e pe t i t i ve be ha vi o r s a nd a be r r a nt be ha vi or s ) t he ne ga t i ve e f f e c t s on t he c hi l dr e n a nd f a m i l i e s a nd t he i nc r e a s e i n t he pr e va l e nc e of A S D p r e s e nt a c r i t i c a l de m a nd f or t he f i e l d o f s pe c i a l e duc a t i on t o r e s pond a nd p r ovi de e f f e c t i ve pr a c t i c e s t o m e e t t he s e c hi l dr e n s ne e ds a t hom e a nd i n e duc a t i ona l s e t t i ngs S e ve r a l r e s e a r c he r s ha ve r e s ponde d t o t hi s ne e d by e xa m i ni ng t he r e l a t i ons hi p be t w e e n a be r r a nt be ha vi or s a nd c om m uni c a t i on a bi l i t i e s of c hi l dr e n w i t h A S D ( e g s e e B ot t F a r m e r & R hode 1997; C hung, J e nne r C ha m be r l a i n & C or be t t 1995; S i ga f oos 2000; S c h r oe de r

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14 S c hr oe de r S m i t h, & D a l l dor f 1978) C hung e t a l f ound a n i nve r s e r e l a t i on be t w e e n c om m uni c a t i on a bi l i t y a nd t he di s pl a y of a be r r a nt be ha vi or s s uc h a s s e l f i nj ur y a nd a gg r e s s i on i n c hi l dr e n w i t h A S D S i m i l a r l y, B ot t e t a l ( 1997) d e t e r m i ne d t ha t i ndi v i dua l s w i t h m o r e de ve l ope d s pe e c h s ki l l s e xhi bi t e d a l ow e r r a t e of a be r r a nt be ha vi or s t ha n t hos e w i t h i m pa i r e d s pe e c h s ki l l s I n a m or e r e c e nt s t udy, S i ga f oos ( 20 00) hypot he s i z e d t ha t i m pa i r e d c om m uni c a t i on de ve l opm e nt i n c hi l d r e n w i t h A S D a nd ot he r de ve l opm e nt a l di s a bi l i t i e s m a y a c t ua l l y c a us e a be r r a nt be ha vi or s W he n c hi l d r e n l a c k t he a ppr opr i a t e c om m un i c a t i on s ki l l s t o c om m uni c a t e t he y m a y us e a be r r a nt be ha vi or s f or c om m uni c a t i on pur pos e s T o a ddr e s s bot h t he c om m uni c a t i on a nd be ha vi o r a l ne e ds of c hi l d r e n w i t h A S D r e s e a r c he r s ha ve i nve s t i ga t e d t he us e of a ppl i e d be ha vi or a na l ys i s i nt e r ve nt i ons ( D ur a nd & C a r r 1987; W a c ke r e t a l 1990) A ppl i e d be ha vi o r a na l ys i s ( A B A ) a ddr e s s e s t he e ve nt s s ur r oundi ng be ha vi or bot h a nt e c e de nt e ve nt s ( oc c ur r i ng pr i or t o a be ha vi or ) a nd c ons e que nt e ve nt s ( oc c ur r i ng a f t e r a be ha vi or ) i n or de r t o m a ni pul a t e t hos e va r i a bl e s a nd pr oduc e be ha vi or c ha nge ( B a e r W ol f & R i s l e y, 1968) A B A i s ba s e d on s e ve r a l pr i nc i pl e s t w o of w hi c h a r e pa r t i c ul a r l y not e w or t hy f or t he c ur r e nt s t udy. F i r s t be ha vi or s a r e l e a r ne d t hr ough a n i ndi vi dua l s i nt e r a c t i ons w i t h hi s or he r e nvi r onm e nt vi a ope r a nt c ondi t i oni ng w hi c h i nvol ve s t he r e l a t i ons hi p be t w e e n s t i m ul us r e s pons e c ons e qu e nc e s ( S ki nne r 1953) A di s c r i m i na t i ve s t i m ul us i s one t ype o f a nt e c e de nt f a c t or t ha t s e t s t he oc c a s i on f o r be ha vi or t o oc c ur a nd s i gna l s t he a va i l a bi l i t y o f a r e i nf or c e r ( or c ons e que nt e ve nt ) T he c ons e que nc e t ha t f o l l ow s t he be ha vi or de t e r m i ne s t he pr oba bi l i t y of t he be ha vi or r e oc c ur r i ng i n t he pr e s e nc e of t he s a m e or a s i m i l a r s t i m ul us T he r e f or e t he i ndi vi dua l s e nvi r onm e nt m us t be a s s e s s e d t o de t e r m i ne t he a nt e c e de nt s a nd c ons e que nc e s s ur r oundi ng t he t a r ge t be ha vi or i n o r de r t o unde r s t a nd t he i r e f f e c t s on t ha t be ha vi or ( B a e r W ol f

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15 & R i s l e y, 1968) ) S e c ond, be ha vi o r a na l ys i s r e s e a r c h s houl d i de nt i f y a nd i nve s t i ga t e pr oc e dur e s t ha t r e l i a bl y p r oduc e s i gni f i c a nt be ha vi or c ha nge ( B a i l e y & B ur c h, 2002 ) T w o of t he m os t pr om i ne nt A B A i nt e r ve nt i on s t r a t e gi e s i n t he l i t e r a t ur e t ha t a r e a ppl i c a bl e t o c hi l dr e n w i t h A S D a nd a ddr e s s t he a r e a s of a be r r a nt be ha vi or a nd c om m uni c a t i on a r e : ( a ) f unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) a nd ( b) m i l i e u t he r a py. A n ove r vi e w of e a c h o f t he s e i nt e r ve nt i ons s t r a t e gi e s f ol l ow s F u n c t i on al C om m u n i c at i o n T r ai n i n g F unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) i s one i nt e r ve nt i on s t r a t e gy t ha t ha s be e n us e d t o a ddr e s s bot h t he c om m uni c a t i on a nd a be r r a nt be ha vi or a l ne e ds of c hi l d r e n w i t h A S D ( C a r r & D ur a nd, 1985; D ur a nd & M e r ge s 2001; W a c ke r e t a l 1990) F C T i nv ol ve s a s s e s s i ng t he f unc t i on ( i e out c om e c ons e que nc e ) of a be ha vi or ( e g. a t t e nt i on e s c a pe t a ngi bl e or s e ns or y) t hr ough a na l ogue a s s e s s m e nt m e t hodol ogy r e f e r r e d t o a s f unc t i ona l a na l ys i s a nd t he n r e pl a c i ng t he a be r r a nt be ha vi or by t e a c hi ng a c om m u ni c a t i v e r e s pons e t ha t s e r ve s t he s a m e f unc t i on ( D ur a nd & C a r r 1987) A num be r o f r e s e a r c he r s ha ve de m ons t r a t e d t he po s i t i ve e f f e c t s of t hi s i nt e r ve nt i on w i t h c hi l dr e n w i t h A S D a nd c hi l d r e n w i t h o t he r de ve l o pm e nt a l di s a bi l i t i e s I n t hi s body of r e s e a r c h c om m uni c a t i ve r e s pons e s e f f e c t i ve l y ha ve r e pl a c e d a be r r a nt be ha vi or s i n e a c h of t he s t udi e s r e vi e w e d. F or e xa m pl e W a c ke r e t a l ( 2005) de m ons t r a t e d F C T w a s a n e f f e c t i ve i nt e r ve nt i on f or a ddr e s s i ng a t t e nt i on a nd e s c a pe f unc t i ons f or c hi l dr e n w i t h a ggr e s s i ve be ha vi or s s e l f i nj ur i ous be ha vi or s a nd de s t r uc t i ve be ha vi or s ( e g. de s t r oyi ng p r ope r t y) D e s pi t e t he s e pos i t i ve f i ndi ngs F C T r e s e a r c h w i t h c hi l dr e n w i t h A S D ha s not e xa m i ne d t he ge ne r a l i t y of t hi s i nt e r ve nt i on t o na t ur a l s e t t i ngs F or e xa m pl e m a n y of t he r e s e a r c he r s of t he s t udi e s r e vi e w e d ha ve pe r f or m e d F C T i nt e r ve nt i ons onl y i n c l i ni c a l s e t t i ngs w i t hout s uf f i c i e nt l y a na l yz i ng

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16 ge ne r a l i z a t i on t o ot he r pe opl e a nd s e t t i ngs a nd p r e dom i na nt l y l i m i t i ng c ha nge a ge nt s t o c l i ni c i a ns a nd r e s e a r c he r s I n c ont r a s t ot he r be ha v i or a l i nt e r ve nt i on s t r a t e gi e s f oc us i ng on c om m uni c a t i on s ki l l s s uc h a s m i l i e u t he r a py, ha ve e xpa nde d r e s e a r c h i nt o t he na t ur a l e nvi r onm e nt ( e g. hom e a nd s c hool ) w i t h na t ur a l c ha nge a ge nt s ( e g. pa r e nt s a nd t e a c he r s ) M i l i e u T h e r ap y M i l i e u t he r a py i s a not he r be ha vi or a l i nt e r ve nt i on w i t h a pl e t hor a of s t udi e s de m ons t r a t i ng t ha t i t ha s be e n e f f e c t i ve l y us e d w i t h c hi l dr e n w i t h de ve l opm e nt a l di s a bi l i t i e s a nd/ or c om m uni c a t i on di s or de r s ( e g H e s t e r 1995 ; Y ode r & W a r r e n, 2002) a nd c hi l dr e n w i t h A S D ( e g. H a nc oc k & K a i s e r 2002 ) I n c ont r a s t t o F C T m i l i e u t he r a py f oc us e s on t e a c hi ng c hi l dr e n ne w c om m uni c a t i on s ki l l s a nd be ha vi or s w i t hi n t h e i r na t ur a l e nvi r onm e nt s ( K a i s e r 1993) T he na t ur a l e nvi r onm e nt m a y r e f e r t o a ny s e t t i ng, i nc l u di n g t he hom e s c hool o r a n i nc l us i ve e duc a t i ona l s e t t i ng w he r e t he c hi l d t ypi c a l l y w oul d s pe nd t i m e ( S c hw a r t z 2003 ) R e s e a r c he r s ha ve us e d f our ba s i c m i l i e u pr oc e dur e s [ i e ( a ) m ode l i ng de s i r e d r e s pons e s a nd c or r e c t i ng r e s pons e s ( b) pr ov i di ng a m a nd a n d t he n m ode l i ng/ c or r e c t i ng i f ne e de d, ( c ) t i m e de l a y, a nd ( d ) i nc i de nt a l t e a c hi ng] i n t he na t u r a l e n vi r onm e nt t o de m ons t r a t e s i gni f i c a nt i nc r e a s e s i n c hi l dr e n s c om m uni c a t i on a nd l a ngua ge s ki l l s ( H a nc oc k & K a i s e r 2002) R e s e a r c he r s ha ve a c c om pl i s he d t hi s by f oc us i ng r e s e a r c h w i t h pa r e nt s a nd t e a c he r s a s na t ur a l c ha nge a ge nt s w i t hi n t he na t ur a l e nvi r onm e nt T e a c hi ng c om m uni c a t i on s ki l l s i n na t u r a l e nvi r onm e nt s ha s m a ny a dva nt a ge s i nc l udi ng: ( a ) i nc r e a s e s i n voc a bul a r y ( Y ode r e t a l 1995) ( b) ge ne r a l i z a t i o n of c om m un i c a t i on s ki l l s ( H a nc o c k & K a i s e r 2002 ) ( c ) m a i nt e na nc e of c om m uni c a t i on s ki l l s ( S pr a dl i n & S i e ge l 1982) a nd ( d) unpr om pt e d us e of l a ngua ge ( Y ode r & W a r r e n, 2002 ) M i l i e u t he r a py i s a be ha vi or a l p r a c t i c e t ha t ha s be e n de m ons t r a t e d t o s uc c e s s f ul l y i nc r e a s e c om m uni c a t i on s ki l l s i n c hi l dr e n w i t h A S D I n c ont r a s t t o t he F C T

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17 l i t e r a t ur e r e vi e w e d, t he f oc us of m i l i e u t he r a py ha s be e n on t e a c hi ng c hi l d r e n ne w s ki l l s a nd be ha vi or s w i t hi n t he i r na t ur a l e nvi r onm e nt s ( e g. hom e a nd s c hool ) S u m m ar y o f F C T an d M i l i e u T h e r ap y P r oc e d u r e s A l t hough bot h F C T a nd m i l i e u t he r a py r e s e a r c h ha ve be e n de m ons t r a t e d t o be e f f e c t i ve i n t e a c hi ng c om m uni c a t i on s ki l l s t o c hi l dr e n w i t h A S D t he s e t e c hni que s ha ve f oc us e d on di f f e r e nt a s pe c t s of t he de ve l opm e nt of c om m uni c a t i on s ki l l s T he m a j o r i t y o f t he F C T r e s e a r c h ha s f oc us e d on r e pl a c i ng a be r r a nt be ha vi or w i t h a s i ngl e c om m uni c a t i on r e s pons e I n c ont r a s t m i l i e u t he r a py r e s e a r c h ha s f oc us e d on i nc r e a s i ng c om m uni c a t i on w i t hi n t he c hi l d s na t ur a l s e t t i ng a nd ha s not f oc us e d on r e pl a c i ng a be r r a nt b e ha vi or s w i t h f unc t i ona l c om m uni c a t i on s ki l l s S t at e m e n t of t h e P r ob l e m A s pr e vi ous l y m e nt i one d, i nd i vi dua l s w i t h A S D t y pi c a l l y ha ve di f f i c ul t y s pe a ki ng a nd c om m uni c a t i ng, w i t h 40% of t he s e i ndi vi dua l s ne v e r de ve l opi ng s pe e c h ( S i ga f oos A r t hu r K e l l y, & B ut t e r f i e l d 2006) T he y a l s o ha ve s oc i a l de f i c i t s w hi c h a r e e xa c e r ba t e d by t he i r c om m uni c a t i on pr obl e m s C onc ur r e nt w i t h t he s e de f i c i t s i ndi vi dua l s w i t h A S D e xhi bi t hi gh l e ve l s of a be r r a nt be ha vi o r s s uc h a s s c r e a m i ng, hi t t i ng, a nd b i t i ng ( S i ga f oos 2000) c r e a t i ng s ubs t a nt i a l obs t a c l e s f or pa r e nt s a nd ot he r i nd i vi du a l s c ha r ge d w i t h t he i r e duc a t i on a nd w e l l be i ng ( D ur a nd & M e r ge s 2001) I n a ddi t i on t o t he s e de f i c i t s c hi l dr e n w i t h A S D ha ve di f f i c ul t y ge ne r a l i z i ng s ki l l s t o na t ur a l s e t t i ngs T he y o f t e n l e a r n s ki l l s i n i s ol a t i on a nd do not a ppl y t he s ki l l s t o ot he r s e t t i ngs s uc h a s t he i r hom e s ( S i ga f o os e t a l 2006) S uc h i s s ue s w i t h c om m uni c a t i on de f i c i t s a be r r a nt be ha vi or s a nd ge ne r a l i z a t i on di f f i c ul t i e s c om bi ne d w i t h t he i nc r e a s e i n t he pr e va l e nc e of A S D de m a nds t ha t t h e f i e l d r e s pond a nd pr ovi de e f f e c t i ve p r a c t i c e s t o m e e t t he s e i ndi vi dua l s ne e ds a t hom e a nd i n e d uc a t i ona l s e t t i ngs

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18 S i gn i f i c an c e o f t h e S t u d y T he c ur r e nt s t udy e xa m i ne d t he e f f e c t i ve ne s s of a n i nt e r ve nt i on t ha t c om bi ne s F C T a nd m i l i e u t he r a py f or i nt e r ve ni ng w i t h c hi l dr e n s c om m uni c a t i on a nd a be r r a nt be ha vi or s i n a na t ur a l s e t t i ng ( i e t he i r hom e ) A ddi t i ona l l y, t hi s s t udy e xa m i ne d ge ne r a l i z a t i on of ne w l y a c qui r e d s ki l l s t o c l a s s r oom s e t t i ngs F i na l l y, t hi s s t udy e xa m i ne d t he m a i nt e na nc e of ne w l y a c qui r e d s ki l l s i n hom e s e t t i ngs T he s e a s pe c t s of t he r e s e a r c h pr oj e c t a r e pa r t i c ul a r l y i m por t a nt ; gi ve n t he di f f i c ul t y c hi l d r e n w i t h A S D ha ve ge ne r a l i z i ng s ki l l s a c r os s i ndi vi dua l s a nd s e t t i ngs P u r p os e of t h e S t u d y T he ove r a l l goa l of t hi s s t udy w a s t o e xa m i ne a m o di f i e d m i l i e u t he r a py i nt e r ve nt i on ( i e c om bi ne d F C T a nd m i l i e u t he r a py) t ow a r d t e a c hi n g young i ndi vi dua l s w i t h A S D f unc t i ona l c om m uni c a t i on s ki l l s T he f ol l ow i ng r e s e a r c h que s t i ons w e r e a ddr e s s e d: ( a ) D oe s t he i m pl e m e nt a t i on o f a m odi f i e d m i l i e u t he r a py i nt e r ve nt i on i nc r e a s e c om m uni c a t i on s ki l l s a nd de c r e a s e de pe nde nc e on pr om pt s i n c hi l d r e n w i t h A S D i n a na t ur a l s e t t i ng? ( b) D o ne w l y a c qui r e d c om m un i c a t i on s ki l l s i n c hi l dr e n w i t h A S D ge ne r a l i z e t o a n unt r a i ne d s e t t i ng ? ( c ) D o ne w l y a c qui r e d c om m uni c a t i on s ki l l s i n c hi l dr e n w i t h A S D m a i nt a i n ove r t i m e ? ( d) D oe s t he i m pl e m e nt a t i on of a m od i f i e d m i l i e u t he r a py i nt e r ve nt i on r e s ul t i n a de c r e a s e of a be r r a nt be ha vi or s i n c hi l dr e n w i t h A S D i n a na t u r a l s e t t i ng?

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19 C H A P T E R 2 L I T E R A T U R E R E V I E W T he pur pos e of t hi s c ha pt e r i s t o p r ovi de a n i nt e gr a t i ve l i t e r a t ur e r e vi e w of t he s t udi e s e xa m i ni ng t he e f f e c t i ve ne s s of us i ng f unc t i ona l c o m m uni c a t i on t r a i ni ng ( F C T ) o r m i l i e u t he r a py w i t h young c hi l d r e n w i t h A S D F i r s t a n i nt r oduc t i on of a ut i s m s pe c t r um di s or de r ( A S D ) i s gi ve n w i t h a de s c r i pt i on o f t he hi s t or y, i nc i de nc e a nd c ha r a c t e r i s t i c s a s s oc i a t e d w i t h A S D S e c ond, a de s c r i pt i on of a ppl i e d be ha vi or a na l ys i s ( A B A ) a c onc e pt ua l a ppr oa c h us e d t o a ddr e s s be ha vi o r a l s ki l l s de f i c i t s a nd e xc e s s e s of c hi l dr e n w i t h A S D i s p r ovi de d. T hi r d a de s c r i pt i on of t w o i nt e r ve nt i on p r a c t i c e s ba s e d on A B A pr i nc i pl e s [ i e f unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) a nd m i l i e u t he r a py] us e d t o a ddr e s s a be r r a nt be ha vi or s a nd c om m uni c a t i ve be ha vi or s r e s pe c t i ve l y, i s pr ovi de d. F i na l l y t he e m pi r i c a l l i t e r a t ur e i n r e f e r e nc e t o f unc t i ona l c om m uni c a t i on t r a i ni ng a nd m i l i e u t he r a py w i t h c hi l dr e n w i t h A S D i s r e vi e w e d. E m pha s i s i s pl a c e d on e va l ua t i ng t he r e s e a r c h i n r e ga r d t o t he e nvi r onm e nt s a nd c ha nge a ge nt s i nvol ve d i n t he r e s e a r c h a nd t he e f f e c t i ve ne s s of F C T a nd m i l i e u t he r a py w i t h c hi l dr e n w ho ha ve a di a gnos i s of A S D A na l ys e s of t he c ha r a c t e r i s t i c s of t he pa r t i c i pa nt s e nvi r onm e nt r e s e a r c h de s i gns t a r ge t be ha vi or s i nt e r ve nt i ons m a j or f i ndi ngs r e l i a bi l i t y a nd t r e a t m e nt f i de l i t y a c r os s s t udi e s a r e pr ovi de d. I n a ddi t i on, a c r i t i que of t he f i ndi ngs t o a ddr e s s s t r e ngt hs l i m i t a t i ons a nd i m pl i c a t i ons f or f ut ur e r e s e a r c he r s i s pr ovi de d. O ve r vi e w of A u t i s m S p e c t r u m D i s or d e r s A S D i s a de ve l opm e nt a l di s or de r a f f e c t i ng t he l i ve s of t hous a nds of c hi l d r e n. A S D w a s f i r s t de s c r i be d by L e o K a nne r i n 1943 t hr ough t he c a s e hi s t or i e s of 11 c hi l dr e n K a nne r obs e r ve d t ha t t he c ha r a c t e r i s t i c s of t he s e c hi l dr e n di f f e r e d s i gni f i c a nt l y f r om ot he r c hi l dr e n; t he r e f o r e he s ugge s t e d a s e pa r a t e di a gnos i s e nt i t y w a s ne e de d t o de s c r i be t he i r uni que c ha r a c t e r i s t i c s S i nc e K a nne r s f i r s t de s c r i pt i on of a ut i s m t he di s or de r h a s e vol ve d i nt o a s pe c t r um d i s or de r ( i e

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20 A S D ) w i t h t he num be r a nd pe r c e nt a ge of di a gn os e s i nc r e a s i ng e a c h ye a r ( C e nt e r f o r D i s e a s e C ont r ol a nd P r e ve nt i on, 2005 ) A c c or di ng t o t he C e nt e r s f or D i s e a s e C ont r ol a nd P r e ve nt i on ( C D C ) t w o t o s i x pe r 1, 000 c hi l dr e n ( a ge s 3 t o 10 ye a r s o f a ge ) ha ve A S D ( C D C 2005) W he r e a s t he A ut i s m S oc i e t y o f A m e r i c a ( A ut i s m S oc i e t y of A m e r i c a 2006 ) s ugge s t s i t i s m or e p r e va l e nt a nd r e por t s t ha t 1 i n 150 c hi l dr e n bo r n t oda y w i l l e ve nt ua l l y be di a gnos e d w i t h A S D T he A ut i s m S oc i e t y of A m e r i c a ( A S A ) a l s o not e s t ha t 1 5 m i l l i on A m e r i c a ns i nc l udi ng c hi l dr e n a nd a dul t s ha ve A S D w hi l e a not he r 15 m i l l i on A m e r i c a ns ( e g f a m i l y e duc a t or s a nd he a l t h c a r e w o r ke r s ) a r e a f f e c t e d by t hi s di s or de r I n s um t he i nc i de nc e a nd pr e va l e nc e r a t e s of A S D a ppe a r s t o be gr ow i ng a t a l a r m i ng r a t e s T he e s s e nt i a l f e a t ur e s of A S D i n c l ude s i gni f i c a nt i m pa i r m e nt s i n s oc i a l i nt e r a c t i on a nd c om m uni c a t i on s ki l l s a nd a hi ghl y r e s t r i c t e d a r e a o f a c t i vi t i e s a nd i nt e r e s t s ( A m e r i c a n P s yc hi a t r i c A s s oc i a t i on, 2000) S oc i a l i nt e r a c t i on pr obl e m s m a y be e xhi bi t e d t hr ough a n i m pa i r m e nt i n nonve r ba l be ha vi or s ( e g e ye t o e y e ga z e body pos t ur e s f a c i a l e xpr e s s i ons ) a nd/ or f a i l u r e t o c r e a t e de ve l opm e nt a l l y a ppr opr i a t e pe e r r e l a t i ons hi ps F or e xa m pl e a c hi l d w i t h A S D i s l e s s l i ke l y t o i ni t i a t e pe e r r e l a t e d s oc i a l i nt e r a c t i ons or r e s pond t o s oc i a l b i ds f r om pe e r s I n a ddi t i on t o s oc i a l i nt e r a c t i on pr obl e m s c hi l dr e n w i t h A S D ha ve c om m uni c a t i on s ki l l de f i c i t s O f t e n, t he s e de f i c i t s i nc l ude a de l a y i n or a bs e nc e of s poke n l a ngua ge ( e g. 40 % ne ve r obt a i n s pe e c h) C hi l d r e n t ha t do de ve l op s pe e c h m a y h a ve di f f i c ul t y i ni t i a t i ng or s us t a i ni ng c onve r s a t i ons w i t h ot he r s F ur t he r t he s e c hi l dr e n m a y de ve l op s t e r e ot ype d a nd r e pe t i t i ve us e of l a ngua ge or i di os ync r a t i c l a ngua ge ( e g. r e pe a t i ng nonf unc t i ona l phr a s e s ove r a nd ove r ) C oi nc i di ng w i t h i m pa i r m e nt s i n s oc i a l i nt e r a c t i on a nd c om m uni c a t i on, c hi l d r e n w i t h A S D m a y

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21 e xhi bi t r e s t r i c t e d, r e pe t i t i ve a nd s t e r e ot ype d pa t t e r ns of be ha vi or i nt e r e s t s a nd a c t i vi t i e s T he y of t e n de m ons t r a t e a p r e oc c upa t i on w i t h i di os ync r a t i c i nt e r e s t s t o a l e ve l c ons i de r e d a bnor m a l i n i nt e ns i t y a nd f oc us ( A m e r i c a n P s yc hi a t r i c A s s oc i a t i on, 2000) F o r e xa m pl e a c hi l d m a y know e ve r y f a c t a bout t he m a ke s a nd m ode l s of c a r s a nd s us t a i n c onve r s a t i ons r e l a t e d t o t hi s t opi c f or hour s but r e m a i n una bl e t o hol d c onve r s a t i ons a bout a ny ot he r t opi c T he y a l s o m a y e nga ge i n i nf l e xi bl e non f unc t i ona l r i t ua l s a nd r ou t i ne s s uc h a s t ur ni ng a doo r knob ove r a nd ove r i n e a c h di r e c t i on be f or e l e a vi ng t he i r hom e A l t hough t he s e r i t ua l s a nd r out i ne s i ni t i a l l y m a y a ppe a r t o de c r e a s e a nxi e t y, t he r out i ne s t ypi c a l l y i m pe de a n i ndi vi dua l s a bi l i t y t o s oc i a l i z e a nd f unc t i on pr ope r l y w i t hi n s oc i e t y ( H e f l i n & A l a i m o, 2006) F ur t he r m a ny c hi l d r e n w i t h A S D ha ve s t e r e ot ype d a nd r e pe t i t i ve m ot o r m a nne r i s m s ( e g. ha nd f l a ppi ng ) F o r e xa m pl e a c hi l d m a y e nga g e i n r e pe a t e d ha nd f l a ppi ng, f or no a ppa r e nt pur pos e C onc ur r e nt w i t h t he a f or e m e nt i one d f e a t ur e s m a ny c hi l d r e n w i t h A S D e xhi bi t hi gh l e v e l s of a be r r a nt be ha vi or s t ow a r d o t he r s or t he m s e l ve s t ha t i nt e r f e r e w i t h t he i r l e a r ni ng, s uc h a s s c r e a m i ng, hi t t i ng, a nd bi t i ng ( S i ga f oos 2000) F or i ns t a nc e s om e c hi l d r e n m a y r e pe a t e dl y bi t e t he m s e l ve s or t he y m a y a ggr e s s t ow a r d ot he r c hi l dr e n o r a dul t s ( e g s c r a t c h ot he r s ) A be r r a nt be ha vi or s s uc h a s bi t i ng c r e a t e s ubs t a nt i a l obs t a c l e s f or i ndi vi dua l s r e s pons i bl e w i t h t he i r e du c a t i on a nd c a r e ( D u r a nd & M e r ge s 2001) M a ny pa r e nt s e xpe r i e nc e s t r e s s w he n t he i r c hi l dr e n e nga ge i n a ggr e s s i on or t a nt r um s U nl i ke ot he r pa r e nt s pa r e nt s of c hi l d r e n w i t h A S D m a y h a ve di f f i c ul t y de t e r m i ni ng t he r e a s on f o r t he t a nt r um be c a us e of t he c hi l d s de f i c i t s i n c om m uni c a t i on. I t i s d i f f i c ul t f o r a n i ndi vi dua l w ho doe s not ha ve a ny c om m uni c a t i on s ki l l s t o e xpl a i n w ha t m a y be t he c a us e of t he t a nt r um T he s e c ha r a c t e r i s t i c s ( i e s oc i a l i nt e r a c t i on i m pa i r m e nt s c om m uni c a t i on de f i c i t s r e pe t i t i ve be ha vi or s a nd a be r r a nt be ha vi or s ) a nd t he i r ne ga t i ve e f f e c t s on t he c hi l dr e n a nd f a m i l i e s c om bi ne d w i t h t he i nc r e a s e i n t he pr e va l e nc e of A S D p r e s e nt a c r i t i c a l de m a nd f o r t he f i e l d o f s pe c i a l e duc a t i on t o

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22 r e s pond a nd pr ovi de e f f e c t i ve pr a c t i c e s t o m e e t t he s e c hi l dr e n s ne e ds a t hom e a nd i n e duc a t i ona l s e t t i ngs O ne a r e a of i m por t a nt r e s e a r c h i s i nve s t i ga t i ng m e t hods a i m e d a t i nc r e a s i ng c om m uni c a t i on s ki l l s de c r e a s i ng a be r r a nt be ha vi o r a nd de t e r m i ni ng t he r e l a t i on be t w e e n c om m uni c a t i on a bi l i t i e s a nd a be r r a nt be ha vi or s A num be r of r e s e a r c he r s ha ve r e s ponde d by e xa m i ni ng t he r e l a t i on be t w e e n a be r r a nt be ha vi o r s a nd c om m uni c a t i on a bi l i t i e s of c hi l d r e n w i t h A S D ( e g s e e B ot t F a r m e r & R hode 1997; C hung, J e nne r C ha m be r l a i n, & C or be t t 1995; S i ga f oos 2000; S c hr oe de r S c hr oe de r S m i t h, & D a l l dor f 1978) C hung e t a l f ound a n i nve r s e r e l a t i on be t w e e n c om m uni c a t i on a bi l i t y a nd t he di s pl a y of a be r r a nt be ha vi or s s uc h a s s e l f i nj ur y a nd a ggr e s s i on i n c hi l dr e n w i t h A S D S i m i l a r l y B ot t e t a l ( 199 7 ) de t e r m i ne d t ha t i ndi vi dua l s w i t h m or e de ve l ope d s pe e c h s ki l l s e xhi bi t e d a l ow e r r a t e o f a be r r a nt be ha vi or s t ha n t hos e w i t h i m pa i r e d s pe e c h s ki l l s F u r t he r S i ga f oos hypot he s i z e d i n a m o r e r e c e nt s t udy t ha t i m pa i r e d c om m uni c a t i on de ve l opm e nt i n c hi l d r e n w i t h A S D a nd ot he r de ve l opm e nt a l di s a bi l i t i e s m a y a c t ua l l y c a us e a be r r a nt be ha vi or s H e s ugge s t e d t h a t w he n c hi l dr e n l a c k t he a ppr op r i a t e s ki l l s t o c om m uni c a t e t he y m i ght a c t ua l l y us e a be r r a nt be h a vi or s f or c om m uni c a t i on pur pos e s T o a ddr e s s bot h t he c o m m uni c a t i on a nd be ha vi o r a l ne e ds of c hi l d r e n w i t h A S D s e ve r a l r e s e a r c he r s ha ve de ve l ope d i nt e r ve nt i on pr a c t i c e s ba s e d on a f r a m e w or k of a ppl i e d be ha vi or a na l ys i s ( D ur a nd & C a r r 1987; W a c ke r e t a l 199 0) T he f r a m e w or k o f a ppl i e d be ha vi or a na l ys i s ( A B A ) i nvol ve s a na l yz i ng t he e ve nt s s ur r oundi ng be ha vi or bot h a nt e c e de nt e ve nt s ( oc c ur r i ng p r i or t o a be ha vi or ) a nd c ons e que nc e e ve nt s ( oc c ur r i ng a f t e r a be ha vi or ) a nd m a ni pul a t i ng t hos e va r i a bl e s t o p r oduc e be ha vi or c ha nge i n t he de s i r e d di r e c t i on ( B a e r W ol f & R i s l e y, 1968; 1987) A B A i s c om p r i s e d of s e ve r a l pr i nc i pl e s t w o o f w hi c h a r e pa r t i c ul a r l y not e w or t hy f or t he c u r r e nt s t udy F i r s t m os t be ha vi or s a r e l e a r ne d t hr ough a n i ndi vi dua l s

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23 i nt e r a c t i ons w i t h hi s or he r e nvi r onm e nt B e ha vi or t ypi c a l l y i s l e a r n e d vi a ope r a nt c ondi t i oni ng w hi c h i nvol ve s t he s t i m ul us r e s pons e c ons e que nc e r e l a t i ons hi p ( S ki nne r 1953) A di s c r i m i na t i ve s t i m ul us s e t s t he oc c a s i on f or be ha v i or t o oc c ur a nd s i gna l s t he a va i l a bi l i t y of a r e i nf or c e r T he c ons e que nc e t ha t f ol l ow s t he be h a v i or de t e r m i ne s t he pr oba bi l i t y of t he be ha vi or r e oc c ur r i ng i n t he p r e s e nc e of t he s a m e or a s i m i l a r s t i m ul us I f t he s ubs e que nt e ve nt f ol l ow i ng a be ha vi or ( i e c ons e que nc e ) i s a r e i nf o r c e r t he f ut ur e pr oba bi l i t y of t he be ha vi or oc c ur r i ng i nc r e a s e s ; ho w e ve r i f t he s ubs e que nt e ve nt s e r ve s a s a puni s he r t he be ha vi o r w i l l de c r e a s e T he r e f or e t he i nd i vi dua l s e nvi r onm e nt m us t be a s s e s s e d t o de t e r m i ne be ha vi or a l e f f e c t s of t he a nt e c e de nt a nd c ons e que nc e s s ur r oundi ng t he t a r g e t be ha vi or ( B a e r W ol f & R i s l e y, 1968; 1987) S e c ond, t he pr i m a r y goa l o f a ppl i e d be ha vi or a na l ys i s r e s e a r c h i s t o di s c ove r p r oc e dur e s t ha t c a n r e l i a bl y p r oduc e c l i ni c a l l y s i gni f i c a nt be h a vi or c ha nge ( B a i l e y & B ur c h, 2002) A n i m por t a nt c om pone nt of e xa m i ni ng be ha vi or c ha nge i s e va l ua t i ng not onl y t he e xpe r i m e nt a l s i gni f i c a nc e but t he s oc i a l s i gni f i c a n c e of t he c ha nge a s w e l l ( B a i l e y & B ur c h, 2002) T he de c i s i on of w ha t c ons t i t ut e s a s i gni f i c a nt be ha vi or c ha nge s houl d a l s o i nc l ude t he pa r t i c i pa nt s i nput r a t he r t ha n de c i de d by t he r e s e a r c he r a l one ( S c hw a r t z 2003 ) I t s e e m s l ogi c a l t ha t t he m or e i nvol ve d t he pa r t i c i pa nt i s i n a s pe c t s of t he i nt e r ve nt i on p r oc e s s t he gr e a t e r t he l i ke l i hood t he c ha nge i n t he be ha vi or w i l l be m e a ni ngf ul R e s e a r c he r s c oul d a c c om pl i s h t hi s by c ons ul t i ng c ons um e r s a bout i m por t a nt pr obl e m s t o r e s e a r c h, a ppr op r i a t e ne s s of t he i nt e r ve nt i ons a nd e f f e c t i ve ne s s of t he out c om e s ( S c hw a r t z 2003) T w o of t he m os t pr om i ne nt s t r a t e gi e s ba s e d on A B A t e c hni que s i n t he l i t e r a t ur e t ha t a r e a ppl i c a bl e t o c hi l dr e n w i t h A S D a nd a ddr e s s e s t he a r e a s of a be r r a nt be ha vi or a nd c om m uni c a t i on a r e : ( a ) f unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) a nd ( b) m i l i e u t he r a py. E a c h of t he s e i nt e r ve nt i ons e m pl oys di f f e r e nt a s pe c t s of A B A pr a c t i c e s A de s c r i pt i ve ove r vi e w o f e a c h i nt e r ve nt i on pr a c t i c e f ol l ow s

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24 F u n c t i on al C om m u n i c at i o n T r ai n i n g F unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) i s one A B A i nt e r ve nt i on s t r a t e gy t ha t ha s be e n us e d t o a ddr e s s bot h t he c om m uni c a t i on a nd a be r r a nt be ha vi or pr ob l e m s of c hi l d r e n w i t h A S D ( C a r r & D ur a nd, 1985; D u r a nd & M e r ge s 2001; W a c ke r e t a l 1990) D e ve l ope d i n t he m i d 1980s F C T i n vol ve s a s s e s s i ng t he f unc t i on ( i e o ut c om e c ons e que nc e ) of a be ha vi o r ( e g. a t t e nt i on, e s c a pe t a ngi bl e or s e ns or y) t hr ough a na l ogue a s s e s s m e nt m e t hodol ogy r e f e r r e d t o a s f unc t i ona l a na l ys i s a nd t he n r e pl a c i ng t he a be r r a nt be ha vi or by t e a c hi ng a c om m uni c a t i ve r e s pons e t ha t s e r ve s t he s a m e f unc t i on ( D ur a nd & C a r r 1987 ) T hr e e s t e ps t ypi c a l l y a r e f ol l ow e d i n t he F C T pr oc e s s F i r s t a n a s s e s s m e nt of t he f unc t i on of a be ha vi or ( e g. a t t e nt i on e s c a pe t a ngi bl e or s e ns or y) t hr ough a f unc t i ona l a na l ys i s ( F A ) i s c onduc t e d. N e xt a c om m uni c a t i ve r e s pons e t ha t m a t c he s t he f unc t i on i s i de nt i f i e d F i na l l y, a n i nt e r ve nt i on pl a n t ha t r e pl a c e s t he a be r r a nt be ha vi o r w i t h a c om m un i c a t i ve r e s pons e t ha t s e r ve s t he s a m e f unc t i on i s i m pl e m e nt e d. F u n c t i on al A n al ys i s an d F u n c t i on al B e h avi or A s s e s s m e n t : S t e p O n e T o i de nt i f y t he f unc t i on, r e s e a r c he r s t ypi c a l l y c om pl e t e a F A by m a ni pul a t i ng c ons e que nc e s s uc h a s e s c a pe f r om de m a nds obt a i ni ng a t t e nt i on, a nd or obt a i ni ng pr e f e r r e d t a ngi bl e i t e m s c ont i nge nt on t he a be r r a nt be ha vi or t o c onc l us i ve l y de t e r m i ne t he f unc t i on of t he be ha vi or O ne i m por t a nt c om pone nt of F A i s t ha t t he r e s ul t s of e a c h of t he s e pr obe c ondi t i ons m us t be c om pa r e d t o t he ot he r c ondi t i ons a s w e l l a s a c ont r ol c ondi t i on t o de t e r m i ne t he f unc t i on of t he be ha vi or ( i e t a ngi bl e f r e e pl a y, a l one or e s c a pe ) F or e xa m pl e i f t he a be r r a nt be ha vi or i nc r e a s e s m or e dur i ng t he a t t e nt i on c ondi t i on i n c o m pa r i s on t o t he o t he r c ondi t i ons t he r e s e a r c he r c onc l ude s t he be ha vi or i s m a i nt a i ne d by a t t e nt i on. T he c ondi t i on i n w hi c h t he a be r r a nt be ha vi or oc c ur s a t t he hi ghe s t s t a bl e r a t e ( i e e s c a pe a t t e nt i on, t a ngi bl e ) de t e r m i ne s t he

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25 f unc t i on of t he be ha vi or P r i or t o c onduc t i ng a F A s om e r e s e a r c he r s us e de s c r i pt i ve f unc t i ona l be ha vi or a l a s s e s s m e nt s t o hypot he s i z e a f unc t i on a nd he l p t o i nf or m t he F A pr oc e s s ( M a nc i l 2006) T he s e f unc t i ona l be ha vi or a l a s s e s s m e nt c o m pone nt s m a y i nc l ude i ndi r e c t a s s e s s m e nt s a nd di r e c t obs e r va t i ons ( B r a dy & H a l l e 1997) I n d i r e c t as s e s s m e n t s I nd i r e c t a s s e s s m e nt i ns t r um e nt s c a n be c a t e gor i z e d i nt o t hr e e f or m a t s : ( a ) c he c kl i s t s ( b) que s t i onna i r e s a nd ( c ) i nt e r vi e w s C he c kl i s t s t ypi c a l l y c ont a i n i t e m s r e l a t e d t o f unc t i ons of a be r r a nt be ha vi or t ha t r e qui r e s a n a dul t ( e g pa r e nt t e a c he r ) f a m i l i a r w i t h t he c hi l d s be ha vi or t o r e s pond t o on a L i ke r t s c a l e T he pa r e nt a nd/ o r t e a c he r m us t t he n s c or e t he i ns t r um e nt l e a di ng t o a hypot he s i s of t he f unc t i on of t he a be r r a nt be ha vi or F o r e xa m pl e t he M ot i va t i on A s s e s s m e nt S c a l e ( M A S ) ( D ur a nd & C r i m m ons 1996 ) i s a c he c kl i s t c om m onl y c om pl e t e d by t e a c he r s a nd ot he r pr of e s s i ona l s F or t hi s c he c kl i s t a L i ke r t s c a l e of 0 t o 6 i s us e d, w i t h 0 be i ng ne ve r a nd 6 be i ng a l w a ys T he r e a r e 16 que s t i ons w i t h f our que s t i ons r e l a t e d t o e a c h pos s i bl e f unc t i on ( i e s e ns or y, e s c a pe a t t e nt i on, a nd t a ngi bl e ) w hi c h a r e r a ndom l y gr oupe d. T he po i nt s a r e t ot a l e d f or e a c h f unc t i on a nd t he one w i t h t he gr e a t e r num be r of poi nt s a nd hi ghe s t r e l a t i ve r a nki ng i s t he hypo t he s i z e d f unc t i on. M a ny que s t i onna i r e s c ont a i n s i m i l a r c ont e nt bu t u s ua l l y c ons i s t of ope n e nde d que s t i ons F or e xa m pl e a que s t i on m a y be pr e s e nt e d a s W he n doe s t he c hi l d e nga ge i n t he be ha vi or ? T he r e t he n m a y be s om e a ddi t i ona l s t i pul a t e d f ol l o w up que s t i ons a bout t he c ont e xt i n w hi c h t he a be r r a nt be ha vi or oc c ur s ( e g D oe s t he c hi l d e nga ge i n t he be ha vi or dur i ng a n a c a de m i c t a s k or m os t l y dur i ng t r a ns i t i ons ? ) I n c ont r a s t i nt e r vi e w s ge ne r a l l y i nvol ve i ni t i a l que s t i ons t ha t a r e va gue a nd s e t t he oc c a s i on f or t he i nt e r vi e w e r t o pr obe f or m or e de t a i l a nd gui de t he pr oc e s s w i t h s pe c i f i c f o l l ow up que s t i ons F o r e xa m pl e t he i n t e r vi e w e r m a y a s k, H ow of t e n doe s t he be ha vi or oc c ur ? I f

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26 t he r e s ponde nt a ns w e r s T he c hi l d s c r e a m s a l l m o r ni ng. t he i nt e r vi e w e r m a y f ol l ow up by a s ki ng D oe s he s c r e a m of t e n or f or e xt e nde d pe r i ods ? T he i nt e r vi e w pr ovi de s m o r e r oom f or a de t a i l e d a s s e s s m e nt but a l s o r e qui r e s bot h a ddi t i o na l t i m e a nd s ki l l l e ve l of t he i nt e r vi e w e r A f t e r t he i nt e r vi e w i s c om pl e t e t he i nt e r vi e w e r c o m pi l e s t he pr ovi de d a ns w e r s a nd hypot he s i z e s a f unc t i on. D i r e c t ob s e r vat i on s U nl i ke i ndi r e c t a s s e s s m e nt s t ha t a r e de s i gne d t o ga i n i nf o r m a t i on t hr ough a t h i r d pa r t y ( e g. t e a c he r pa r e nt ) di r e c t obs e r va t i ons c ons i s t of di r e c t l y obs e r vi ng t he be ha vi or a l a nd c om m u ni c a t i ve be ha vi or s o f t he c hi l dr e n i n va r i ous s e t t i ngs s uc h a s t he c l i ni c c l a s s r oom a nd pl a ygr ound. F or e xa m pl e a r e s e a r c he r m a y obs e r ve a c hi l d a nd r e c or d w ha t oc c ur s be f or e ( a nt e c e de nt ) a nd a f t e r ( c ons e que nc e ) t he a be r r a nt be ha vi or s B ot h i ndi r e c t a s s e s s m e nt s ( e g. c he c kl i s t s que s t i onna i r e s i nt e r v i e w s ) a nd di r e c t obs e r va t i ons a i d i n de ve l opi ng a hypot he s i s of t he be ha vi or s f unc t i on ( e g t he i nt e r v i e w a nd di r e c t obs e r va t i on m a y s ugge s t t ha t a t t e nt i on i s t he f unc t i on be c a us e e ve r y t i m e t he a be r r a nt be ha vi or w a s obs e r ve d, t he t e a c he r o r pa r e nt gi ve s t he c hi l d a t t e nt i on) I d e n t i f yi n g a C om m u n i c at i ve R e s p on s e : S t e p T w o A f t e r de t e r m i ni ng t he be ha vi or a l f unc t i on t he ne xt s t e p i n t he F C T p r oc e s s i nvol ve s i de nt i f yi ng a c om m un i c a t i ve r e s pons e t ha t m a t c he s t he i de nt i f i e d f unc t i on o f t he a be r r a nt be ha vi or T hi s r e pl a c e m e nt c om m uni c a t i ve r e s pons e m a y be i n t he f or m f r om one of t he f ol l ow i ng c a t e gor i e s : ve r ba l l a ngua ge pi c t u r e c om m uni c a t i on, ge s t ur e s o r a s s i s t i ve t e c hnol ogy de vi c e s ( B r a dy & H a l l e 1997) T he s e l e c t i on of t hi s r e s pons e i s ba s e d on f our c r i t e r i a ( D unl a p & D uda 2005; H or ne r & D a y, 1991 ) F i r s t c ha ng e a ge nt s s houl d c ons i de r t he c hi l d s c a pa bi l i t y of c om pl e t i ng t he r e s pons e F or e xa m pl e i f t he c hi l d l a c ks t he ve r ba l a bi l i t i e s t o r e que s t a de s i r e d t a ngi bl e i t e m t he r e s e a r c he r m a y c hoos e pi c t ur e c om m uni c a t i on o r a ge s t ur a l r e s pons e t o

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27 t e a c h t he c hi l d t o us e i n r e pl a c e m e nt o f t he a be r r a n t be ha vi or S e c ond r e s e a r c he r s t e a c he r s a nd pa r e nt s s houl d c ons i de r t he e a s e of t e a c hi ng t he r e s pons e I f a c hi l d i s non ve r ba l i t m a y be di f f i c ul t a nd t i m e c ons um i ng t o t e a c h a ve r ba l r e s p ons e ; t hus a not he r r e s pons e s uc h a s pi c t ur e c om m uni c a t i on or ge s t ur e w oul d be m o r e e f f i c i e nt T hi r d r e s e a r c he r s t e a c he r s a nd pa r e nt s s houl d c ons i de r w he t he r or not ot he r s a r e a bl e t o u nde r s t a nd a nd a c know l e dge t he r e s pons e I f no i ndi vi dua l i n t he c hi l d s l i f e know s s i gn l a ngua ge t he r e s e a r c he r s houl d c hoos e a r e s pons e pe opl e c oul d e a s i l y unde r s t a nd a nd a c know l e dge s uc h a s a pi c t ur e o r a n a s s i s t i ve t e c hnol ogy de vi c e F i na l l y r e s e a r c he r s t e a c he r s a nd pa r e nt s s houl d f ur t he r c ons i de r how e f f i c i e nt a nd e f f e c t i ve t he r e s pons e s e r ve s i t s f unc t i on i n t he c o m m uni t y a t l a r ge F or e xa m pl e i f ot he r i ndi vi dua l s i n t he c hi l d s e nvi r onm e nt ( e g s t or e ) a r e una bl e t o unde r s t a nd t he r e s pons e a nd/ or t he c hi l d ha s di f f i c ul t y c om pl e t i ng t he c om m uni c a t i ve r e s pons e t he r e s pons e m a y not ne c e s s a r i l y s e r ve i t s f unc t i on D e ve l op m e n t of T r e at m e n t P l a n : S t e p T h r e e A f t e r t he f unc t i ona l c om m uni c a t i on r e s pons e i s s e l e c t e d, a n i nt e r ve nt i on pl a n i s de s i gne d t o t e a c h t he t a r ge t c hi l d t he r e s pons e ( L a l l i C a s e y, & K a t e s 1995 ) T ypi c a l l y, di s c r e t e t r i a l pr oc e dur e s ha ve be e n us e d t o t e a c h t he t a r ge t c hi l d t he c om m uni c a t i ve r e pl a c e m e nt r e s pons e D i s c r e t e t r i a l pr oc e dur e s i nvol ve r e m ovi ng t he t a r g e t c hi l d f r om t he na t ur a l r out i ne a nd pr ovi di ng di r e c t a nd r e pe a t e d t r i a l s ove r a nd ove r r e qui r i ng t he c hi l d t o r e s pond t o t he r e s e a r c he r s m a nd ( i e r e que s t ) w i t h t he t r a i ne d c om m uni c a t i ve r e s pons e unt i l m a s t e r y c r i t e r i on i s m e t I n t hi s r e s e a r c h l i t e r a t ur e t hi s c r i t e r i on t yp i c a l l y i nvol ve s t he c hi l d p r ovi di ng a c or r e c t r e s pons e 10 c ons e c ut i ve t i m e s F or e xa m pl e a c hi l d m a y be t a ught t o s a y, he l p or t o pe r f or m a ge s t ur e t ha t r e p r e s e nt s t he w or d, he l p t o r e pl a c e s c r e a m i ng a s t he m e t hod f or ob t a i n i ng a t t e nt i on A ddi t i ona l l y a c hi l d m a y be t a ught t o h a nd a pi c t ur e o f a de s i r e d t a ngi bl e i t e m t o

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28 a dul t s t o r e pl a c e a be r r a nt be ha vi or s s uc h a s hi t t i ng a not he r i ndi vi dua l t o ga i n t he t a ngi b l e i t e m T he f i na l c om pone nt i n F C T i nvol ve s pl a c i ng t he a be r r a nt be ha vi or on e xt i nc t i on ( i e w i t hhol di ng r e i nf o r c e m e nt f o r t he be ha vi or ) a nd pr om pt i ng a nd r e i nf or c i ng t he c hi l d s us e o f t he f unc t i ona l c om m uni c a t i ve r e s pons e t ha t r e pl a c e s t he a be r r a nt be ha vi or ( L a l l i e t a l 1995) F or e xa m pl e i f t he t a r ge t c hi l d e n ga ge s i n a t a nt r um t o obt a i n a de s i r e d t a ngi bl e i t e m t he a dul t i gnor e s t he t a nt r um p r om pt s t he c hi l d t o a s k f or t h e t a ngi bl e i t e m us i ng t he f unc t i ona l c om m uni c a t i ve r e s pons e a nd pr ovi de s t he c hi l d a c c e s s t o t he t a ngi bl e i t e m f ol l ow i ng t he a ppr opr i a t e c om m uni c a t i ve r e s pons e A num be r o f r e s e a r c he r s ha ve de m ons t r a t e d t ha t t he F C T t r e a t m e nt pr oc e s s s uc c e s s f ul l y pr oduc e s a de c r e a s e i n a be r r a nt be ha vi or s w hi l e i nc r e a s i ng a ppr opr i a t e f unc t i ona l c om m uni c a t i on s ki l l s ( e g. s e e C a r r & D ur a nd 1985; D ur a nd & M e r ge s 2001; W a c ke r e t a l 1990) I n s um F C T i s one A B A i nt e r ve nt i on pr a c t i c e t ha t ha s be e n de m ons t r a t e d t o e f f e c t i ve l y i nc r e a s e f unc t i ona l c om m uni c a t i on s ki l l s i n c hi l dr e n w i t h A S D a nd r e duc e a be r r a nt be ha vi or s R e s e a r c he r s ha ve de m ons t r a t e d F C T i s e f f e c t i ve w i t h va r i ous f unc t i ons a nd t opogr a phi e s of a be r r a nt be ha vi or A l t houg h F C T ha s m a ny s t r e ng t hs i t i s not t he onl y a ppr oa c h us e d t o i nc r e a s e c om m uni c a t i on s ki l l s w i t h c hi l dr e n w i t h A S D I n t he ne xt s e c t i on, m i l i e u t he r a py, a not he r s uc c e s s f ul a ppr oa c h, w i l l be r e vi e w e d. M i l i e u T h e r ap y M i l i e u t he r a py i s a s e c ond s t r a t e gy w i t h a pl e t ho r a of s t udi e s de m ons t r a t i ng t ha t i t ha s be e n e f f e c t i ve l y us e d t o t e a c h c om m un i c a t i on s ki l l s t o c hi l dr e n w i t h de ve l opm e nt a l di s a bi l i t i e s a nd/ or c om m uni c a t i on di s or de r s ( e g H e s t e r 199 5; Y ode r & W a r r e n, 2002) a nd t o a l e s s e r e xt e nt c hi l dr e n w i t h A S D ( e g H a nc oc k & K a i s e r 2002; R os s & G r e e r 2003) I n m i l i e u t he r a py, t he f oc us i s t e a c hi ng c hi l dr e n ne w s ki l l s a nd be ha vi or s w i t hi n t he i r na t u r a l

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29 e nvi r onm e nt s ( K a i s e r 1993 ) T he na t u r a l e nvi r on m e nt m a y r e f e r t o a ny s e t t i ng t ha t t he c hi l d w oul d na t ur a l l y s pe nd t i m e r e ga r dl e s s of hi s or he r di s a bi l i t y, i nc l udi ng t he hom e s c hool or a n i nc l us i ve e duc a t i ona l s e t t i ng ( S c hw a r t z 2003) A s de m ons t r a t e d i n t he l i t e r a t ur e t e a c hi ng c o m m uni c a t i on s ki l l s i n na t ur a l e nvi r onm e nt s ha s m a ny a dva nt a ge s i nc l udi ng: ( a ) i nc r e a s e s i n voc a bul a r y ( Y ode r e t a l 1995 ) ( b) ge ne r a l i z a t i on ( H a nc oc k & K a i s e r 2002 ) ( c ) m a i nt e na nc e ( S pr a dl i n & S i e ge l 1982) a nd ( d ) unpr om pt e d us e of l a ngua ge ( Y ode r & W a r r e n 2002) M i l i e u t he r a py i nc l ude s t he f o l l ow i ng ba s i c pr oc e d ur e s : ( a ) p r ovi di ng a m ode l o f de s i r e d r e s pons e s a nd c or r e c t i ng c hi l d r e s pons e s ( b) pr ovi di ng a m a nd a nd t he n m ode l i ng/ c o r r e c t i ng i f ne e de d, ( c ) us i ng a t i m e de l a y, a nd ( d) e m pl oyi ng i nc i de n t a l t e a c hi ng s t r a t e gi e s ( H a nc oc k & K a i s e r 2002) O ne of t he s t r a t e gi e s us e d i n m i l i e u t he r a py t o p r om ot e c om m uni c a t i on i n na t u r a l e nvi r onm e nt s i s m ode l i ng c or r e c t r e s pons e s a nd c or r e c t i ng t he t a r ge t c hi l d s r e s pons e s T hi s i nvol ve s m ode l i ng a t a r ge t be ha vi or a nd t he n pr ov i di ng c or r e c t i on t o t he c hi l d a s ne c e s s a r y ( A l pe r t & K a i s e r 1992 ) F o r e xa m pl e w hi l e out s i de on t he pl a yg r ound, a c hi l d m a y t a p on t he a dul t s a r m a nd l ook a t t he t oy dum p t r uc k. T he a dul t ga i ns t he c hi l d s a t t e nt i on a nd p r ovi de s a ve r ba l pr om pt t ha t m a t c he s t he c hi l d s c om m uni c a t i on s ki l l l e ve l s uc h a s W a nt t r uc k? I f t he c hi l d s a ys W a nt t r uc k, t he a dul t pr ovi de s pr a i s e r e pe a t s t he c hi l d s ph r a s e ( e g s a ys ye s w a nt t r uc k ) a nd pr ovi de s t he c hi l d t he t oy dum p t r uc k. O t he r w i s e t he a dul t p r ovi de s a c or r e c t i ve m ode l r e pe a t e dl y, W a nt t r uc k unt i l t h e t a r ge t c hi l d c or r e c t l y m ode l s t he r e s pons e H ow e ve r i f t he c hi l d doe s not r e s pond i n a r e a s ona bl e t i m e f r a m e ( e g t w o t o t h r e e s e c onds ) a s pr e de t e r m i ne d by t he r e s e a r c he r p a r e nt a nd/ o r t e a c he r t he a dul t pr ovi de s a m ode l a nd gi ve s t he obj e c t t o t he c hi l d. T he pur pos e of m ode l i ng a n d c or r e c t i ng r e s pons e s i s t o pr ovi de t he t a r ge t c hi l d t he ne c e s s a r y pr om pt s a nd i ns t r uc t i ons i n na t ur a l s i t ua t i ons t o a s s i s t i n s ki l l de ve l opm e nt

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30 A not he r c om pone nt of m i l i e u t he r a py i s t he m a nd m ode l t e c hni que T he m a nd m ode l t e c hni que i nvol ve s gi vi ng a di r e c t i ns t r uc t i on ( c om m onl y r e f e r r e d t o i n t he l i t e r a t ur e a s a m a nd) w i t hi n a na t ur a l l y oc c ur r i ng a c t i vi t y a nd c ont e xt T he m a nd i s a voc a l op e r a nt t ha t i s m a i nt a i ne d by a r e i nf o r c e r ( e g. ob t a i ni ng a p r e f e r r e d i t e m s uc h a s a t oy c a r ) a nd i s e voke d by t he di s c r i m i na t i ve s t i m ul i f o r t ha t r e i nf o r c e r ( S ki nne r 1957) F or e xa m pl e i f a c hi l d s a ys W a t e r pl e a s e a nd r e c e i ve s t he w a t e r i t i s l i ke l y t ha t t hi s i s a m a nd. A l s o, i t i s i m por t a nt t o r e c ogni z e t ha t r e s pons e s a r e de e m e d m a nds ba s e d on t he i r c o nt r ol l i ng va r i a bl e s a nd not on t he i r t opogr a phy. S i gn l a ngua ge a nd pi c t ur e c a r ds c a n f unc t i on a s m a nds t he s a m e a s voc a l r e s pons e s f unc t i on a s m a nds W he n ne c e s s a r y, t hi s m a nd w o ul d be f ol l ow e d by a m ode l a nd a c or r e c t i on s i m i l a r t o t he de s c r i pt i on a bove T he m a nd m ode l i s pe r f or m e d by f i r s t ga i ni ng t he c hi l d s a t t e nt i on a nd t he n p r ovi di ng a pr om pt f o r a t a r ge t be ha vi or A f t e r t he pr o m pt a gui de d m o de l ( i e a s s i s t i ng t he c hi l d i n pe r f or m i ng t he t a r ge t be ha vi or ) i s p r ovi de d w he n ne c e s s a r y. F or i ns t a nc e a c hi l d i s gi ve n a ppl e j ui c e f or s na c k a nd r e a c he s t o pi c k i t up w i t h hi s ha nds T he a dul t pr ovi de s a r e s pons e bl oc k ( e g. bl oc ks hi s ha nds ) o bt a i ns t he c hi l d s a t t e nt i on, a nd s a ys T e l l m e w ha t you w a nt ( m a nd) pl a c e s t he c om m uni c a t i on c a r d w i t h t he pi c t ur e of j ui c e on i t i n t he c hi l d s ha nd a nd phys i c a l l y gui de s hi s ha nd t o t he a dul t w ho ha s t he a ppl e j ui c e ( c or r e c t i ve m ode l ) I f t he c hi l d c ont i nue s t o a s k f o r j ui c e by us i ng t he pi c t u r e c a r d, t he a dul t pr ovi de s t he j ui c e pa i r e d w i t h pos i t i ve pr a i s e ( e g G ood j ob a s ki ng ) I f t he c hi l d a t t e m pt s t o gr a b t he j ui c e a ga i n w i t hout us i ng t he c om m uni c a t i on c a r d, t he a dul t r e pe a t s t he pr oc e s s T he pur pos e of t he m a nd/ m ode l s t r a t e gy i s t o de ve l op i nde pe nde nt s ki l l s by pr ovi di ng t he c hi l d w i t h a pr om pt a nd a n e xa m pl e o f pe r f or m i ng t he c om m uni c a t i ve r e s pons e c or r e c t l y. T he a dul t c ont i nue s w i t h t hi s pr oc e dur e un t i l a pe r f or m a nc e c r i t e r i on i s m e t ( e g. c hi l d pe r f or m t he t a s k c or r e c t l y f o r t w o da ys )

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31 T i m e de l a y i s a not he r pr oc e dur e of t e n us e d i n m i l i e u t he r a py t ha t i nvol ve s t he a dul t pr ovi di ng a s t i m ul us a nd t he n w a i t i ng a ppr oxi m a t e l y 5 t o 30 s e c onds ba s e d on t he c hi l d s de ve l opm e nt a l a nd m e nt a l a ge f or a c hi l d i ni t i a t e d r e s pons e ( K a i s e r 1993) T i m e de l a y t ypi c a l l y i s c om bi ne d w i t h ot he r t e c hni que s s uc h a s t he m a nd m ode l I f t he c hi l d doe s not r e s pond, t he a dul t pr ovi de s a m a nd m ode l F o r e x a m pl e a c hi l d m a y w a nt h i s c oa t but ne e d he l p ge t t i n g i t f r o m t he s he l f W hi l e a t t e ndi ng t o t he c hi l d, t he a dul t w a i t s f or a pe r i od of 5 t o 30 s e c onds ( de pe ndi ng on t he c hi l d s de ve l opm e nt a l l e ve l ) f or t he c hi l d t o r e que s t he l p. I f t he c hi l d r e que s t s by us i ng a c om m uni c a t i ve r e s pons e s uc h a s a pi c t ur e c a r d o r voc a l i z a t i on, t he a dul t pr ovi de s i m m e di a t e pr a i s e a nd a c or r e c t m ode l Y ou w a nt your c oa t ? I f t he c hi l d doe s not i nde pe nde nt l y r e que s t he l p w i t hi n t he t i m e de l a y, t he a dul t pr ovi de s a m a nd m ode l T he a m ount of t i m e de l a y c hos e n de pe nds on t he c hi l d s l e ve l T he l onge r t he w a i t pe r i od, t he gr e a t e r t he c ha nc e of l os i ng t he c hi l d s i nt e r e s t ; t he r e f or e c a r e i s ne e de d i n c hoos i ng t he a pp r opr i a t e t i m e de l a y. T he pur pos e o f t i m e de l a y i s t o de c r e a s e t he c hi l d s de pe nde nc e on a dul t p r om pt i ng i ns t r uc t i on s a nd m ode l s ; t hus pr om ot i ng i nde pe n de nt a nd s pont a ne ous ( i e unp r om pt e d) c om m uni c a t i on. I nc i de nt a l t e a c hi ng i s a not he r s t r a t e gy of t e n e m pl o ye d w i t hi n t he f r a m e w or k of m i l i e u t he r a py. I nc i de nt a l t e a c hi ng i s a pr oc e s s w he r e c o m m uni c a t i on s ki l l s a r e l e a r ne d i n na t ur a l l y oc c ur r i ng i nt e r a c t i ons o r i nt e r a c t i ons a r r a nge d i n n a t ur a l c ont e xt s w hi c h m a y be t he r e a s on t he t e r m s i nc i de nt a l t e a c hi ng a nd m i l i e u t he r a py ha ve be e n us e d i nt e r c ha nge a bl y a t t i m e s H a r t a nd R i s l e y ( 1968; 1975) de s c r i be d i nc i de nt a l t e a c hi ng a s a n i nt e r a c t i on be t w e e n a n a dul t ( e g pa r e nt ) a nd a c hi l d dur i ng uns t r uc t ur e d s i t ua t i ons s uc h a s f r e e pl a y w he r e t he c hi l d c ont r ol s t he i nc i de nc e s i n w hi c h t e a c hi ng oc c ur s by s i gna l i ng i nt e r e s t i n t he e nvi r onm e nt F o r e xa m pl e w hi l e pl a yi ng w i t h t oy c a r s a c hi l d m a y poi nt t o a c a r a nd s a y, c a T he a dul t r e i nf or c e s t hi s

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32 be ha vi or by pr ov i di ng pos i t i ve p r a i s e a nd gi vi ng t h e c hi l d t he t oy c a r I nc i de nt a l t e a c hi ng t ypi c a l l y i s c om bi ne d w i t h t he ot he r pr oc e dur e s a n d i s a ppl i e d dur i ng s i t ua t i ons w h e n c hi l dr e n a r e r e que s t i ng e i t he r voc a l l y or non voc a l l y. P r om pt s a r e pr ovi de d i f ne c e s s a r y. F ur t he r a c c e s s t o de s i r e d obj e c t s a r e c ont i nge nt upon c or r e c t r e s p ons e s w hi c h a r e f ol l ow e d by be ha vi or s pe c i f i c pr a i s e F o r e xa m pl e a n a dul t m a y c r e a t e a s i t ua t i on by a c c i de nt a l l y f or ge t t i ng t o gi ve a c hi l d he r m i l k dur i ng s na c k ( i e s a bot a gi ng t he e nvi r on m e nt ) T he a dul t t he n w oul d us e t he a f or e m e nt i one d t e c hni que s t o e nha nc e c om m uni c a t i on by gi vi ng a p r om pt w he n ne e de d, pr a i s i ng t he c hi l d f o r c or r e c t r e s pons e s a nd gi vi ng t he c hi l d t he m i l k ( c ont i nge nt a c c e s s ) f or c or r e c t r e s pons e s T he pur pos e of i nc i de nt a l t e a c hi ng i s t o pr om ot e f l ue nc y a nd e xpa nd s ki l l s o f c hi l dr e n w i t h de l a ye d l a ngua ge s ki l l s w hi c h m a y i nc l ude c hi l dr e n w i t h A S D ( e g. s e e H a r t & R i s l e y, 1975; M a c D uf f K r a nt z M a c D uf f & M c C l a nna ha n, 1988) I n s um m i l i e u t he r a py i s one p r a c t i c e t ha t r e s e a r c he r s ha ve us e d t o s uc c e s s f ul l y de m ons t r a t e a n i nc r e a s e i n c om m uni c a t i on s ki l l s o f c hi l dr e n w i t h A S D I n c ont r a s t t o t he F C T l i t e r a t ur e r e vi e w e d, t he f oc us i n m i l i e u t he r a py i s t e a c hi ng c hi l dr e n ne w s ki l l s a nd be ha vi or s w i t hi n t he i r na t ur a l e nvi r onm e nt s ( e g hom e a nd s c hool ) T hi s ha s be e n done us i ng f ou r ba s i c pr oc e dur e s ( a ) m ode l i ng de s i r e d r e s pons e s a nd c or r e c t i ng r e s pons e s ( i e m ode l / c or r e c t ) ( b ) pr ovi di ng a m a nd a nd t he n m ode l i ng/ c or r e c t i ng i f ne e de d ( i e m a nd/ m ode l / c o r r e c t ) ( c ) us i ng t i m e de l a y, a nd ( d) e m pl oyi ng i nc i de nt a l t e a c hi ng w hi c h ha s r e s ul t e d i n s ki l l s ge ne r a l i z i ng t o ot he r s e t t i ngs a nd pe opl e S u m m ar y o f F C T an d M i l i e u T h e r a p y P r oc e d u r e s A l t hough bot h F C T a nd m i l i e u t he r a py r e s e a r c h ha ve be e n de m ons t r a t e d t o be e f f e c t i ve i n t e a c hi ng c om m uni c a t i on s ki l l s t o c hi l dr e n w i t h A S D t he s e t e c hni que s ha ve f oc us e d on di f f e r e nt a s pe c t s of t he de ve l opm e nt of c om m uni c a t i on s ki l l s T he m a j o r i t y o f t he F C T r e s e a r c h

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33 ha s f oc us e d on i de nt i f yi ng f unc t i ons of a be r r a nt be ha vi or a nd r e pl a c i ng a be r r a nt be ha vi or w i t h a s i ngl e c om m uni c a t i on r e s pons e I n c ont r a s t m i l i e u t he r a py r e s e a r c h ha s f oc us e d on i nc r e a s i ng c om m uni c a t i on w i t hi n t he c hi l d s na t ur a l s e t t i ng a nd ha s not f oc us e d on r e pl a c i ng a be r r a nt be ha vi or s w i t h f unc t i ona l c om m uni c a t i on s ki l l s B ot h t e c hni que s a r e e m pi r i c a l l y va l i da t e d a nd ha ve t he i r s t r e ngt hs a nd w e a kne s s e s I n t he f ol l ow i ng s e c t i on, a c ont r a s t be t w e e n F C T a nd m i l i e u t he r a py w i l l be pr ovi de d t o hi ghl i gh t t he i r s i m i l a r i t i e s a nd di f f e r e nc e s C on t r as t of F C T an d M i l i e u T h e r ap y A s a ppa r e nt f r om t he a f o r e m e nt i one d de s c r i pt i ons of F C T a nd m i l i e u t he r a py, a di r e c t c om pa r i s on of t he s e t w o i nt e r ve nt i ons r e ve a l s a n a r r a y of s i m i l a r i t i e s a nd di f f e r e nc e s T he f ol l ow i ng s e c t i ons pr ovi de a c ont r a s t be t w e e n F C T a nd m i l i e u t he r a py. F i r s t s i m i l a r i t i e s of t he t w o pr a c t i c e s w i l l be p r ovi de d. N e xt di f f e r e nc e s be t w e e n t he t w o pr a c t i c e s w i l l be hi ghl i ght e d S i m i l ar i t i e s F C T a nd m i l i e u t he r a py ha ve s i m i l a r i t i e s F i r s t bo t h i nt e r ve nt i ons pa r t l y i nc l ude c ha ngi ng a nt e c e de nt s t o be ha vi or a s a n i n t e r ve nt i on s t r a t e gy. T ha t i s bot h i nt e r ve nt i ons us e pr om pt s a s a n a nt e c e de nt s t r a t e gy t o obt a i n t he de s i r e d be ha vi or ( i e c om m uni c a t i on r e s pons e ) ; how e ve r t he s e pr om pt s di f f e r i n e a c h a ppr oa c h. A l s o, bot h i nt e r ve nt i ons a ppl y c ha nge s t o c ons e que nc e s t o i nc r e a s e a ppr opr i a t e c om m uni c a t i ve be ha vi or F o r F C T t he c ons e que nc e i nvol ve s obt a i ni ng a c c e s s t o t he i de nt i f i e d f unc t i on of t he be ha vi or ( e g t a ngi bl e i t e m e s c a pe a s i t ua t i on) t hr ough s ki l l i ns t r uc t i on i n a r e pl a c e m e nt be ha vi or I n m i l i e u t he r a py, t he c ons e que nc e i s obt a i ni ng t he r e que s t e d i t e m w hi c h m a y or m a y not s e r ve a s a f unc t i ona l r e i nf or c e r F i na l l y e a c h a ddr e s s e s t he c om m uni c a t i on de f i c i t o f c h i l d r e n w i t h A S D a s pr e vi ous l y de t a i l e d. D i f f e r e n c e s I n a ddi t i on t o s i m i l a r i t i e s F C T a nd m i l i e u t he r a py ha ve p r om i ne nt di f f e r e nc e s A s m e nt i one d pr e vi ous l y, pr om pt pr o c e dur e s a r e us e d w i t hi n bot h F C T a nd m i l i e u

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34 t he r a py i nt e r ve nt i ons H ow e ve r t ypi c a l a ppl i c a t i o n of t he pr om pt s s ys t e m a t i c a l l y di f f e r s be t w e e n t he t w o a ppr oa c he s P r om pt s i n F C T t yp i c a l l y a r e ba s e d on t he oc c ur r e nc e of a be r r a nt be ha vi or ( C a r r & D ur a nd 1985 ) A pr om pt of t e n i s gi ve n t o t he c hi l d t o pe r f o r m t he c om m uni c a t i on r e s pons e w he n t he c hi l d e nga ge s i n a be r r a nt be ha vi or A l t hou gh t i m e de l a y m a y be us e d i n F C T f or pr om pt s t he r e ha s not be e n a s ys t e m a t i c de s c r i pt i on of t he pr oc e dur e i n t he F C T l i t e r a t u r e ( B our r e t V ol l m e r a nd R a pp, 2001; M a nc i l 2006) I n c ont r a s t p r om pt s w i t hi n m i l i e u t he r a py t r a i ni ng a r e not ba s e d on a be r r a nt b e ha vi or oc c ur r e nc e s P r om pt s a r e not gi ve n onl y i n r e s pons e t o a be r r a nt be ha vi or s T ypi c a l l y, t he pr om pt s i n m i l i e u t he r a py a r e c onne c t e d t o t i m e de l a y pr oc e dur e s s ys t e m a t i c a l l y ( H a nc oc k & K a i s e r 2002) F or e xa m pl e i f a c hi l d doe s not c om m uni c a t e w i t hi n 10s a p r om pt m a y be gi v e n. A not he r di f f e r e nc e be t w e e n t he t w o p r oc e dur e s a p pa r e nt f r om t he a f o r e m e nt i one d de s c r i pt i ons c onc e r ns t he unde r l yi ng pur pos e of t h e t r a i ne d c om m uni c a t i on r e s pons e F C T a l w a ys c onne c t s t he c om m uni c a t i on r e s pons e t o f u nc t i on ( C a r r & D ur a nd 1985 ) T he unde r l yi ng pur pos e i s t o de c r e a s e a be r r a nt be ha vi o r by r e pl a c i ng i t w i t h t he c om m uni c a t i on r e s pons e C om m uni c a t i on r e s pons e s t a ught i n m i l i e u t he r a py, i n c ont r a s t a r e not ne c e s s a r i l y t i e d t o f unc t i on s ys t e m a t i c a l l y. I f a c hi l d doe s not r e que s t a n i t e m t he c hi l d i s gi ve n a c c e s s t o t he i t e m a f t e r s e ve r a l pr om p t s ha ve oc c ur r e d ( K a i s e r 1993 ) T hi s doe s not oc c ur i n F C T be c a us e i t m a y r e i nf or c e t he i na ppr opr i a t e be ha vi or A not he r di f f e r e nc e i s m a ni pul a t i on o f t he e nvi r on m e nt A l t hough F C T r e s e a r c he r s m a y a l t e r t he e nvi r on m e nt t hi s i s not m e nt i one d i n t he r e s e a r c h s t udi e s a s a n e s s e nt i a l f e a t ur e I n c ont r a s t m a na gi ng t he e nvi r onm e nt i s a pr om i ne nt f e a t ur e o f m i l i e u t he r a py ( K a i s e r 1993 ) F o r e xa m pl e a n e s s e nt i a l f e a t ur e of m i l i e u t he r a py i nv ol ve s s e t t i ng up t he e nvi r on m e nt t o e nha nc e

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35 c om m uni c a t i on. F or e xa m pl e K a i s e r ( 1993) de s c r i be d how t o p l a c e de s i r a bl e obj e c t s i n vi e w a nd out of r e a c h of c hi l dr e n; t hus i nc r e a s i ng t he l i ke l i hood f r om c om m uni c a t i on t o oc c ur A f i na l di f f e r e nc e be t w e e n t he t w o i nt e r ve nt i ons w hi c h r e qui r e s e m pha s i s i s t ha t m i l i e u t he r a py i s i n vi vo T he c hi l d l e a ds s o i f he or s he c hoos e s t o a ba ndon one i t e m / t a s k, t he y a r e a l l ow e d t o m ove on t o a not he r i t e m T hi s i s no t t h e c a s e w i t h F C T W he n us i ng F C T pr oc e dur e s f ol l ow i ng a c or r e c t r e s pons e c hi l dr e n t ypi c a l l y a r e r e t u r ne d t o t he t a s k a t ha nd a nd pr e s e nt e d w i t h a not he r t r i a l H ow e ve r a s not e d by B our r e t V ol l m e r a nd R a pp ( 2001) m a ny of t he s t ud i e s on F C T do not r e por t e xpl i c i t l y how m a nd pr oc e dur e s a r e s e l e c t e d or c onduc t e d. T hus a c om pl e t e a nd c onf i de nt c om pa r i s on be t w e e n F C T a nd m i l i e u t he r a py c a nnot be pr ovi de d. I n t he f ol l ow i ng s e c t i on, t he l i t e r a t ur e ba s e e xa m i ni ng t he us e of F C T a nd m i l i e u t he r a py w i t h c hi l d r e n w i t h A S D w i l l be r e vi e w e d. F u n c t i on al C om m u n i c at i o n T r ai n i n g L i t e r at u r e R e vi e w T o i de nt i f y r e l e va nt r e s e a r c h s t udi e s t he F C T l i t e r a t ur e r e vi e w c ons i s t e d of a t hor ough r e vi e w of t he E R I C E duc a t i on P s yc I N F O a nd A c a de m i c S e a r c h P r e m i e r da t a ba s e s us i ng va r i ous c om bi na t i ons of t he f ol l ow i ng t e r m s : f unc t i ona l c om m uni c a t i on t r a i ni ng, f unc t i ona l e qui va l e nc e t r a i ni ng, a ut i s m a ut i s m s pe c t r um d i s or de r a nd c om m uni c a t i on. A ha nd s e a r c h w a s c onduc t e d of t he f ol l ow i ng j ou r na l s c ove r i ng t he s pa n of 1985 t o t he pr e s e nt : F oc us on A ut i s m and O t he r D e v e l opm e nt al D i s abi l i t i e s J our nal of A ut i s m and D e v e l opm e nt al D i s or de r s J our nal of A ppl i e d B e hav i or A nal y s i s a nd J our nal of P os i t i v e B e hav i or I nt e r v e nt i ons N e xt a f t e r r e vi e w i ng t he r e t r i e ve d a r t i c l e s a n a r c hi va l s e a r c h w a s c onduc t e d. T he s e s e a r c he s pr oduc e d 30 a r t i c l e s i n w hi c h F C T w a s t he pr i m a r y i n t e r ve nt i on a ddr e s s i ng a be r r a nt be ha vi or s a nd c om m uni c a t i on de f i c i t s o f w hi c h e i ght i nc l ude d c hi l dr e n w i t h A S D T he f ol l ow i ng c r i t e r i a w e r e us e d f or i nc l us i on i n t hi s r e vi e w : ( a ) a t l e a s t one pa r t i c i pa nt of t he s t udy w a s a c hi l d w i t h a n

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36 a ut i s m s pe c t r um di s or de r di a gnos i s ( b) t he f unc t i o n of t he a be r r a nt be ha vi or w a s de t e r m i ne d by a f unc t i ona l be ha vi or a s s e s s m e nt a nd ( c ) t he p r i m a r y i nt e r ve nt i on w a s f unc t i ona l c om m uni c a t i on t r a i ni ng E i ght a r t i c l e s t ha t m e t t he c r i t e r i a w e r e r e vi e w e d t o de t e r m i ne t he e f f e c t i ve ne s s of F C T w i t h c hi l dr e n w i t h A S D T he s t udi e s w e r e a na l yz e d t o de t e r m i ne t he c ha r a c t e r i s t i c s of t he s t udy pa r t i c i pa nt s r e s e a r c h s e t t i ng s be ha vi or s i nt e r ve nt i ons r e s e a r c h de s i gns r e l i a bi l i t y t r e a t m e nt f i de l i t y, a nd m a j or f i ndi ngs a c r os s s t udi e s a r e pr ov i de d. C h ar ac t e r i s t i c s of S t u d y P ar t i c i p an t s A t ot a l num be r of 22 pa r t i c i pa nt s w i t h A S D w e r e i nve s t i ga t e d a c r os s a l l of t he e i ght s t udi e s T he m a j or i t y of r e s e a r c he r s r e por t e d ge nde r a l ong w i t h c hr onol ogi c a l ( C A ) l a ngua ge / c om m uni c a t i on l e ve l s ( L A ) a nd m e nt a l a ge s ( M A ) E i gh t e e n ( 82% ) o f t he pa r t i c i pa nt s w e r e m a l e a nd f ou r ( 18% ) w e r e f e m a l e A l t hough t hi s m a y a t f i r s t s e e m ove r r e pr e s e nt e d by m a l e s t he r a t i o of m a l e s t o f e m a l e s i s r e pr e s e nt a t i ve of t he ove r a l l popul a t i on of i ndi vi dua l s di a gnos e d w i t h A S D ( L ot t e r 1966; V ol km a r S z a t m a r i & S pa r r ow 1993) A s s how n i n T a bl e 2. 1, pa r t i c i pa nt s r a nge d i n a ge f r om 2 7 t o 13 ye a r s ( M = 8 0 ye a r s ) T he l a ngua ge a ge ( L A ) r e por t e d r a nge d f r om 1. 8 t o 13 3 ye a r s ( M = 7 6 ye a r s ) w hi l e t he m e nt a l a ge r e por t e d r a nge d f r om 2 4 t o 7. 9 ye a r s ( M = 5. 0 ye a r s ) W he n c om p a r i ng C A M A a nd L A l e ve l s a pa r t i c i pa nt w i t h a l ow c h r onol ogi c a l a ge c oul d ha ve a l a ngua g e a nd m e nt a l a ge hi ghe r t ha n t ha t of a n ol de r pa r t i c i pa nt A l s o, w hi l e s om e pa r t i c i pa nt s ha d a m e nt a l a ge gr e a t e r t ha n t he i r l a ngua ge a ge ot he r pa r t i c i pa nt s a ge s w e r e oppos i t e i n c or r e l a t i o n. F o r e xa m pl e a pa r t i c i pa nt m a y ha ve a m e nt a l a ge of 5 ye a r s ol d a nd a l a ngua ge a ge o f 3 ye a r s ol d. I n c ont r a s t a not he r pa r t i c i pa nt m a y ha ve a m e nt a l a ge of 3 ye a r s o l d a nd a l a ngua ge a g e of 5 ye a r s ol d. T he r e w a s no c or r e l a t i on be t w e e n w hi c h s houl d be hi ghe r M A or L A

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37 P a r t i c i pa nt s di f f e r e d i n t he i r l e ve l s of l a ngua ge pr i or t o t he s t udi e s a nd w he t he r o r not t he y ha d c onc om i t a nt di a gnos e s O f t he s pe e c h l e ve l s r e por t e d f o r 12 pa r t i c i pa nt s f i ve pa r t i c i pa nt s ( 42% ) s poke i n c om pl e t e s e nt e nc e s ; how e ve r t he i r s e nt e nc e s w e r e not a l w a ys f unc t i ona l F or e xa m pl e s om e of t he c om pl e t e s e nt e nc e s w e r e r e por t e d i n t he r e s e a r c h a s e c hol a l i c ( i e r e pe a t e d phr a s e ove r a nd ove r ) w hi l e ot he r s w e r e bi z a r r e ( e g. a c hi l d s a yi ng, t he c a t f l e w on a br oom w i t hout a n a ppa r e nt c ont e xt ua l r e f e r e nc e ) A l s o, of t he pa r t i c i pa nt s w ho s poke i n c om pl e t e s e nt e nc e s onl y 1 ( 1/ 5 20 % ) w a s r e por t e d t o s pe a k s pont a ne ous l y. T w o pa r t i c i pa nt s ( 2/ 12, 16% ) w e r e nonve r ba l a nd di d n ot c om m uni c a t e w i t h s i gns o r ge s t ur e s O f a l l t he s e pa r t i c i pa nt s onl y s i x ( 6/ 22, 27% ) w e r e r e por t e d t o ha ve a ddi t i ona l di a gnos e s w hi c h i nc l ude d c om m uni c a t i on di s or de r s s e i z ur e di s or de r s a nd s e ve r e / pr of ound m e nt a l r e t a r da t i on. C h ar ac t e r i s t i c s of R e s e ar c h S e t t i n g T he t ype o f r e s e a r c h e nvi r onm e nt t he s t udi e s w e r e c onduc t e d i n w a s s i m i l a r a c r os s m os t of t he s t ud i e s W i t h a f e w e xc e pt i ons a nd unl i ke p a r t i c i pa nt c ha r a c t e r i s t i c s t he t r a i ne r s a nd t r a i ni ng s e s s i ons w e r e r e m ove d f r om t he na t u r a l e n vi r onm e nt a nd t he r e s e a r c h s e s s i ons w e r e c onduc t e d i n a c l i ni c a l s e t t i ng T r ai n e r A s s how n i n T a bl e 2 2, r e s e a r c he r s a nd r e s e a r c h a s s i s t a nt s i m pl e m e nt e d t he m a j or i t y of t he i n t e r ve nt i ons ( i e 6/ 8 75 % ) O nl y one s t udy ( 1/ 8 12 5% ) i nvol ve d a t e a c he r a s a n i m pl e m e nt e r but s he w a s not t he pa r t i c i pa nt s t e a c he r S he w a s r e c r ui t e d by t he r e s e a r c he r s t o c onduc t t he s t udy a nd s e r ve d m o r e i n t he r ol e of a r e s e a r c h a s s i s t a nt ( W a c ke r e t a l 1990 ) F ur t he r onl y one s t udy ( 1/ 8 12 5% ) us e d pa r e nt s a s t r a i ne r s ( W a c ke r e t a l 2005) T r ai n i n g s e s s i on s T he m a j o r i t y o f t r a i ne r s c ondu c t e d t r a i ni ng s e s s i ons i n c l i ni c r oom s F or e xa m pl e t he m a j o r i t y o f t r a i ni ng ( i e 6/ 8 s t ud i e s 75% ) oc c ur r e d i n s e pa r a t e r oom s t ha t us ua l l y c ont a i ne d onl y a t a bl e a nd c ha i r s T he s e c l i ni c r oom s w e r e no t de s i gne d t o m i r r o r t he

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38 c l a s s r oom T w o s t udi e s ( 2/ 8, 25% ) h ow e ve r w e r e c onduc t e d i n m or e na t ur a l e nvi r onm e nt s ( e g. c l a s s r oom a nd hom e ) F o r e xa m pl e O N e i l l a nd S w e e t l a nd B a ke r ( 2001) c onduc t e d a s t udy i n va r i ous l oc a t i ons of t he pa r t i c i pa nt s c l a s s r oom w hi l e W a c ke r e t a l ( 2005) c onduc t e d t r a i ni ng i n de s i gna t e d r oom s of t he pa r t i c i pa nt s ho m e C h ar ac t e r i s t i c s of B e h avi or s I n t e r ve n t i on s an d R e s e ar c h D e s i gn s T he t ype o f a be r r a nt be ha vi or s a nd t he i r f unc t i ons va r i e d a m ong pa r t i c i pa nt s C ons e que nt l y, r e s e a r c he r s i m pl e m e nt e d va r i ous i nt e r ve nt i ons t o a ddr e s s t he s e f unc t i ons D i f f e r e nc e s i de nt i f i e d a c r os s t he s t udi e s c a n be o r g a ni z e d i n t he f o l l ow i ng c a t e gor i e s : ( a ) a be r r a nt be ha vi or s ( b) F B A pr oc e dur e s ( c ) be ha vi or f unc t i ons ( d) c om m uni c a t i ve r e s pons e s a nd ( e ) F C T r e s e a r c h de s i gns A b e r r an t b e h avi or s A s s how n i n T a bl e 2 3, r e s e a r c he r s r e por t e d e i ght di f f e r e nt c a t e gor i e s of a be r r a nt be ha vi o r s w i t h m a ny pa r t i c i pa nt s e xhi bi t i ng m or e t ha n one be ha vi or T he c a t e gor i e s i nc l ude d a ggr e s s i on ( e g. hi t t i ng, ha i r p ul l i ng) s e l f i nj ur i ous be ha vi or ( e g. ha nd bi t i ng) de s t r oyi ng p r ope r t y, t a nt r um s ( e g ye l l i ng ) body r oc ki ng ha nd f l a ppi ng, oppos i t i ona l be ha vi or ( e g r e f us e t o do w o r k) a nd w a l ki ng a w a y. F our t e e n pa r t i c i pa nt s out of 22 ( 64% ) e xhi bi t e d a ggr e s s i on, s e l f i nj ur i ous be ha vi or or de s t r uc t i on of p r ope r t y A l s o, f ou r t e e n pa r t i c i pa nt s ( 14/ 22, 64% ) e xhi bi t e d m or e t ha n one a be r r a nt be ha vi or F or e xa m pl e one pa r t i c i pa nt e nga ge d i n a ggr e s s i ve be ha vi or t a nt r u m s s e l f i nj ur i ous be ha vi or a nd pr ope r t y de s t r uc t i on ( C a r r & D ur a nd 1985) F B A p r oc e d u r e s B a s i c F B A pr oc e dur e s us e d t o a na l yz e t he va r i ous be ha vi or s f or t he m os t pa r t w e r e s i m i l a r a c r os s a l l s t udi e s E a c h r e s e a r c h t e a m us e d a f unc t i ona l a na l ys i s ( F A ) a s t he pr i m a r y m e t hod t o de r i ve a t a be ha vi or a l f unc t i on. H ow e ve r a s s how n i n t a bl e 3 t h r e e r e s e a r c h t e a m s ( 3 out o f 8 38 % ) a l s o c onduc t e d F B A t ha t i nc l ude d i ndi r e c t a s s e s s m e nt s

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39 P r i or t o t he F A r e s e a r c h t e a m s i n t he s e t hr e e s t udi e s f i r s t c ol l e c t e d i nf o r m a t i on t h r ough i ndi r e c t a s s e s s m e nt s w i t h t e a c he r s or pa r e nt s I nd i r e c t a s s e s s m e nt s us e d i n va r i ous s t udi e s di f f e r e d i n t ype a nd l e ngt h. W hi l e s om e r e s e a r c he r s r e por t e d i n t e r vi e w s t ha t w e r e i nf or m a l a nd s hor t ( C a r r & D ur a nd 1985; D ur a nd & C a r r 1987 ) ot he r s r e por t e d i ndi r e c t a s s e s s m e nt s t ha t w e r e m or e f o r m a l a nd gr e a t e r i n l e ngt h ( D ur a nd & C a r r 1992) C a r r a nd D ur a nd ( 1 985 ) a nd D ur a nd a nd C a r r ( 1987) s i m pl y i nt e r vi e w e d t e a c he r s a nd a s ke d w hi c h of t he i r s t ude nt s e nga ge d i n a be r r a nt be ha vi or a nd w ha t s uppos e d f unc t i on t he be ha vi or s e r ve d. D ur a nd a nd C a r r ( 1992) ha d t e a c he r s c om pl e t e a pr obl e m be ha vi or c he c kl i s t a nd t he M o t i v at i on A s s e s s m e nt Sc al e ( M A S ) t o he l p hypot he s i z e a be ha vi or a l f unc t i on. A s m e nt i one d pr e vi ous l y, e a c h r e s e a r c h t e a m c onduc t e d a F A t o de t e r m i ne t he f unc t i on R e s e a r c he r s us e d a t r a di t i ona l F A ( i e a na l yz i ng c ons e que nc e s ) w i t h t he e xc e pt i on o f C a r r a n d D ur a nd ( 1985) w ho i nc or po r a t e d a nt e c e de nt e ve nt s i nt o t he i r f unc t i ona l a na l ys i s D e s i gns us e d a nd r e por t e d by t he a ut hor s f or t he F A di f f e r e d. A s s how n i n T a bl e 2 3, f i ve s t udi e s ( 5/ 8, 63% ) us e d a l t e r na t i ng t r e a t m e nt de s i gns w he r e t he a s s e s s m e nt c ondi t i ons w e r e s ys t e m a t i c a l l y a l t e r na t e d. F or e xa m pl e C a r r a nd D ur a nd a l t e r na t e d e a s y ve r s us di f f i c ul t t a s ks a nd a l ow ( 33 % ) ve r s us hi gh ( 100% ) a t t e nt i on c ondi t i on. S i m i l a r l y W a c ke r e t a l ( 1990 ) a l t e r na t e d e s c a pe t a ngi bl e a l one a nd s oc i a l a t t e nt i on c ond i t i ons D ur a nd a nd C a r r ( 1987; 1992) us e d a r e ve r s a l de s i gn t o e xa m i ne e f f e c t s of di f f e r e nt c ondi t i ons W a c ke r e t a l a nd ot he r s ( 2005 ) us e d a m ul t i e l e m e nt de s i gn t o c om pa r e a s s e s s m e nt c ondi t i ons ( i e a t t e nt i on e s c a pe t a ngi bl e a nd f r e e pl a y) by c oun t e r ba l a nc i ng t he m a c r os s s e s s i ons T he s e di f f e r e nc e s m a y be m o r e i n na m e t ha n a c t ua l di f f e r e nc e s F or e xa m pl e t he m ul t i e l e m e nt a nd a l t e r na t e t r e a t m e nt de s i gns a r e de r i va t i ve s of a r e ve r s a l de s i gn.

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40 B e h avi or f u n c t i on s A f t e r t he c om pl e t i on o f t he F B A pr oc e dur e s be ha vi or a l f unc t i ons de f i ni t i ve l y w e r e i de nt i f i e d i n e a c h s t udy f o r a l l bu t one pa r t i c i pa nt ( W a c ke r e t a l 2005) w hos e be ha vi or a l f unc t i on w a s de t e r m i ne d t o be undi f f e r e nt i a t e d. A c r os s a l l t he s t udi e s 12 pa r t i c i pa nt s ( 12/ 22, 55 % ) e m i t t e d a be r r a nt be ha vi or s t o e s c a pe a t a s k or s i t ua t i on, w hi l e e i ght pa r t i c i pa nt s ( 8/ 22, 36 % ) di s pl a ye d a be r r a nt be ha vi or s t o ga i n a t t e nt i on. O nl y t h r e e pa r t i c i pa nt s ( 3/ 22, 14% ) e nga ge d i n a be r r a nt be ha vi or s t o ga i n a t a ngi bl e i t e m A l s o, o f t he 12 pa r t i c i pa nt s w hos e be ha vi or a l f unc t i on w a s e s c a pe f ou r of t he m ( 18% ) a l s o e nga ge d i n t he be ha vi or t o ga i n a t t e nt i on. S i m i l a r l y, one pa r t i c i pa nt ( 1/ 22 5% ) w h o e nga ge d i n a be r r a nt be ha vi or s di d s o t o ga i n a t t e nt i on a nd t o ga i n a c c e s s t o a t a ngi bl e i t e m C om m u n i c at i ve r e s p on s e s W i t h t he know l e dge of t he be ha vi or a l f unc t i on ( s ) t r a i ne r s t a ught a n a r r a y of c om m uni c a t i ve r e s pons e s t o r e pl a c e t he a be r r a nt be ha vi or s w i t h e qua l s uc c e s s r e ga r dl e s s of t he r e s pons e c a t e gor y. R e s pons e s t a ught a l i gne d w i t h t he i de nt i f i e d f unc t i on a nd f i t i nt o one of t he f ol l ow i ng c a t e gor i e s : ( a ) ve r ba l l a n gua ge ( b) s i gn l a ngua ge ( c ) pi c t ur e i c on ba s e d l a ngua ge or ( d ) a ugm e nt a t i ve de vi c e s A s s how n i n T a bl e 2 3, t r a i ne r s i n s i x s t udi e s t a ught pa r t i c i pa nt s t o ve r ba l l y m a nd F or e xa m pl e D ur a nd a nd C a r r ( 1987 ) t a ught pa r t i c i pa nt s t o ve r ba l l y m a nd H e l p m e t o r e pl a c e body r oc ki ng a nd ha nd f l a ppi ng t ha t s e r ve d t o e s c a pe a ve r s i ve t a s ks a nd s i t ua t i ons D ur a nd a nd C a r r ( 19 92) t a ught pa r t i c i pa nt s i n a not he r s t udy t o ve r ba l l y m a nd, A m I doi ng goo d w or k? t o r e pl a c e t a nt r um s t ha t s e r ve d t o ga i n a t t e nt i on. R e s e a r c he r s i n t w o s t udi e s t a ught c hi l dr e n t o us e s i gn l a ngua ge f or m a ndi ng ( W a c ke r e t a l 2005; W a c ke r e t a l 1990) F or e xa m pl e t o ga i n a c c e s s t o a t a ngi bl e W a c ke r a nd c ol l e a gue s ( 1990) t a u ght pa r t i c i pa nt s t o m a nd t he s i gn, pl e a s e I n t w o s t udi e s r e s e a r c h t e a m s t a ught c hi l dr e n t o us e i c ons t o s e r ve a s t he m a nd ( M a r t i n, D r a s gow H a l l e & B r uc ke r 2005; W a c ke r e t a l 2005 ) F or e xa m pl e M a r t i n e t a l t a ught t he i r pa r t i c i pa nt t o p r e s e nt a n i c on c a r d w i t h t he

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41 w or ds N o T ha nk Y ou w r i t t e n upon i t t o r e pl a c e t a nt r um s w hi c h s e r ve d a s a n e s c a pe f unc t i on W a c ke r e t a l ( 2005) us e d a n a ugm e nt a t i ve de vi c e t o t e a c h a pa r t i c i pa nt t o p r e s s a m i c r o s w i t c h t ha t s a i d, P l e a s e T hi s r e s pons e r e pl a c e d s e l f i nj ur i ous be ha vi or w hi c h w a s a t t e nt i on m a i nt a i ne d. A c r os s a l l s t udi e s c om m uni c a t i on r e s pons e s w e r e t a ught i n a s i m i l a r f a s hi on. F or e xa m pl e w he n D ur a nd a nd C a r r ( 1992) t a ught pa r t i c i pa nt s t o ve r ba l l y m a nd, A m I doi ng good w or k? t he t r a i ni ng s e s s i ons a s de s c r i be d pr e vi ous l y c ont i nue d unt i l t he pa r t i c i pa nt s w e r e a bl e t o pe r f or m t he t a s k c or r e c t l y 10 c ons e c ut i ve t i m e s D ur i ng t he t r a i ni ng s e s s i ons t he t r a i ne r s a t a c r os s t he t a bl e f r om t he pa r t i c i pa nt a nd w a i t e d f or t he pa r t i c i pa nt t o r e s pond t o t he m a nd. S i m i l a r l y, i n t he s t udy c onduc t e d by M a r t i n a nd c o l l e a gue s ( 2005) pa r t i c i pa nt s w e r e t r a i ne d t o e m i t t he c om m uni c a t i ve r e s pons e w i t hout e r r o r I n s um m a r y, a l l pa r t i c i pa nt s i n e a c h of t he s t udi e s w e r e t a ught one m a nd unt i l t he y w e r e a bl e t o r e s pond c or r e c t l y 10 c ons e c ut i ve t i m e s F C T r e s e ar c h d e s i gn s A f t e r t he c om m uni c a t i ve r e s pons e s w e r e t a ught r e s e a r c he r s us e d one of t he f ol l ow i ng t w o s i ngl e s ubj e c t r e s e a r c h de s i gns f or e va l ua t i ng t he e f f e c t i ve ne s s of F C T : ( a ) r e ve r s a l or ( b) m ul t i pl e ba s e l i ne A s s ho w n i n T a bl e 2. 3 r e s e a r c he r s us e d a r e ve r s a l de s i gn i n f our s t udi e s F or e xa m pl e C a r r a nd D ur a nd ( 1985 ) a l t e r na t e d r e l e va nt a nd i r r e l e va nt r e s pons e pha s e s w i t h ba s e l i ne F i r s t ba s e l i ne da t a w e r e c ol l e c t e d on a be r r a nt be ha vi or s T he n, pa r t i c i pa nt s w e r e r e i nf o r c e d f or r e l e va nt c om m u ni c a t i ve r e s pons e s by t he t r a i ne r gi v i ng t he m a s s i s t a nc e F ol l ow i ng t hi s pha s e r e i n f or c e m e nt w a s r e m ove d, t hus r e t ur ni ng t o ba s e l i ne N e xt pa r t i c i pa nt s w e r e r e i nf o r c e d f or i r r e l e va nt r e s pons e s T he s e r e s pons e s how e ve r w e r e i r r e l e va nt t o t he t a s k a t ha nd or t he f unc t i on T he s e que nc e w a s t he n r e pe a t e d; how e ve r t he pha s e s ( i e r e l e va nt a nd i r r e l e va nt ) w e r e c ount e r ba l a nc e d. A l s o a s s how n i n T a bl e 2. 3 f ou r s t udi e s us e d a m ul t i pl e ba s e l i ne de s i gn. F or e xa m pl e D u r a nd a n d C a r r ( 1992) i m pl e m e nt e d t he p r oc e dur e s

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42 w i t h one pa r t i c i pa nt a s t he y c ont i nue d t o c ol l e c t ba s e l i ne da t a on t he r e m a i ni ng pa r t i c i pa nt s A f t e r a f e w s e s s i ons t he y i m pl e m e nt e d t he p r oc e dur e s w i t h t he ne xt pa r t i c i pa nt a s t he y c ont i nue d t o i m pl e m e nt t he pr oc e dur e w i t h t he f i r s t pa r t i c i pa nt T hi s c ont i nue d unt i l t he pr oc e dur e w a s i m pl e m e nt e d w i t h e ve r y pa r t i c i pa nt F ur t he r t he y c onduc t e d s e s s i ons w i t h a na ve t r a i ne r ( i e gr a dua t e ps yc hol ogy m a j or ) t o t e s t f or ge ne r a l i z a t i on t o ot he r pe opl e T hi s w a s t he onl y s t udy t o c he c k f or ge ne r a l i z a t i on a c r o s s pe r s ons or s e t t i ngs R e p or t e d R e l i ab i l i t y R e por t e d r e s e a r c h r e s ul t s w oul d be c om pr om i s e d unl e s s t he a f or e m e nt i one d obs e r va t i ons w e r e r e l i a bl e a nd p r oc e dur e s w e r e i m pl e m e nt e d w i t h f i de l i t y R e s e a r c he r s a l l r e por t e d hi gh i n t e r r a t e r r e l i a bi l i t y ( i e a g r e e m e nt of obs e r ve d phe nom e non) r a ngi ng f r om 79% t o 100 % F o r e xa m pl e C a r r a nd D ur a nd ( 1985) r e por t e d r e l i a bi l i t y of 80 % o r g r e a t e r f o r a l l c a t e gor i e s S i m i l a r l y, W a c ke r e t a l ( 1990) ha d a n a ve r a ge r e l i a bi l i t y of 92% w i t h 80% o r m o r e f o r e a c h c a t e gor y. M a r t i n a nd c ol l e a gue s ( 2005) r e por t e d g r e a t e r r e l i a bi l i t y r a ngi ng f r om 97% t o 99 % R e p or t e d T r e at m e n t F i d e l i t y I n a ddi t i on t o r e l i a bi l i t y, a l l r e s e a r c h t e a m s r e por t e d hi gh t r e a t m e nt f i de l i t y ( i e c ons i s t e nc e of i m pl e m e nt a t i on of t he m e t hods a nd p r oc e dur e s of t r e a t m e nt ) w i t hi n t he i r pr os pe c t i ve s t udi e s T he y s ugge s t e d t r e a t m e nt f i de l i t y w a s hi gh ba s e d on di r e c t obs e r va t i ons but r e s e a r c h t e a m s s e l dom r e por t e d a pe r c e nt a ge of s t e ps c om pl e t e d c or r e c t l y. T he r e s e a r c he r s s i m pl y s t a t e d t ha t t he t r e a t m e nt s w e r e i m pl e m e nt e d w i t h hi gh f i de l i t y w i t hout pr ovi di ng t he t r e a t m e nt da t a M aj or F C T F i n d i n gs F or e a c h of t he s e s t udi e s r e s e a r c h t e a m s r e por t e d s i m i l a r f i ndi ngs i n t ha t a l l pa r t i c i pa nt s l e a r ne d f u nc t i ona l c om m uni c a t i on r e s pons e s m a t c he d t o t he f unc t i ons of t he i r a be r r a nt

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43 be ha vi or s w i t h t he e xc e pt i on of t he one pa r t i c i pa n t w hos e be ha vi or a l f unc t i on w a s unde t e r m i ne d. A s s how n i n T a bl e 2 4, t he s uc c e s s of t he i nt e r ve nt i on w a s de m ons t r a t e d by a de c r e a s e of a be r r a nt be ha vi or s w i t h a c or r e s pondi ng i nc r e a s e i n t he t r a i ne d c om m uni c a t i on r e s pons e A f t e r i m pl e m e nt a t i on o f F C T r e s e a r c h t e a m s f ound a de c r e a s e i n a be r r a nt be ha vi or a c r os s a l l s t udi e s F or e xa m pl e W a c ke r a nd c ol l e a gue s ( 2005) f ound t ha t F C T c om bi ne d w i t h t i m e out r e s ul t e d i n ha nd bi t i ng de c r e a s i ng t o z e r o pe r c e nt S i m i l a r l y C a r r a nd D u r a nd ( 1985 ) f ound a be r r a nt be ha vi or s t o de c r e a s e t o 0 5% upon t he s uc c e s s f ul i m pl e m e nt a t i on of F C T A l s o, W a c ke r a nd c ol l e a gue s f ound s i gni f i c a nt de c r e a s e s i n a be r r a nt be ha vi or f or a l l but one pa r t i c i pa nt w hos e be ha vi or s f unc t i on w a s undi f f e r e nt i a t e d. C ons e que nt l y, W a c ke r a nd c ol l e a gue s not e d t ha t t he c om m uni c a t i on r e s pons e m us t m a t c h t he a be r r a nt be ha vi or s f unc t i on, s i nc e no f unc t i on w a s i de nt i f i e d, no F C T c oul d oc c ur A ki n t o de c r e a s e s i n a be r r a nt be ha vi or r e s ul t s a c r o s s s t udi e s pa r t i c i pa nt s i nc r e a s e d t he i r us e of c om m uni c a t i on m a nds H ow e ve r t he s e m a nds w e r e l i m i t e d i n r a nge O nl y one m a nd w a s t a ught t o t he pa r t i c i pa nt s F or e xa m pl e C a r r a nd D ur a nd ( 1985) not e d s us t a i ne d r a t e s of r e l e va nt r e s pons e s i n t he f i na l pha s e s of t he s t udy, but onl y one r e s pons e w a s t a ught a nd m e a s ur e d. I n a l a t e r s t udy, D u r a nd a nd C a r r ( 1992 ) a l s o f ound a n i nc r e a s e i n unpr om pt e d c om m uni c a t i on t he c om m uni c a t i on, how e ve r w a s a ga i n l i m i t e d t o one t ype of m a nd. M or e r e c e nt l y, t he pa r t i c i pa nt i n M a r t i n e t a l s ( 2005) s t udy i nde pe nde nt l y us e d hi s i c on c a r d t o r e que s t a n i t e m 100% of t he t i m e f ol l ow i ng t r a i ni ng; s i m i l a r t o pr e vi ous s t udi e s t he y f oc us e d on one m a nd w i t h no e xpa n s i on of c om m uni c a t i on. O nl y one r e s e a r c h t e a m r e por t e d ge ne r a l i z a t i on t o ot he r pe opl e or s e t t i ngs ( D ur a nd a nd C a r r 1992 ) D ur a nd a nd C a r r e xa m i ne d f or ge ne r a l i z a t i on w i t h a not he r pe r s on or s e t t i ng f o r c hi l dr e n w i t h A S D T he y c onduc t e d f i na l s e s s i ons w i t h a na ve t r a i ne r ( i e gr a dua t e ps yc hol ogy

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44 m a j or ) t o t e s t f o r ge ne r a l i z a t i on t o ot he r pe opl e T he c hi l dr e n w ho ha d r e c e i ve d F C T t r a i ni ng m a i nt a i ne d t he i r a ppr op r i a t e r e pl a c e m e nt c om m uni c a t i ve r e s pons e a nd l ow l e ve l s of a be r r a nt be ha vi or S u m m ar y o f F C T L i t e r at u r e I n s um m a r y, F C T i s one a ppr oa c h r e s e a r c he r s ha ve e m pl oye d t o a ddr e s s t he c om m uni c a t i on a nd be ha vi or a l ne e ds of c hi l d r e n w i t h A S D T he e f f e c t i ve ne s s of F C T w a s de m ons t r a t e d i n e a c h s t udy. R e s e a r c he r s de m ons t r a t e d t ha t F C T r e s ul t e d i n a be r r a nt be h a vi or de c r e a s i ng a nd t he t r a i ne d c om m uni c a t i ve r e s pons e i nc r e a s i ng. A l t ho ugh t he r e s ul t s a r e p r om i s i ng, t he F C T l i t e r a t ur e a l s o pr e s e nt s a num be r of l i m i t a t i ons w h i c h a r e de s c r i be d be l ow F C T ha s be e n de m ons t r a t e d t o be a s uc c e s s f ul s t r a t e gy f or de c r e a s i ng pr obl e m be ha vi or s a nd i nc r e a s i ng f unc t i ona l c om m uni c a t i ve r e s pons e s how e ve r t he m a j o r i t y o f t he r e s e a r c h ha s be e n c onduc t e d i n c l i ni c a l s e t t i ngs r a t he r t ha n c hi l dr e n s na t ur a l e nvi r onm e nt s ( e g. c hi l d r e n s c l a s s r oom s a nd hom e s ) W he n i m pl e m e nt i ng t he pr oc e dur e s dur i ng i ni t i a l de ve l opm e nt s t a ge s r e s e a r c he r s pr oduc e d pos i t i ve be ha vi or a l a nd c om m uni c a t i on r e s ul t s F or e xa m pl e D u r a nd a nd C a r r ( 1987) i ndi c a t e d a n i nc r e a s e i n c om m uni c a t i o n a nd a de c r e a s e i n a be r r a nt be ha vi or s but t hi s s t udy oc c ur r e d w i t hi n a s e pa r a t e 5 x 10 m e t e r c l a s s r oom t ha t e xc l ude d t he c hi l d s t e a c he r a nd di d not de s i gn t he e nvi r onm e nt t o l ook l i ke t he c hi l d s r e gul a r c l a s s r oom S i m i l a r l y, pa r e nt s a nd t e a c he r s ve r y s e l dom ha ve b e e n us e d a s c ha nge a ge nt s I n t he m a j or i t y of t he s t udi e s r e s e a r c h a s s i s t a nt s ha ve s e r ve d a s t he r a pi s t s W a c ke r a nd c ol l e a gue s ( 2005) w e r e t he onl y r e s e a r c he r s t o us e pa r e nt s a s na t ur a l c ha nge a ge nt s N one of t he r e s e a r c h s t udi e s ha ve us e d a t a r ge t c hi l d s t e a c he r a s t he c ha nge a ge nt I n a ddi t i on t o t r a i ni ng i n c l i ni c a l s e t t i ngs r e s e a r c he r s f oc us e d on onl y a s i ngl e c om m uni c a t i on m a nd. R e s e a r c he r s t a ught one c o m m uni c a t i on r e s pons e t o e a c h c hi l d a nd di d

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45 not a t t e m pt t o e xpa nd t he voc a bul a r y voc a l or non voc a l of a ny c hi l d F i na l l y, r e s e a r c h s t udi e s ha v e f a i l e d t o e va l ua t e t he ge ne r a l i z a t i on a nd m a i n t e na nc e of a c qui r e d c om m uni c a t i ve r e s pons e s O nl y one s t udy a na l yz e d ge ne r a l i z a t i on a c r os s i ndi vi dua l s ( D ur a nd & C a r r 1992) N o s t udy e va l ua t e d ge ne r a l i z a t i on a c r os s s e t t i ngs or m a i nt e na nc e of a c qui r e d s ki l l s C l e a r l y, t he F C T ha s m a de a s i gni f i c a nt i m pa c t on c hi l dr e n w i t h A S D ; how e ve r t he r e a r e a num be r of a r e a s w i t hi n t he l i t e r a t ur e t ha t ne e d f ur t he r r e s e a r c h a nd e xpa ns i on. T he s e w i l l be de s c r i be d i n t he f i na l s e c t i on of t hi s c ha pt e r M i l i e u T h e r ap y L i t e r at u r e R e vi e w T he l i t e r a t u r e r e vi e w o f r e s e a r c h c onduc t e d i n t he a r e a of m i l i e u t he r a py be ga n w i t h s e a r c he s of E R I C E duc a t i on, P s yc I N F O a nd A c a de m i c S e a r c h P r e m i e r e l e c t r oni c da t a ba s e s us i ng va r i ous c om bi na t i ons of t he f ol l ow i ng t e r m s : m i l i e u t he r a py, i nc i de nt a l t e a c hi ng, t i m e de l a y, e m be dde d i ns t r uc t i on, a ut i s m a ut i s m s pe c t r um di s or de r a nd c om m uni c a t i on F ol l ow i ng t he e l e c t r oni c da t a ba s e s e a r c h, a ha nd s e a r c h w a s c onduc t e d of t he f ol l ow i ng j ou r na l s c ove r i ng t he s pa n of 1968 t o t he pr e s e nt : E duc at i on and T r ai ni ng i n D e v e l opm e nt al D i s abi l i t i e s F oc us on A ut i s m and O t he r D e v e l opm e nt al D i s abi l i t i e s J our nal of A ppl i e d B e hav i or A nal y s i s J our nal of E ar l y I n t e r v e nt i on, J our nal of P os i t i v e B e hav i or I nt e r v e nt i on, a nd T opi c s i n E ar l y C hi l dhood Spe c i al E duc at i on F i na l l y, a f t e r r e vi e w i ng t he r e t r i e ve d a r t i c l e s a n a r c hi va l s e a r c h w a s c onduc t e d. T he s e s e a r c he s pr oduc e d 28 a r t i c l e s i n w hi c h c om pone nt s of m i l i e u t he r a py w e r e t he pr i m a r y i nt e r ve nt i on f or i nc r e a s i ng c om m uni c a t i on i n c hi l d r e n, o f w hi c h e i gh t i nc l ude d c hi l d r e n w i t h a ut i s m s pe c t r um di s or de r s T he f o l l ow i ng c r i t e r i a w e r e us e d f o r i nc l us i on i n t hi s r e vi e w : ( a ) a t l e a s t one pa r t i c i pa nt o f t he s t udy w a s a c hi l d w i t h a n a ut i s m s pe c t r um di s or de r di a gnos i s ( b ) t he t r a i ni ng oc c ur r e d i n e nvi r onm e nt s t ha t m i r r or e d t he na t ur a l e nvi r onm e nt ( e g c l i ni c a r r a nge d l i ke a t ypi c a l c l a s s r oom ) ( c ) t he p r i m a r y i nt e r ve nt i on i nvol ve d a t l e a s t one of t he i de nt i f i e d

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46 m i l i e u t he r a py t e c hni que s a nd ( d ) t he pr i m a r y i nt e r ve nt i on w a s t o i nc r e a s e c om m uni c a t i on i n c hi l dr e n. T he e i ght a r t i c l e s t ha t m e t t he c r i t e r i a w e r e r e vi e w e d t o de t e r m i ne t he e f f e c t i ve ne s s of m i l i e u t he r a py w i t h c hi l dr e n w i t h A S D P a r t i c ul a r l y, t he s t udi e s w e r e a na l yz e d t o de t e r m i ne t he c ha r a c t e r i s t i c s of t he s t udy pa r t i c i pa nt s r e s e a r c h s e t t i ng, be ha vi or i nt e r ve nt i ons r e s e a r c h de s i gns r e l i a bi l i t y, t r e a t m e nt f i de l i t y a nd m a j o r f i ndi ngs a c r os s s t udi e s a r e pr ovi de d. C h ar ac t e r i s t i c s of S t u d y P ar t i c i p an t s T he m a j or i t y of r e s e a r c he r s r e por t e d ge nde r a l ong w i t h c hr onol ogi c a l a nd m e nt a l a ge s w i t h onl y t w o r e s e a r c h t e a m s r e por t i ng l a ngua ge a ge T w e nt y f i ve out of 34 ( 74% ) of t he pa r t i c i pa nt s w e r e m a l e ; f ou r ( 12% ) w e r e f e m a l e a nd t he ge nde r o f f i ve pa r t i c i pa nt s ( 14% ) ( R os s & G r e e r 2003) w e r e not r e por t e d A s s how n i n T a bl e 2. 5, pa r t i c i pa nt s r a nge d i n a ge f r o m 2. 9 t o 15. 8 ye a r s w i t h t he a ve r a ge a ge be i ng 7 3 ye a r s M e nt a l a ge w a s not r e por t e d c ons i s t e nt l y a c r os s s t udi e s T he a ut ho r s of one s t udy r e po r t e d I Q s c or e s w i t h a r a nge o f < 50 t o 95 w i t h a n a ve r a ge of 61 ( H a nc oc k & K a i s e r 2002) T he a ut ho r s of f i ve ot he r s t udi e s r e por t e d a m e nt a l a ge s c or e w i t h a r a nge o f 2 7 t o 6. 2 ye a r s w i t h a n a ve r a ge o f 3. 9 ye a r s L a ngua ge / c om m uni c a t i on a ge w a s r e por t e d f o r t w o s t udi e s w i t h a r a nge of 1. 6 t o 5 7, w i t h a n a ve r a ge of 2. 8 ye a r s P a r t i c i pa nt s di f f e r e d i n t he i r l a n gua ge l e ve l s pr i o r t o t he s t udi e s w i t h a l l pa r t i c i pa nt s r e por t e d t o ha ve di a gnos e s of A S D O f t he pr i o r s pe e c h l e ve l s r e po r t e d f or 20 pa r t i c i pa nt s ni ne pa r t i c i pa nt s ( 9/ 20, 45 % ) de m ons t r a t e d e c hol a l i a ( i e r e pe a t e d phr a s e ove r a nd ove r ) f our pa r t i c i pa nt s ( 4 20, 20% ) w e r e nonve r ba l a nd s i x pa r t i c i pa nt s ( 6/ 20, 3 0% ) ha d l i m i t e d s pe e c h ( i e one t o t w o w or d phr a s e s r e que s t i ng ba s i c ne e ds s uc h a s f ood) one i ndi vi dua l ( 1/ 20 5 % ) ha d e xt e ns i ve s pe e c h a nd s poke s pont a ne ous l y.

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47 C h ar ac t e r i s t i c s of R e s e ar c h S e t t i n g T he t ype o f s e t t i ngs t he s t udi e s w e r e c onduc t e d i n w a s s i m i l a r a c r os s t he m a j or i t y of t he s t udi e s M os t s t udi e s w e r e c onduc t e d i n t he c hi l d s na t ur a l e nvi r onm e nt ( i e hom e a nd c om m uni t y s e t t i ng) a nd t he c ha nge a ge nt s i nc l ude d i ndi vi dua l s w ho na t u r a l l y i nt e r a c t w i t h t he t a r ge t c hi l d ( e g. pa r e nt s t e a c he r s ) T r ai n e r s A s s how n i n T a bl e 2. 6 t e a c he r s pa r a pr of e s s i ona l s a nd pa r e nt s i m pl e m e nt e d t he m a j or i t y of m i l i e u t he r a py t r a i ni ng O nl y one s t udy ( 12. 5 % ) i nvol ve d a r e s e a r c he r a s t he s ol e i m pl e m e nt e r w hi c h w a s one of t he e a r l i e r i nve s t i g a t i ons w i t h m i l i e u t he r a py t e c hni que s ( C ha r l op, S c h r i e bm a n, & T hi bode a u, 1985 ) T r ai n i n g s e s s i on s T he m a j or i t y of t r a i ne r s c ondu c t e d t r a i ni ng s e s s i ons i n t he na t ur a l e nvi r onm e nt F or e xa m pl e 75% ( i e 6/ 8 s t udi e s ) of t he s t udi e s oc c ur r e d i n t he t a r ge t c hi l d s na t ur a l e nvi r onm e nt t ha t i s t w o s t udi e s w e r e c ond uc t e d i n hom e s a nd f ou r i n c l a s s r oom s e t t i ngs H ow e ve r t w o s t udi e s ( 2/ 8 25 % ) w e r e c onduc t e d i n s e t t i ngs t ha t w e r e not t he c hi l d s na t ur a l e nvi r onm e n t F or e xa m pl e C ha r l op e t a l c onduc t e d t he i r s t udy i n c l i ni c r oom s a r r a nge d l i ke c l a s s r oom s a nd pa r t i t i one d a r e a s of c l a s s r oom s w h i l e H a nc oc k a nd K a i s e r ( 2002) c onduc t e d s e s s i ons i n a pl a yr oom i n a uni ve r s i t y s e t t i ng. H o w e ve r H a nc oc k a nd K a i s e r t he n m e a s ur e d ge ne r a l i z a t i on i n t he ho m e a nd de m ons t r a t e d t ha t t hr e e out of f ou r c hi l d r e n ge ne r a l i z e d t r a i ni ng f r om t he uni ve r s i t y s pl a yr oo m t o t he c hi l d r e n s r e s pe c t i ve hom e s C h ar ac t e r i s t i c s of T ar ge t B e h avi or I n t e r ve n t i o n s an d R e s e ar c h D e s i gn s R e s e a r c he r s i m pl e m e nt e d va r i ous m i l i e u t he r a py t e c hni que s t o a ddr e s s t he va r i e d c om m uni c a t i on s ki l l de f i c i t s de m ons t r a t e d by pa r t i c i pa nt s D i f f e r e nc e s i de nt i f i e d a c r os s t he s t udi e s c a n be or ga ni z e d i n t he f ol l ow i ng c a t e gor i e s : ( a ) t a r ge t e d c om m uni c a t i on s ki l l s t a ught ( i e be ha vi or ) ( b) i nt e r ve nt i ons ( i e m i l i e u p r oc e dur e s us e d) a nd ( c ) r e s e a r c h de s i gns

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48 T ar ge t b e h avi or s S i nc e c om m uni c a t i on l e ve l s o f pa r t i c i pa nt s va r i e d, r e s e a r c he r s t a ught di f f e r e nt c om m un i c a t i on r e s pons e s ( i e be ha vi or ) t o va r i ous pa r t i c i pa n t s a nd f oc us e d on a va r i e t y of c om m uni c a t i on s ki l l s a c r os s s t udi e s ( s e e T a bl e 2 7) T he s e i nc l ude d ba s i c ne e d phr a s e s ( e g. I w a nt s na c k ) ; e m ot i ona l ph r a s e s ( e g. I l i ke you ) ; de s c r i pt i ve phr a s e s ( e g B l oc k i s bi g ) ; pa i r s o f pr e pos i t i ons ( e g. on un de r ) ; que s t i ons ( e g W ha t do you w a nt ? ) ; r e c e pt i ve l a be l i ng ( e g ha ndi ng c o r r e c t f o od i t e m t o t e a c he r ) ; a nd i nc r e a s e s i n t he m e a n l e ngt h of ut t e r a nc e ( i e nu m be r o f w or ds s poke n t oge t he r i n one phr a s e ) A s s how n i n T a bl e 2 7, ba s i c ne e d ph r a s e s w e r e t a ught t o a hi ghe r pe r c e nt a ge of pa r t i c i pa nt s ( 62 % 21 pa r t i c i pa nt s ) w hi l e r e c e pt i ve l a be l i ng w a s t a ught t o onl y t w o pa r t i c i pa nt s ( 6% ) F o r e xa m pl e C ha r l op e t a l ( 1985) t a ught s e ve n pa r t i c i pa nt s t o s a y, I w a nt c ooki e A l s o, R os s a nd G r e e r ( 2003 ) t a ught f i ve pa r t i c i pa nt s t o s a y, c ooki e I n t e r ve n t i on s R e s e a r c he r s us e d va r i ous m i l i e u t h e r a py t e c hni que s t o a ddr e s s t he c om m uni c a t i on di f f i c ul t i e s of t he pa r t i c i pa nt s i n t h e i r r e s pe c t i ve s t udi e s T ypi c a l l y one or m or e of t he f ol l ow i ng m i l i e u t e c hni que s w e r e us e d: ( a ) m ode l / c or r e c t ( b) m a nd/ m ode l / c or r e c t ( c ) t i m e de l a y, o r ( d) i nc i de nt a l t e a c hi ng. T he s t r a t e gi e s va r i e d a c r os s s t udi e s H ow e ve r t he m a j or i t y of r e s e a r c he r s us e d t i m e de l a y a nd/ o r t he m a nd/ m ode l / c or r e c t t e c hni que ( i e 6 / 8, 75 % ) A s s how n i n T a bl e 2 7, t i m e de l a y w a s us e d t o t e a c h t w e nt y one pa r t i c i pa nt s ( 62% ) c om m uni c a t i on s ki l l s F or e xa m pl e C ha r l op e t a l ( 1985) us e d a 2s t o 10s t i m e de l a y a nd J ohns on, M c D onne l l H ol z w a r t h, a nd H unt e r ( 200 4) us e d a 4s t i m e de l a y t o t e a c h c om m uni c a t i on s ki l l s S i m i l a r l y t w e nt y one pa r t i c i pa nt s ( 62% ) w e r e t a ught us i ng t he m a nd/ m ode l / c or r e c t t e c hni que L a s ki e t a l ( 1988 ) us e d m a nd/ m ode l / c or r e c t t o t e a c h ba s i c ne e d phr a s e s de s c r i pt i on phr a s e s a nd que s t i ons A l s o C ha r l op a nd W a l s h ( 1986 ) us e d m a nd/ m ode l / c or r e c t t o t e a c h e m ot i ona l ph r a s e s F ur t he r t i m e de l a y a nd m a nd/ m ode l / c or r e c t

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49 w e r e us e d s i m ul t a ne ous l y f or 13 pa r t i c i pa nt s ( 38 % ) F or e xa m pl e H a nc oc k a nd K a i s e r ( 2002) a nd R os s a nd G r e e r ( 2003 us e d bot h t e c hni que s t o t e a c h c om m uni c a t i o n s ki l l s I n c ont r a s t onl y one pa r t i c i pa nt ( 3 % ) w a s t a ught us i ng t he m ode l / c or r e c t t e c hni que w hi c h w a s done by J ohns on e t a l ( 2004) s i m ul t a ne ous l y w i t h a 4s t i m e de l a y. R e s e ar c h d e s i gn s I n t he s t udi e s r e vi e w e d, a l l r e s e a r c he r s us e d a m ul t i pl e ba s e l i ne s i ngl e s ubj e c t m e t hodol ogy t o e va l ua t e t he e f f e c t i v e ne s s of t he m i l i e u t he r a py i nt e r ve nt i on T he ba s e l i ne pha s e s i n t he s t udi e s w e r e a c r os s pa r t i c i pa nt s c om m uni c a t i on s ki l l s a nd/ or s e t s of obj e c t s A s s how n i n T a bl e 2 7, f i ve o f e i ght ( 62 5 % ) r e s e a r c h t e a m s a na l yz e d t he i nt e r ve nt i on us i ng a m ul t i pl e ba s e l i ne a c r os s onl y pa r t i c i pa nt s one ( 12. 5 % ) r e s e a r c h t e a m a na l yz e d t he i nt e r ve nt i on us i ng a m ul t i pl e ba s e l i ne a c r os s onl y c om m uni c a t i on s ki l l s one ( 12. 5% ) r e s e a r c h t e a m a na l yz e d t he i nt e r ve nt i on us i ng a m ul t i pl e ba s e l i ne a c r os s pa r t i c i pa nt s a nd c om m uni c a t i on s ki l l s a nd one ( 12 5) r e s e a r c h t e a m a na l yz e d t he i nt e r ve nt i ons us i ng a m ul t i pl e ba s e l i ne a c r os s s e t s of obj e c t s ( i e r e c e pt i ve l a ngua ge w he r e c hi l d r e n c hos e t he c or r e c t obj e c t ) R e p or t e d R e l i ab i l i t y R e s e a r c h r e s ul t s w oul d be c om pr om i s e d unl e s s obs e r va t i ons w e r e r e l i a bl e F o r t una t e l y a l l r e s e a r c h t e a m s r e por t e d hi gh i nt e r r a t e r r e l i a bi l i t y. F or e xa m pl e C ha r l op e t a l ( 1985 ) r e por t e d r e l i a bi l i t y of 98% or gr e a t e r f or a l l be ha vi or a l c a t e gor i e s S i m i l a r l y J ohns on e t a l ( 2004) ha d a n a ve r a ge r e l i a bi l i t y o f 99% w i t h a r a nge of 97 t o 10 0% T he ot he r s t udi e s ha d s i m i l a r f i nd i ngs R e p or t e d T r e at m e n t F i d e l i t y I n a ddi t i on t o r e l i a bi l i t y, a l l r e s e a r c h t e a m s w i t h t h e e xc e pt i on of L a s ki C ha r l op a nd S c hr e i bm a n ( 1988) r e por t e d hi gh t r e a t m e nt f i de l i t y ( i e c ons i s t e nc e of i m pl e m e nt a t i on o f t he m e t hods a nd pr oc e dur e s of t r e a t m e nt ) w i t hi n t he i r pr os pe c t i ve s t udi e s T he r e s e a r c h t e a m s r e por t e d t ha t t r e a t m e nt f i de l i t y w a s hi gh ba s e d on di r e c t obs e r va t i ons S i m i l a r t o t he F C T

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50 l i t e r a t ur e r e vi e w e d, r e s e a r c h t e a m s f or m i l i e u t he r a py s e l dom r e por t e d a pe r c e nt a ge of s t e ps c om pl e t e d c or r e c t l y a nd s i m pl y s t a t e d t ha t t he t r e a t m e nt s w e r e i m pl e m e nt e d w i t h hi gh f i de l i t y w i t hout pr ovi di ng t he t r e a t m e nt da t a M aj or M i l i e u T h e r ap y F i n d i n gs R e ga r dl e s s of t he m i l i e u s t r a t e gi e s us e d, r e s e a r c h t e a m s r e por t e d s i m i l a r f i ndi ngs i n t ha t t he y w e r e a l l s uc c e s s f ul i n t e a c hi ng c hi l d r e n w i t h A S D c om m uni c a t i on s ki l l s r e ga r dl e s s of t he c om bi na t i on of t e c hni que s us e d or t he c om m uni c a t i o n s ki l l s t a r ge t e d. F ur t he r t he m a j or i t y of t he c hi l dr e n w i t h A S D pa r t i c i pa t i ng i n t he s e s t udi e s ge ne r a l i z e d t he i r c om m uni c a t i on s ki l l s a c r os s pe opl e a nd/ or s e t t i ngs A s s how n i n T a bl e 2 8, t he s uc c e s s of m i l i e u t he r a py w a s de m ons t r a t e d by a n i nc r e a s e i n t a r ge t e d c om m uni c a t i on s ki l l s f o r a l l 34 pa r t i c i pa nt s F o r e xa m pl e C ha r l op e t a l ( 1985) not e d t ha t a l l 7 pa r t i c i pa nt s i n t he i r s t udy a c hi e ve d t he t a r ge t e d c om m uni c a t i on s ki l l s a t 90 % a c c ur a c y or hi ghe r I n a not he r s t udy, H a nc oc k a nd K a i s e r ( 2 002) not e d t ha t a l l 4 pa r t i c i pa nt s m e a n l e ngt h ut t e r a nc e ( M L U ) a nd di ve r s i t y o f w or ds ( i e noun s a nd ve r bs ) i nc r e a s e d f ol l ow i ng t r a i ni ng S i m i l a r l y, M c G e e K r a nt z a nd M c C l a nna ha n ( 198 5) not e d t ha t a l l t h r e e pa r t i c i pa nt s a c hi e ve d t a r ge t e d c om m uni c a t i on s ki l l s I n a d di t i on t o i nc r e a s i ng t a r ge t e d c om m uni c a t i on s ki l l s i n t he t r a i ni ng s e t t i ng, s e ve r a l r e s e a r c he r s not e d t ha t t he s e s ki l l s ge ne r a l i z e d. F or e xa m pl e C ha r l op e t a l not e d t ha t 6 pa r t i c i pa nt s ( 86% ) ge ne r a l i z e d c om m uni c a t i on s ki l l s t o unt r a i ne d obj e c t s a nd 2 pa r t i c i pa nt s ( 29% ) ge ne r a l i z e d t he c om m un i c a t i on s ki l l s t o unf a m i l i a r s e t t i ngs S i m i l a r t o t he C ha r l op e t a l s t udy, ge ne r a l i z a t i on t o a not he r s e t t i ng oc c ur r e d i n a s t udy c onduc t e d by H a nc oc k a nd K a i s e r ( 2002) H ow e ve r 3 pa r t i c i pa nt s ( 75% ) ge ne r a l i z e d c om m uni c a t i on s ki l l s t o a not he r s e t t i ng a s c om pa r e d t o onl y 29% f or t he C ha r l op e t a l s t udy O ne e xpl a na t i on c oul d be be c a us e H a nc oc k a nd K a i s e r i nc l ude d t he m a nd/ m ode l / c or r e c t t e c hni que i n t he i r s t udy. A ddi t i ona l l y t he

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51 pa r e nt c onduc t e d t he t r a i ni ngs ( s e e T a bl e 2 8) I n a ddi t i on, M c G e e K r a nt z a nd M c C l a nna ha n ( 1985) not e d t ha t a l l t hr e e pa r t i c i pa nt s a c hi e ve d ge ne r a l i z a t i on t o a not he r c l a s s r oom a f t e r a c qui s i t i on w a s a c hi e ve d dur i ng t e a c hi ng s e s s i ons S i m i l a r l y, s e ve r a l r e s e a r c he r s not e d m a i nt e na nc e o f t a r ge t e d c om m un i c a t i on s ki l l s F o r e xa m pl e H a nc oc k a nd K a i s e r ( 2002 ) de m ons t r a t e d t ha t i nc r e a s e s i n t a r ge t l a ngua ge w e r e m a i nt a i ne d f or t he f ou r c hi l d r e n i n t he i r s t udy a s i n di c a t e d t hr ough f o l l ow up obs e r va t i ons c onduc t e d s i x m ont hs a f t e r t he s t udy e nde d. S i m i l a r l y, R os s a nd G r e e r ( 2003) de m ons t r a t e d t ha t a l l pa r t i c i pa nt s i n t he i r s t udy s how e d m a i nt e na nc e of voc a l i z a t i on s ki l l s dur i ng a f ol l ow up pr obe t hr e e m ont hs a f t e r t he s t udy w a s c om pl e t e d. S u m m ar y o f M i l i e u T h e r ap y L i t e r at u r e I n s um m a r y, m i l i e u t he r a py i s one a ppr oa c h r e s e a r c he r s ha ve us e d t o a ddr e s s t he c om m uni c a t i on ne e ds of c hi l dr e n w i t h A S D A s r e s e a r c he r s i nve s t i ga t e d t he us e of m i l i e u t he r a py w i t h c hi l d r e n w i t h A S D t he y pr ovi de d i nt e r ve nt i ons i n na t ur a l e nvi r onm e nt s w he r e t e a c he r s a nd pa r e nt s c onduc t e d t he m a j or i t y of t r a i ni ng. W he n i m pl e m e nt i ng va r i ous m i l i e u t he r a py pr oc e dur e s a c r os s r e s e a r c h s t udi e s r e s e a r c he r s de m ons t r a t e d t ha t c hi l dr e n w i t h A S D i m pr ove d t he i r c om m uni c a t i on s ki l l s A l t hough S i ga f oos ( 2000) ha s not e d t ha t poo r c om m uni c a t i on s ki l l s a nd a be r r a nt be ha vi or s i n c hi l dr e n w i t h A S D a r e hi gh l y l i nke d t hi s r e vi e w f ound no m e nt i on of a be r r a nt be ha vi or s i n t he m i l i e u t he r a py l i t e r a t u r e T hus r e a de r s m a y a c know l e dge t ha t m i l i e u t he r a py i nc r e a s e s c om m uni c a t i on s ki l l s a nd f or m a ny i nd i vi dua l s ge ne r a l i z e s t o ot he r pe opl e a nd s e t t i ngs w he n t r a i n i ng i s c onduc t e d i n t he na t ur a l e nvi r onm e nt H ow e ve r t he e f f e c t m i l i e u t he r a py ha s on a be r r a nt be ha vi or s ha s not be e n i nve s t i ga t e d i n t he l i t e r a t ur e C l e a r l y, t hi s i s a l ogi c a l e xt e ns i on of t he l i t e r a t ur e a nd ne e ds f u r t he r i nve s t i ga t i on.

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52 D i s c u s s i on C hi l dr e n w i t h A S D ha ve s i gni f i c a nt i m pa i r m e nt s t ha t i nf l ue nc e t he i r da i l y f unc t i oni ng. T w o i nt e r r e l a t e d i m pa i r m e nt s t yp i c a l l y e xhi bi t e d a r e de f i c i t s i n a ppr opr i a t e c om m uni c a t i on a nd be ha vi or C hi l dr e n w i t h A S D t yp i c a l l y ha ve de f i c i t s i n a ppr opr i a t e us e of f unc t i ona l c om m uni c a t i on s ki l l s a nd of t e n e nga ge i n a be r r a nt be ha vi or s t ha t s e r ve a c om m uni c a t i ve f unc t i on ( S i ga f oos 2000 ) I n a n a t t e m pt t o a dd r e s s c om m uni c a t i on a nd be ha vi or a l ne e ds r e s e a r c he r s i nde pe nde nt l y ha ve a ddr e s s e d one or b ot h of t he s e pr obl e m s F unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) i s one a r e a of r e s e a r c h t ha t ha s i nve s t i ga t e d t he e f f e c t i ve ne s s of t e a c hi ng c hi l dr e n w i t h A S D f unc t i ona l c om m uni c a t i on s ki l l s t o r e pl a c e t he i r a be r r a nt b e ha vi or s M i l i e u t he r a py i s a not he r a r e a of r e s e a r c h t ha t ha s f oc us e d on t he de ve l opm e nt o f c om m uni c a t i on s ki l l s w i t hout a t t e nt i on t o be ha vi o r a l c ha l l e nge s A l t hough bo t h a r e a s of r e s e a r c h ha ve pr oduc e d pos i t i ve c hi l d out c om e s e a c h a r e a a l s o ha s a num be r o f l i m i t a t i ons T he s t r e ngt hs a nd l i m i t a t i ons of e a c h a r e a of r e s e a r c h w i l l be di s c us s e d ne xt F u n c t i on al C om m u n i c at i o n T r ai n i n g F C T i s one a ppr oa c h r e s e a r c he r s ha ve e m pl oye d t o pr i m a r i l y a ddr e s s t he be ha vi or a l ne e ds of c hi l dr e n w i t h A S D ( e g s e e M a nc i l 200 6) R e s e a r c he r s ha ve i nve s t i ga t e d t he e f f e c t s of t e a c hi ng a r e pl a c e m e nt c om m uni c a t i ve r e s pons e w hi c h m a t c he s t he f unc t i on o f t he a be r r a nt be ha vi or ha s on t he a s s oc i a t e d a be r r a nt be ha vi or F C T i nt e r ve nt i ons ha ve be e n s uc c e s s f ul l y i m pl e m e nt e d pr i m a r i l y i n c l i ni c a l s e t t i ngs r a t he r t ha n i n na t ur a l c om m uni c a t i ve e nvi r onm e nt s T he F C T l i t e r a t ur e i ndi c a t e s a de c r e a s e i n a be r r a nt be ha vi or a nd a n i nc r e a s e i n t he r e pl a c e m e nt c om m uni c a t i ve r e s pons e f or t he pa r t i c i pa nt s w i t h A S D w hi c h i s a s t r e ngt h o f t hi s i n t e r ve nt i on. S t r e n gt h s A s di s c us s e d i n pr e vi ous s e c t i ons F C T r e s e a r c he r s ha ve de m ons t r a t e d s e ve r a l s t r e ngt hs of t hi s i nt e r ve nt i on F i r s t r e s e a r c he r s ha ve pr ovi de d a p l e t hor a of e vi de nc e

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53 de m ons t r a t i ng t ha t F C T ha s a s i gni f i c a nt i m pa c t o n a be r r a nt b e ha vi or ( D ur a nd & C a r r 1992; W a c ke r e t a l 2005) S e c ond, e vi de nc e pr ov i de d b y r e s e a r c he r s c ons i s t e nt l y de m ons t r a t e s t ha t c hi l dr e n w ho r e c e i ve F C T us e t he r e pl a c e m e nt c o m m uni c a t i ve be ha vi or i n pl a c e of t he a be r r a nt be ha vi or dur i ng i nt e r ve nt i on s e s s i ons F i na l l y, t he di s c r e t e t r i a l pr oc e dur e s t ypi c a l l y us e d by F C T r e s e a r c he r s ha ve be e n s how n t o be m os t e f f e c t i ve a t i ni t i a l a c qui s i t i on of c om m uni c a t i on s ki l l s w he n c om pa r e d t o s uc h t e c hni que s a s i nc i de nt a l t e a c hi ng ( M i r a nda L i nne & M e l i n, 1992 ) L i m i t at i on s D e s pi t e t he s t r e ngt hs de m ons t r a t e d b y F C T r e s e a r c he r s a f e w l i m i t a t i ons s houl d be a ddr e s s e d. F i r s t l i m i t e d F C T r e s e a r c h h a s be e n c onduc t e d i n na t ur a l e nvi r onm e nt s O nl y t w o s t udi e s ( 2 of 8 25 % ) w e r e i de nt i f i e d t ha t ha ve c onduc t e d t r a i ni ng i n na t u r a l e nvi r onm e nt s ( e g hom e ) F or e xa m pl e O N e i l l a nd S w e e t l a nd B a ke r ( 2001) c onduc t e d t he i r s t udy i n va r i ous l oc a t i ons of t he pa r t i c i pa nt s c l a s s r oom w hi l e W a c ke r e t a l ( 2005) c onduc t e d t r a i ni ng i n de s i gna t e d r oom s of t he pa r t i c i pa nt s ho m e S e c ond, pa r e nt s a nd t e a c he r s s e l dom w e r e i nc l ude d a s t he c ha nge a ge nt O nl y t w o s t udi e s us e d a t e a c he r ( W a c ke r e t a l 1990) o r a pa r e nt ( W a c ke r e t a l 2005) a s a c ha nge a ge nt T h i r d, a l t hough r e s e a r c he r s ha ve de m ons t r a t e d t ha t F C T r e s ul t s i n a n i nc r e a s e i n c om m u ni c a t i on, t hi s ha s be e n l i m i t e d t o onl y one t r a i ne d c om m uni c a t i on m a nd. N o s t udi e s ha ve t a ught m or e t ha n one c om m uni c a t i on m a nd t o a c hi l d. F i na l l y, t he r e ha s be e n a l a c k o f e m pha s i s on ge ne r a l i z a t i on a nd m a i nt e na nc e i n t he r e s e a r c h. D ur a nd a nd C a r r ( 19 92) c onduc t e d t he onl y s t udy t ha t e va l ua t e d a nd de m ons t r a t e d ge ne r a l i z a t i on of c om m uni c a t i on t o a not he r pe r s on. N o s t udi e s ha ve be e n c onduc t e d t ha t e xa m i ne d t he ge ne r a l i z a t i on t o ot he r s e t t i ngs or m a i n t e na nc e a c r os s t i m e M i l i e u T h e r ap y M i l i e u t he r a py i s a not he r a ppr oa c h r e s e a r c he r s ha ve us e d t o i m pr ove c om m uni c a t i ve f unc t i oni ng of c hi l dr e n w i t h A S D R e s e a r c he r s i n t hi s a r e a ha ve f oc us e d pr i m a r i l y on i nc r e a s i ng

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54 t a r ge t e d c om m uni c a t i on s ki l l s T he y ha ve i nve s t i g a t e d t he e f f e c t s t ha t t e c hni que s s uc h a s t i m e de l a y a nd i nc i de nt a l t e a c hi ng ha ve on t he c om m un i c a t i on of c hi l d r e n w i t h A S D A s r e s e a r c he r s e xa m i ne d m i l i e u t he r a py t he y s uc c e s s f ul l y i m pl e m e nt e d t he m i l i e u i nt e r ve nt i on s t r a t e gi e s i n t he na t ur a l e nvi r onm e nt w hi c h r e s ul t e d i n a n i nc r e a s e i n c om m uni c a t i on s ki l l s S t r e n gt h s S e ve r a l s t r e ngt hs of m i l i e u t he r a py a r e e vi de nt F i r s t va r i ous t e c hni que s s uc h a s t i m e de l a y ( J ohns on e t a l 2004) a nd m a nd/ m od e l / c or r e c t ( R os s & G r e e r 2003 ) ha ve pr oduc e d pos i t i ve r e s ul t s s uc h a s i nc r e a s i ng t he r e s pons e va r i a t i on of c hi l dr e n s c om m uni c a t i ve s ki l l s ( W a r r e n & G a z da g, 1990; Y ode r & W a r r e n, 2002) F or e xa m pl e H a nc oc k a nd K a i s e r ( 2002) s how e d a n i nc r e a s e i n t he M L U ( c om pl e xi t y) a nd voc a bul a r y ( di ve r s i t y) of c hi l dr e n w i t h A S D S e c ond, t he m a j o r i t y o f t he m i l i e u t he r a py r e s e a r c h ha s be e n c onduc t e d i n t he c hi l dr e n s na t ur a l e nvi r onm e nt S i x out of 8 ( 75% ) s t udi e s w e r e c onduc t e d i n a na t u r a l e nvi r on m e nt T hi r d, pa r e nt s a nd t e a c he r s ha ve de m ons t r a t e d t he a bi l i t y t o be e f f e c t i ve na t u r a l c ha nge a ge nt s us i ng m i l i e u t he r a py ( 7 ou t of 8, 88% r e s e a r c h s t udi e s r e vi e w e d) F or e xa m pl e a m ot he r i m pl e m e nt e d m i l i e u t he r a py i nt e r ve nt i ons i n a s t ud y c onduc t e d by H a nc oc k a nd K a i s e r ( 2002) I n a s t udy c onduc t e d by R os s a nd G r e e r ( 2003) a t e a c he r i m pl e m e nt e d t he m i l i e u t he r a py i nt e r ve nt i ons F i na l l y, r e s e a r c he r s c ons i s t e nt l y ha ve de m ons t r a t e d t ha t c om m uni c a t i on s ki l l s t a ught t o c hi l d r e n w i t h A S D us i ng m i l i e u t he r a py pr oc e dur e s ge ne r a l i z e t o ot he r pe opl e a nd s e t t i ngs ( M c G e e e t a l 1985 ) a nd ha ve gr e a t e r m a i nt e na nc e t ha n di s c r e t e t r i a l p r oc e dur e s ( M i r a nda L i nne & M e l i n, 1992 ) L i m i t at i on s A l t hough m i l i e u t he r a py r e s e a r c he r s ha ve de m ons t r a t e d num e r ous s t r e ngt hs of t hi s i nt e r ve nt i on, a f e w l i m i t a t i ons s ho ul d be a ddr e s s e d. F i r s t r e s e a r c he r s ha ve not e va l ua t e d m i l i e u t he r a py s e f f e c t s on a be r r a nt be ha vi or R e s e a r c h c ons um e r s do not know i f i m pr ove m e nt s i n a be r r a nt be ha vi or oc c ur r e d, w hi c h m a y e f f e c t de c i s i ons of c ons um e r s w ho a r e

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55 l ooki ng f or c om pr e he ns i ve i nt e r ve nt i ons S e c ond, t he r e i s a pa uc i t y o f r e s e a r c h i nvol vi ng c hi l dr e n w i t h A S D T he f e w m i l i e u t he r a py r e s e a r c h s t udi e s t ha t ha ve i nc l ude d c hi l dr e n w i t h A S D w e r e not de s i gne d s pe c i f i c a l l y f or t he A S D p opul a t i on; i ns t e a d, t he y w e r e de s i gne d f or a ny i ndi vi dua l w i t h c om m un i c a t i on de f i c i t s F u t u r e R e s e ar c h D i r e c t i on s W he n c ons i de r i ng t he s t r e ngt hs a nd l i m i t a t i ons de s c r i be d i n t he F C T a nd m i l i e u t he r a py l i t e r a t ur e f ut ur e r e s e a r c h s houl d a ddr e s s c onc e r ns t o e xt e nd t he l i t e r a t ur e o f bot h a r e a s of r e s e a r c h. A l ogi c a l e xt e ns i on of t he F C T r e s e a r c h i s t o e xt e nd t hi s l i t e r a t ur e by e x a m i ni ng t he f ol l ow i ng: ( a ) t he e f f e c t i ve ne s s of F C T s t r a t e gi e s i n na t ur a l e nvi r o nm e nt s ( b ) t he ge ne r a l i t y o f F C T a c r os s pe opl e ( a dul t s a nd pe e r s ) a nd s e t t i ngs ( hom e s c hool c om m un i t y) a nd ( c ) t he m a i nt e na nc e of s ki l l s a c qui r e d t h r ough F C T a c r os s t i m e A s di s c us s e d pr e vi ous l y, f e w F C T r e s e a r c h s t udi e s ha ve be e n c onduc t e d i n na t ur a l e n vi r onm e nt s F ur t he r r e s e a r c he r s ha ve not i nve s t i ga t e d t he ge ne r a l i z a t i on or m a i nt e na nc e of a c qui r e d s ki l l s s uf f i c i e nt l y. I n a ddi t i on r e s e a r c he r s ha ve not e xa m i ne d t he us e of pa r e nt s a nd t e a c he r s a s na t ur a l c ha nge a ge nt s s uf f i c i e nt l y. S i m i l a r l y, t he r e a r e l ogi c a l e xt e ns i ons of t he m i l i e u t he r a py r e s e a r c h. A na l ys i s of t he f ol l ow i ng: ( a ) t he c onne c t i on t o be ha vi o r a l pr obl e m s a nd ( b ) t he de s i gn of s t udi e s s pe c i f i c a l l y f or c h i l d r e n w i t h A S D w oul d e xt e nd t he c ur r e nt r e s e a r c h ba s e A s de s c r i be d pr e vi ous l y, m i l i e u t he r a py r e s e a r c he r s ha ve not s ys t e m a t i c a l l y a na l yz e d t he r e l a t i on be t w e e n a c qui s i t i on of c om m uni c a t i on s ki l l s a nd a be r r a nt be ha vi or F o r e xa m pl e one que s t i on f or f ut u r e r e s e a r c he r s t o c ons i de r i s w he t he r a be r r a nt be ha vi or s c ont i nue t o de c r e a s e a c r os s s e t t i ngs a s t he c hi l d s c om m uni c a t i on r e pe r t oi r e i nc r e a s e s ? T he f i e l d c a nnot c onc l ude w ha t i nf l ue nc e i f a ny t ha t m i l i e u t he r a py ha s on c hi l dr e n s a be r r a nt be ha vi or pa r t i c ul a r l y f o r c hi l dr e n w i t h A S D A l s o, s t udi e s

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56 ha ve not be e n de s i gne d f or c hi l dr e n w i t h A S D R a t he r t he s t udi e s ha ve be e n de s i gne d f or c hi l dr e n w i t h l a ngua ge de l a ys w hi c h m a y o r m a y not i nc l ude c hi l dr e n w i t h A S D O ne l ogi c a l e xt e ns i on of t he l i t e r a t u r e i s t o c om bi n e t he s t r e ngt hs i n F C T a nd m i l i e u t he r a py. E a c h a ppr oa c h ha s s t r e ngt hs t ha t w oul d s uppor t t he f ut ur e r e s e a r c h di r e c t i ons f o r t he ot he r a ppr oa c h ( e g. m i l i e u t he r a py i s i n na t u r a l e n vi r onm e nt s a nd F C T de c r e a s e s a be r r a nt be ha vi or ) C om bi ni ng bo t h a r e a s of r e s e a r c h m a y ( a ) i nc r e a s e t he r e s pons e va r i a t i on ( i e m or e w or ds a nd m or e c om pl e x w or ds ) o f c hi l d r e n s c om m uni c a t i ve s ki l l s ( b ) pr ov i de a n a na l ys i s of t he r e l a t i on be t w e e n a be r r a nt be ha vi or s a nd c om m uni c a t i on, ( c ) f a c i l i t a t e ge ne r a l i z a t i on a n d m a i nt e na nc e of c om m uni c a t i ve s ki l l s i n na t ur a l e n vi r onm e nt s t ha t a l s o r e pl a c e a be r r a nt be ha vi or a nd ( d) de m ons t r a t e t ha t t he s e s ki l l s c a n be t a ught by na t ur a l c ha nge a ge nt s A s pr e vi ous l y m e nt i one d, r e s e a r c he r s i nve s t i ga t i ng m i l i e u t he r a py c ons i s t e nt l y ha ve de m ons t r a t e d t ha t us i ng pr oc e dur e s s uc h a s t i m e d e l a y a nd m a nd/ m ode l / c or r e c t i n t he na t ur a l e nvi r onm e nt gr e a t l y i nc r e a s e s t he r e s pons e va r i a t i on of c hi l d r e n s c om m uni c a t i ve s ki l l s ( W a r r e n & G a z da g, 1990; Y ode r & W a r r e n, 2002) T hus c om bi ni ng bot h a r e a s of r e s e a r c h a nd f ol l ow i ng t he s a m e m i l i e u t he r a py pr oc e dur e s w hi l e i m p l e m e nt i ng F C T s houl d r e s ul t i n s i m i l a r f i ndi ngs I n a ddi t i on t o i nc r e a s i ng r e s pons e va r i a t i on, s i m ul t a ne ous l y a na l yz i ng c om m uni c a t i on a nd a be r r a nt be ha vi or s i s pa r t i c ul a r l y i m por t a n t be c a us e m a ny r e s e a r c he r s ( C a r r & D ur a nd, 1985; S i ga f oos 2000) ha ve hypot he s i z e d a di r e c t r e l a t i o ns hi p be t w e e n a be r r a nt be ha vi or s a nd c om m uni c a t i on s ki l l s i n c hi l dr e n w i t h A S D D e s pi t e t hi s hypot he s i s t he r e l a t i ons hi p be yond one be ha vi or a nd c om m uni c a t i on m a nd us i ng F C T ha s not be e n i nve s t i ga t e d a de qua t e l y. T he f i ndi ngs of F C T r e s e a r c h ha ve s how n t ha t t e a c hi ng a c om m uni c a t i ve r e s pons e w i l l de c r e a s e one be ha vi or ; how e ve r t he s e s t udi e s ha ve not i nve s t i ga t e d w he t he r a be r r a nt be ha vi o r s i n va r i ous s e t t i ngs c ont i nue t o de c r e a s e a s m or e c om m uni c a t i on m a nds a r e t a ught t o c hi l d r e n w i t h A S D

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57 ( M a nc i l 2006) I n c ont r a s t r e s e a r c h i n m i l i e u t he r a py w i t h c hi l dr e n w i t h A S D ha s not a ddr e s s e d t hi s r e l a t i ons hi p, be c a us e t hi s r e s e a r c h f oc us e s pr i m a r i l y on t he c om m uni c a t i o n of c hi l dr e n w i t h A S D C om bi ni ng bot h a r e a s of r e s e a r c h s houl d a ddr e s s t he r e l a t i ons hi p be t w e e n t he t w o va r i a bl e s A not he r be ne f i t o f c om bi ni ng bot h r e s e a r c h a r e a s i s t ha t m i l i e u t he r a py r e s e a r c he r s ha ve a n e xt e ns i ve hi s t or y de m ons t r a t i ng t he e f f e c t i v e ne s s of r e s e a r c h i n t he na t u r a l e nvi r on m e nt ( A l pe r t & K a i s e r 1992; H a l l e B a e r & S pr a dl i n, 1 981; H a r t & R i s l e y, 1975; W a r r e n & G a z da g, 1990) A s a f or e m e nt i one d t he s e m e t hods ha ve de m ons t r a t e d ge ne r a l i z a t i on a nd m a i nt e na nc e of c om m uni c a t i on s ki l l s i n c hi l dr e n w i t h A S D a nd ot he r di s a bi l i t i e s s uc h a s s pe e c h di s or de r s ( M i r a nda L i nne & M e l i n, 1992 ) B y us i ng m i l i e u t he r a py pr oc e dur e s i n t he na t u r a l e nvi r onm e nt r e s ul t s m a y i ndi c a t e s i m i l a r ge ne r a l i z a t i on a nd m a i nt e na nc e of t a r ge t e d c om m uni c a t i on s ki l l s t h a t r e pl a c e t he a be r r a nt be h a vi or I n a ddi t i on t o t r a i ni ng i n na t ur a l e nvi r onm e nt s m i l i e u t he r a py r e s e a r c he r s ha ve de m ons t r a t e d t he s uc c e s s of t r a i ni ng pa r e nt s a nd t e a c he r s t o i m pl e m e nt t he i nt e r ve nt i on T he pa r e nt s a nd t e a c he r s us e d t he pr oc e dur e s w i t h hi gh f i de l i t y a nd r e s ul t s i ndi c a t e d a n i nc r e a s e i n c om m uni c a t i on s ki l l s f or a l l c hi l d r e n. C om bi ni ng m i l i e u t he r a py w i t h F C T m a y s how s i m i l a r r e s ul t s f or a n i nc r e a s e i n c om m uni c a t i on s ki l l s a nd a de c r e a s e i n a be r r a nt be ha vi or w i t h pa r e nt s a s na t ur a l c ha nge a ge nt s A not he r r e a s on t o s i m ul t a ne ous l y a na l yz e t he d i ve r s i t y of c om m uni c a t i on m a nds a nd a be r r a nt be ha vi or s i s e f f i c i e nc y. A s not e d by K oe ge l a nd L a Z e bni k ( 2004 ) t he ke y t o a ny t r e a t m e nt pr ogr a m i s t o s t a r t i nt e r ve nt i on a t a n e a r l y a ge K oe ge l a nd L a Z e bni k f ur t he r not e d t ha t e a c h m om e nt de f i c i t s i n c hi l dr e n w i t h A S D a r e not a ddr e s s e d; t he c ha nc e t he c hi l dr e n w i l l f unc t i on i nde pe nde nt l y i n s oc i e t y de c r e a s e s s i gni f i c a nt l y. H ow e ve r c hi l d r e n w i t h A S D a nd t he i r

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58 f a m i l i e s ha ve a l i m i t e d a m ount o f t i m e a va i l a bl e f o r t he r a py, a s do m a ny i ndi vi dua l s ; t hus c om bi ni ng t w o f or m s of i nt e r ve nt i on ( i e F C T a n d m i l i e u t he r a py) opt i m i z e s t he us e of t i m e by c onc ur r e nt l y a ddr e s s i ng m or e t ha n one de f i c i t a r e a I n s um m a r y, bot h F C T a nd m i l i e u t he r a py ha ve be e n us e d s uc c e s s f ul l y t o a ddr e s s t he ne e ds of c hi l dr e n w i t h A S D F unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) ha s f oc us e d on t e a c hi ng c hi l dr e n w i t h A S D f unc t i ona l c om m uni c a t i on s ki l l s t o r e pl a c e a be r r a nt be ha vi or s I n c ont r a s t m i l i e u t he r a py ha s f oc us e d on t he de ve l opm e nt o f c om m uni c a t i on s ki l l s w i t hout a t t e nt i on t o be ha vi or a l c ha l l e nge s A l t hough bot h a r e a s of r e s e a r c h ha ve pr oduc e d pos i t i ve c hi l d out c om e s e a c h a r e a a l s o ha s a num be r of l i m i t a t i ons I n c onc l us i on, t he c om bi na t i on o f m i l i e u t he r a py a nd F C T w i l l e xt e nd c u r r e nt r e s e a r c h by a ddr e s s i ng m a i nt e na nc e a nd ge ne r a l i z a t i on. M a i nt e na nc e a nd ge ne r a l i z a t i on w i l l be a dd r e s s e d by us i ng m i l i e u t he r a py pr oc e dur e s e m be dde d i n t he n a t ur a l e nvi r onm e nt a nd by t r a i ni ng pa r e nt s i n hom e s a nd t e a c he r s i n c l a s s r oom s ( i e na t u r a l e nv i r onm e nt ) w hi l e c ol l e c t i ng da t a a c r os s t i m e s e t t i ngs a nd pe opl e T hi s w i l l he l p de t e r m i ne i f t h e t r a i ni ng o f a c hi l d w i t h A S D by hi s or he r pa r e nt i n t he hom e s e t t i ng w i l l m a i nt a i n ove r t i m e a nd/ or ge ne r a l i z e t o a c l a s s r oom s e t t i ng. T he r e f or e t he p u r pos e of t hi s s t udy w a s t o de t e r m i ne t he e f f e c t i ve ne s s of c om bi ni ng t he s t r e ngt hs of t w o e f f e c t i ve s t r a t e gi e s [ i e m i l i e u t h e r a py a nd f unc t i ona l c om m uni c a t i on t r a i ni ng ( F C T ) ] t o r e pl a c e a be r r a nt be ha vi o r w i t h f unc t i ona l c om m uni c a t i ve s ki l l s i n t he i ndi v i dua l s na t ur a l e nvi r onm e nt s w i t h pa r e nt s a s c ha nge a ge nt s T he f ol l ow i ng r e s e a r c h que s t i ons w i l l be a ddr e s s e d: ( a ) D oe s t he i m pl e m e nt a t i on o f a m odi f i e d m i l i e u t he r a py i nt e r ve nt i on i nc r e a s e c om m uni c a t i on r e s pons e s a nd de c r e a s e de pe nde nc e on pr om pt s i n c hi l dr e n w i t h A S D i n a na t ur a l s e t t i ng?

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59 ( b) D o ne w l y a c qui r e d c om m un i c a t i on s ki l l s i n c hi l dr e n w i t h A S D ge ne r a l i z e t o a n unt r a i ne d s e t t i ng ? ( c ) D o ne w l y a c qui r e d c om m uni c a t i on s ki l l s i n c hi l dr e n w i t h A S D m a i nt a i n ove r t i m e ? ( d) D oe s t he i m pl e m e nt a t i on of a m od i f i e d m i l i e u t he r a py i nt e r ve nt i on r e s ul t i n a de c r e a s e of a be r r a nt be ha vi or s i n c hi l dr e n w i t h A S D i n a na t u r a l s e t t i ng?

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60 T a bl e 2 1 C ha r a c t e r i s t i c s of t he s t udy pa r t i c i pa nt s of F C T S t udy N C A L A M A M F D i a gnos i s P r i or s pe e c h l e ve l C a r r & D u r a nd ( 1985 ) 1 13 N / A 3 1 A ut i s m V e r ba l ( c om pl e t e s e nt e nc e s ) D ur a nd & C a r r ( 1987 ) 4 7 13 3. 3 7 7 3 7 9 4 2 A ut i s m ; V e r ba l ( e c hol a l i a c om pl e x 2 P D D s e nt e nc e s bi z a r r e s pe e c h) D ur a nd & C a r r ( 1992 ) 3 3. 8 4. 9 1. 8 3 8 2. 4 4. 4 2 1 A ut i s m N / A M a r t i n e t a l ( 2005 ) 1 10 N / A N / A 1 A ut i s m N onve r ba l O N e i l l & S w e e t l a nd 2 6 15 N / A N / A 2 A ut i s m M R V e r ba l ( non f unc t i ona l ) B a ke r ( 2001) R os s ( 2002) 3 9 14. 8 7 13. 3 N / A 1 2 A ut i s m V e r ba l W a c ke r e t a l ( 1990) 1 7 N / A N / A 1 A ut i s m M R N one S e i z ur e di s or de r W a c ke r e t a l ( 2005) 7 2. 7 6. 5 N / A N / A 6 1 3 A ut i s m N / A 4 P D D 1 S e i z ur e d i s or de r 2 C D T ot a l 22 m = 8 m = 5. 7 m = 4. 1 18 4 R a nge ( 2 7 15 ) ( 1. 8 13 3) ( 2. 4 7. 9 ) N ot e C A = c hr onol ogi c a l a ge ; L A = l a ngua ge a ge ; M A = m e nt a l a ge ; N / A = not a va i l a bl e ; M R = m e nt a l r e t a r da t i on; f unc = f unc t i ona l ; M = m a l e ; F = f e m a l e ; m = m e a n; C D = c om m uni c a t i on di s or de r *A ge i n ye a r s / m ont hs

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61 T a bl e 2 2 C ha r a c t e r i s t i c s of t he e nvi r onm e nt of F C T S t udy F C T i m pl e m e nt e r F C T t r a i ni ng l oc a t i on D e s c r i pt i on o f l oc a t i on C a r r & D u r a nd ( 1985 ) R e s e a r c he r S e pa r a t e c l a s s 5 x 10 m c l a s s r oom ne xt doo r D ur a nd & C a r r ( 1987 ) R e s e a r c he r / A s s i s t a nt s S e pa r a t e c l a s s C ont a i ne d t a bl e t w o c ha i r s D ur a nd & C a r r ( 1992 ) R e s e a r c h A s s i s t a nt s S e pa r a t e c l a s s T a bl e c ha i r s f or t r a i ne r c hi l dr e n M a r t i n e t a l ( 2005 ) R e s e a r c he r S e pa r a t e c l a s s N / A O N e i l l & S w e e t l a nd R e s e a r c he r V a r i ous c l a s s l oc a t i ons N / A B a ke r ( 2001) R os s ( 2002) R e s e a r c he r S e pa r a t e c l a s s T a bl e books he l f 3 c ha i r s W a c ke r e t a l ( 1990) T he r a pi s t g r a dua t e S t a nda r d c l a s s r oom / T he r a py r oom ha d t a bl e c ha i r s s t ude nt s 1 t e a c he r t he r a py r oom W a c ke r e t a l ( 2005) C hi l dr e n s pa r e nt s R oom a t hom e N / A N ot e N / A = not a va i l a bl e

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62 T a bl e 2 3 R e s e a r c h D e s i gns a nd I nt e r ve nt i ons S t udy F C T de s i gn F B A pr oc e dur e s D e pe nde nt m e a s ur e s F unc t i on R e s pons e C a r r & D u r a nd ( 1985 ) R e ve r s a l I F A A l t T x A G T A N S I B D P E V e r ba l D ur a nd & C a r r ( 1987 ) M ul t i pl e I F A A l t T x 2 B R ; 2 H F E V e r ba l B a s e l i ne D ur a nd & C a r r ( 1992 ) M ul t i pl e I F A A l t T x 2 D P ; 2 O P ; T A N A V e r ba l B a s e l i ne M a r t i n e t a l ( 2005 ) A l t T x F A A l t T x T A N A G W E P i c t ur e c a r d O N e i l l & S w e e t l a nd M ul t i pl e F A A l t T x 2 W ; 1 D P ; 1 S I B E V e r ba l B a ke r ( 2001) B a s e l i ne R os s ( 2002) R e ve r s a l F A A l t T x no or poo r i ni t i a t i on 1 A 1 E 1 T V e r ba l W a c ke r e t a l ( 1990) R e ve r s a l F A A l t T x S I B T S i gn l a ngua ge W a c ke r e t a l ( 2005) M ul t i pl e F A m ul t i pl e 6 A G ; 4 S I B ; 3 D P 4 A & E ; S i gns B a s e l i ne E l e m e nt de s i gn 1 A & T ; P i c t ur e s 1 U V e r ba l A s s i s t i ve t e c hnol ogy N ot e A G = a ggr e s s i ve be ha vi or ; S I B = s e l f i nj ur i o us be ha vi or ; D P = de s t r oyi ng pr ope r t y; O P = oppo s i t i ona l ; T A N = t a nt r um ; W = w a l k a w a y; F C T = f unc t i ona l c om m un i c a t i on t r a i n i ng; F A = f unc t i ona l a na l ys i s ; F B A = f unc t i ona l be ha vi or a l a s s e s s m e nt ; H F = ha nd f l a ppi ng; B R = body r oc ki ng; N / A = not a va i l a bl e ; I = i nt e r vi e w ; A l t T x = a l t e r na t i ng t r e a t m e nt ; A = a t t e nt i on; E = e s c a pe ; T = t a ngi bl e ; U = undi f f e r e nt i a t e d

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63 T a bl e 2 4 M a j or f i ndi ngs of F C T S t udy T x F I R r e l i a bi l i t y B e ha vi or a l r e s ul t s C om m uni c a t i on r e s ul t s G e n. M a i nt C a r r & D u r a nd ( 1985 ) H i gh 80% or hi ghe r D B de c r e a s e d t o 0. 5% R e l e va nt r e s pons e s N N m a i nt a i ne d D ur a nd & C a r r ( 1987 ) H i gh 80% or hi ghe r R e duc t i on i n H F B R C om m uni c a t i on i nc r e a s e d N N e xhi bi t e d f ol l ow i ng t r a i ni ng D ur a nd & C a r r ( 1992 ) H i gh N / A D e c r e a s e d, m a i nt a i ne d U npr om pt e d c om m uni c a t i on Y N be s t i n F C T / t i m e out M a r t i n e t a l ( 2005 ) H i gh 97 99% B e a r huggi ng de c r e a s e d I nde pe nde nt l y a f t e r A pha s e N N O N e i l l & S w e e t l a nd H i gh 87 99% D i s r upt i ve be ha vi or S t i m ul us ge ne r a l i z a t i on N N B a ke r ( 2001) de c r e a s e d oc c ur r e d a c r os s s om e t a s ks R os s ( 2002) H i gh 88 100% N / A F a ul t y r e s pons e s de c r e a s e d N N W a c ke r e t a l ( 1990) H i gh 92% a ve r a ge F C T w / t i m e out S i gni ng w a s m a i nt a i ne d N N r e s ul t e d i n ha nd bi t i ng de c r e a s i ng t o 0% W a c ke r e t a l ( 2005) H i gh 90 100% B e ha vi or s de c r e a s e d M a ndi ng i nc r e a s e d Y N f or a l l pa r t i c i pa nt s r a ngi ng f r om 66 25% t o 100 % r e duc t i on N ot e T x = t r e a t m e nt ; H F = ha nd f l a ppi ng; B R = b ody r oc ki ng; N / A = not a va i l a bl e ; F C T = f unc t i ona l c om m uni c a t i on t r a i ni ng; D b = di s r upt i ve be ha vi or ; T x F = t r e a t m e nt f i de l i t y; G e n. = ge ne r a l i z a t i on; M a i nt = m a i nt e na nc e ; I R = i nt e r r a t e r ; N = no; Y = ye s

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64 T a bl e 2 5 C ha r a c t e r i s t i c s of t he s t udy pa r t i c i pa nt s of m i l i e u t he r a py S t udy N C A L A M A M F D i a gnos i s P r i or S pe e c h L e ve l C ha r l op, S c hr i e bm a n 7 5. 1 10 9 N / A U 6. 1 7 A ut i s m 2 N onve r ba l ; & T hi bode a u ( 1985) 5 E c hol a l i c C ha r l op & W a l s h ( 1986 ) 4 6 8. 8 N / A 3. 6 6 2 4 A ut i s m 2 E c hol a l i c 1 L i m i t e d s pe e c h 1 E xt e ns i ve s pe e c h H a nc oc k & K a i s e r ( 2002) 4 2. 9 4 5 1. 7 2. 2 N / A 3 1 A ut i s m L i m i t e d s pe e c h J ohns on, M c D onne l l 1 8 N / A N / A 1 A ut i s m L i m i t e d s pe e c h H ol z w a r t h, & H unt e r ( 2004) L a s ki C ha r l op, & 8 5 9. 6 N / A 1 7 3. 1 7 1 A ut i s m 4 N onve r ba l S c hr i e bm a n ( 1988) 4 E c hol a l i c M c G e e K r a nt z M a s on & 2 12 6 15. 8 N / A 5 5 7 1 1 A ut i s m L i m i t e d s pe e c h M c C l a nna ha n ( 1985) M c G e e K r a nt z & 3 6 9 3. 0 5. 7 2. 2 5 3 3 A ut i s m L i m i t e d s pe e c h, o f t e n M c C l a nna ha n ( 1985) e c hol a l i c R os s & G r e e r ( 2003) 5 5. 5 6 9 N / A N / A N / A A ut i s m L i m i t e d s pe e c h T ot a l 34 m = 7. 3 m = 2. 8 m = 3. 9 25 4 R a nge ( 2. 9 15. 8 ) ( 1. 6 5 7) ( 2 7 6 2) N ot e C A = c hr onol ogi c a l a ge ; L A = l a ngua ge a ge ; M A = m e nt a l a ge ; N / A = not a va i l a bl e ; U = unt e s t a bl e ; f unc = f unc t i ona l ; M = m a l e ; F = f e m a l e ; m = m e a n *a ge i n ye a r s

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65 T a bl e 2 6 C ha r a c t e r i s t i c s of t he e nvi r onm e nt of m i l i e u t he r a py S t udy T he r a py i m pl e m e nt e r T he r a py t r a i ni ng l oc a t i on D e s c r i pt i on of l oc a t i on C ha r l op e t a l ( 1985 ) R e s e a r c he r S e pa r a t e c l a s s P a r t i t i one d a r e a o f c l a s s r oom a nd c l i ni c r oom C ha r l op & W a l s h ( 1986 ) R e s e a r c he r / P a r e nt T ypi c a l pl a y a r e a P l a y r oom w / t oys out s i de i n gr a s s a r e a H a nc oc k & K a i s e r ( 2002) P a r e nt S e pa r a t e c l a s s C l i ni c r oom J ohns on e t a l ( 2004 ) P a r a pr of e s s i ona l C l a s s r oom N / A L a s ki e t a l ( 1988 ) P r i m a r y c a r e t a ke r H om e V a r i ous r oom s of t ypi c a l hom e M c G e e e t a l ( 1983) T e a c he r G r oup H om e V a r i ous r oom s of t ypi c a l hom e M c G e e e t a l ( 1985) T e a c he r C l a s s r oom T ypi c a l c l a s s r oom R os s & G r e e r ( 2003) T e a c he r C l a s s r oom T ypi c a l c l a s s r oom N ot e N / A = not a va i l a bl e P r i m a r y c a r e t a ke r i s a r e s i de nt hom e pa r e nt

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66 T a bl e 2 7 R e s e a r c h D e s i gns a nd I nt e r ve nt i ons of M i l i e u T h e r a py S t udy R e s e a r c h de s i gn M i l i e u pr oc e dur e s D e pe nde nt m e a s ur e s C om m uni c a t i on s ki l l C ha r l op e t a l ( 1985 ) M ul t i pl e ba s e l i ne T i m e de l a y ( 2s 10s ) C S B a s i c ne e ds A c r os s pa r t i c i pa nt s ( e g. I w a nt ___ ) C ha r l op & W a l s h ( 1986 ) M ul t i pl e ba s e l i ne T i m e de l a y ( 2s 10s ) C S E m ot i on ph r a s e A c r os s pa r t i c i pa nt s M ode l / C or r e c t a nd ( i e I l i ke you ) M a nd/ M ode l / C or r e c t H a nc oc k & K a i s e r ( 2002) M ul t i pl e ba s e l i ne T i m e de l a y ( N / A ) C S M L U A c r os s pa r t i c i pa nt s M a nd/ M ode l / C or r e c t J ohns on e t a l ( 2004 ) M ul t i pl e ba s e l i ne T i m e de l a y ( 4s ) C S B a s i c ne e ds ( U s e of A c r os s C S M ode l / C or r e c t de vi c e t o r e que s t he l p, br e a k, a nd s na c k) L a s ki e t a l ( 1988 ) M ul t i pl e ba s e l i ne M a nd/ M ode l / C or r e c t C S B a s i c ne e ds ( i e A c r os s pa r t i c i pa nt s I w a nt c a r ) ; D e s c r i pt i on ( i e B l oc k i s bi g ) ; a nd Q ue s t i ons ( i e W ha t do you w a nt ? ) M c G e e e t a l ( 1983) M ul t i pl e ba s e l i ne I nc i de nt a l t e a c hi ng C S R e c e p t i ve l a be l i ng of A c r os s s e t s of obj e c t s obj e c t s M c G e e e t a l ( 1985) M ul t i pl e ba s e l i ne I nc i de nt a l t e a c hi ng C S P a i r s of p r e pos i t i ons A c r os s pa r t i c i pa nt s ( on/ unde r i ns i de / ne xt a nd pa i r s of p r e pos i t i ons t o, a nd i n f r on t o f / i n ba c k of ) R os s & G r e e r ( 2003) M ul t i pl e ba s e l i ne T i m e de l a y ( 5s ) C S B a s i c ne e ds / A c r os s pa r t i c i pa nt s M a nd/ M ode l / C or r e c t V oc a l i m i t a t i ons N ot e M L U = m e a n l e ngt h of u t t e r a nc e ; N / A = not a va i l a bl e ; C S = c om m uni c a t i on s ki l l

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67 T a bl e 2 8 M a j or f i ndi ngs of m i l i e u t he r a py S t udy T x F I R r e l i a bi l i t y H ow r e por t e d R e s ul t s G e n. M a i n. C ha r l op e t a l ( 1985 ) H i gh 98% B y t r i a l a nd b l oc ks of 10 A l l a c qui r e d C S w i t hi n Y Y 60 t r i a l s C ha r l op & W a l s h ( 1986 ) H i gh 100% # of c o r r e c t r e s pons e s 2 C S qui c kl y i nc r e a s e d t o Y Y pe r da y c r i t e r i a l e ve l 2 m e t c r i t e r i a a f t e r t i m e de l a y pr oc e dur e H a nc oc k & K a i s e r ( 2002) H i gh N / A % of oppor t uni t i e s M L U % of oppor t uni t i e s w / c or r e c t Y Y di ve r s i t y, a nd P P V T R r e s pons e i nc r e a s e d, M L U i nc r e a s e d J ohns on e t a l ( 2004 ) H i gh 97 100% % of c or r e c t r e s pons e s H e l p ( 100% ) b r e a k a nd Y Y s na c k ( 80 100% ) L a s ki e t a l ( 1988 ) L ow 79 98% % of i nt e r va l s A l l c hi l dr e n i nc r e a s e d % of Y Y i nt e r va l s i n w hi c h voc a l i z e d M c G e e e t a l ( 1983) H i gh 94 100% % of c or r e c t r e s pons e s 75 100% f or a l l s e t s of Y Y obj e c t s f or bot h pa r t i c i pa nt s M c G e e e t a l ( 1985) H i gh 87 100% % of c or r e c t r e s po ns e s 90 100% Y Y R os s & G r e e r ( 2003) H i gh 89 100% % of c or r e c t r e s pons e s 20 100% r a nge a l l i nc r e a s e d Y Y dr a m a t i c a l l y f r om ba s e l i ne N ot e T x = t r e a t m e nt ; C S = c om m uni c a t i on s ki l l s ; T xF = t r e a t m e nt f i de l i t y; I R = i nt e r r a t e r ; G e n. = g e ne r a l i z a t i on; M a i n, = m a i nt e na nc e ; Y = ye s ; N = no

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68 C H A P T E R 3 M E T H O D S T he pur pos e of t hi s c ha pt e r i s t o de s c r i be t he m e t h ods t ha t w e r e us e d t o c onduc t t he s t udy. F i r s t c r i t e r i a f or s e l e c t i ng t he pa r t i c i pa nt s t he s e t t i ng i n w hi c h t he s t udy w a s c onduc t e d, a nd t he c ha nge a ge nt s a nd m a t e r i a l s ne e de d t o c a r r y out t he s t udy a r e r e vi e w e d. S e c ond, t he de pe nde nt m e a s ur e s c odi ng de f i ni t i ons e xpe r i m e nt a l pr oc e dur e s s t udy de s i gn, a nd da t a a na l ys i s m e t hods a r e de s c r i be d. F i na l l y s t r a t e gi e s t o e ns ur e i n t e r obs e r ve r a gr e e m e nt t r e a t m e nt i nt e gr i t y, a nd s oc i a l va l i di t y a r e s um m a r i z e d. P ar t i c i p an t s T he pur pos e of t hi s s t udy w a s t o de t e r m i ne t he e f f e c t i ve ne s s of m odi f i e d m i l i e u t he r a py i nt e r ve nt i on [ i e c om bi ne d f unc t i ona l c om m un i c a t i on t r a i ni ng ( F C T ) a nd m i l i e u t he r a py] i m pl e m e nt e d i n t he na t ur a l e nvi r onm e nt of c hi l dr e n w i t h A S D by t he i r pa r e nt s o r ot he r gua r di a n. T he pa r t i c i pa nt s f o r t he s t udy i nc l ude d t h r e e pr e s c hool or e l e m e nt a r y a ge d c hi l dr e n w i t h A S D w ho w e r e be t w e e n t he a ge s of f our a nd e i ght T he y w e r e r e c r ui t e d w i t h t he he l p o f a l oc a l a ge nc y f or i ndi vi dua l s w i t h A S D P r i or t o pa r t i c i pa t i ng i n t he s t udy, I ns t i t ut i ona l R e vi e w B oa r d ( I R B ) a ppr ova l w a s obt a i ne d f r om t he U ni ve r s i t y of F l or i da U pon I R B a ppr ova l pa r e nt s a nd t e a c he r s of t he t a r ge t c hi l dr e n s i gne d c ons e nt f or m s f or t he i r c hi l d r e n t o pa r t i c i pa t e i n t he s t udy, a nd f or t he s t udy t o oc c ur i n t he hom e s a nd c l a s s r oom s of t he t a r ge t c h i l dr e n. T he t a r ge t c hi l d r e n ha d a di a gnos i s of A S D obt a i ne d i nde pe nde nt l y f r om a phys i c i a n, l i c e ns e d ps yc hol og i s t or di a gnos t i c c e nt e r I n a ddi t i on, t he S oc i a l C om m uni c a t i on Q ue s t i onna i r e ( S C Q ; R ut t e r B a i l e y, & L or d 2003 ) a nd t he A ut i s m D i a gnos t i c I nt e r vi e w R e vi s e d ( A D I R ; L o r d, R ut t e r D i L a vor e & R i s i 1999) w e r e a dm i ni s t e r e d t o obt a i n a ddi t i ona l s t a nda r di z e d s c or e s i ndi c a t i ng a di a gnos i s of a ut i s m

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69 T he s e l e c t i on c r i t e r i a f or t he t a r ge t e d c hi l dr e n i nc l ude d ( a ) e n r ol l e d i n a pr e s c hool or e l e m e nt a r y s c hool ( b ) nonve r ba l or l i m i t e d l a ngua ge ( c ) a m e nt a l a ge of a t l e a s t 28 m ont hs ( M c F e e M c C r i m m on, & B e bko, 2 006 ) ( d) a ut i s m di a gnos i s a c c or di ng t o t he A D I R a nd ( e ) di s pl a y of a be r r a nt be ha vi or us e d f o r c om m uni c a t i on t o obt a i n a t a ngi bl e i t e m I ni t i a l l y pa r e nt a nd t e a c he r i nt e r vi e w s de t e r m i ne d i f t he t a r ge t c hi l dr e n m e t t he a f or e m e nt i one d c r i t e r i a A f t e r t he i nt e r vi e w s w e r e c onc l ude d, di r e c t obs e r va t i ons a nd f o r m a l t e s t i ng w e r e c onduc t e d t o c onf i r m t ha t e a c h c hi l d m e t t he l a t t e r t hr e e i nc l us i on a nd e x c l us i on c r i t e r i a T he t h i r d a nd f our t h c r i t e r i a ( i e di a gnos i s of a ut i s m a nd m e nt a l a ge of a t l e a s t 28 m ont h s ) w e r e c onf i r m e d ba s e d on da t a obt a i ne d f r om t he A D I R ( L e C out e ur L or d & R ut t e r 2003 ) S C Q ( R ut t e r e t a l 2003 ) a nd M ul l e n S c a l e s of E a r l y L e a r n i ng ( M ul l e n, 1992) T he s e w e r e gi ve n by t he p r i m a r y e xpe r i m e nt e r w ho w a s c l i ni c a l l y t r a i ne d t o a dm i ni s t e r t he A D I R a nd ot he r i ns t r u m e nt s I n a ddi t i on t he f i na l c r i t e r i on ( i e t a ngi bl e f unc t i on of be ha vi or ) w a s c onf i r m e d by c onduc t i ng a f unc t i ona l a na l ys i s ( s e e A ppe ndi x A f or t he f unc t i ona l a na l ys i s pr ot oc ol ) S c ot t S c ot t a C a uc a s i a n m a l e w a s 7 ye a r s a n d 11 m ont h s a t t he s t a r t o f t he s t udy ( s e e T a bl e 3. 1) H e pa r t i c i pa t e d i n a pr i va t e s c hool f or c hi l d r e n w i t h a ut i s m a nd r e l a t e d di s a bi l i t i e s S c ot t w a s di a gnos e d w i t h A ut i s m a t t he a ge o f t h r e e by a ps yc hi a t r i s t ( no s pe c i f i c d i a gnos t i c m e a s ur e w a s r e por t e d ) A c c or di ng t o t e a c he r a nd pa r e nt i nt e r vi e w s hi s s oc i o c om m uni c a t i ve s ki l l s i nc l ude d t he a bi l i t y t o i ni t i a t e a nd r e s pond t hr ough ge s t ur e s a nd ve r ba l l a ngua ge ( 2 3 w o r d ut t e r a nc e s ) H ow e ve r t he y not e d he ha d t o be pr o m pt e d t o c om m uni c a t e t he m a j or i t y of t i m e H e de m ons t r a t e d a l ow r a t e of s oc i a l i n i t i a t i ons t o pe e r s a nd a dul t s S c ot t s ove r a l l m e nt a l a ge w a s 49 m ont hs a s i ndi c a t e d by t he M ul l e n S c a l e s of E a r l y L e a r n i ng. H i s S C Q s c or e w a s 25, w e l l a bove t he c ut of f s c or e o f 15; t hus i nd i c a t i ng a ut i s m a nd a ne e d f or f ur t he r t e s t i ng. F ur t he r

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70 S c ot t s A D I R s c or e s f o r t he t hr e e dom a i ns w e r e 2 6 f or r e c i pr oc a l s oc i a l i nt e r a c t i on ( c ut o f f = 10) 22 f o r c om m uni c a t i on ( c ut of f = 8 ) a nd 10 f or r e pe t i t i ve be ha vi or ( c ut of f = 3) w hi c h w e r e a l l w e l l a bove t he i r r e s pe c t i ve c ut of f s c or e s ; i ndi c a t i ng a di a gnos i s of a ut i s m I n a ddi t i on t a ngi bl e f unc t i on f or a be r r a nt be ha vi or w a s de t e r m i ne d by a f unc t i ona l a na l ys i s t o m a i nt a i n hi s a be r r a nt be ha vi or ( i e hi t t i ng a nd pi nc hi ng o t he r s ) S c ot t s m ot he r t he na t u r a l c ha nge a ge n t f or t hi s s t udy, ha s t w o c hi l d r e n of w hi c h S c ot t i s t he younge s t ( s e e T a bl e 3 2) S he ha s a B a c he l or s de gr e e a nd ha s pa r t i c i pa t e d i n s e ve r a l r e s e a r c h s t udi e s pr i or t o t hi s s t udy. I n a ddi t i on, s he i ndi c a t e d ha vi ng r e c e i ve d t r a i ni ng i n A ppl i e d B e ha vi or A na l ys i s a nd t he P i c t ur e E xc ha nge C om m uni c a t i on S ys t e m ( P E C S ) f r om a w or ks hop hos t e d by t he C e nt e r f o r A ut i s m a nd R e l a t e d D i s a bi l i t i e s S c ot t s t e a c he r ha d a B a c he l or s de gr e e i n e duc a t i o n ( s e e T a bl e 3 3) S he ha d s i x ye a r s t e a c hi ng e xpe r i e nc e a nd w a s A B A t r a i ne d. I n a ddi t i on t o S c ot t s he ha d 4 ot he r s t ude nt s i n he r c l a s s r oom ( i e a t ot a l of 5 s t ude nt s ) D avi d D a vi d, a C a uc a s i a n m a l e w a s 4 ye a r s a nd 1 m ont h a t t he s t a r t of t he s t udy ( s e e T a bl e 3. 1) H e pa r t i c i pa t e d i n a publ i c s c hool s pe c i a l e du c a t i on c l a s s r oom f or c hi l d r e n w i t h va r yi ng di s a bi l i t i e s D a vi d w a s di a gnos e d w i t h A ut i s m a t t he a ge of t w o by a ne ur ol ogi s t ( no s pe c i f i c di a gnos t i c m e a s ur e w a s r e por t e d) A c c or di ng t o t e a c he r a nd pa r e nt i nt e r vi e w s hi s s oc i o c om m uni c a t i ve s ki l l s i nc l ude d t he a bi l i t y t o i ni t i a t e a nd r e s pond t hr ough ge s t ur e s a nd ve r ba l l a ngua ge ( 2 3 w o r d ut t e r a nc e s ) H ow e ve r t he y not e d he ha d t o be pr om pt e d t o c om m un i c a t e t he m a j or i t y of t i m e H e de m ons t r a t e d l ow r a t e s of s oc i a l i ni t i a t i ons t o pe e r s a nd a dul t s D a vi d s ove r a l l m e nt a l a g e w a s 29 m ont hs a s i ndi c a t e d by t he M ul l e n S c a l e s of E a r l y L e a r ni ng. H i s S C Q s c or e w a s 24, w e l l a bove t he c ut o f f s c or e o f 15; t h us i ndi c a t i ng a ut i s m a nd a ne e d f o r a ddi t i ona l

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71 t e s t i ng. F ur t he r D a vi d s A D I R s c or e s f o r t he t hr e e dom a i ns w e r e 26 f or r e c i pr oc a l s oc i a l i nt e r a c t i on ( c ut of f = 10 ) 14 f or c om m uni c a t i on ( c ut of f = 7) a nd 10 f or r e pe t i t i ve be ha vi or ( c ut of f = 3) w hi c h w e r e a l l w e l l a bove t he i r r e s pe c t i ve c ut of f s c or e s ; i ndi c a t i ng a di a gnos i s of a ut i s m I n a ddi t i on, t a ngi bl e f unc t i on f o r a be r r a nt b e ha vi or w a s de t e r m i ne d by a f unc t i ona l a na l ys i s t o m a i nt a i n hi s a be r r a nt be ha vi or ( i e h i t t i ng a nd bi t i ng s e l f ) D a vi d s m ot he r t he na t ur a l c ha nge a ge nt f o r t hi s s t udy, ha s t w o c hi l dr e n o f w hi c h D a vi d i s t he ol de s t ( s e e T a bl e 3 2) S he ha s a B a c he l or s de gr e e i n N ur s i ng a nd ha s not pa r t i c i pa t e d i n r e s e a r c h s t udi e s pr i or t o t hi s s t udy. I n a ddi t i on, s he di d not i ndi c a t e ha vi ng r e c e i ve d t r a i ni ng i n s uc h t e c hni que s a s A ppl i e d B e ha vi or A na l ys i s D a vi d s t e a c he r ha d a M a s t e r s de gr e e i n e duc a t i on ( s e e T a bl e 3 3 ) S he ha d t w e l ve ye a r s t e a c hi ng e xpe r i e nc e a nd w a s not A B A t r a i ne d I n a ddi t i on t o D a vi d s he ha d e i gh t ot he r s t ude nt s i n he r c l a s s r oom ( i e a t ot a l o f 9 s t ude nt s ) Z e b Z e b, a C a uc a s i a n m a l e w a s 4 ye a r s a nd 10 m ont hs a t t he s t a r t of t he s t udy ( s e e T a bl e 3. 1) H e pa r t i c i pa t e d i n a publ i c s c hool s pe c i a l e du c a t i on c l a s s r oom f or c hi l d r e n w i t h va r yi ng di s a bi l i t i e s Z e b w a s di a gnos e d w i t h a ut i s m a t t he a ge of t w o by a ne ur o l ogi s t ( no s pe c i f i c di a gnos t i c m e a s ur e w a s r e por t e d) A c c or di ng t o t e a c he r a nd pa r e nt i nt e r vi e w s hi s s oc i o c om m uni c a t i ve s ki l l s i nc l ude d t he a bi l i t y t o i ni t i a t e a nd r e s pond t hr ough ge s t ur e s a nd ve r ba l l a ngua ge ( 2 3 w o r d ut t e r a nc e s ) H ow e ve r t he y not e d he ha d t o be pr om pt e d t o c om m un i c a t e t he m a j or i t y of t i m e H e de m ons t r a t e d l ow r a t e s of s oc i a l i ni t i a t i ons t o pe e r s a nd a dul t s Z e b s ove r a l l m e nt a l a ge w a s 32 m ont hs a s i ndi c a t e d by t he M ul l e n S c a l e s of E a r l y L e a r ni ng. H i s S C Q s c or e w a s 27, w e l l a bove t he c ut o f f s c or e o f 15; t h us i ndi c a t i ng a ut i s m a nd a ne e d f o r f ur t he r t e s t i ng. F ur t he r Z e b s A D I R s c or e s f or t he t h r e e dom a i ns w e r e 26 f o r r e c i pr oc a l s oc i a l

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72 i nt e r a c t i on ( c ut of f = 10 ) 16 f or c om m uni c a t i on ( c ut of f = 7) a nd 10 f or r e pe t i t i ve be ha vi or ( c ut of f = 3) w hi c h w e r e a l l w e l l a bove t he i r r e s pe c t i ve c ut of f s c or e s ; i ndi c a t i ng a di a gnos i s of a ut i s m I n a ddi t i on, t a ngi bl e f unc t i on f o r a be r r a nt be ha vi or w a s de t e r m i ne d by a f unc t i ona l a na l ys i s t o m a i nt a i n hi s a be r r a nt be ha vi or ( i e t a nt r um s s c r e a m i ng) Z e b s m ot he r t he na t ur a l c ha nge a ge nt f or t hi s s t u dy, ha s t w o c hi l d r e n of w hi c h Z e b i s t he ol de s t ( s e e T a bl e 3 2) S he ha s a hi gh s c hool d i pl om a a nd ha s not pa r t i c i pa t e d i n r e s e a r c h s t udi e s pr i or t o t hi s s t udy. I n a ddi t i on, s he di d not i ndi c a t e ha vi ng e ve r r e c e i ve d t r a i ni ng i n s uc h t e c hni que s a s A ppl i e d B e ha vi or A na l ys i s Z e b s t e a c he r ha d a M a s t e r s de gr e e i n e duc a t i on ( s e e T a bl e 3. 3 ) S he ha d f i f t e e n ye a r s t e a c hi ng e xpe r i e nc e a nd w a s not A B A t r a i ne d I n a ddi t i on t o Z e b, s he ha d f i ve ot he r s t ude nt s i n he r c l a s s r oom ( i e a t ot a l of 6 s t ude nt s ) S e t t i n gs C h an ge A ge n t s an d M at e r i al s T hi s s e c t i on de s c r i be s t he s e t t i ngs i n w hi c h e a c h p ha s e of t he s t udy w a s c onduc t e d, t he c ha nge a ge nt s w ho c onduc t e d t he e xpe r i m e nt a l p r oc e dur e s a nd c ol l e c t e d da t a dur i ng e a c h pha s e a nd t he m a t e r i a l s us e d t o c onduc t t he s t udy. S e t t i n gs A l l f our pha s e s of t he s t udy w e r e c onduc t e d i n t he na t ur a l e nvi r onm e nt s of t he pa r t i c i pa nt s ( i e hom e a nd s c hool ) T he pha s e s i nc l ude d: ( a ) p r e i nt e r ve nt i on/ a s s e s s m e nt ( b) ba s e l i ne ( c ) i nt e r ve nt i on, a nd ( d ) m a i nt e na nc e A d di t i ona l l y, ge ne r a l i z a t i on w a s e xa m i ne d t hr oughout t h e s t udy. F o r t he pr e i nt e r ve nt i on pha s e ba s e l i ne pha s e a nd i nt e r ve nt i on pha s e da t a w e r e c ol l e c t e d i n t he hom e of e a c h pa r t i c i pa nt ( e g l i vi ng r oom o r ot he r a r e a w he r e c om m uni c a t i on t ypi c a l l y oc c ur r e d ) T r a i ni ng o f t h e c hi l d pa r t i c i pa nt s a nd pa r e nt s o c c ur r e d i n t he hom e of e a c h r e s pe c t i ve pa r t i c i pa nt A ddi t i ona l l y, ge ne r a l i z a t i on da t a w e r e c ol l e c t e d i n t he

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73 pa r t i c i pa nt s c l a s s r oom s dur i ng t he ba s e l i ne i nt e r v e nt i on, a nd m a i n t e na nc e pha s e s i n t he hom e s e t t i ng. T he l oc a t i on o f t he s t udy w i t hi n t he hom e a nd c l a s s r oom w e r e s e l e c t e d by t he pa r e nt s a nd t e a c he r s a nd r e pr e s e nt e d l oc a t i ons w he r e t he c om m uni c a t i on s ki l l s t ypi c a l l y oc c ur r e d ( e g. pl a ygr ound, s na c k t i m e ) I n a ddi t i o n t he m a i nt e na nc e pha s e oc c ur r e d i n t he hom e a nd c l a s s r oom i n t he s a m e l oc a t i on a s t he pr e vi ous pha s e s C h an ge age n t s T he pr i m a r y e xpe r i m e nt e r w ho c onduc t e d t he p r e i nt e r ve nt i on/ a s s e s s m e nt pha s e s ha s s e ve r a l ye a r s e xpe r i e nc e w or ki ng w i t h c hi l dr e n w i t h A S D T he pr i m a r y e xpe r i m e nt e r ha s s e ve r a l publ i c a t i ons r e l a t e d t o A S D a nd hi s r e s e a r c h c ur r e nt l y f oc us e s on c om m uni c a t i on a nd s oc i a l be ha vi or s of c hi l dr e n w i t h A S D P a r e nt s s e r ve d a s t he c ha nge a ge nt s f or t he ba s e l i ne i nt e r ve nt i on, a nd m a i nt e na nc e pha s e s A l l pa r e nt s s poke E ngl i s h a nd w e r e l i t e r a t e I n a ddi t i on i nf or m a t i on on t he i r e duc a t i on, e xpe r t i s e a nd e xpe r i e nc e w a s obt a i ne d t o a c c ount f or a ny pot e nt i a l di f f e r e nc e s ba s e d on i m pl e m e nt e r c ha r a c t e r i s t i c s ( s e e A ppe ndi x B f or da t a s he e t ) F or e xa m pl e one pa r e nt pa r t i c i pa t e d i n pr e vi ous c om m uni c a t i on s t udi e s T e a c he r s a l s o s poke E ngl i s h. S i m i l a r t o t he pa r e nt c ha r a c t e r i s t i c s da t a w a s c ol l e c t e d on t he t e a c he r s e duc a t i on, e xpe r t i s e a nd e xpe r i e nc e ( s e e T a bl e 3. 3 ) M at e r i al s D ur i ng e a c h of t he pha s e s m a t e r i a l s w e r e us e d t o pr ovi de i nt e r ve nt i ons a nd t o c ol l e c t c ode a nd a na l yz e da t a T he s e i nc l ude d pi c t ur e c a r ds pr e f e r r e d i t e m s t r a i ni ng vi de os a di g i t a l vi de o c a m e r a a l a pt op c om put e r a nd da t a c ol l e c t i on s he e t s T he pi c t ur e c a r ds ( c r e a t e d us i ng t he c om put e r pr ogr a m B oa r d M a ke r ) w e r e us e d dur i ng i nt e r ve nt i on, ge ne r a l i z a t i on, a nd m a i nt e na nc e s e s s i ons ( s e e A ppe ndi x C f or s a m pl e c a r ds ) I n a dd i t i on, a l ong w i t h t he t r a i ni ng vi de os t he c a r ds

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7 4 w e r e us e d t o t r a i n pa r e nt s P r e f e r r e d i t e m s ( e g. t o ys ) i de nt i f i e d du r i ng p r e f e r e nc e a s s e s s m e nt s w e r e us e d dur i ng a l l t hr e e pha s e s A di gi t a l c a m e r a w a s us e d t o vi de o a l l pha s e s of t he s t udy. D e p e n d e n t M e as u r e s T hi s s e c t i on out l i ne s t he p r i m a r y a nd s e c onda r y de pe nde nt m e a s ur e s D e f i ni t i ons of t he pr i m a r y de pe nde nt m e a s ur e s t ha t w e r e c ol l e c t e d o n t he pa r t i c i pa nt s a be r r a nt a nd c om m uni c a t i on be ha vi or s dur i ng t he s t udy s f our pha s e s a r e pr ovi de d. I n a ddi t i on de f i ni t i ons of t he s e c onda r y de pe nde nt m e a s ur e s t ha t w e r e c ol l e c t e d on t he pa r t i c i pa nt s pl a y be ha vi or s a nd a dul t s pr om pt i ng be ha vi or s a r e pr ovi de d T he s pe c i f i c de f i ni t i ons us e d t o ope r a t i ona l l y de f i ne e a c h be ha vi or a r e de s c r i be d ( s e e A ppe ndi x D f or c odi ng m a nua l ) a nd ha ve be e n a da pt e d f r om pr e vi ous r e s e a r c he r s ( L a l l i C a s e y, & K a t e s 1995; W a c ke r e t a l 2005) P r e I n t e r ve n t i on M e as u r e s T w o e xpe r i m e nt a l p r e a s s e s s m e nt s w e r e c onduc t e d F i r s t a n e va l ua t i on of t a r ge t i ndi vi dua l s pr e f e r e nc e f or t a ngi bl e i t e m s w e r e a s s e s s e d t hr ough a pr e f e r e nc e a s s e s s m e nt ( R oa ne e t a l 1998) D a t a w e r e c ol l e c t e d i n v i vo on t he du r a t i on of pl a y w i t h t a ngi bl e i t e m s du r i ng t he pr e f e r e nc e a s s e s s m e nt P l a y c ons i s t e d of t he pa r t i c i pa nt e nga ge d w i t h a n i t e m f o r a pe r i od o f t w o or m or e s e c onds i n w hi c h t he pa r t i c i pa nt a l s o m a d e e ye c ont a c t w i t h t he i t e m F or e xa m pl e i f a c hi l d pi c ke d up a t oy c a r ( i e t a ngi bl e i t e m ) br i e f l y l ooke d a t t he i t e m a nd he l d i t f or a t l e a s t t w o s e c onds pl ay w a s c ode d. I n c ont r a s t i f a c hi l d pi c ke d up a t oy c a r ne ve r l ooke d a t i t a nd w a l ke d a r ound t he r oom w i t h t he c a r i n hi s ha nd f o r f ou r s e c onds pl ay w a s not c ode d. D ur a t i on of pl a y w i t h t a ngi bl e i t e m s w a s r e c or de d w i t h a s t opw a t c h us i ng a pa pe r a nd pe nc i l r e c or di ng s ys t e m w hi l e vi e w i ng t he vi de o ( s e e A ppe ndi x E f or da t a s he e t s ) T he obs e r ve r us e d a s t opw a t c h t o r e c or d t he dur a t i on of t i m e t he t a r ge t c hi l d w a s e nga ge d w i t h t he t a ngi bl e a nd t he n r e c or de d t he t i m e on a da t a c ol l e c t i on s he e t

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75 S e c ond, i de nt i f i c a t i on of t he f unc t i on ( o r c om m uni c a t i ve out c om e ) of a be r r a nt be ha vi o r w a s de t e r m i ne d t hr ough a f unc t i ona l a na l ys i s A be r r a nt be ha vi or w a s de f i ne d br oa dl y a s be ha vi or t ha t ne ga t i ve l y i m pa c t e d t a r ge t c hi l d l e a r ni ng a nd i nd e pe nde nc e a nd r a nge d f r om m i l d ( e g. t h r ow s a t oy on t he f l oor onc e ) t o s e ve r e be h a vi or ( e g t a nt r um s f or a n hour or ba ngs he a d on t he w a l l ) ( B a i l e y a nd B ur c h 2002 ) I ndi vi dua l de f i ni t i ons of a be r r a nt be ha vi or va r i e d a nd w e r e a dj us t e d ba s e d on e a c h t a r ge t c hi l d's f o r m o f t he be ha vi or T he s e be ha vi or s w e r e ope r a t i ona l l y de f i ne d i n obs e r va bl e a nd m e a s ur a bl e t e r m s ( B a i l e y a nd B ur c h 2002 ) F or e a c h pa r t i c i pa nt t he t a r ge t e d a be r r a nt be ha vi or w a s i de nt i f i e d f r om da t a obt a i ne d t hr ough pa r e nt a nd t e a c he r i n t e r vi e w s ( i e i nf or m a l i nt e r vi e w que s t i ons ) a nd d i r e c t obs e r va t i ons T he pa r e nt s a nd t e a c he r s f i r s t i de nt i f i e d t he m os t pr e va l e nt a be r r a nt be ha vi or f o r e a c h c hi l d. T he pa r e nt a nd t e a c he r a g r e e d on t he s a m e t a r ge t be ha vi or of e a c h r e s pe c t i ve t a r ge t c hi l d T he p r i m a r y e xpe r i m e nt e r t he n obs e r ve d t h e c hi l d f o r one hou r ( K a z di n, 1982 ) i n t he hom e a nd c l a s s r oom t o c onf i r m t ha t t he t a r ge t be h a vi or oc c ur r e d. T he p r i m a r y e xpe r i m e nt e r r e c or de d e a c h oc c ur r e nc e of t he t a r ge t be ha vi or us i ng pa pe r a nd pe nc i l ( s e e A p pe ndi x E f o r da t a s he e t s ) A f t e r t he a be r r a nt be ha vi or w a s de f i ne d, a n F A w a s c onduc t e d. T o e va l ua t e t he r e l a t i ve di f f e r e nc e s of va r i ous F A c ondi t i ons da t a w e r e c ol l e c t e d on r e s pons e s pe r m i nut e o f a be r r a nt be ha vi or i n e a c h c ondi t i on ( s e e A ppe ndi x A f or p r ot oc ol ) I n t e r ve n t i on G e n e r al i z at i on an d M ai n t e n an c e M e as u r e s D ur i ng t he i n t e r ve nt i on, ge ne r a l i z a t i on, a nd m a i nt e na nc e pha s e s of t he s t udy, da t a w e r e t a ke n i n vi vo on f i ve de pe nde nt m e a s ur e s : ( a ) f r e q ue nc y of a be r r a nt be ha vi or ( b ) f r e que nc y of unpr om p t e d a nd p r om pt e d c om m uni c a t i on r e s pons e s ( c ) l a t e nc y of unp r om pt e d c om m uni c a t i on r e s pons e s i n t he t r a i ni ng s e t t i ng, ( d ) f r e que nc y of a dul t ve r ba l ve r ba l / ge s t ur a l a nd phys i c a l pr om pt s ( w hi c h a l s o s e r ve s a s a t r e a t m e nt i nt e gr i t y m e a s ur e ) a nd ( e ) num be r a nd di ve r s i t y ( i e

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76 ve r bs nouns ) of unpr om p t e d ve r ba l i z a t i ons E a c h of t he s e be ha vi or s w a s r e c or de d us i ng a pa pe r a nd pe nc i l da t a c ol l e c t i on s ys t e m w hi l e vi e w i ng t h e vi de o ( s e e A ppe ndi x E f o r da t a s he e t s ) T he pr i m a r y e xpe r i m e nt e r vi e w e d t he vi de ot a pe s a nd r e c or de d t he f i r s t f our m e a s ur e s i ni t i a l l y F ol l ow i ng t hi s obs e r va t i on pe r i od, t he vi de ot a pe w a s vi e w e d a s e c ond t i m e D ur i ng t hi s t i m e t he num be r a nd di ve r s i t y of w or ds w a s r e c or de d T he de f i ni t i ons f or t he s e m e a s ur e s f ol l ow ( s e e A ppe ndi x D f or de t a i l e d c odi ng m a nua l ) A b e r r an t b e h avi or A be r r a nt be ha vi or de f i n i t i ons va r i e d a nd w e r e a dj us t e d ba s e d on e a c h t a r ge t c hi l d's f or m of t he be ha vi or S om e pa r t i c i pa nt s e nga ge d i n t a nt r um s a nd ot he r s e nga ge d i n pr ope r t y de s t r uc t i on or a ggr e s s i on t ow a r d ot he r s U n p r om p t e d c om m u n i c at i on r e s p on s e U npr om pt e d c om m uni c a t i on r e s pons e s w e r e de f i ne d a s ha ndi ng pi c t ur e c om m uni c a t i on c a r ds t o t he t r a i ne r i nvol ve d i n t he s e s s i on w i t hout a ny pr om pt s P r om p t e d c om m u n i c at i on r e s p on s e P r om pt e d c om m uni c a t i on r e s pons e s w e r e de f i ne d a s ha ndi ng pi c t ur e c om m uni c a t i on c a r ds t o t he t r a i ne r i nvol ve d i n t he s e s s i on f ol l ow i ng a pr om pt T hi s c ons i s t e d of one of t he f o l l ow i ng p r o m pt s : ( a ) phys i c a l ve r ba l or ve r ba l / ge s t ur a l P r om p t s P r om pt s a s e c onda r y de pe nde nt m e a s ur e c ons i s t e d of a dul t s pr ovi di ng ve r ba l ve r ba l / ge s t ur a l or phys i c a l pr om pt s f r om l e a s t t o m os t i nt r us i ve r e s pe c t i ve l y. V e r ba l pr om pt s c ons i s t e d of ve r ba l c ue ( e g T e l l m e w h a t you w a nt ) V e r ba l / ge s t ur a l pr om pt s c ons i s t e d of a c om bi ne d ve r ba l a nd vi s ua l c ue ( e g. pa r e nt hol ds ha nd out w i t h pa l m up i n a nt i c i pa t i on of r e c e i vi ng a c a r d w hi l e s a yi ng T e l l m e w ha t you w a nt ) P hys i c a l pr om pt s c ons i s t e d of ha nd ove r ha nd e xc ha nge s ( e g. pa r e n t l e a di ng a c hi l d s ha nd t o a c a r d)

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77 S p on t an e ou s ve r b al i z at i on s S pont a ne ous ve r ba l i z a t i ons a s e c onda r y de pe nde nt m e a s ur e w e r e de f i ne d a s ve r ba l w or ds e m i t t e d by pa r t i c i pa nt s t ha t w e r e not e c hol a l i c i n na t ur e or i m i t a t i ve of a dul t w or ds T he s e va r i e d i n num be r a nd di ve r s i t y ( e g nouns ve r bs ) E xp e r i m e n t al P r oc e d u r e s a n d S t u d y D e s i gn T he e xpe r i m e nt a l p r oc e dur e s s e c t i on out l i ne s t he s t e ps t ha t w e r e f ol l ow e d t o c onduc t e a c h pha s e of t he s t udy, a nd t he s t udy de s i gn s e c t i on de s c r i be s t he s i ngl e s ubj e c t de s i gn us e d t o e va l ua t e t r e a t m e nt e f f e c t s F ou r pha s e s w e r e c onduc t e d ( a ) p r e i nt e r ve nt i on/ a s s e s s m e nt ( f unc t i ona l a na l ys i s a nd pr e f e r e nc e a s s e s s m e nt ) ( b ) ba s e l i ne ( c ) i nt e r ve nt i on, a nd ( d ) m a i nt e na nc e A ddi t i ona l l y, ge ne r a l i z a t i on w a s c ol l e c t e d t hr oughout t he s t udy. P r e i n t e r ve n t i on / A s s e s s m e n t P h as e T w o a s s e s s m e nt s w e r e c onduc t e d: ( 1) pr e f e r e nc e a s s e s s m e nt a nd ( 2) f unc t i ona l a na l ys i s P r e f e r e n c e as s e s s m e n t A p r e f e r e nc e a s s e s s m e nt w a s c onduc t e d ba s e d on pr oc e dur e s de s c r i be d by R oa ne a nd c ol l e a gue s ( 1998) F i r s t pa r e nt i nt e r vi e w s w e r e c onduc t e d t o pr ovi de i ns i ght i nt o t a r ge t c hi l dr e n s i nt e r e s t s a nd be ha vi or a l f unc t i ons I t e m i nt e r e s t s obt a i ne d i n t he c a r e gi ve r i nt e r vi e w w e r e us e d f or t he pr e f e r e nc e a s s e s s m e nt F r om t hi s l i s t o f i t e m s t he t op s e ve n w e r e c hos e n f or t he p r e f e r e nc e a s s e s s m e nt T hi s s e t of s e ve n i t e m s w a s a r r a nge d i n a c i r c l e i n t he s pe c i f i e d l oc a t i on, c hos e n by t he pa r e nt a t t he hom e T he p r i m a r y e xpe r i m e nt e r w a l ke d t he c hi l d t o t he c e nt e r of t he c i r c l e w hi c h w a s e qui di s t a nc e f r om a l l i t e m s T he c hi l d w a s t ol d t o c hoos e a t oy E a c h t a r ge t c hi l d w a s a l l o w e d t o c hoos e a ny i t e m he w a nt e d t o i nt e r a c t w i t h, i nc l udi ng m ul t i pl e i t e m s F or a pe r i od of f i ve m i n ut e s t he obs e r ve r r e c or de d t he du r a t i on t he t a r ge t c hi l d pl a ye d w i t h e a c h i t e m T he i t e m t he t a r ge t c hi l d pl a ye d w i t h f o r t he l onge s t dur a t i on w a s us e d a s t he f i r s t i t e m of i n t e r e s t i n t he i nt e r ve n t i on pha s e

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78 A f t e r t he f i r s t p r e f e r e nc e a s s e s s m e nt w a s c onduc t e d, t he i t e m t he t a r ge t c hi l d e nga ge d w i t h f or t he l onge s t t i m e pe r i od w a s r e m ove d. F ol l ow i ng t hi s a not he r pr e f e r e nc e a s s e s s m e nt w a s c onduc t e d m i nu s t he or i gi na l pr e f e r r e d i t e m T hi s w a s r e pe a t e d unt i l t hr e e i t e m s w e r e i de nt i f i e d, w hi c h w e r e c hos e n a s t he i t e m s us e d t o t e a c h e a c h c om m uni c a t i on m a nd t o t he t a r ge t c hi l d. T he f i r s t a s s e s s m e nt de t e r m i ne d t he f i r s t i t e m t o us e f o r t he m a nd a nd t he ne xt t w o pr e f e r e nc e a s s e s s m e nt s de t e r m i ne d t he s ubs e que nt i t e m s t o us e f or m a nd t r a i ni ng. F u n c t i on al an al ys i s T he f unc t i ona l a na l ys i s w a s c onduc t e d t o de t e r m i ne t he f unc t i on of t he a be r r a nt be ha vi or A s s t a t e d, onl y c hi l d r e n w ho di s pl a ye d a t a ngi bl e f unc t i on w e r e c hos e n f o r i nc l us i on i n t hi s s t udy. T a ngi bl e f unc t i ons w e r e c h os e n be c a us e of t he i nhe r e nt de s i gn of t he i nt e r ve nt i on t e c hni que s s uc h a s i nc i de nt a l t e a c hi n g ( i e t o r e que s t i t e m s ) a nd t o a voi d e xpos i ng a c hi l d t o a ve r s i ve s t i m ul i t ha t e l i c i t s e s c a p e be ha vi or A f unc t i ona l a na l ys i s w a s c onduc t e d i n t he pa r t i c i pa nt s hom e s e t t i ngs us i ng t he pr oc e dur e s out l i ne d by I w a t a D or s e y, S l i f e r B a um a n, a nd R i c hm a n ( 1982/ 1994) w i t h t he a ddi t i on o f a t a ngi bl e c ondi t i on. T he f unc t i ona l a na l ys i s ( F A ) w a s c onduc t e d by m a ni pul a t i ng c ons e que nc e s s uc h a s e s c a pe f r om de m a nds c ont i nge nt a t t e nt i on a nd c o nt i nge nt t a ngi bl e i t e m s t o de t e r m i ne t he f unc t i on of t he be ha vi or T o i de nt i f y a pr i m a r y f un c t i on, t he r e l a t i ve e f f e c t s of c ont i nge nt r e i nf or c e m e nt w e r e c om pa r e d t o t he ot he r c ondi t i o ns ( i e t a ngi bl e f r e e pl a y e s c a pe ) ( s e e A ppe ndi x A f or F A pr ot oc ol ) A f t e r c om pl e t i ng t h e F A a t a ngi bl e f unc t i on w a s i de nt i f i e d f or e a c h pa r t i c i pa nt B as e l i n e an d I n t e r ve n t i on P h as e s T he ba s e l i ne a nd i n t e r ve nt i on pha s e s c ons i s t e d of ba s e l i ne t r a i ni ng, a nd t he i nt e r ve nt i on. B as e l i n e P r i o r t o be gi nni ng ba s e l i ne t he pr i m a r y e xpe r i m e nt e r i n t e r vi e w e d pa r e nt s a nd t e a c he r s a nd c onduc t e d di r e c t obs e r va t i ons i n t he h om e a nd c l a s s r oom i n l oc a t i ons t r a i ni ng

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79 oc c ur r e d. D ur i ng t he i nt e r vi e w s t he pr i m a r y e xpe r i m e nt e r a s ke d t he pa r e nt s a nd t e a c he r s t o i de nt i f y r out i ne s dur i ng w hi c h t he t a r ge t c hi l dr e n t ypi c a l l y ha d a c c e s s t o t he pr e f e r r e d i t e m s A f t e r obt a i ni ng t he a f o r e m e nt i one d da t a ba s e l i ne obs e r va t i ons oc c ur r e d dur i ng t ypi c a l hom e a nd c l a s s r oom r out i ne s w hi c h w e r e i de nt i f i e d a nd he l d c ons t a nt f or e a c h t a r ge t c hi l d B a s e l i ne c ons i s t e d of di r e c t obs e r va t i on o f a l l de pe nde nt m e a s ur e s D ur i ng ba s e l i ne t he t a r ge t c hi l d w a s gi ve n a c c e s s t o t he f i r s t p r e f e r r e d i t e m f or 30s T he pa r e nt t he n r e m ove d t he i t e m a nd i nt e r a c t e d w i t h t he f i r s t pr e f e r r e d i t e m f o r 30s A f t e r i nt e r a c t i ng w i t h t he pr e f e r r e d i t e m t he pa r e nt r e t u r ne d t he i t e m t o t he t a r ge t c hi l d f or a not he r 30s a c c e s s pe r i od. T hi s i nt e r a c t i on c yc l e c ont i nue d f o r t he 5m i n s e s s i on. D ur i ng t hi s t i m e t he t a r ge t c hi l d ha d a c c e s s ( i e c a r d w a s on t he f l oo r ne xt t o t he t a r ge t c hi l d) t o t he pi c t ur e c a r d of t he f i r s t pr e f e r r e d i t e m T he s e pr oc e dur e s w e r e r e pe a t e d t hr oughout e a c h 5m i n s e s s i on. T r ai n i n g. B e f or e i ni t i a t i ng t he i nt e r ve nt i on, pa r e n t s w e r e t a ught t he pr oc e dur e s f or t e a c hi ng t he i r c hi l d t o c om m uni c a t e us i ng t he m od i f i e d m i l i e u t he r a py i nt e r ve nt i on. T hi s s ki l l w a s t a ught t hr ough vi e w i ng vi de os of t he e xpe r i m e nt e r c onduc t i ng a n i n t e r ve nt i on w i t h a c hi l d w i t h a ut i s m a nd t h r ough r o l e pl a y t r a i n i ng s e s s i ons A s out l i ne d i n A ppe ndi x F pa r e nt s f i r s t r e a d t he t r a i ni ng m a nua l T he pr i m a r y e xpe r i m e nt e r c l a r i f i e d a ny que s t i ons a bout c odi ng de f i ni t i ons T he n, t he pr i m a r y e xpe r i m e nt e r a nd pa r e nt s vi e w e d vi de os a nd i de nt i f i e d a nd r e c or de d i nt e r ve nt i on pr oc e dur e s T he y us e d pa pe r a nd pe nc i l t o r e c or d a nd c l a s s i f y ( e g. ve r ba l phys i c a l ) e a c h pr om pt gi ve n t o t he c hi l d i n t he vi d e o. I n a ddi t i on, t he p r i m a r y e xpe r i m e nt e r a nd pa r e nt s w r ot e e a c h r e s pons e f r om t he c hi l d a nd r e c or de d w he t he r t he r e s pons e w a s pr om pt e d or unpr om pt e d, c l a s s i f yi ng t he pr om pt T hi s w a s don e unt i l t he pa r e nt s a c hi e ve d 90% i nt e r obs e r ve r a gr e e m e nt ( I O A ) w i t h t he pr i m a r y e xpe r i m e nt e r F i na l l y, pa r e nt s r ol e pl a ye d t he i nt e r ve nt i on pr oc e dur e s w i t h t he p r i m a r y e xpe r i m e nt e r T he pa r e nt pr a c t i c e d t a ki ng a n i t e m a nd pl a yi ng w i t h

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80 t he i t e m a nd gi vi ng ve r ba l ve r ba l / ge s t ur a l a nd ph ys i c a l pr om pt s w i t h t he pr i m a r y e xpe r i m e nt e r unt i l t he y w e r e a bl e t o pe r f or m t he s ki l l s c or r e c t l y 10 c ons e c ut i ve t r i a l s ( s e e A ppe ndi x F f or de t a i l e d t r a i ni ng m a nua l ) F or pur pos e s of ge ne r a l i z a t i on, i n c ont r a s t t e a c he r s w e r e t a ught a s i ngl e s ki l l T he y w e r e t a ught t o pl a c e hi ghl y pr e f e r r e d i t e m s i n vi e w but out of r e a c h of t he c hi l d A ddi t i ona l l y, t he t e a c he r s w e r e i ns t r uc t e d t o gi ve t he hi ghl y pr e f e r r e d i t e m s t o t he c hi l d w he n t he c hi l d ga ve t he m a pi c t ur e c a r d. T he t e a c he r s pr a c t i c e d t he s e s ki l l s t hr ough r ol e pl a y w i t h t he pr i m a r y e xpe r i m e nt e r unt i l t he y w e r e a bl e t o c om pl e t e t hi s s ki l l s uc c e s s f ul l y a s e va l ua t e d a nd de f i ne d by pa r e nt s a nd t e a c he r s pe r f or m i ng t he p r oc e dur e s c or r e c t l y 10 c ons e c ut i ve t r i a l s ( s e e A ppe ndi x F f or t r a i ni ng m a nua l a nd w or ks he e t s ) I n t e r ve n t i on F ol l ow i ng ba s e l i ne a nd c om pl e t i on of a dul t t r a i ni ng, t he i n t e r ve nt i on be ga n ( s e e F i gur e 3 11 f o r vi s ua l o f t he i nt e r ve nt i o n pr oc e dur e s ) T he i n t e r ve nt i on pha s e c ons i s t e d of t hr e e c ondi t i ons ( i e e a c h t a ngi bl e i t e m w a s a ne w c ondi t i on) T he i nt e r ve nt i on s e s s i ons i ni t i a l l y oc c ur r e d i n a n a r e a o f t he hom e p r e de t e r m i ne d i n t he i nt e r vi e w s dur i ng t he pr e i nt e r ve nt i on/ a s s e s s m e nt pha s e H ow e ve r i f t he c hi l d i ni t i a t e d c om m uni c a t i on a nd t he n be ga n t o pl a y i n ot he r l oc a t i ons ( e g. be dr oom f l oo r ki t c he n t a bl e ) t he pa r e nt f ol l ow e d t he c hi l d a nd c onduc t e d t he i nt e r ve nt i on i n t he ne w l oc a t i on D ur i ng t he i n t e r ve nt i on, a t i m e de l a y of 5 s e c onds w a s us e d pr i or t o pr om pt i ng t he c hi l d f or t he t a ngi bl e i t e m s I f t he c hi l d a s ke d f or t he i t e m a t a ny t i m e t he c hi l d w a s a l l ow e d a c c e s s t o t he pr e f e r r e d i t e m f or 30 s e c onds a nd t he n t he pr i m a r y e xpe r i m e nt e r pr om pt e d t he pa r e nt t o t a ke t he i t e m a nd p l a y w i t h t he i t e m A n a c c e s s t i m e of 30 s e c onds w a s us e d be c a u s e t hi s t i m e pe r i od ha s be e n i de nt i f i e d a s e nough t i m e t o ke e p a c hi l d s i nt e r e s t but not s a t i a t e ( O N e i l l & S w e e t l a nd B a ke r 2001)

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81 T he i nt e r ve nt i on be ga n by a l l ow i ng t he c hi l d a c c e s s t o t he pr e f e r r e d i t e m f o r 30 s e c onds a nd t he n pe r f o r m i ng a t w o s t e p m ode l i ng pr oc e dur e T he f i r s t s t e p of t he m ode l i ng p r oc e dur e c ons i s t e d of t he pr i m a r y e xpe r i m e nt e r gi vi ng t he p a r e nt a vi s ua l pr om p t ( i e i nde x c a r d w i t h P r ovi de M ode l w r i t t e n on i t ) t he pa r e nt t he n s a i d, I w a nt t he ___ ga ve t he pi c t ur e c a r d t o t he c hi l d, a nd t he n t ook t he p r e f e r r e d i t e m T he pa r e nt t he n pl a ye d w i t h t he i t e m of i nt e r e s t i n t he hom e f or 30 s e c onds w i t hout i m m e di a t e l y pr ovi di ng a not he r pr o m pt I f t he c hi l d di d not us e t he pi c t ur e c a r d, t he s e c ond s t e p of t he m ode l i ng pr oc e dur e c ons i s t e d of t he p r i m a r y e xpe r i m e nt e r pr ovi di ng a v i s ua l pr om pt ( i e i nde x c a r d w i t h t he w or ds P hys i c a l pr om pt w r i t t e n on i t ) f o r t he pa r e nt t o pr ovi de a phys i c a l pr om pt ( i e ha nd ove r ha nd a s s i s t a nc e ) a nd t he n a l l ow a c c e s s t o t he pr e f e r r e d i t e m f or 30 s e c onds T hi s t w o s t e p m ode l pr oc e dur e w a s done w i t h e a c h t a r ge t c hi l d a nd w a s not r e c or de d a s c om m uni c a t i on r e s pons e s A f t e r t he t w o s t e p m ode l i ng p r oc e dur e t he pr i m a r y e xpe r i m e nt e r p r ovi de d a v i s ua l pr om pt ( i e i nde x c a r d w i t h T a ke T oy w r i t t e n o n i t ) t he pa r e nt t ook t he i t e m a nd pl a ye d w i t h t he i t e m of i nt e r e s t i n t he hom e w i t hout i m m e di a t e l y pr ovi di ng a ve r ba l m a nd. I f t he c hi l d di d not a s k f or t he i t e m w i t hi n t he de f i ne d t i m e de l a y f or t he t a ngi bl e i t e m t he p r i m a r y e xpe r i m e nt e r pr ovi de d a vi s ua l p r om pt ( i e i nde x c a r d w i t h t he w or ds V e r ba l pr om pt w r i t t e n on i t ) i ndi c a t i ng t o t he pa r e nt t o pr ovi de a ve r ba l pr om pt T he pa r e nt w oul d t he n s a y, T e l l m e w ha t you w a nt I f t he c hi l d di d no t i ni t i a t e c om m u ni c a t i on w i t hi n t he 5s t i m e de l a y f o r t he t a ngi bl e i t e m t he pr i m a r y e xpe r i m e nt e r pr ovi de d a vi s ua l p r om pt ( i e i nde x c a r d w i t h t he w o r ds V e r ba l / ge s t ur a l w r i t t e n on i t ) f or t he pa r e nt t o p r ovi de a c om bi ne d ve r ba l / ge s t ur a l pr om pt I f t he c hi l d s t i l l d i d not r e s pond w i t hi n t he 5s t i m e de l a y, t he p r i m a r y e xpe r i m e nt e r p r ovi de d a vi s ua l pr om pt ( i e i nde x c a r d w i t h t he w o r ds P hy s i c a l pr om pt w r i t t e n on i t ) f or t he pa r e nt t o

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82 pr ovi de a phys i c a l pr om p t ( i e ha nd ove r ha nd a s s i s t a nc e ) a nd t he n a l l ow a c c e s s t o t he pr e f e r r e d i t e m f or 30 s e c onds T hi s c ondi t i on f or t he i nt e r ve nt i on pha s e w a s c ont i nue d t w o t o t hr e e t i m e s a w e e k unt i l t he l a t e nc y of t he c hi l d s r e s pons e oc c ur r e d c ons i s t e nt l y w i t hi n t he a l l ot t e d 5s t i m e de l a y f or t he t a ngi bl e i t e m a nd de c r e a s e d l e ve l s of a be r r a nt be ha vi or s w e r e i ndi c a t e d. W he n t he c hi l d di s pl a ye d t he c om m uni c a t i ve r e s pons e f ol l ow i ng t he m a nd f or t he f i r s t i t e m c ons i s t e nt l y w i t hi n 5 s e c onds f or a t l e a s t 75 % of t he p r om pt s a nd a t l e a s t 20% of t he c om m uni c a t i on r e s pons e s i n t he l a s t t hr e e s e s s i ons w e r e unpr om pt e d, t he s a m e p r o c e dur e s w e r e f ol l ow e d t o t e a c h t w o a ddi t i ona l m a nds f or p r e f e r r e d i t e m s I n e a c h ne w c ondi t i on o f t he i nt e r ve nt i on pha s e ( i e c ondi t i on t w o a nd t hr e e ) t he c hi l d ha d a c c e s s t o t he ne w c a r d i nd i c a t i ng a ne w i t e m a nd t he c a r d ( s ) f r om t he pr e vi ous c ondi t i on( s ) o f t he i nt e r ve nt i on pha s e M ai n t e n an c e P h as e T he pur pos e of t he m a i nt e na nc e pha s e w a s t o de t e r m i ne i f unp r om pt e d c om m un i c a t i on t r a i ne d i n t he hom e m a i nt a i ne d ove r t i m e T w o w e e ks f ol l ow i ng t he c onc l us i o n of t he i nt e r ve nt i on pha s e t he pr i m a r y e xpe r i m e nt e r a nd g r a dua t e a s s i s t a nt vi de ot a pe d s e s s i ons i n t he hom e unt i l a s t a bl e t r e nd i n da t a w a s obs e r ve d. D u r i ng t he s e s e s s i ons t he pr i m a r y e xpe r i m e nt e r di d not p r ovi de a ny p r om pt s t o t he pa r e nt s P a r e nt s c on t i nue d t o pr ov i de t he i nt e r ve nt i on a s pr e vi ous l y i m pl e m e nt e d dur i ng t he l a s t c ondi t i on o f t he i nt e r ve nt i on pha s e w i t hout a ny a s s i s t a nc e f r om t he p r i m a r y e xpe r i m e nt e r D ur i ng t hi s pha s e t he t a r ge t c hi l d ha d a c c e s s t o a l l t hr e e pi c t ur e c a r ds I n a ddi t i on t he pa r e nt r a ndom l y i nt e r a c t e d w i t h e a c h pr e f e r r e d i t e m a c r os s s e s s i ons E a c h pr e f e r r e d i t e m w a s i nt e r a c t e d w i t h f or a t l e a s t one e nt i r e s e s s i on ( s e e T a bl e 3. 4 )

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83 G e n e r al i z at i on T he pur pos e of t he ge ne r a l i z a t i on pr obe s w a s t o de t e r m i ne i f a nd w he n c om m u ni c a t i on t r a i ne d i n t he hom e e nvi r on m e nt ge ne r a l i z e d t o t he c l a s s r oom e nvi r onm e nt G e ne r a l i z a t i on da t a w e r e c ol l e c t e d s i m ul t a ne ous l y w hi l e t he i nt e r ve nt i on pha s e of t he s t udy w a s be i ng i m pl e m e nt e d. T he da t a w e r e c ol l e c t e d du r i ng t ypi c a l c l a s s r oom r out i ne s a nd a c t i vi t i e s a s i de nt i f i e d t h r ough t he pr e a s s e s s m e nt i nt e r vi e w s ( e g. s na c k, p l a yt i m e c e nt e r t i m e ) T he r out i ne s t a r ge t e d de pe nde d on t he i t e m of i nt e r e s t a nd w he n t he i t e m w a s t ypi c a l l y a va i l a bl e t o t he t a r ge t c hi l d F or e xa m pl e i f t he pr e f e r r e d i t e m w a s a t oy c a r t ha t t he t a r ge t c hi l d w oul d pl a y w i t h dur i ng pl a yt i m e a nd c e nt e r t i m e t he n da t a w e r e c ol l e c t e d du r i ng t hos e pe r i ods D ur i ng t he s e r out i ne s t he t a r ge t c hi l d ha d a c c e s s t o t he pi c t ur e c a r ds W he n da t a s t a bi l i z e d i n e a c h pha s e a t hom e a t l e a s t t hr e e ge ne r a l i z a t i on pr obe s w e r e c onduc t e d i n t he c l a s s r oom ( K e nne dy, 2005) T he pr i m a r y e xpe r i m e nt e r vi de ot a pe d ge ne r a l i z a t i on s e s s i ons i n t he c l a s s r oom t ha t c or r e s ponde d t o s e s s i ons i n e a c h c hi l d s hom e A f t e r a f e w s e s s i ons i n t he hom e s e t t i ng, ge ne r a l i z a t i on da t a w e r e c ol l e c t e d i n t he c l a s s r oom f or a t l e a s t a f our t o one r a t i o. T ha t i s f or e ve r y f our s e s s i ons i n t he hom e a t l e a s t one ge ne r a l i z a t i on da t a s e s s i on w a s c onduc t e d. D ur i ng t he ge ne r a l i z a t i on s e s s i ons t he t e a c he r s di d not pr ov i de a ny p r om pt s E a c h t a r ge t c hi l d s r e s pe c t i ve pr e f e r r e d i t e m s w e r e i n vi e w bu t not a c c e s s i bl e w i t hout r e que s t i ng t he i t e m A s a f or e m e nt i one d, e a c h t a r ge t c hi l d ha d a c c e s s t o t he pi c t ur e c a r ds t ha t i ndi c a t e d h i s r e s pe c t i ve pr e f e r r e d i t e m s T he pi c t ur e c a r ds a c c e s s i bl e t o e a c h t a r ge t c hi l d m i r r or e d t hos e a c c e s s i bl e i n t he c or r e s pondi ng c ondi t i on o f t he i nt e r ve nt i on pha s e I f t he t a r ge t c hi l d r e que s t e d t he p r e f e r r e d i t e m us i ng t he pi c t ur e c a r d he w a s gi ve n 30s a c c e s s t o t he i t e m

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84 E xp e r i m e n t al D e s i gn A c onc ur r e nt m ul t i pl e ba s e l i ne de s i gn a c r os s pa r t i c i pa nt s w a s us e d t o e va l ua t e t he e f f e c t i ve ne s s of t he m odi f i e d m i l i e u t he r a py i nt e r v e nt i on on de c r e a s i ng a be r r a nt be ha vi or s a nd i nc r e a s i ng c om m uni c a t i on be ha vi or W hi l e pa r e nt s i m pl e m e nt e d t he i nt e r ve nt i on i n t he h o m e t he pr i m a r y e xpe r i m e nt e r v i de ot a pe d t he c hi l d i n t he c l a s s r oom t o de t e r m i ne i f s ki l l s ge ne r a l i z e d t o t he c l a s s r oom a nd t e a c he r E f f e c t s of m ul t i pl e b a s e l i ne de s i gns a r e de m ons t r a t e d by i nt r oduc i ng t he i nt e r ve nt i on t o di f f e r e nt pa r t i c i pa nt s a t di f f e r e n t t i m e s ( K a z di n 1982) U s i ng vi s ua l a na l ys i s i f c ha nge s i n t he de pe nde nt va r i a bl e s oc c ur f ol l ow i ng t he i nt r oduc t i on of t he i nt e r ve nt i on, t he n t hi s c ha nge c a n be a t t r i but e d t o t he i nt e r ve nt i on. D at a A n al ys i s T he da t a a na l ys i s s e c t i on out l i ne s t he pr oc e dur e s u s e d t o a na l yz e a nd e va l ua t e t he c ode d da t a T he i nt e r obs e r ve r a gr e e m e nt s e c t i on w i l l de s c r i be t he s t e ps t a ke n t o e ns ur e t he r e l i a bi l i t y of t he da t a c ol l e c t e d. D at a C ol l e c t i on C od i n g, an d A n al ys i s S e s s i ons a c r os s a l l pha s e s w e r e vi de ot a pe d us i ng a P a na s oni c m i ni D V di g i t a l c a m c or de r a nd s ubs e que nt l y c ode d us i ng r e a l t i m e da t a c ol l e c t i on s he e t s ( s e e A ppe ndi x E ) T he da t a w e r e t r a ns f e r r e d t o a n i book G 4 l a pt op c om pu t e r f or da t a a na l ys i s us i ng i m ovi e a nd Q ui c kt i m e P r o s of t w a r e E a c h s e s s i on w a s c o nduc t e d f or 5 m i nut e s D ur i ng e a c h s e s s i on, t he pr i m a r y e xpe r i m e nt e r r e c or de d t he f r e que nc y of a be r r a nt be ha vi or s f r e que nc y o f pr o m pt e d a nd unp r om pt e d c om m uni c a t i on r e s pons e s l a t e nc y t o r e s pond t o pr om pt s f r e que nc y o f t ype s o f pr o m pt s a nd d i v e r s i t y a n d num be r of unp r om pt e d ve r ba l i z a t i ons T he f r e que nc y of t he a be r r a nt be ha vi or w a s r e c or de d i n r e a l t i m e ( i e e ve r y

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85 a be r r a nt be ha vi or w a s r e c or de d ) R e s pons e s pe r m i nut e w e r e c a l c ul a t e d by t a ki ng t he f r e que nc y of a be r r a nt be ha vi or s dur i ng t he s e s s i on a nd di vi di ng by t he t ot a l a m ount of t i m e of t he s e s s i on ( f i ve m i nut e s ) L a t e nc y da t a w e r e c ol l e c t e d on t he t i m e be t w e e n t he a dul t t a ki ng t he pr e f e r r e d i t e m f r o m t he t a r ge t c hi l d a nd t he t a r ge t c hi l d r e que s t i ng t he i t e m s pont a ne ous l y. T he a ve r a ge l a t e nc y t o r e s pond pe r s e s s i on w a s c a l c ul a t e d by a ddi ng t he l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on dur i ng t he f i ve m i nut e s e s s i on a nd di vi di ng by t he t o t a l num be r of unpr om pt e d c om m uni c a t i on r e s pons e s C onc ur r e nt l y, t he num be r a nd t ype s of pr om pt s p r ovi de d by pa r e nt s w e r e c ount e d F ur t he r t he p r i m a r y e xpe r i m e nt e r vi e w e d t he vi de ot a pe s a s e c ond t i m e t o c ol l e c t t he di ve r s i t y a nd num be r of unpr om p t e d ve r ba l i z a t i ons by r e c or di ng t he oc c ur r e nc e o f e a c h ve r ba l i z a t i on on a da t a c ol l e c t i on s he e t ( s e e A ppe ndi x E f or da t a s he e t ) E ve r y ve r ba l w or d s poke n du r i ng e a c h f i ve m i nut e s e s s i on w a s r e c or de d. E a c h of t he de pe nde nt m e a s ur e s w e r e gr a phe d a nd a na l yz e d vi s ua l l y f ol l ow i ng pr oc e dur e s out l i ne d by K e nne dy ( 2005) t o de t e r m i ne t he e f f e c t s of t he i nt e r ve nt i on on t he d e pe nde nt va r i a bl e s A l l pha s e s w e r e c onduc t e d un t i l vi s ua l i ns pe c t i on of t he g r a phe d da t a r e ve a l e d a t l e a s t t hr e e c ons e c ut i ve a nd s t a bl e da t a poi nt s T he pr i m a r y e xpe r i m e nt e r us e d t he M i c r os of t E xc e l s of t w a r e p r ogr a m t o gr a ph t he da t a L i ne g r a phs w e r e d r a w n f or t he f r e que nc y da t a ( c onve r t e d t o r e s pons e s pe r m i nut e or pe r c e nt a ge of s e s s i on da t a ) B a r g r a phs w e r e dr a w n f or t he l a t e nc y da t a ( c onve r t e d t o m e a n l a t e nc y) a n d ve r ba l i z a t i ons da t a ( m e a n r a t e pe r c ondi t i on) K e nne dy ( 2005) r e c om m e nde d t he e xa m i n a t i on o f t hr e e a s pe c t s of l i ne gr a phs w hi c h w e r e us e d f or t he pr i m a r y de pe nde nt m e a s ur e s i n t hi s s t udy, t o de t e r m i ne t he i nf l ue nc e of t he

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86 i nt e r ve nt i on ( a ) l e ve l o f t he de pe nde nt va r i a bl e ( b) t r e nd o f t he da t a ( s l ope a nd m a gni t ude ) a nd ( c ) va r i a bi l i t y. H e f ur t he r r e c om m e nds t w o a s pe c t s of l i ne g r a phs t o de t e r m i ne t he i n f l ue nc e of t he i nde pe nde nt va r i a bl e a c r os s c ondi t i ons ( a ) i m m e di a c y of e f f e c t t ha t i s how qui c kl y c ha nge oc c ur s be t w e e n pha s e s a nd ( b) ove r l a p of da t a be t w e e n pha s e s T he s e pr oc e dur e s w e r e f ol l ow e d t o vi s ua l l y a na l yz e t he da t a f or de t e r m i ni ng pha s e c ha nge s I n t e r ob s e r ve r A gr e e m e n t I nt e r obs e r ve r a gr e e m e nt ( I O A ) i s t he e xt e nt t o w hi c h t w o or m or e obs e r ve r s a g r e e t ha t a be ha vi or oc c ur r e d, a nd m o r e s pe c i f i c a l l y, w he n a nd how l ong a be ha vi or oc c ur r e d ( K a z di n 1982) I t pr ovi de s a m e a s ur e of t he r e l i a bi l i t y ( c on s i s t e nc y of s c or e s ove r t i m e ) of t he obs e r ve r s I nt e r obs e r ve r a gr e e m e nt s houl d be a s s e s s e d f or t h r e e r e a s ons : ( a ) t o m i ni m i z e obs e r ve r bi a s e s t ha t m a y de ve l op, ( b) t o c ont r ol f or i nc ons i s t e nc y of obs e r ve r s a s one s our c e of va r i a t i on i n da t a c ol l e c t i on, a nd ( c ) t o de t e r m i ne i f t he t a r ge t be ha vi or s a r e w e l l de f i ne d ( K a z di n, 1982) K a z di n ( 1982) r e c om m e nds t ha t I O A be c ol l e c t e d dur i ng a t l e a s t 25% of a l l obs e r va t i ons a c r os s t he di f f e r e nt ph a s e s of t he i nve s t i ga t i on. T hi s r e s e a r c h pr oj e c t a dhe r e d t o K a z di n s c r i t e r i on. I O A w a s c a l c ul a t e d on a t l e a s t 25% of t h e s e s s i on s dur i ng e a c h pha s e of t he s t udy. F or f r e que nc y m e a s ur e s ( e g. c om m un i c a t i on r e s p ons e s pr om pt s ) t ot a l a gr e e m e nt w a s c a l c ul a t e d ( K e nne dy, 2005) T o c a l c ul a t e I O A f or f r e que nc y m e a s ur e s t he num be r of r e s pons e s r e c or de d by t he pr i m a r y obs e r ve r w a s t ot a l e d. S i m i l a r l y, t he num be r of r e s pons e s r e c or de d by t he s e c onda r y obs e r ve r w a s t ot a l e d. F i na l l y t he s m a l l e r t ot a l w a s di vi de d by t he l a r ge r t ot a l a nd m ul t i pl i e d by 100. T h i s ga ve t he I O A t ot a l a gr e e m e nt f or e a c h f r e que nc y m e a s ur e F or l a t e nc y ( e g. c om m un i c a t i on r e s pons e ) a nd du r a t i on ( e g. pl a y) m e a s ur e s t he t o t a l a gr e e m e nt a ppr oa c h w a s us e d ( K e nne dy, 2005 ) T o c a l c ul a t e I O A f o r l a t e nc y m e a s ur e s t he l a t e nc y r e c or de d by t he pr i m a r y obs e r ve r w a s t ot a l e d. S i m i l a r l y t he l a t e nc y r e c or de d by t he

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87 s e c onda r y obs e r ve r w a s t ot a l e d. F i na l l y, t he s m a l l e r t ot a l w a s di vi de d by t he l a r ge r t ot a l a nd m ul t i pl i e d by 100. T h i s ga ve t he I O A t ot a l a gr e e m e nt f or l a t e nc y. T o c a l c ul a t e I O A f o r dur a t i on m e a s ur e s t he dur a t i on r e c or de d by t he pr i m a r y ob s e r ve r w a s t ot a l e d. S i m i l a r l y, t he dur a t i on r e c or de d by t he s e c onda r y obs e r ve r w a s t ot a l e d. F i na l l y, t he s m a l l e r t ot a l w a s di vi de d by t he l a r ge r t ot a l a nd m ul t i pl i e d by 100 T h i s ga ve t he I O A t ot a l a gr e e m e nt f or du r a t i on. T he pr i m a r y e xpe r i m e nt e r w a s t he pr i m a r y da t a c o l l e c t or dur i ng e a c h pha s e of t he s t udy a nd a t r a i ne d g r a dua t e s t ude nt a s s i s t e d w i t h I O A A gr e e m e nt on a t l e a s t 80 % of a l l obs e r va t i ons m us t oc c ur f or obs e r ve r s t o a c hi e ve a c c e pt a bl e i nt e r r a t e r a gr e e m e nt F or t hi s t o oc c ur t he obs e r ve r s m us t be w e l l t r a i ne d a nd t he be ha vi o r s m us t be c l e a r l y de f i ne d P r i or t o t he c ol l e c t i on of da t a a l l da t a c ol l e c t or s w e r e a t l e a s t 80 % r e l i a bl e a c r os s t hr e e c ons e c ut i ve s e s s i ons on t he c odi ng s ys t e m us e d f or e a c h pha s e of t he s t udy by c odi ng vi de ot a pe s of c hi l dr e n w i t h A S D w hom ha ve s i m i l a r c ha r a c t e r i s t i c s a s t he a c t ua l pa r t i c i pa nt s T he p r i m a r y e xpe r i m e nt e r a nd gr a dua t e s t ude nt i nde pe nde nt l y w a t c he d vi de ot a pe s of t he i n t e r ve nt i on be i ng pe r f o r m e d w i t h a c hi l d w i t h A S D B ot h da t a c ol l e c t or s us e d t he c odi ng s ys t e m t o c ode f r e que nc y a nd l a t e nc y m e a s ur e s I O A t he n w a s c a l c ul a t e d be t w e e n t he m e a s ur e s r e c or de d by t he pr i m a r y e xpe r i m e nt e r a nd t he gr a dua t e s t ude nt T he I O A obt a i ne d w a s a n a ve r a ge of 92 % ( r a nge of 80% t o 100 % ) T he a f or e m e nt i one d I O A p r oc e dur e s w e r e us e d f or t he pr e f e r e nc e a s s e s s m e nt s f unc t i ona l a na l ys e s ba s e l i ne i nt e r ve nt i on a nd ge n e r a l i z a t i on s e s s i ons f or e a c h de pe nde nt m e a s ur e F i r s t I O A f or t he pr e f e r e nc e a s s e s s m e nt s w i l l be pr ovi de d. S e c ond, I O A f or t he f unc t i ona l a na l ys e s w i l l be r e po r t e d. F i na l l y, I O A f or ba s e l i ne i nt e r ve nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i on s w i l l be r e po r t e d f o r e a c h pa r t i c i pa nt on t he de pe nde nt m e a s ur e s t ha t i nc l ude c om m uni c a t i on r e s pons e s pr om pt s a be r r a nt be ha vi or l a t e nc y t o r e s pond, a nd ve r ba l i z a t i ons

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88 P r e f e r e n c e A s s e s s m e n t F or t he p r e f e r e nc e a s s e s s m e nt s a gr e e m e nt on t he dur a t i on of t i m e e a c h pa r t i c i pa nt phys i c a l l y t ouc he d a n i t e m w a s 100% R e l i a bi l i t y w a s c a l c ul a t e d f or 100% of t he s e s s i ons f or e a c h c hi l d. F u n c t i on al A n al ys i s F or t he f unc t i ona l a na l ys i s s e s s i ons a gr e e m e nt on t he f r e que nc y of a be r r a nt be ha vi or dur i ng s e s s i ons f or S c ot t a ve r a ge d 95% ( 90% 100 % ) D a vi d a ve r a ge d 96 % ( 92 % 100% ) a nd Z e b a ve r a ge d 92% ( 89% 95% ) R e l i a bi l i t y w a s c a l c ul a t e d f or 40 % o f t he s e s s i ons f or e a c h c hi l d C om m u n i c at i o n R e s p on s e s A gr e e m e nt on S c ot t s c om m uni c a t i on r e s pons e s a ve r a ge d 96% w i t h a r a nge of 88 % t o 100% A s f or D a vi d, a gr e e m e nt on hi s c om m uni c a t i on r e s pons e s a ve r a ge 95% w i t h a r a nge o f 87% t o 100 % I O A on Z e b s c om m uni c a t i on r e s pons e s a ve r a ge d 97% w i t h a r a nge of 87% t o 100% R e l i a bi l i t y w a s c a l c ul a t e d f or a ppr oxi m a t e l y 50% t o 100% of a l l ba s e l i ne i nt e r ve nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i ons f or e a c h c hi l d on c om m uni c a t i on r e s pons e s P r om p t s S c ot t A gr e e m e nt on t ot a l p r om pt s f o r S c ot t a ve r a ge d 93% ( 86% 100 % ) O f t he t ot a l pr om pt s f or S c ot t a gr e e m e nt on ve r ba l p r om pt s a v e r a ge d 91% ( 80% 100 % ) ve r ba l / ge s t ur a l pr om pt s a ve r a ge d 94% ( 84% 100% ) a nd phys i c a l pr om pt s a ve r a ge d 100% D avi d A gr e e m e nt on t ot a l pr om pt s f or D a vi d a ve r a ge d 96% ( 86 % 100% ) O f t he t ot a l pr om pt s f or D a vi d, a gr e e m e nt on ve r ba l pr o m pt s a ve r a ge d 94% ( 87% 100 % ) ve r ba l / ge s t ur a l pr om pt s a ve r a ge d 95% ( 88% 100% ) a nd phys i c a l pr om p t s a ve r a ge d 100% Z e b A gr e e m e nt on t ot a l p r om pt s f o r Z e b a ve r a ge d 91% ( 84% 100 % ) O f t he t o t a l pr om pt s f or Z e b a gr e e m e nt on ve r ba l pr om pt s a ve r a ge d 88% ( 80% 97 % ) ve r ba l / ge s t ur a l

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89 pr om pt s a ve r a ge d 92% ( 87% 100% ) a nd phys i c a l pr om pt s a ve r a ge d 100% R e l i a bi l i t y w a s c a l c ul a t e d f or a ppr oxi m a t e l y 50% t o 100 % o f a l l b a s e l i ne i nt e r ve nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i on s f or e a c h c hi l d on p r om pt s A b e r r an t B e h avi or A gr e e m e nt on S c ot t s a be r r a nt be ha vi or a ve r a ge d 96% w i t h a r a nge o f 85% t o 100% A s f or D a vi d a gr e e m e nt on hi s a be r r a nt be ha vi or a ve r a ge 97% w i t h a r a nge o f 89 % t o 100% I O A on Z e b s a be r r a nt be ha vi or a ve r a ge d 95% w i t h a r a nge of 87% t o 100 % R e l i a bi l i t y w a s c a l c ul a t e d f or a ppr oxi m a t e l y 50% t o 100 % o f a l l b a s e l i ne i nt e r ve nt i on, m a i nt e na n c e a nd ge ne r a l i z a t i on s e s s i on s f or e a c h c hi l d on a be r r a nt b e ha vi or L at e n c y A gr e e m e nt on S c ot t s l a t e nc y t o r e s pond a ve r a ge d 91% w i t h a r a nge o f 83% t o 100% A s f or D a vi d a gr e e m e nt on hi s l a t e nc y t o r e s pond a ve r a ge 92% w i t h a r a nge of 88% t o 100% I O A on Z e b s l a t e nc y t o r e s pond a ve r a ge d 92 % w i t h a r a nge of 85% t o 100 % R e l i a bi l i t y w a s c a l c ul a t e d f or a ppr oxi m a t e l y 50% t o 100 % o f a l l b a s e l i ne i nt e r ve nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i on s f or e a c h c hi l d on l a t e nc y t o r e s pond. V e r b al i z at i on s A gr e e m e nt on S c ot t s ve r ba l i z a t i ons a ve r a ge d 94 % w i t h a r a nge o f 80% t o 100% A s f o r D a vi d, a gr e e m e nt on hi s ve r ba l i z a t i ons a ve r a ge d 9 9% w i t h a r a nge o f 97% t o 100% I O A on Z e b s ve r ba l i z a t i ons a ve r a ge d 97% w i t h a r a nge o f 84% t o 100% R e l i a bi l i t y w a s c a l c ul a t e d f or a ppr oxi m a t e l y 50% t o 100 % of a l l ba s e l i ne i nt e r v e nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i ons f or e a c h c hi l d on ve r ba l i z a t i ons

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90 T r e at m e n t I n t e gr i t y an d S oc i al V al i d i t y D e s pi t e t he i m por t a nc e of t r e a t m e nt i nt e gr i t y a nd s oc i a l va l i di t y, s e l dom i s e i t he r c ol l e c t e d i n s i ngl e s ubj e c t s t udi e s t a r ge t i ng young c hi l dr e n w i t h A S D ( O dom e t a l 2003) T hi s s e c t i on w i l l de s c r i be how t r e a t m e nt i nt e gr i t y a nd s oc i a l va l i di t y w e r e c ol l e c t e d f or t he c ur r e nt s t udy. T r e at m e n t I n t e gr i t y D a t a on t r e a t m e nt i n t e gr i t y w e r e ga t he r e d by vi e w i ng t he vi de ot a pe s f r om t he ba s e l i ne i nt e r ve nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i ons D a t a w e r e ga t he r e d dur i ng ba s e l i ne t o e ns ur e t ha t t he i nt e r ve nt i on w a s not be i ng i m pl e m e nt e d. D a t a c ol l e c t or s vi e w e d t he vi de os a nd r e c o r de d a ny a dul t pr om pt s p r ovi de d by t he pa r e nt s a nd t e a c he r s ( i e r e c or de d a ny p r om pt s be c a us e t he pa r e nt s a nd t e a c he r s w e r e i ns t r uc t e d t o m a ke no p r om pt s ) I n a ddi t i on, da t a w e r e ga t he r e d on t he i n t e r ve nt i on i n t he hom e s e t t i ng t o e ns ur e t ha t t he i nt e r ve nt i on pr oc e dur e s w e r e i m pl e m e nt e d c ons i s t e nt l y a c r os s pa r t i c i pa nt s D a t a a l s o w e r e ga t he r e d du r i ng t he m a i nt e na nc e pha s e t o e ns ur e t ha t t he i n t e r ve nt i on p r oc e dur e s w e r e i m pl e m e nt e d c ons i s t e nt l y a c r os s pa r t i c i pa nt s F i na l l y da t a w e r e ga t he r e d du r i ng ge ne r a l i z a t i on s e s s i ons t o e ns ur e t ha t t he t e a c he r s w e r e f ol l ow i ng i ns t r uc t i ons a nd t he m odi f i e d m i l i e u t he r a py i nt e r ve nt i on w a s not be i ng i m pl e m e nt e d i n t he c l a s s r oom A da t a c ol l e c t or vi e w e d t he vi de os a nd c om pa r e d t he pr oc e dur e s vi e w e d w i t h t hos e out l i ne d i n t he e xpe r i m e nt a l p r oc e dur e s s e c t i on. F or e xa m pl e t r e a t m e nt i nt e g r i t y da t a w e r e c ol l e c t e d on t he pe r c e nt a ge of t i m e s t he c a r e gi ve r s a nd t e a c he r s pr ovi de d t he hi ghl y pr e f e r r e d i t e m t o t he c hi l d w he n t he i t e m w a s r e que s t e d. F o r e a c h pr oc e dur e i m pl e m e nt e d t he da t a c ol l e c t or a nd e xpe r t m a r ke d a ye s i f t hi s s t e p w a s done c or r e c t l y a nd a no i f t hi s s t e p w a s

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91 done i nc or r e c t l y ( s e e A ppe ndi x G f o r t r e a t m e nt i nt e gr i t y da t a s he e t ) T he t ot a l c or r e c t pr oc e dur e s w e r e di vi de d by t he t ot a l num be r of p r oc e dur e s t o b e i m pl e m e nt e d. A l t hough t he r e i s no t a c ons e ns us on a pa r t i c ul a r c r i t e r i on l e ve l ( K a z di n, 1982) a c r i t e r i a l e ve l of 80 % w a s us e d t o de t e r m i ne i f hi gh t r e a t m e nt i nt e gr i t y e xi s t e d. T he 80 % c r i t e r i on l e ve l e na bl e d t he pr i m a r y e xpe r i m e nt e r t o m a ke m or e p r e c i s e c onc l us i ons a bout t he i nt e r r e l a t i on be t w e e n t he i nt e r ve nt i on a nd t he de pe nde nt va r i a bl e s I n a ddi t i on da t a w e r e ga t he r e d dur i ng t he ge ne r a l i z a t i on pha s e w i t hi n t he c l a s s r oom t o e ns ur e t he t e a c he r i m pl e m e nt e d t he ge ne r a l i z a t i on pr oc e dur e s c or r e c t l y a nd d i d not pr ovi de uni nt e nt i ona l pr om pt s D a t a c ol l e c t or s vi e w e d t he vi de os a nd r e c or de d t he nu m be r o f uni nt e nt i ona l pr om pt s p r ovi de d by t he t e a c he r ( i e r e c or de d a ny pr om p t s be c a us e t he t e a c he r w i l l be i ns t r uc t e d t o m a ke no pr om pt s ) S oc i al V al i d i t y S oc i a l va l i di t y da t a w e r e c ol l e c t e d on t he i nt e r ve nt i on a nd out c om e s C a r e gi ve r s a nd t e a c he r s w e r e a s ke d t o c om pl e t e r a t i ng s c a l e s c onc e r ni ng t he i nva s i ve ne s s a nd f r i e ndl i ne s s of t he pr oc e dur e s ( s e e A ppe ndi x G ) t o de t e r m i ne t he s oc i a l va l i di t y o f t he p r oc e s s I n a ddi t i on vi de ot a pe a na l ys e s by one e xpe r t i n t he f i e l d of A S D w e r e us e d t o de t e r m i ne t he r a pe ut i c out c om e s of t he pa r t i c i pa nt s s oc i a l c om m uni c a t i v e be ha vi or s T he e xpe r t w a s c hos e n f r om t he U ni ve r s i t y of F l or i da a nd ha d s e ve r a l ye a r s e xpe r i e nc e w or ki ng w i t h c hi l dr e n w i t h A S D a nd t he i r pa r e nt s a nd t e a c he r s T he e xpe r t w a s a s ke d t o vi e w 10 m i nu t e vi de o c l i ps o f r a ndom l y s e l e c t e d f oot a ge of t he pa r t i c i pa nt s dur i ng t he ba s e l i ne a nd i nt e r ve nt i on s e s s i ons T he e xpe r t c om pl e t e d a L i ke r t s c a l e t o i ndi c a t e t he de gr e e of a ppr opr i a t e s oc i a l c om m uni c a t i ve be ha vi or di s pl a ye d by t he pa r t i c i pa nt on t he vi de o c l i ps ( s e e A ppe ndi x G )

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92 T a bl e 3 1 P a r t i c i pa nt c ha r a c t e r i s t i c s N ot e A ge i n ye a r s m on t hs ; M A = m e nt a l a ge ; S C R = R e c i pr oc a l s oc i a l i nt e r a c t i on, c om m uni c a t i on, r e pe t i t i ve be ha vi or s T a bl e 3 2 M ot he r s s ur ve y r e s ul t s P a r t i c i pa nt # of c hi l d r e n B i r t h or de r O t he r s t udi e s E duc a t i on A B A t r a i ne d S c ot t 2 Y ounge s t Y e s B a c he l or s Y e s D a vi d 2 O l de s t N o B a c he l or s N o Z e b 2 O l de s t N o H i gh s c hool N o T a bl e 3 3 T e a c he r s s ur ve y r e s ul t s P a r t i c i pa nt # of s t ude nt s O t he r s t udi e s E duc a t i on A B A t r a i ne d E xpe r i e nc e S c ot t s t e a c he r 5 N o B a c he l or s Y e s 6 yr s D a vi d s t e a c he r 9 Y e s M a s t e r s N o 12 yr s Z e b s t e a c he r 6 N o M a s t e r s N o 15 yr s T a bl e 3 4 M a i nt e na nc e s e s s i on i t e m s P a r t i c i pa nt S e s s i on 1 S e s s i on 2 S e s s i on 3 S e s s i on 4 S e s s i on 5 S c ot t B a l l C om put e r T oy s t or y C om put e r B a l l D a vi d S w i ng T r a i n T oy s t or y T oy s t or y S w i ng Z e b S w i ng C om put e r T oy s t or y C om put e r S w i ng A D I R P a r t i c i pa nt T opogr a phy F unc t i on of P a r t i c i pa nt A ge D i a gnos i s S C R S C Q M A of B e h a vi or B e ha vi or S c ot t 7 11 A ut i s m 26 22 10 25 49 m ont hs H i t pi nc h T a ngi bl e D a vi d 4 1 A ut i s m 26 14 10 24 29 m ont hs H i t bi t e s e l f T a ngi bl e Z e b 4 10 A ut i s m 26 16 10 27 32 m ont hs T a nt r um T a ngi bl e

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93 Fi g u re 3 1 In t e rv en t i o n p ro ced u r es Ch i l d p l ay i n g w i t h t o y (3 0 s acces s ) T ak e t o y Ph y s i cal Pro mp t 5 s t i me d el ay V e rb al Pro mp t 5 s t i me d el ay V e rb al / G es t u ral Pro mp t 5 s t i me d el ay Paren t p l ay i n g w i t h t o y Ch i l d R eq u es t H an d o v er H an d A s s i s t an ce Ch i l d Req u es t Ch i l d R eq u es t 3 0 s A c ces s t o T o y Sta rt Ov er

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94 C H A P T E R 4 R E S U L T S T he pur pos e of t hi s s t udy w a s t o e xa m i ne t he e f f e c t s of a m od i f i e d m i l i e u t he r a py i nt e r ve nt i on on t he c om m uni c a t i ve be ha vi or s o f yo ung c hi l dr e n w i t h a ut i s m s pe c t r um di s or de r s T he s t udy w a s c onduc t e d a c r os s 4 pha s e s : ( a ) p r e i nt e r ve nt i on/ a s s e s s m e nt pha s e ( b) ba s e l i ne ( c ) i nt e r ve nt i on a nd ( d) m a i nt e na nc e T he i nt e r ve nt i on pha s e c ons i s t e d of t hr e e c ondi t i ons e a c h t e a c hi ng a ne w c om m uni c a t i ve be ha vi or A ddi t i on a l l y, ge ne r a l i z a t i on o f c om m uni c a t i ve be ha vi or s a c r os s s e t t i ngs w a s e xa m i ne d t hr oughout t he s t udy. I nt e r obs e r ve r a gr e e m e nt w a s c onduc t e d t o a s s e s s t he r e l i a bi l i t y of be ha vi or a l ob s e r va t i ons a nd t he f i ndi ngs F i na l l y t r e a t m e nt i nt e gr i t y a nd s oc i a l va l i di t y da t a w e r e c ond uc t e d. P r e I n t e r ve n t i on / A s s e s s m e n t P h as e P r e f e r e n c e A s s e s s m e n t A s de s c r i be d i n C ha pt e r 3, t he p r e f e r e nc e a s s e s s m e nt s w e r e c onduc t e d a c c or di ng t o pr oc e dur e s out l i ne d by R oa ne V ol l m e r R i ngda hl & M a r c us ( 1998) T he r e s ul t s of t he pr e f e r e nc e a s s e s s m e nt s f or a l l t h r e e pa r t i c i pa nt s a r e f ound i n T a bl e 4 1. S c ot t F or t he f i r s t p r e f e r e nc e a s s e s s m e nt S c ot t w a s pr e s e nt e d w i t h t he f ol l ow i ng i t e m s : a gr e e n ba l l t oy d i nos a ur t oy t r uc k c om put e r s w i ng, f a vo r i t e book a nd f a vor i t e m ovi e ( i e t oy s t or y) I n t h e f i r s t s e s s i on, S c ot t e xc l us i ve l y c hos e t he gr e e n ba l l f o r t he e nt i r e t i m e of t he pr e f e r e nc e a s s e s s m e nt s e s s i on ( i e 5 m i n) D u r i ng t he s e c ond pr e f e r e nc e a s s e s s m e nt s e s s i on, he i nt e r a c t e d w i t h t he c om pu t e r f or 3 m i n 45s a nd di d not i nt e r a c t w i t h a ny ot h e r i t e m dur i ng t he r e m a i nde r of t he s e s s i on. I n t he f i na l pr e f e r e nc e a s s e s s m e nt s e s s i on, S c ot t e nga ge d w i t h t he T oy S t or y f or 4 m i n 46s a nd di d not i nt e r a c t w i t h a ny o t he r i t e m du r i ng t he s e s s i on. T he r e f o r e e a c h of t he s e i t e m s i nd i vi dua l l y, w a s de t e r m i ne d t o be t he pr e f e r r e d i t e m f or e a c h o f t he 3 c om m uni c a t i on c ondi t i ons r e s pe c t i ve l y.

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95 D avi d F o r t he f i r s t pr e f e r e nc e a s s e s s m e nt D a vi d w a s pr e s e nt e d w i t h t he f ol l ow i ng i t e m s : a t oy t r uc k, t oy f a r m a ni m a l s s w i ng, t oy t r a i n, f a vo r i t e m ovi e ( i e t oy s t or y ) f a vor i t e book, a nd t oy j a c k i n t he box I n t he f i r s t p r e f e r e nc e a s s e s s m e nt s e s s i on, D a vi d i nt e r a c t e d w i t h t he t oy t r a i n f o r 4 m i n 3s a nd w i t h t he t oy t r uc k f or 20s D ur i ng t he s e c ond pr e f e r e nc e a s s e s s m e nt s e s s i on, he c hos e T oy S t o r y f o r 3 m i n 48s a nd i n t e r a c t e d a ga i n w i t h t he t oy t r uc k f or 35s I n t he f i na l pr e f e r e nc e a s s e s s m e nt s e s s i on, D a vi d e nga ge d w i t h t he s w i ng f or 3 m i n 11s a nd onc e a ga i n c hos e t he t oy t r uc k f o r 1 m i n 2s T he r e f or e e a c h of t he s e i t e m s i ndi vi dua l l y, w a s de t e r m i ne d t o be t he pr e f e r r e d i t e m f o r e a c h of t he 3 c om m uni c a t i on c ondi t i ons r e s pe c t i ve l y. Z e b F or t he f i r s t pr e f e r e nc e a s s e s s m e nt Z e b w a s pr e s e nt e d w i t h t he f ol l ow i ng i t e m s : a s w i ng, t oy di nos a ur t oy t r uc k, c om put e r puz z l e f a vor i t e book, a nd f a vo r i t e m ovi e ( i e T oy S t or y) I n t he f i r s t p r e f e r e nc e a s s e s s m e nt s e s s i on, Z e b e xc l us i ve l y c hos e t he c om put e r D ur i ng t he s e c ond pr e f e r e nc e a s s e s s m e nt s e s s i on, he i nt e r a c t e d w i t h t he s w i ng f o r 3 m i n 4 s a nd d i d not i nt e r a c t w i t h a ny ot he r i t e m I n t he f i na l pr e f e r e nc e a s s e s s m e nt s e s s i on, Z e b e nga ge d w i t h T oy S t or y f or 5 m i n a nd di d not i nt e r a c t w i t h a ny ot he r i t e m T he r e f or e e a c h of t he s e i t e m s i ndi vi dua l l y, w a s de t e r m i ne d t o be t he pr e f e r r e d i t e m f or e a c h of t he 3 c om m uni c a t i on c ondi t i ons r e s pe c t i ve l y. F u n c t i on al A n al ys i s F unc t i ona l a na l ys e s w e r e c onduc t e d f or a l l t hr e e p a r t i c i pa nt s t o de t e r m i ne f unc t i ons of t he i r a be r r a nt be ha vi or s ( s e e F i gur e s 4 1 4. 3 ) S c ot t S c ot t s r e s ul t s of t he f unc t i ona l a na l ys i s a r e de pi c t e d i n f i gu r e 4. 1 T he r a t e of S c ot t s a ggr e s s i ve be ha vi or ( i e p i nc hi ng a nd hi t t i ng ot he r s ) w a s hi ghe r i n t he t a ngi bl e c ondi t i on ( M = 0. 6/ m i n r a nge 0. 4 0. 8/ m i n) i n c ont r a s t t o t h e a t t e nt i on c ondi t i on ( M = 0/ m i n ) e s c a pe c ondi t i on ( M = 0 05, r a nge 0 0. 2/ m i n ) a nd f r e e pl a y c ondi t i on ( M = 0) T he r e w a s no ove r l a p i n

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96 da t a be t w e e n c ondi t i ons a l t hough t he da t a dur i ng t he t a ngi bl e c ondi t i on va r i e d. F ur t he r S c ot t e nga ge d i n a ggr e s s i ve be ha vi or i n onl y one s e s s i on out s i de of t he t a ngi bl e c ondi t i on T he s e r e s ul t s i ndi c a t e t ha t S c ot t s a gg r e s s i ve be ha vi or w a s m a i nt a i ne d by a c c e s s t o t a ngi bl e i t e m s of i nt e r e s t D avi d D a vi d s r e s ul t s of t he f unc t i ona l a na l ys i s a r e de pi c t e d i n f i gur e 4 2. T he r a t e of D a vi d s s e l f i nj ur i ous be ha vi or ( S I B ; i e hi t t i ng a nd bi t i ng s e l f ) w a s t he hi ghe r i n t he t a ngi bl e c ondi t i on ( M = 2 0/ m i n r a nge 1. 6 2 6/ m i n ) i n c on t r a s t t o t he a t t e nt i on c ondi t i on ( M = 1 1/ m i n r a nge 0. 8 1 6/ m i n ) e s c a pe c ondi t i on ( M = 0 3, r a n ge 0. 2 0 6/ m i n) a nd f r e e pl a y c ondi t i on ( M = 0) T he r e w a s no ove r l a p i n t he da t a be t w e e n c ondi t i ons I n a ddi t i on, hi s da t a du r i ng t he t a ngi bl e c ondi t i on w a s m os t l y s t a bl e unt i l t he f i na l s e s s i on, w hi c h e nde d on a n i nc r e a s i ng t r e nd. T he s e r e s ul t s i ndi c a t e t ha t D a vi d s S I B w a s m a i nt a i ne d b y a c c e s s t o t a ngi bl e i t e m s of i nt e r e s t Z e b Z e b s r e s ul t s of t he f unc t i ona l a na l ys i s a r e de pi c t e d i n f i gu r e 4 3. T he r a t e of Z e b s t a nt r um s ( i e s c r e a m i ng a nd w hi ni ng ) w a s hi ghe r i n t he t a ngi bl e c ondi t i on ( M = 1. 9/ m i n, r a nge 1. 6 2. 2/ m i n) i n c ont r a s t t o t he a t t e nt i on c ondi t i on ( M = 0/ m i n) e s c a pe c ondi t i on ( M = 0. 35/ m i n, r a nge 0. 2 0 6/ m i n ) a nd f r e e pl a y c ondi t i on ( M = 0 / m i n) T he r e w a s no ove r l a p i n da t a be t w e e n c ondi t i ons I n a ddi t i on, da t a dur i ng t he t a ngi b l e c o ndi t i on w a s s t a bl e a nd pr oduc e d a n i nc r e a s i ng t r e nd. F u r t he r S c ot t e nga ge d i n a gg r e s s i ve be ha vi or i n on l y one o t he r c ondi t i on ( i e e s c a pe ) but r e s pons e r a t e s w e r e m uc h l ow e r c om pa r e d t o t he t a ngi bl e c ondi t i on. T he s e r e s ul t s i ndi c a t e t ha t Z e b s t a nt r um be ha vi or w a s m a i nt a i ne d by a c c e s s t o t a ngi bl e i t e m s of i nt e r e s t I n t e r ve n t i on R e s u l t s F ol l ow i ng t he p r e i nt e r ve nt i on pha s e of t he s t udy, ba s e l i ne i nt e r ve nt i on, a nd m a i nt e na nc e pha s e s w e r e i m pl e m e nt e d f or e a c h pa r t i c i pa nt ( s e e F i gu r e s 4. 4 a nd 4. 5 ) B a s e d on e a c h pa r t i c i pa nt s r e s pons e s t he num be r o f oppo r t uni t i e s f or c om m un i c a t i on di f f e r e d a c r os s e a c h

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97 s e s s i on ( s e e T a bl e 4. 2 ) I n a ddi t i on, a n a s s e s s m e nt of ge ne r a l i z a t i on o f s ki l l s a c r os s s e t t i ngs dur i ng e a c h of t he s e pha s e s w a s c onduc t e d. D a t a w e r e c ol l e c t e d a c r os s a l l pha s e s of t he s t udy on t a r ge t c hi l dr e n s c om m uni c a t i ve a nd a be r r a nt be ha vi or s T he r e s ul t s f or e a c h t a r ge t be ha vi or f ol l ow C om m u n i c at i o n S c ot t s b as e l i n e B a s e l i ne da t a w e r e c ol l e c t e d on S c ot t s t ot a l pe r c e nt a ge o f c om m uni c a t i on r e s pons e s ( P C R ) D ur i ng ba s e l i ne no pr om p t s w e r e gi ve n t o S c ot t A f t e r t he da t a w e r e s t a bl e dur i ng ba s e l i ne i n t he p r i m a r y t r a i ni ng s e t t i ng ( i e t he ho m e ) f or a l l pa r t i c i pa nt s w hi c h s t a bi l i z e d a t 0 % w i t h no c e l e r a t i on ( s e e F i gur e 4. 4) t he f i r s t i nt e r ve nt i on c ondi t i on w a s i m pl e m e nt e d w i t h S c ot t S c ot t s c on d i t i on 1. F ol l ow i ng t he i m pl e m e nt a t i o n of t he f i r s t i nt e r ve nt i on c ondi t i on ( c ondi t i on 1) S c ot t s t ot a l P C R c ha nge d i n l e ve l f r om t he ba s e l i ne pha s e t o i nt e r ve nt i on pha s e f r om 0 % t o 37% D ur i ng c ondi t i on 1 hi s t o t a l P C R i ni t i a l l y s t a bi l i z e d a c r os s s i x s e s s i ons a nd t he n w a s e l e va t e d i n s e s s i on 12 a nd a ga i n s t a bi l i z e d w i t h a s l i ght a c c e l e r a t i on t r e nd A c r os s c ondi t i on 1, hi s t ot a l P C R r a nge d f r om 40 % t o 86 % w i t h a n a ve r a ge o f 64 % A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 56 % ( 37 % t o 78% ) w hi l e hi s unp r om pt e d P C R a ve r a ge d 8% ( 0 % t o 29% ) I n a ddi t i on t he r e w a s no ove r l a p i n t he da t a be t w e e n t h e ba s e l i ne a nd i nt e r ve nt i on pha s e s F ur t he r dur i ng c ondi t i on 1 hi s m e a n l a t e nc y t o r e s pond w i t h unpr om p t e d c om m uni c a t i on r e s pons e s w a s 2. 87s ( 2. 00s 4. 50s ; s e e F i gur e 4. 6 ) w hi c h i s c ons i s t e nt w i t h t he l a t e nc y t o r e s pond i n t ypi c a l l y de ve l opi ng c hi l dr e n ( H a r t & R i s l e y, 1999 ) S c ot t r e qui r e d pr om pt s f or t he m a j o r i t y o f s e s s i ons dur i ng t hi s c o ndi t i on, but a t l e a s t 20% ( M = 27% r a nge 20 % 33% ) of e a c h of t he l a s t t hr e e s e s s i ons w a s unpr om pt e d c om m uni c a t i on r e s pons e s ( s e e F i gur e 4. 4)

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98 S c ot t s c on d i t i on 2. A f t e r S c ot t s t ot a l P C R s t a bi l i z e d a bove 75% f o r a t l e a s t 3 c ons e c ut i ve s e s s i ons i n t he f i r s t c ondi t i on a nd a t l e a s t 20% of e a c h of t he l a s t t hr e e s e s s i ons di d not r e qui r e pr om pt s t he ne w c om m un i c a t i ve r e s pons e c a r d w a s i nt r oduc e d. D u r i ng i nt e r ve nt i on c ondi t i on 2, hi s r e s pons e s s t a bi l i z e d a bove 75% f o r t he l a s t t h r e e s e s s i ons w i t h a n a c c e l e r a t i on t r e nd. A c r os s c ondi t i on 2, hi s t ot a l P C R r a nge d f r o m 56% t o 100% w i t h a n a ve r a ge of 82 % A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 64% ( 32% t o 100 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 18% ( 0 % t o 55% ) S i m i l a r t o c ondi t i on 1, hi s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s w a s c ons i s t e nt w i t h t ypi c a l l y de ve l opi ng c hi l dr e n w i t h a n a ve r a ge of 3. 10s ( 2. 40s 4. 20s ) S i m i l a r t o c ondi t i on 1, S c o t t c ont i nue d t o ne e d p r om pt s f o r t he m a j or i t y of s e s s i ons H e us e d unpr om pt e d c om m u ni c a t i on r e s pons e s f or hi s l a s t t hr e e s e s s i ons of c ondi t i on 2 ( M = 44% r a nge 28 % 63% ) S c ot t s c on d i t i on 3 A f t e r S c ot t s t ot a l P C R s t a bi l i z e d a bove 75% f o r a t l e a s t 3 c o ns e c ut i ve s e s s i ons i n t he s e c ond c ondi t i on a nd a t l e a s t 20% o f e a c h of t he l a s t t h r e e s e s s i ons di d not r e qui r e p r om pt s a ne w c om m uni c a t i ve r e s pons e c a r d f or c ondi t i on 3 w a s i nt r oduc e d. D ur i ng t hi s c ondi t i on S c ot t s t ot a l P C R w a s c ons t a nt t hr oughout t he c ondi t i on a t 100% A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 9% ( 0% t o 33 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 91% ( 67 % t o 100% ) S i m i l a r t o t he ot he r t w o c ondi t i ons hi s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s r e m a i ne d c ons i s t e nt w i t h t ha t of t ypi c a l l y de ve l opi ng c hi l dr e n a t a n a ve r a ge of 2 94s ( 2 71s 3 03s ) I n c ont r a s t t o t he ot he r c ondi t i ons S c ot t no l onge r r e qui r e d a ny pr o m pt s t o c om m uni c a t e f or t h e m a j or i t y o f t he s e s s i ons S c ot t s m a i n t e n an c e F ol l ow i ng t he l a s t s e s s i on of c ondi t i on 3 i n t he i nt e r ve nt i on pha s e no obs e r va t i ons w e r e c onduc t e d f or 2 w e e ks A t t h e e nd of t he t w o w e e k pe r i od, t he e xpe r i m e nt e r r e t ur ne d a nd c ol l e c t e d m a i nt e na nc e d a t a D ur i ng t he m a i nt e na nc e pha s e S c ot t s

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99 t ot a l P C R s t a bi l i z e d a t 100% f o r t h r e e c ons e c ut i ve s e s s i ons ( M = 80% r a nge 50% 100% ) A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 20% ( 0% t o 50 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 60% ( 0 % t o 100% ) I n a ddi t i on, hi s c om m uni c a t i ve r e s pons e s m a i nt a i ne d a nd di d not r e t ur n t o ba s e l i ne l e ve l s S i m i l a r t o t he t hr e e c o ndi t i ons i n t he i nt e r ve nt i on pha s e hi s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i o n r e s pons e s r e m a i ne d c ons i s t e nt w i t h t ha t of t ypi c a l l y de ve l opi ng c hi l dr e n a t a n a ve r a ge of 2 12 s ( 2. 00s 2 40s ) H e a l s o di d not r e qu i r e pr om pt s f or t he f i na l t h r e e s e s s i ons D avi d s b as e l i n e A f t e r t he i nt e r ve nt i on w a s i m pl e m e nt e d w i t h S c ot t t he e xpe r i m e nt e r c ont i nue d t o c ol l e c t ba s e l i ne da t a on D a vi d. A s w i t h S c ot t no p r om pt s w e r e gi ve n dur i ng t he s e s e s s i ons P C R r e m a i ne d a t z e r o pe r c e nt dur i ng t he ba s e l i ne pha s e D avi d s c on d i t i o n 1 W he n da t a w e r e a t a s t a bl e t r e nd i n ba s e l i ne f or D a vi d a nd a pr e di c t a bl e a c c e l e r a t i ng t r e nd i n c ondi t i on 1 f o r S c ot t t he f i r s t i nt e r ve nt i on c ondi t i on w a s i m pl e m e nt e d w i t h D a vi d. S i m i l a r t o S c ot t s c ha nge of l e ve l f r om ba s e l i ne t o i nt e r ve nt i on, D a vi d s t ot a l P C R c ha nge d i n l e ve l f r o m t he ba s e l i ne pha s e t o i nt e r ve nt i on pha s e f r om 0% t o 36% D u r i ng c ondi t i on 1, D a vi d s t ot a l P C R ha d a n a c c e l e r a t i ng t r e nd, w i t h h i s l a s t f our s e s s i ons a bove 75% a nd z e r o c e l e r a t i on. A c r os s c ondi t i on 1 hi s t ot a l P C R r a nge d f r om 43% t o 88% w i t h a n a ve r a ge of 68 % A br e a kdow n s how s t ha t h i s pr om pt e d P C R a ve r a ge d 50% ( 28% t o 73 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 15% ( 0% t o 32% ) I n a ddi t i on, t he r e w a s no ove r l a p i n t he da t a be t w e e n t he ba s e l i ne a nd i nt e r ve nt i on pha s e s F ur t he r dur i ng c ondi t i on 1 D a vi d s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i o n r e s pons e s w a s 2. 15s ( 2. 00s 2 33s ; s e e F i gur e 4. 7 ) w hi c h i s c ons i s t e nt w i t h t ypi c a l l y de ve l opi ng c hi l dr e n ( H a r t & R i s l e y, 1999 ) H ow e ve r he r e qui r e d pr o m pt s f or t he m a j o r i t y o f s e s s i on t i m e dur i ng t hi s c ondi t i on ( s e e F i gu r e

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100 4. 4) D a vi d s us e d unpr om p t e d c om m uni c a t i on f or pa r t o f hi s l a s t t h r e e s e s s i ons of c ondi t i on 1 ( M = 27% r a nge 25% 28 % ) D avi d s c on d i t i o n 2 W he n da t a w e r e a t a s t a bl e a nd pr e di c t a bl e a c c e l e r a t i ng t r e nd i n c ondi t i on 2 f or S c ot t D a vi d s t ot a l P C R s t a bi l i z e d a bove 75% f o r a t l e a s t 3 c ons e c ut i ve s e s s i ons dur i ng c ondi t i on 1, a nd a t l e a s t 20% of e a c h of t he l a s t t hr e e s e s s i ons di d not r e qui r e p r om pt s t he ne w c a r d f or c ondi t i on 2 w a s i m pl e m e nt e d w i t h D a vi d. D ur i ng c ondi t i on 2 D a vi d s t ot a l P C R ha d a n a c c e l e r a t i on t r e nd a nd s t a bi l i z e d w i t h z e r o c e l e r a t i on a t 100% f or 3 c ons e c ut i ve s e s s i ons A c r os s c ondi t i on 2, hi s t ot a l P C R r a nge d f r om 71 % t o 100 % w i t h a n a ve r a ge of 89% A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 11% ( 0% t o 60 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 78% ( 11 % t o 100% ) S i m i l a r t o c on di t i on 1, hi s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s w a s c ons i s t e nt w i t h t ypi c a l l y de ve l opi ng c hi l dr e n w i t h a n a ve r a ge of 3. 08s ( 2. 25s 4. 42s ) I n c ont r a s t t o c on di t i on 1, D a vi d di d not r e qui r e p r om pt s f o r t he m a j or i t y of s e s s i ons H e us e d unpr om pt e d c om m u ni c a t i on f or 100% of hi s l a s t t hr e e s e s s i ons dur i ng c ondi t i on 2. D avi d s c on d i t i o n 3 W he n da t a w e r e a t a s t a bl e a nd pr e di c t a bl e t r e nd i n c ondi t i on 3 f or S c ot t D a vi d s t ot a l P C R s t a bi l i z e d a bove 75 % f o r a t l e a s t 3 c ons e c ut i ve s e s s i on s dur i ng c ondi t i on 2, a nd a t l e a s t 20% o f e a c h of t he l a s t t h r e e s e s s i on s di d not r e qui r e pr om p t s t he ne w c a r d f or c ondi t i on 3 w a s i m pl e m e nt e d w i t h D a vi d. D ur i ng t hi s c ondi t i on hi s t ot a l P C R a ve r a ge d 98% ( r a nge 78% 100% ) w hi c h w a s 100% f or a l l but t he f i r s t s e s s i on. A b r e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 3 % ( 0 % t o 25% ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 95% ( 53% t o 100% ) S i m i l a r t o t he ot he r t w o c ondi t i ons hi s m e a n l a t e nc y t o r e s pond w i t h unpr om p t e d c om m uni c a t i on r e s pons e s r e m a i ne d c ons i s t e nt w i t h t ha t of t ypi c a l l y de ve l opi ng c hi l dr e n a t a n a ve r a ge of 3. 53s ( 2. 33s 4. 88s ) D a vi d a l s o no l on ge r r e qui r e d pr om pt s t o c om m uni c a t e f o r t he

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101 m a j or i t y of t he s e s s i ons S i m i l a r t o c ondi t i on 2 he us e d unpr om pt e d c om m uni c a t i on f or 100 % o f hi s l a s t t hr e e s e s s i ons dur i ng c ondi t i on 3 D avi d s m ai n t e n an c e F ol l ow i ng t he l a s t s e s s i on of c ondi t i on 3, no da t a w e r e c ol l e c t e d f or 2 w e e ks A t t he e nd of t he t w o w e e k pe r i od, t h e e xpe r i m e nt e r r e t u r ne d a nd c ol l e c t e d m a i nt e na nc e da t a D ur i ng t hi s pha s e D a vi d s t ot a l P C R s t a bi l i z e d a t 100% f or f i ve c ons e c ut i ve s e s s i ons ( M = 100% ) A b r e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 0% w hi l e hi s unpr om pt e d P C R a ve r a ge d 100% I n a ddi t i on h i s c om m uni c a t i ve r e s pons e s m a i nt a i ne d a nd di d not r e t ur n t o ba s e l i ne l e ve l s S i m i l a r t o t he ot he r t h r e e c ondi t i ons hi s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s r e m a i ne d c ons i s t e nt w i t h t ha t of t ypi c a l l y de ve l opi ng c hi l dr e n a t a n a ve r a ge of 3 4s ( 2 50s 4 20s ) H e a l s o di d not r e qui r e a ny pr om pt s du r i ng m a i nt e na nc e s e s s i ons Z e b s b as e l i n e A f t e r t he i n t e r ve nt i on w a s i m pl e m e nt e d w i t h S c ot t a nd D a vi d, t he e xpe r i m e nt e r c ont i nue d t o c ol l e c t ba s e l i ne da t a on Z e b. A s w i t h S c ot t a nd D a vi d, no p r om pt s w e r e gi ve n dur i ng t he s e s e s s i ons P C R r e m a i ne d z e r o dur i ng t he ba s e l i ne pha s e Z e b s c on d i t i on 1. W he n da t a w e r e a t a s t a bl e a nd pr e di c t a bl e a c c e l e r a t i ng t r e nd i n c ondi t i on 1 f or D a vi d t he i nt e r ve nt i on w a s i m pl e m e nt e d w i t h Z e b S i m i l a r t o S c ot t a nd D a vi d s c ha nge of l e ve l f r om ba s e l i ne t o i nt e r ve nt i on D a vi d s t ot a l P C R c ha nge d i n l e ve l f r om 0 % t o 37% D u r i ng c ondi t i on 1, Z e b s t ot a l P C R ha d a n a c c e l e r a t i ng t r e nd, w i t h hi s l a s t t hr e e s e s s i ons c ons t a nt a t 100% A c r os s c ondi t i on 1 hi s t ot a l P C R r a nge d f r om 31% t o 100 % w i t h a n a ve r a ge of 70% A br e a kdow n s how s t ha t hi s p r om pt e d P C R a ve r a ge d 30% ( 0 % t o 59% ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 44% ( 0 % t o 100% ) I n a ddi t i on, t he r e w a s no ove r l a p i n t he da t a be t w e e n t he ba s e l i ne a nd i nt e r ve nt i on pha s e s F u r t he r du r i ng c ondi t i on 1, Z e b s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s w a s 2. 12s ( 2. 00s 2. 20s ; s e e F i gu r e 4. 8 )

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102 w hi c h i s c ons i s t e nt w i t h t ypi c a l l y de ve l opi ng c hi l d r e n ( H a r t & R i s l e y, 1999) S i m i l a r t o D a vi d, he r e qui r e d p r om pt s f o r t he m a j or i t y of s e s s i ons dur i ng t hi s c ondi t i on ( s e e F i gu r e 4. 4 ) H ow e ve r Z e b us e d unpr om pt e d c om m uni c a t i on f o r t he m a j o r i t y of hi s l a s t t h r e e s e s s i ons of c ondi t i on 1 ( M = 90% r a nge 83% 100 % ) Z e b s c on d i t i on 2. W he n da t a w e r e a t a s t a bl e a nd pr e di c t a bl e a c c e l e r a t i ng t r e nd i n c ondi t i on 2 f or D a vi d Z e b s t ot a l P C R s t a bi l i z e d a bove 75% f or a t l e a s t 3 c ons e c ut i ve s e s s i ons dur i ng c ondi t i on 1, a nd a t l e a s t 20% of e a c h of t he l a s t t hr e e s e s s i ons di d not r e qui r e p r om pt s t he ne w c om m uni c a t i on r e s pons e f or c ondi t i on 2 w a s i m pl e m e nt e d w i t h Z e b D u r i ng c ondi t i on 2, Z e b s t ot a l P C R ha d a n a c c e l e r a t i on t r e nd a nd s t a b i l i z e d w i t h z e r o c e l e r a t i on a t 100 % f or s i x c ons e c ut i ve s e s s i ons A c r os s c ondi t i on 2, hi s t ot a l P C R r a nge d f r om 63% t o 100 % w i t h a n a ve r a ge of 93% A br e a kdow n s how s t ha t hi s p r om pt e d P C R a ve r a ge d 47% ( 0% t o 80 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 45 % ( 0 % t o 100% ) S i m i l a r t o c ondi t i on 1 hi s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s w a s c ons i s t e nt w i t h t ypi c a l l y de ve l opi ng c hi l dr e n w i t h a n a ve r a ge of 2. 10s ( 1. 29s 2. 33s ) I n c ont r a s t t o c ondi t i on 2 Z e b di d no t r e qui r e pr om pt s f or t he m a j o r i t y o f s e s s i ons A por t i on of hi s l a s t t hr e e s e s s i ons of c o ndi t i on 2 w a s unpr om pt e d c om m uni c a t i on r e s pons e s ( M = 38% r a nge 20% 66% ) Z e b s c on d i t i on 3. W he n da t a w e r e a t a s t a bl e a nd pr e di c t a bl e t r e nd i n c ondi t i on 3 f or D a vi d, Z e b s t ot a l P C R s t a bi l i z e d a bove 75 % f o r a t l e a s t 3 c ons e c ut i ve s e s s i ons dur i ng c ondi t i on 2, a nd a t l e a s t 20% of e a c h o f t he l a s t t hr e e s e s s i ons di d not r e qui r e p r om pt s t he ne w c om m uni c a t i on r e s pons e f or c ondi t i on 3 w a s i m p l e m e nt e d w i t h Z e b D ur i ng t hi s c ondi t i on h i s t ot a l P C R a ve r a ge d 94% ( r a nge 67 % 100% ) w hi c h w a s 100% f o r t he f i na l t hr e e s e s s i ons A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 28% ( 0% t o 83 % ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 72% ( 17 % t o 100% ) S i m i l a r t o t he ot he r t w o c ondi t i ons hi s m e a n l a t e nc y t o

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103 r e s pond w i t h unpr om pt e d c om m uni c a t i on r e s pons e s r e m a i ne d c ons i s t e nt w i t h t ha t of t ypi c a l l y de ve l opi ng c hi l dr e n a t a n a ve r a ge of 3. 18s ( 1. 57s 4. 80s ) Z e b a l s o di d not r e qui r e pr om pt s t o c om m uni c a t e f or t he m a j or i t y of t he s e s s i ons S i m i l a r t o c ondi t i on 2 hi s l a s t t h r e e s e s s i ons of c ondi t i on 3 e a c h ha d r e m ova l pr o m pt s ( M = 94% r a nge 83% 100% ) Z e b s m ai n t e n an c e F ol l ow i ng t he l a s t s e s s i on of c ondi t i on 3, no da t a w e r e c ol l e c t e d f o r 2 w e e ks A t t he e nd of t he t w o w e e k pe r i od, t he e x pe r i m e nt e r r e t u r ne d a nd c ol l e c t e d m a i nt e na nc e da t a D ur i ng t hi s pha s e Z e b s t ot a l P C R s t a bi l i z e d a t 100% f o r f i ve c ons e c ut i ve s e s s i ons ( M = 100% ) A br e a kdow n s how s t ha t hi s pr om pt e d P C R a ve r a ge d 11% ( 0 % t o 42% ) w hi l e hi s unpr om pt e d P C R a ve r a ge d 89% ( 58% t o 100% ) I n a ddi t i on hi s c om m un i c a t i ve r e s pons e s m a i nt a i ne d a nd di d not r e t u r n t o ba s e l i ne l e ve l s S i m i l a r t o t he ot he r t hr e e c ondi t i ons hi s m e a n l a t e nc y t o r e s pond w i t h unpr o m pt e d c om m uni c a t i on r e s pons e s r e m a i ne d c ons i s t e nt w i t h t ha t of t ypi c a l l y de ve l opi ng c hi l dr e n a t a n a ve r a ge of 2 10s ( 2 00s 2 20s ) H e a l s o di d not r e qui r e pr om p t s d ur i ng t he m a j or i t y of m a i nt e na nc e s e s s i on t i m e A l a r ge pe r c e nt a ge of Z e b s c om m uni c a t i on dur i ng m a i nt e na nc e w a s unpr om pt e d ( M = 89% r a nge 57 % 100% ) A b e r r an t B e h avi or S c ot t D ur i ng ba s e l i ne S c ot t s a be r r a nt be ha vi or ( hi t t i ng, p i nc hi ng pa r e nt ) r a t e a ve r a ge d 1. 44 r e s pons e s pe r m i nut e ( R P M ) w i t h a r a nge o f 1. 00 t o 1. 80 R P M ( s e e F i gur e 4. 5) D u r i ng c ondi t i on 1, hi s a be r r a nt be ha vi or r a t e de c r e a s e d a nd s t a bi l i z e d a t z e r o ( M = 0 45 R P M r a nge 0 1. 20 R P M ) w hi c h c or r e s ponde d w i t h hi s i nc r e a s e i n c om m uni c a t i on r e s pons e s H i s a be r r a nt be ha vi or r a t e r e m a i ne d l ow a nd de c r e a s e d t o z e r o ( M = 0. 20 R P M r a nge 0 0. 40 R P M ) dur i ng c ondi t i on 2. D ur i ng c ondi t i on 3 hi s a be r r a nt be ha v i or r a t e w a s s t a bl e a t z e r o ( M = 0 R P M ) f or t he e nt i r e c ondi t i on S c ot t m a i nt a i ne d l ow r a t e s of a be r r a nt be ha vi or ( M = 0 20 R P M r a nge 0 0. 80) du r i ng m a i nt e na nc e s e s s i ons w i t h t he l a s t t h r e e s e s s i ons a t 0 R P M

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104 D avi d D ur i ng ba s e l i ne hi s a be r r a nt be ha vi or ( hi t t i ng, bi t i ng s e l f ) r a t e a ve r a ge d 1 86 R P M w i t h a r a nge o f 0 80 t o 2. 60 R P M ( s e e F i gu r e 4. 5) D ur i ng c ondi t i on 1, hi s a be r r a nt be ha vi or r a t e de c r e a s e d t o z e r o ( M = 0 56 R P M r a nge 0 1. 60 R P M ) w hi c h c or r e s ponde d w i t h hi s i nc r e a s e i n c om m uni c a t i on r e s pons e s H i s a be r r a nt be ha vi or r a t e r e m a i ne d a t z e r o ( M = 0 04 R P M r a nge 0 0 40 R P M ) f or e i ght o f 9 s e s s i ons d ur i ng c ondi t i on 2. D ur i ng c ondi t i on 3, hi s a be r r a nt be ha vi or r a t e r e m a i ne d a t z e r o ( M = 0 R P M ) f or a l l s e s s i ons I n c ont r a s t t o S c ot t D a vi d s a be r r a nt be ha vi or r a t e s t a bi l i z e d a r ound 0. 8 R P M ( M = 0 72 R P M r a nge 0 60 0. 80 ) dur i ng m a i nt e na nc e e ve n t hough hi s c om m uni c a t i o n r e m a i ne d hi gh H ow e ve r he di d not r e t ur n t o pr e i nt e r ve nt i on r a t e s o f a be r r a nt be ha vi or Z e b D ur i ng ba s e l i ne Z e b s a be r r a nt be ha vi or ( t a n t r um ) r a t e a ve r a ge d 2 11 R P M w i t h a r a nge of 1 40 t o 2. 60 R P M H i s a be r r a nt be ha vi or r a t e de c r e a s e d t o ne a r z e r o ( M = 0. 56 R P M r a nge 0 1. 60 R P M ) dur i ng c ondi t i on 1, w hi c h c or r e s ponde d w i t h hi s i nc r e a s e i n c om m uni c a t i on. D ur i ng c ondi t i on 2, hi s a be r r a nt be ha vi o r r a t e r e m a i ne d a t z e r o ( M = 0 R P M ) f or a l l s e s s i ons S i m i l a r t o t he p r i o r c ondi t i on, Z e b s a be r r a nt be ha vi or r a t e r e m a i ne d a t z e r o ( M = 0 R P M ) f or a l l s e s s i ons I n c ont r a s t t o D a vi d, Z e b m a i nt a i ne d a n a be r r a nt be ha vi or r a t e of 0 R P M ( M = 0 R P M ) dur i ng a l l m a i nt e na nc e s e s s i ons S p on t an e ou s V e r b al i z at i o n s S c ot t D ur i ng ba s e l i ne s e s s i on s S c ot t ha d a s pont a ne ous ve r ba l i z a t i on r a t e of 1. 24 r e s pons e s pe r m i nut e ( R P M ; s e e T a bl e 4 3 f or m or e de t a i l ) I n c ondi t i on 1 of t he i nt e r ve nt i on pha s e S c ot t s s pont a ne ous ve r ba l i z a t i on r a t e i nc r e a s e d t o 3. 38 R P M S c ot t s s pont a ne ous ve r ba l i z a t i o n r a t e i nc r e a s e d t o 4. 91 R P M dur i ng c o ndi t i on 2. H i s s pont a ne ous ve r ba l i z a t i on r a t e c ont i nue d t o i nc r e a s e dur i ng c ondi t i on 3 t o 6. 7 R P M S c ot t s s pont a ne ous ve r ba l i z a t i ons m a i nt a i ne d dur i ng f ol l ow up a t a r a t e of 5. 76 R P M

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105 D avi d I n c ont r a s t t o S c ot t D a v i d di d not pr oduc e s pont a ne ous ve r ba l i z a t i ons a s de f i ne d i n t hi s s t udy dur i ng a ny s e s s i ons Z e b S i m i l a r t o D a vi d, Z e b di d not p r oduc e s pont a ne ous ve r ba l i z a t i ons dur i ng ba s e l i ne c ondi t i on 1 o r c ondi t i on 2. H ow e ve r he di d p r odu c e s pont a ne ous ve r ba l i z a t i ons dur i ng c ondi t i on 3. I t w a s not e d t ha t Z e b ha d a s pont a ne ous ve r ba l i z a t i on r a t e of 0. 05 R P M dur i ng c ondi t i on 3 D ur i ng m a i nt e na nc e s e s s i ons hi s s pont a ne ous ve r ba l i z a t i ons m a i nt a i ne d a t a r a t e of 0 84 R P M G e n e r al i z at i on R e s u l t s C om m u n i c at i o n S c ot t D u r i ng ba s e l i ne S c ot t di d not e nga ge i n un pr om pt e d c om m uni c a t i on. S c ot t s c om m uni c a t i on r e s pons e s di d not ge ne r a l i z e t o t he c l a s s r oom dur i ng c ondi t i on 1 e i t he r D ur i ng c ondi t i on 2, hi s c om m uni c a t i on r e s pons e s ge ne r a l i z e d f r om t he t r a i ni ng s e t t i ng t o t he ge n e r a l i z a t i on s e t t i ng ( i e c l a s s r oom s e t t i ng) F or t w o s e s s i ons i n t he c l a s s r oom S c ot t ha d a r e s pons e r a t e of 0 40. A l s o, he de m ons t r a t e d a ge n e r a l i z e d us e of t he ne w c om m uni c a t i on r e s pons e ( i e t he ne w pi c t ur e c a r d ) f o r 3 s e s s i ons i n t he c l a s s r oom dur i ng c ondi t i on 3 w he r e he ha d a n a ve r a ge r e s pons e r a t e of 0. 20 ( r a nge of 0 0. 40) I n a ddi t i on, ge ne r a l i z a t i on o f hi s c om m uni c a t i on r e s pons e s m a i nt a i ne d w i t h a n a ve r a ge of 0. 20 R P M ( r a nge 0. 20 0 20) D avi d D a vi d di d not ge ne r a l i z e hi s c om m uni c a t i o n r e s p ons e s ( unpr om pt e d) du r i ng ba s e l i ne or c ondi t i on 1 S i m i l a r t o S c ot t h i s c om m uni c a t i on r e s pons e s ge ne r a l i z e d f r om t he t r a i ni ng s e t t i ng t o t he ge ne r a l i z a t i on s e t t i ng ( i e c l a s s r oom s e t t i ng) dur i ng c ondi t i on 2 H ow e ve r r a t he r t ha n t he c om m uni c a t i on r e s pon s e t a ught i n c ondi t i on 2, D a vi d us e d t he c om m uni c a t i on r e s pons e w i t h t he c a r d f r om c ondi t i on 1 dur i ng ge ne r a l i z a t i on. F o r t hr e e s e s s i ons i n t he c l a s s r oom D a vi d ha d a n a ve r a ge r e s pons e r a t e of 0 23 ( r a nge 0 0. 60 ) A l s o, he ge ne r a l i z e d t he us e of t he ne w c om m uni c a t i on r e s pons e f or s e ve n of 8 s e s s i ons i n t he c l a s s r oom

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106 dur i ng c ondi t i on 3 w he r e he ha d a n a ve r a ge r e s pons e r a t e of 0 48 ( r a nge 0 0 60) I n a ddi t i on ge ne r a l i z a t i on of hi s c om m un i c a t i on r e s pons e s m a i nt a i ne d w i t h a n a ve r a ge of 0 30 R P M ( r a nge 0 0 80) Z e b S i m i l a r t o S c ot t a nd D a vi d, Z e b i ni t i a l l y di d not ge ne r a l i z e hi s c om m uni c a t i on r e s pons e s ( unpr om pt e d) dur i ng ba s e l i ne F ur t he r h e onl y us e d t he c om m uni c a t i on r e s pons e onc e dur i ng ge ne r a l i z a t i on s e s s i ons i n c ondi t i on 1 S i m i l a r t o S c ot t a nd D a vi d Z e b s c om m uni c a t i on r e s pons e s ge ne r a l i z e d f r om t he t r a i ni n g s e t t i ng t o t he ge ne r a l i z a t i on s e t t i ng ( i e c l a s s r oom s e t t i ng) f or t hr e e c ons e c ut i ve s e s s i ons dur i ng c ondi t i on 2. D ur i ng ge ne r a l i z a t i on s e s s i ons i n c ondi t i on 2 i n t he c l a s s r oom Z e b ha d a n a ve r a ge r e s pons e r a t e of 0. 29 ( r a nge 0 0. 6) A l s o, he ge ne r a l i z e d t he us e of t he ne w c om m uni c a t i on r e s pons e f or e ve r y s e s s i on of c ondi t i on 3 i n t he c l a s s r oom w he r e he ha d a n a ve r a ge r e s pons e r a t e of 0. 63 ( r a nge of 0. 4 0 8) I n a ddi t i on, ge ne r a l i z a t i on o f hi s unp r om pt e d c om m uni c a t i on r e s pons e s m a i nt a i ne d w i t h a n a ve r a ge o f 0 6 R P M ( M = 0. 6) A b e r r an t B e h avi or S c ot t S c ot t s a be r r a nt be ha vi or r a t e a ve r a ge d 0 3 R P M w i t h a r a nge o f 0 2 t o 0. 6 R P M ( s e e F i gur e 4 5) du r i ng ba s e l i ne H i s a be r r a nt be ha vi or r a t e d e c r e a s e d t o 0. 2 R P M ( M = 0 05 R P M r a nge 0 0 2 R P M ) dur i ng c ondi t i on 1 D ur i n g c ondi t i on 2 hi s a be r r a nt be ha vi or r a t e r e m a i ne d a t 0 R P M ( M = 0 R P M ) H i s a be r r a nt be ha vi or r a t e r e m a i ne d l ow du r i ng c ondi t i on 3 ( M = 0. 16 R P M r a nge 0 0. 6 ) H i s a be r r a nt be ha v i or r a t e r e m a i ne d l ow du r i ng m a i nt e na nc e ( M = 0. 13 R P M r a nge 0 0 4) D avi d D ur i ng ba s e l i ne D a vi d s a be r r a nt be ha vi or r a t e a ve r a ge d 1 73 R P M w i t h a r a nge of 1. 5 t o 2 0 R P M ( s e e F i gur e 4 5) D a vi d s a be r r a nt be ha vi or r a t e r e m a i ne d hi gh dur i ng c ondi t i on 1 ge ne r a l i z a t i on s e s s i ons ( M = 1. 95 R P M r a nge 1 8 2. 2 R P M ; s e e F i gur e 4. 5) H i s

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107 a be r r a nt be ha vi or r a t e de c r e a s e d t o 0 R P M ( M = 0 1 R P M r a nge 0 0. 2 R P M ) dur i ng c ondi t i on 2. H i s a be r r a nt be ha vi or r a t e r e m a i ne d a t 0 R P M ( M = 0 R P M ) dur i ng c ondi t i on 3. H i s a b e r r a nt be ha vi or r a t e r e m a i ne d a t 0 R P M ( M = 0 R P M ) a l s o dur i ng m a i nt e na nc e Z e b Z e b s a be r r a nt be ha vi or r a t e a ve r a ge d 0 55 R P M w i t h a r a nge of 0. 4 t o 0 8 R P M ( s e e F i gur e 4 5) du r i ng ba s e l i ne H i s a be r r a nt be ha vi or r a t e de c r e a s e d dur i ng c ondi t i on 1 ( M = 0 18 R P M r a nge 0 0 4 R P M ) H i s a be r r a nt be ha vi or r a t e de c r e a s e d t o 0 R P M ( M = 0. 1 R P M r a nge 0 0. 2 R P M ) dur i ng c ondi t i on 2. S i m i l a r t o D a vi d, Z e b s a be r r a nt be ha vi or r a t e r e m a i ne d a t 0 R P M ( M = 0 R P M ) dur i ng c ondi t i on 3. H i s a be r r a nt be ha vi or r a t e a l s o r e m a i ne d a t 0 R P M ( M = 0 R P M ) dur i ng m a i nt e na nc e S p on t an e ou s V e r b al i z at i o n s S c ot t D ur i ng ba s e l i ne ge ne r a l i z a t i on s e s s i ons S c ot t di d not pr oduc e s pont a ne ous ve r ba l i z a t i ons ( s e e T a bl e 4. 3 ) S c ot t d i d pr oduc e s pont a ne ous ve r ba l i z a t i ons dur i ng c ondi t i on 1 ge n e r a l i z a t i on s e s s i on s w i t h a s pont a ne ous ve r ba l i z a t i on r a t e of 0. 95 R P M I t a l s o w a s not e d t ha t S c ot t ha d a s pont a ne ous ve r ba l i z a t i on r a t e o f 0 3 R P M dur i ng c ondi t i on 2 ge ne r a l i z a t i on s e s s i ons H i s s pont a ne ous ve r ba l i z a t i ons i nc r e a s e d i n c ondi t i on 3 ge ne r a l i z a t i on s e s s i ons t o a r a t e of 1. 56 R P M D u r i ng m a i nt e na nc e s e s s i ons hi s s pont a ne ous ve r ba l i z a t i ons m a i nt a i ne d a t a r a t e of 2. 73 R P M D avi d I n c ont r a s t t o S c ot t D a vi d di d not pr oduc e s pont a ne ous ve r ba l i z a t i ons a s de f i ne d i n t hi s s t udy dur i ng a ny ge ne r a l i z a t i on s e s s i ons Z e b S i m i l a r t o D a vi d, Z e b di d not p r oduc e s pont a ne ous ve r ba l i z a t i ons dur i ng ba s e l i ne c ondi t i on 1, or c ondi t i on 2 ge ne r a l i z a t i on s e s s i ons ( s e e T a bl e 4. 3 ) H ow e ve r he di d p r oduc e s pont a ne ous ve r ba l i z a t i ons dur i ng c ondi t i on 3 ge ne r a l i z a t i on s e s s i ons I t w a s not e d t ha t Z e b ha d

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108 a s pont a ne ous ve r ba l i z a t i on r a t e of 0. 27 R P M dur i ng c ondi t i on 3 D ur i ng m a i nt e na nc e s e s s i ons hi s s pont a ne ous ve r ba l i z a t i ons i nc r e a s e d a nd m a i nt a i ne d a t a r a t e of 2 07 R P M T r e at m e n t I n t e gr i t y T r e a t m e nt i nt e gr i t y i s r e por t e d f or t r a i ni ng a nd t r e a t m e nt s e s s i ons ( i e ba s e l i ne i nt e r ve nt i on, m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i ons ) T r ai n i n g P ar e n t t r ai n i n g. A s a f or e m e nt i one d i n C ha pt e r 3, pa r e nt s w e r e t r a i ne d t o c r i t e r i o n. F i r s t t he y vi e w e d vi de os of t he i nt e r ve n t i on w i t h t he pr i m a r y e xpe r i m e nt e r a nd i de nt i f i e d pr oc e dur e s unt i l t he y a c hi e ve d a 90 % I O A T hi s s t e p t ook a n a ve r a ge of t w o hour s a nd 30 m i nut e s ( s e e T a bl e 4. 4 ) S e c ond, t he pa r e nt s r ol e pl a ye d p r oc e dur e s w i t h t he p r i m a r y e xpe r i m e nt e r unt i l t he y pe r f or m e d e a c h p r oc e dur e c or r e c t l y ( i e 100% a c c ur a c y) t e n c ons e c ut i ve t i m e s P a r e nt s r e qui r e d a n a ve r a ge 51 t r i a l s t ha t t ook a n a ve r a ge of 1 hou r a nd 25 m i nut e s of r ol e p l a y t o r e a c h c r i t e r i a ( s e e T a bl e 4. 4 ) T e ac h e r t r ai n i n g. A s a f o r e m e nt i one d i n C ha pt e r 3, t e a c he r s w e r e t r a i ne d t o c r i t e r i on on gi vi ng t he r e que s t e d i t e m t o t he t a r ge t c hi l d upon d i s pl a y of unpr om p t e d c om m uni c a t i on. T he t e a c he r s r ol e pl a ye d w i t h t he pr i m a r y e xpe r i m e nt e r unt i l t he y pe r f or m e d t he pr oc e dur e c o r r e c t l y ( i e 100 % a c c ur a c y) t e n c ons e c ut i ve t i m e s T e a c he r s r e qui r e d a n a ve r a ge of 23 t r i a l s t ha t t ook a n a ve r a ge of 15 m i nut e s of r ol e p l a y t o r e a c h c r i t e r i a ( s e e T a bl e 4. 5) T r e at m e n t S e s s i on s T r e a t m e nt i nt e gr i t y da t a f or ba s e l i ne i nt e r ve nt i on m a i nt e na nc e a nd ge ne r a l i z a t i on s e s s i ons i nc l ude : ( a ) pe r c e nt a ge of c or r e c t pr oc e du r a l pr om pt s ( i e ve r ba l ve r ba l / ge s t ur a l / or r e m ova l ) ( b) c or r e c t i m pl e m e nt a t i on o f t he t i m e d e l a y pr oc e dur e a nd ( c ) t he pe r c e nt a ge o f t i m e s t he r e que s t e d i t e m w a s gi ve n t o pa r t i c i pa nt f or t he c or r e c t t i m e ( i e 30s a c c e s s c ont i nge nt on

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109 c om m uni c a t i on r e s pons e ) w he n i t e m w a s r e que s t e d. A s m e nt i one d i n C ha pt e r 3 t r e a t m e nt i nt e gr i t y f o r e a c h a f o r e m e nt i one d pr oc e dur e w a s c a l c ul a t e d by m a r ki ng a ye s i f i t w a s done c or r e c t l y a nd a no i f i t w a s done i nc o r r e c t l y. T he t ot a l c or r e c t pr oc e dur e s w e r e d i vi de d by t he t ot a l num be r o f p r oc e dur e s M e a n pe r c e nt a ge s a n d r a nge s a r e r e po r t e d f o r e a c h t r e a t m e nt i nt e gr i t y m e a s ur e ( s e e T a bl e 4. 6 ) P r oc e d u r al p r om p t s A c r os s pha s e s t r e a t m e nt i n t e gr i t y f o r pr oc e dur a l pr om pt s w a s hi gh f or e a c h pa r t i c i pa nt i n t he i nt e r ve nt i on s e t t i ng T he a ve r a ge i nt e gr i t y w a s 81. 4 % w i t h a r a nge of 63 % t o 100% T r e a t m e nt i nt e g r i t y i n t he ge ne r a l i z a t i on s e t t i ng f or pr oc e dur a l pr om pt s a ve r a ge d hi ghe r T he a ve r a ge i n t e gr i t y a c r os s pa r t i c i pa nt s w a s 98. 7% w i t h a r a nge o f 75 % t o 100% T i m e d e l ay. A c r os s pha s e s t r e a t m e nt i nt e gr i t y f or t he us e of t i m e de l a y w a s hi gh f o r e a c h pa r t i c i pa nt i n t he t r a i ni ng s e t t i ng. T he a ve r a g e i nt e gr i t y w a s 87 1% w i t h a r a nge of 73% t o 100% T r e a t m e nt i nt e gr i t y i n t he ge ne r a l i z a t i on s e t t i ng f or t i m e de l a y a ve r a ge d hi ghe r T he a ve r a ge i nt e gr i t y a c r os s pa r t i c i pa nt s w a s 100% R e q u e s t e d i t e m p r oc e d u r e s A c r os s pha s e s t r e a t m e nt i nt e gr i t y f or r e que s t e d i t e m pr oc e dur e s w a s hi gh f or e a c h pa r t i c i pa nt i n t he t r a i ni ng s e t t i ng. T he a ve r a ge i n t e g r i t y w a s 87 7 % w i t h a r a nge o f 73 % t o 100% T r e a t m e nt i nt e g r i t y i n t he ge ne r a l i z a t i on s e t t i ng f or r e que s t e d i t e m pr oc e dur e s a ve r a ge d hi ghe r T he a ve r a ge i nt e gr i t y a c r os s pa r t i c i pa nt s w a s 100% S oc i al V al i d i t y T he pa r t i c i pa nt s pa r e nt s t e a c he r s a nd a n e xpe r t i n t he f i e l d of A S D c om pl e t e d L i ke r t t ype r a t i ng s c a l e s t o de t e r m i ne t he s oc i a l va l i di t y o f t he i nt e r ve nt i on p r oc e s s a nd out c om e s r e s pe c t i ve l y. F or t he e xpe r t r a t i ng s c a l e s L i ke r t va l ue s r a nge d f r om 1, t ypi c a l l y i nd i c a t i ng t he pr oc e s s a nd out c om e s w e r e not at a l l us e f ul t o 5 t ypi c a l l y i ndi c a t i ng t he p r oc e s s a nd out c om e s

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110 w e r e v e r y us e f ul t o t he t e a c he r a nd or c hi l d. T he l i ke r t va l ue s f or t he pa r e nt a nd t e a c he r r a t i ng s c a l e s w e r e s i m i l a r e xc e pt f or que s t i on 1 f o r w hi c h a f i ve i ndi c a t e d t ha t t he t r a i ni ng w a s t oo t i m e c ons um i ng. P ar e n t S oc i al V al i d i t y A c r os s pa r t i c i pa nt s pa r e nt s r e s ponde d t o que s t i ons i n a s i m i l a r m a nne r P a r e nt r e s pons e s t o que s t i on one w hi c h i nqui r e d a bout h ow t i m e c ons um i ng t he i nt e r ve nt i ons pr oc e dur e s w e r e a ve r a ge d 2. 7 ( r a n ge : 2 3) T he m e a n r e s pons e f or que s t i on t w o c onc e r ni ng t he i m pr ov e m e nt of e ve r yda y r out i ne s i n t he hom e w a s 4. 7 ( r a nge : 4 5) R e s pons e s t o que s t i on t hr e e a ve r a ge d 4. 3 ( r a nge : 3 5 ) T hi s que s t i on a ddr e s s e d t he how m uc h i nc r e as e di d t he pa r e nt obs e r ve i n t h e c hi l d s c om m uni c a t i on. T he m e a n r e s pons e f or que s t i on f our de a l i ng w i t h how m uc h i nc r e as e i n appr opr i at e be hav i or di d t he pa r e nt ob s e r ve i n t he c hi l d a ve r a ge d 4. 7 ( r a nge : 4 5) R e s pons e s t o que s t i on f i ve a ve r a ge d 5 ( r a nge : 5 ) t he hi ghe s t pos s i bl e va l ue T hi s que s t i on a ddr e s s e d t he w i l l i ngne s s of t he par e nt t o us e t he i nt e r v e nt i on i n t he f ut ur e T e ac h e r S oc i al V al i d i t y S i m i l a r t o pa r e nt s oc i a l va l i di t y que s t i onna i r e s t e a c he r s r e s ponde d s i m i l a r a c r os s pa r t i c i pa nt s T e a c he r s r e s pons e s t o que s t i on one w h i c h i nqui r e d a bout how t i m e c ons um i ng t he i nt e r ve nt i on pr oc e dur e s w e r e a ve r a ge d 1 ( r a nge : 1 ) T he m e a n r e s pons e f or que s t i on t w o c onc e r ni ng t he i m pr ov e m e nt of e ve r yda y r out i ne s i n t he hom e w a s 3 3 ( r a nge : 3 4 ) R e s pons e s t o que s t i on t hr e e a ve r a ge d 4. 3 ( r a nge : 4 5) T hi s que s t i on a ddr e s s e d t he how m uc h i nc r e as e di d t he t e a c he r obs e r ve i n t he c hi l d s c om m uni c a t i on. T he m e a n r e s pons e f or que s t i on f our de a l i ng w i t h how m uc h i nc r e as e i n appr opr i at e be hav i or di d t he t e a c he r obs e r ve i n t he c hi l d a ve r a ge d 4 ( r a nge : 4) R e s pons e s t o que s t i on f i ve a ve r a ge d 4 7 ( r a nge : 4 5) T hi s que s t i on a ddr e s s e d t he w i l l i ngne s s of t he t e ac he r t o us e t he i nt e r v e nt i on i n t he f ut ur e

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111 E xp e r t S oc i al V al i d i t y W he n t he e xpe r t vi e w e d t he vi de o of t he c hi l d r e n i n t he hom e a nd c l a s s r oom s e t t i ng f or t he ba s e l i ne i nt e r ve nt i on a nd m a i nt e na nc e pha s e s t he e xpe r t s r e s pons e t o que s t i on one t ha t i nqui r e d a bout t he appr opr i at e ne s s of t he t ar ge t c hi l d s c om m uni c at i on a ve r a ge d 4 ( r a nge : 3 5) w he n t he e xpe r t vi e w e d vi de o of t he c hi l dr e n i n t h e hom e a nd c l a s s r oom s e t t i ng f o r t he ba s e l i ne i nt e r ve nt i on, a nd m a i nt e na nc e pha s e s T he a ve r a ge r e s pons e t o que s t i on t w o c onc e r ni ng t he l e v e l of abe r r ant be hav i or of t he c hi l d a ve r a ge d 2. 6 ( r a nge : 2 4) w he n t he e xpe r t vi e w e d vi de o o f t he c hi l dr e n i n t he hom e a n d c l a s s r oom s e t t i ng f or ba s e l i ne i nt e r ve nt i on a nd m a i nt e na nc e pha s e s T he e xpe r t s m e a n r e s pons e t o que s t i on t hr e e t ha t a ddr e s s e d t he f r e que nc y of t he c hi l d s c om m uni c a t i on a ve r a ge d 4. 6 ( r a nge : 4 6) T he f i na l que s t i on de a l t w i t h t he t a r ge t c hi l d s ov e r a l l i m pr ov e m e nt c onc e r ni ng c om m uni c a t i on a nd a be r r a nt be ha vi or T he e xpe r t s m e a n r e s pons e t o que s t i on f our w a s 5 ( r a nge : 4 6) S u m m ar y B a s e d on t he da t a r e por t e d, c onc l us i ons c a n be dr a w n w i t hi n a nd a c r os s t he t hr e e pa r t i c i pa nt s O ve r a l l t a r ge t c hi l dr e n s pe r c e nt a ge of c om m uni c a t i on r e s pons e i nc r e a s e d, l e ve l e d, a nd r e m a i ne d s t a bl e a t o r a bove 75 % a c r os s t he i nt e r ve nt i on c ondi t i ons I n a ddi t i on t hi s w a s m a i nt a i ne d a t f ol l ow up s e s s i ons c onduc t e d t w o w e e ks a f t e r t he c onc l us i on of t he l a s t i nt e r ve nt i on c ondi t i on F u r t he r c om m uni c a t i on s ki l l s ge ne r a l i z e d t o t he c l a s s r oom s e t t i ng ( i e ge ne r a l i z a t i on s e t t i ng) i n c ondi t i ons 2 a nd 3 f o r S c ot t a nd D a vi d a nd c ondi t i ons 1, 2, a nd 3 f or Z e b. H ow e ve r t he c om m uni c a t i on r e s pons e r a t e s f or ge ne r a l i z a t i on w e r e t he hi gh e s t i n c ondi t i on 3 a nd m a i nt e na nc e s e s s i ons f or e a c h pa r t i c i pa nt T he pa r t i c i pa nt s de pe nde nc e on pr om pt s de c r e a s e d a c r os s a l l t hr e e i nt e r ve nt i on c ondi t i ons w i t h l e s s pr om pt s be i ng r e qui r e d f o r c o ndi t i on 3 o r m a i nt e na nc e s e s s i ons D ur i ng

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112 c ondi t i on 3 a nd m a i nt e na nc e s e s s i ons 80% or g r e a t e r of t he pa r t i c i pa nt s c om m uni c a t i on r e s pons e s di d not r e qui r e a phys i c a l ve r ba l / ge s t ur a l or ve r ba l pr om pt E a c h pa r t i c i pa nt r e s ponde d on a ve r a ge be t w e e n 3 a nd 4s a c r os s a l l t hr e e i nt e r ve nt i on c ondi t i ons ; how e ve r t hi s m e a s ur e w a s s l i ght l y va r i a bl e S i m i l a r t o t he pe r c e nt a ge of c om m uni c a t i on r e s pons e l e ve l s a be r r a nt be ha vi or r a t e de c r e a s e d, l e ve l e d, a nd r e m a i ne d l ow a c r os s c ondi t i ons a nd m a i nt a i ne d a t 0 R P M by c ondi t i on 3 I n a ddi t i on a be r r a nt be ha vi or r a t e r e m a i ne d a t z e r o dur i ng m a i nt e na nc e s e s s i ons f or e a c h pa r t i c i pa nt e xc e pt D a vi d, w hos e r a t e r e m a i ne d w e l l be l ow ba s e l i ne l e ve l s F u r t he r a be r r a nt be ha vi or r a t e s f or e a c h pa r t i c i pa nt dur i ng ge ne r a l i z a t i on pr obe s l e ve l e d a nd s t a bi l i z e d a t z e r o. T r e a t m e nt i nt e gr i t y da t a r e ve a l e d t ha t t he i nt e r ve nt i on w a s c onduc t e d w i t h a hi g h l e ve l o f i nt e gr i t y w i t hi n a nd a c r os s pa r t i c i pa nt s F i na l l y, s oc i a l va l i di t y da t a de m ons t r a t e d t ha t t he t e a c he r s pa r e nt s a nd a n e xpe r t i n t he f i l e d of A S D f ound t he s t udy t o be be ne f i c i a l t o t he pa r t i c i pa nt s

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113 T a bl e 4 1 P r e f e r e nc e a s s e s s m e nt c hoi c e s P a r t i c i pa nt C ondi t i on 1 I t e m C ondi t i on 2 I t e m C ondi t i on 3 I t e m S c ot t B a l l ( 5 m i n ) C om put e r ( 3 m i n 45s ) T oy S t o r y ( 4 m i n 46s ) D a vi d T r a i n ( 4 m i n 3s ) T oy S t o r y ( 3 m i n 48s ) S w i ng ( 3 m i n 11s ) Z e b C om pu t e r ( 5 m i n) S w i ng ( 3 m i n 4s ) T oy S t o r y ( 5 m i n ) T a bl e 4 2 A ve r a ge ( r a nge ) nu m be r o f t r i a l s P a r t i c i pa nt B a s e l i ne C ondi t i on 1 C ondi t i on 2 C ondi t i on 3 M a i nt e na nc e S c ot t 5 15 ( 12 21 ) 13 ( 10 16 ) 9 ( 8 10 ) 10 ( 8 12 ) D a vi d 5 14 ( 8 19 ) 10 ( 7 15 ) 9 ( 7 11 ) 9 ( 8 10 ) Z e b 5 14 ( 8 21 ) 11 ( 8 13 ) 10 ( 8 13 ) 8 ( 8 9 ) T a bl e 4 3 S pont a ne ous ve r ba l i z a t i ons B a s e l i ne C 1 C 2 C 3 M a i nt e na nc e S c ot t s T x S e t t i ng 1. 24 3. 38 4. 91 6. 7 5. 76 S c ot t s G e n. S e t t i ng 0 0. 95 0. 3 1. 56 2. 73 D a vi d T x S e t t i ng 0 0 0 0 0 D a vi d G e n. S e t t i ng 0 0 0 0 0 Z e b T x S e t t i ng 0 0 0 0. 05 0. 84 Z e b G e n. S e t t i ng 0 0 0 0. 27 2. 07 N ot e C 1 = c ondi t i on 1; C 2 = c ondi t i on 2 ; C 3 = c ondi t i on 3; T x = T r e a t m e nt ; G e n. = ge ne r a l i z a t i on. T a bl e 4 4 P a r e nt t r a i ni ng P a r e nt V i de o vi e w i ng R ol e pl a y S c ot t s m ot he r 2 hou r s 45m i nut e s 2 hour s ( 72 t r i a l s ) D a vi d s m ot he r 1 hour 15 m i nut e s 1 hour ( 36 t r i a l s ) Z e b s m ot he r 3 hour s 30 m i nut e s 1 hour 15 m i nut e s ( 45 t r i a l s ) T a bl e 4 5 T e a c he r t r a i ni ng T e a c he r R ol e pl a y S c ot t s t e a c he r 11 m i nut e s ( 20 t r i a l s ) D a vi d s t e a c he r 2 3 m i nut e s ( 32 t r i a l s ) Z e b s t e a c he r 10 m i nut e s ( 18 t r i a l s )

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114 T a bl e 4 6 T r e a t m e nt I nt e gr i t y D a t a B a s e l i n e C o n d i t i o n 1 C o n d i t i o n 2 C o n d i t i o n 3 M a i n t e n a n c e P r o c e d u r e C h i l d T r a i n i n g G e n T r a i n i n g G e n T r a i n i n g G e n T r a i n i n g G e n T r a i n i n g G e n P r o c e d u r a l P r o m p t s S c o t t M = 1 0 0 % M = 1 0 0 % M = 8 2 % ( 8 0 % 1 0 0 % ) M = 1 0 0 % M = 8 6 % ( 8 2 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 8 0 % ( 7 5 % 1 0 0 % ) M = 8 0 % ( 7 5 % 1 0 0 % ) D a v i d M = 1 0 0 % M = 1 0 0 % M = 8 0 % ( 7 5 % 1 0 0 % ) M = 1 0 0 % M = 1 0 M = 1 0 0 % M = 9 0 % ( 8 2 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % Z e b M = 1 0 0 % M = 1 0 0 % M = 8 3 % ( 7 3 % 1 0 0 % ) M = 1 0 0 % M = 9 0 % ( 8 5 % 1 0 0 % ) M = 1 0 0 % M = 8 0 % ( 6 3 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 8 0 % ( 7 5 % 1 0 0 % ) T i m e D e l a y S c o t t M = 1 0 0 % M = 1 0 0 % M = 8 2 % ( 8 0 % 9 5 % ) M = 1 0 0 % M = 8 6 % ( 8 2 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 8 0 % ( 7 3 % 1 0 0 % ) M = 1 0 0 % D a v i d M = 1 0 0 % M = 1 0 0 % M = 8 3 % ( 7 3 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 9 0 % ( 8 6 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % Z e b M = 1 0 0 % M = 1 0 0 % M = 8 5 % ( 8 0 % 1 0 0 % ) M = 1 0 0 % M = 9 0 % ( 8 6 % 1 0 0 % ) M = 1 0 0 % M = 8 5 % ( 8 0 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % R e q u e s t e d I t e m T i m e S c o t t M = 1 0 0 % M = 1 0 0 % M = 9 5 % ( 9 2 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % D a v i d M = 1 0 0 % M = 1 0 0 % M = 9 0 % ( 8 6 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 9 5 % ( 9 2 % 1 0 0 % ) M = 1 0 0 % Z e b M = 1 0 0 % M = 1 0 0 % M = 9 5 % ( 9 2 % 1 0 0 % ) M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 1 0 0 % M = 9 0 % ( 7 3 % 1 0 0 % ) M = 1 0 0 % N ot e M = m e a n; G e n = ge ne r a l i z a t i on

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115 F i gur e 4 1 S c ot t s r a t e of a be r r a nt be ha vi or pe r m i n dur i ng t he f unc t i ona l a na l ys i s

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116 F i gur e 4 2 D a vi d s r a t e of a be r r a nt be ha vi or pe r m i n dur i ng t he f unc t i ona l a na l ys i s

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117 F i gur e 4 3 Z e b s r a t e of a be r r a nt be ha vi or pe r m i n dur i ng t he f unc t i ona l a na l ys i s

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118

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119

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120 F i gur e 4 6 S c ot t s m e a n l a t e nc y t o r e s pond unp r o m pt e d.

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121 F i gur e 4 7 D a vi d s m e a n l a t e nc y t o r e s pond w i t h unpr om pt e d.

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122 F i gur e 4 7 Z e b s m e a n l a t e nc y t o r e s pond unp r om pt e d.

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123 C H A P T E R 5 D I S C U S S I O N T he pur pos e of t hi s c ha pt e r i s t o e xpound upon t he r e s ul t s of t he c ur r e nt s t udy. F i r s t t he c ha pt e r be gi ns w i t h a di s c us s i on of t he l i m i t a t i ons of t he c ur r e nt s t udy. N e xt bot h a n ove r vi e w a nd i nt e r pr e t a t i on of t he f i ndi ngs i s pr ovi de d. I n a d di t i on, t h i s c ha pt e r a ddr e s s e s t he c ont r i but i on of t hos e f i ndi ngs t o t he or y F i na l l y, t he c ha pt e r c o nc l ude s w i t h a di s c us s i on of t he i m p l i c a t i ons f or f ut ur e r e s e a r c h a nd pr a c t i c e L i m i t at i on s A l t hough t he i nt e r ve nt i o n w a s f unc t i ona l l y r e l a t e d t o a n i nc r e a s e i n c om m uni c a t i on r e s pons e s a nd a de c r e a s e i n a be r r a nt be ha vi or s a c r os s a l l pa r t i c i pa nt s a f e w l i m i t a t i ons m a y l i m i t t he out c om e s F i r s t a s w i t h m a ny s i ngl e s ubj e c t r e s e a r c h s t udi e s t he s m a l l s a m pl e s i z e l i m i t s t he e xt e r na l va l i di t y o f t hi s s t udy ( K a z di n, 1982) T he t hr e e pa r t i c i pa nt s ha d a di a gnos i s of a ut i s m ; t hus i t i s unknow n w he t he r t he s t udy s f i nd i ngs c oul d be r e pl i c a t e d w i t h c hi l dr e n w ho ha ve di f f e r e nt i a l d i a gnos e s of A S D ( i e P D D D N O S or A s pe r ge r s s yndr om e ) o r i f t he f i ndi ngs c oul d e xt e nd t o a l a r ge r s a m pl e of c hi l dr e n w i t h a ut i s m I n a ddi t i on, s i nc e t he s t udy onl y i nc l ude d young c hi l dr e n w hos e a be r r a nt be ha vi or w a s m a i nt a i ne d by a t a ngi bl e f unc t i on, one c a nnot be c e r t a i n t ha t t he f i ndi ngs w oul d e xt e nd t o o l de r c hi l dr e n w i t h ot he r be ha vi or a l f unc t i ons ( e g. a t t e nt i on or e s c a pe ) S e c ond, t he pa r t i c i pa nt s onl y ha d a c c e s s t o t he f i r s t pi c t ur e c a r d dur i ng ba s e l i ne O ne c a nnot de t e r m i ne c onc l us i ve l y w he t he r t he pa r t i c i p a nt s c oul d us e t he ot he r p i c t ur e c a r ds p r i or t o t r a i ni ng. H ow e ve r pa r e nt s a nd t e a c he r s r e por t e d t ha t t he pa r t i c i pa nt s ha d ne ve r be e n t r a i ne d t o us e a ny of t he p i c t ur e c a r ds a nd ha d not us e d t he s e pi c t ur e c a r ds s pont a ne ous l y i n t he pa s t I n

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124 a ddi t i on, t he pa r t i c i pa nt s i ni t i a l l y di d no t us e a ny o f t he pi c t u r e c a r ds a s t he y w e r e i nt r oduc e d dur i ng ge ne r a l i z a t i on. T hi r d, due t o t he na t u r e of t he i nt e r ve nt i on, t he nu m be r a nd t ype of p r om pt s va r i e d a c r os s pha s e s P a r t i c ul a r l y, no pr om pt s w e r e gi ve n du r i ng t he ba s e l i ne pha s e of t he s t udy. H ow e ve r by t he e nd of e a c h c ondi t i on o f t he i nt e r ve nt i on pha s e t he us e o f unpr o m pt e d c om m uni c a t i on f or a t l e a s t 20% of s e s s i ons w e r e r e qui r e d f or e a c h pa r t i c i pa nt t o m ove t o t he ne xt c ondi t i on F u r t he r t he pr ovi di ng of p r om pt s t o e l i c i t c om m uni c a t i ve r e s pons e s w a s c hos e n a s a pa r t of t he i nt e r ve nt i on t o pr e ve nt t he e s c a l a t i on of a be r r a nt b e ha vi or s a nd i nc r e a s e t he e t hi c a l t r e a t m e nt of t he i nt e r ve nt i on f or t he c hi l dr e n I n a ddi t i on t he pr oc e dur e s f or t he s ys t e m of pr om p t s w e r e c ons i s t e nt a c r os s c ondi t i ons w i t hi n t he i nt e r ve nt i o n pha s e a nd r e s ul t e d i n c om pl e t e l y f a di ng t he us e of pr om pt s by t he e nd of c ondi t i on 3 F our t h, t he pa r e nt s m a y ha ve us e d t he i nt e r ve nt i on w he n t he p r i m a r y e xpe r i m e nt e r w a s not i n t he hom e w hi c h c oul d ha ve a f f e c t e d t he ou t c om e of t he s t udy. A pa r e nt us i ng t he i nt e r ve nt i on e ve r yda y f or t hr e e hour s w oul d ha ve a di f f e r e nt r e s ul t t ha n a pa r e nt w ho ne ve r us e d t he i nt e r ve nt i on out s i de t he i nt e r ve nt i on s e s s i ons F i na l l y, t he ut i l i t y of t he pr e f e r e nc e s m a y not ha ve be e n c ons t a nt f or a l l pa r t i c i pa nt s ( H a nl e y, I w a t a & R os c oe 2006) P r e f e r e nc e s m a y c ha nge ba s e d on s t a t e s of de pr i va t i on a nd s a t i a t i on. I f a n i ndi vi dua l ha s a c c e s s t o a n i t e m f or a n e xt e nde d t i m e pr i o r t o t r e a t m e nt s e s s i ons t he s t r e ngt h of t he pr e f e r e nc e m a y de c r e a s e ( H a nl e y, e t a l 2006) H ow e ve r t he e xpe r i m e nt e r a t t e m pt e d t o c ont r ol t hi s by r e que s t i ng pa r e nt s a nd t e a c he r s t o w i t hhol d a c c e s s t o t he pr e f e r r e d i t e m s on t he da y o f t he i nt e r ve nt i on but not on ot h e r da ys I t i s unknow n i f t hi s m a y ha ve i nf l ue nc e d t he out c om e s I n a ddi t i on pa r t i c i pa nt s m a y ha ve ha d a l onge r a c c e s s hi s t or y t o s om e pr e f e r e nc e i t e m s i n t he s c hool s e t t i ng. T he hi s t or y of i nt e r a c t i on w i t h i t e m s m a y e xpl a i n w hy

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12 5 s om e i t e m s ge ne r a l i z e d m or e qui c kl y a t s c hool i n c om pa r i s on t o t he i n t e r ve nt i on c ondi t i on ( O no 2004) F or e xa m pl e t he s w i ng w a s a n i t e m pa r t i c i pa nt s ha d us e d e ve r yda y a t s c hool a nd w a s a pa r t of t he i r r e s pe c t i ve s c he dul e s w he r e a s pl a yi n g w i t h t he t r a i n w a s not T hi s m a y pa r t i a l l y e xpl a i n w hy t he s w i ng ge ne r a l i z e d a t a hi ghe r r a t e de s pi t e t ha t i t w a s not t he f i r s t p r e f e r r e d i t e m H ow e ve r t he e xpe r i m e nt e r i nt e r v i e w e d t he t e a c he r s t o e ns ur e t ha t e a c h i t e m i nc l ude d i n t he pr e f e r e nc e a s s e s s m e nt s ha d be e n a va i l a bl e a nd us e d s e ve r a l t i m e s by t he pa r t i c i pa nt s i n t he s c hool s e t t i ng. O ve r vi e w of F i n d i n gs T he t a r ge t c hi l dr e n a l l a c qui r e d t he c om m uni c a t i o n r e s pons e s dur i ng e a c h c ondi t i on o f t he i nt e r ve nt i on pha s e a nd r e s ponde d a t l e a s t 75% of t he t i m e f o r a t l e a s t t he l a s t t hr e e s e s s i ons of e a c h c ondi t i on. B y t he t hi r d c ondi t i on, t he m a j o r i t y of c om m uni c a t i on r e s pons e s w e r e unpr om pt e d, w hi l e c om m uni c a t i on r e s pons e s w e r e m a i nt a i ne d a nd ge ne r a l i z e d t o t he c l a s s r oom s e t t i ng. C or r e s pondi ng w i t h t he i nc r e a s e i n c om m uni c a t i on r e s pons e s t he t a r ge t c hi l d r e n s a be r r a nt be ha vi or s de c r e a s e d a nd w e r e s t a bl e a t 0 R P M by t he e nd of t he i nt e r ve nt i on pha s e A be r r a nt be ha vi or r e m a i ne d l ow du r i ng m a i nt e na nc e a nd t he ge ne r a l i z a t i on s e t t i ngs ( i e c l a s s r oom s e t t i ng ) by t he e nd of t he i nt e r ve nt i on p ha s e s ( i e c ondi t i on 3 ) T w o of t he t h r e e pa r t i c i pa nt s i nc r e a s e d t he i r us e of s pont a ne ous ve r ba l i z a t i ons f r om t he ba s e l i ne t o i nt e r ve nt i on pha s e s w hi l e t he t hi r d t a r g e t c hi l d ( D a vi d) ne ve r e xhi b i t e d s pont a ne ous ve r ba l i z a t i on dur i ng s e s s i ons T he t w o pa r t i c i pa nt s w ho us e d s pont a ne ous ve r ba l i z a t i on m a i nt a i ne d t he s e ve r ba l i z a t i ons a nd us e d t he m i n t he ge ne r a l i z a t i on s e t t i ng ( i e c l a s s r oom s e t t i ng)

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126 E xp l an at i on o f F i n d i n gs A l t hough t he s t udy s f i ndi ngs r e l a t i ve l y a r e s t r a i gh t f or w a r d a f e w o f t he f i ndi ngs de s e r ve f ur t he r e xpl a na t i on T he s e i nc l ude : ( a ) ge n e r a l i z a t i on of p r e f e r r e d i t e m s a nd ( b) D a vi d s m a i nt e na nc e da t a G e n e r al i z at i on of P r e f e r r e d I t e m s O ne of t he pu r pos e s of t hi s s t udy w a s t o e xa m i ne t he r e l a t i ons hi p be t w e e n c om m uni c a t i ve r e s pons e s l e a r ne d i n one s e t t i ng ( i e hom e ) a nd t he ge ne r a l i z a t i on o f t he s e r e s pons e s t o a s e c ond s e t t i ng ( i e s c hool ) A s di s c us s e d i n t he r e s ul t s s e c t i on, f o r t he m a j or i t y of t he pa r t i c i pa nt s ge ne r a l i z a t i on of c om m un i c a t i ve r e s pons e s be ga n t o oc c ur i n c ondi t i on 2 w i t h t he e xc e pt i on of Z e b, w ho r e que s t e d t he i t e m onl y onc e dur i ng c ondi t i on 1. A l t hough ge ne r a l i z a t i on of c om m uni c a t i on r e s pons e s di d oc c ur i t i s not c l e a r w hy ge ne r a l i z a t i on di d no t be gi n t o oc c ur unt i l t he s e c ond r e s pons e w a s a c qui r e d. O ne pl a us i bl e e xpl a na t i on m a y be be c a us e dur i ng c ondi t i on 2, unpr om p t e d c om m uni c a t i on r e s pons e s i nc r e a s e d f or a l l pa r t i c i pa nt s R e s e a r c he r s ha ve s ugge s t e d t ha t ge ne r a l i z a t i on t ha t doe s not oc c ur i m m e di a t e l y m a y i nc r e a s e ove r t i m e w he n m or e e xe m pl a r s ha ve be e n pr e s e nt e d. F or e xa m pl e G r i f f i t hs a nd C r a i ghe a d ( 1972) a nd S t oke s a nd B a e r ( 1977) r e f e r r e d t o t h i s phe nom e non a s t r ai ni ng s uf f i c i e nt e x e m pl ar s ( i e t r a i ni ng m u l t i pl e e xa m pl e s of a ne w s ki l l ) I n a ddi t i on, S t oke s a nd B a e r pur po r t e d t ha t i nt r oduc i ng i ndi vi dua l s t o na t ur a l c ont i nge nc i e s m a y i nc r e a s e t he c ha nc e of ge ne r a l i z a t i on. F o r i ns t a nc e a c hi l d a s ki ng f o r a pr e f e r r e d t a ngi bl e i t e m t ha t he o r s he w oul d ha ve a c c e s s t o i n t he na t ur a l s e t t i ng a nd t he n r e c e i vi ng t he i t e m r e que s t e d w oul d be a na t ur a l c ont i nge nc y T he r e f or e t he ge ne r a l i z a t i on oc c ur r i ng i n t h i s s t udy m a y be a t t r i but e d t o a l l t h r e e w hi c h i nc l ude : ( a ) t he i nc r e a s e i n t he pa r t i c i pa nt s unp r om pt e d c om m un i c a t i on, ( b ) t r a i ni ng s uf f i c i e nt e xe m pl a r s a nd ( c ) i nt r oduc i ng t o na t ur a l c ont i nge nc i e s E a c h of t h e s e w i l l be f ur t he r di s c us s e d.

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127 U n p r om p t e d c om m u n i c at i on O ne pos s i bl e e xpl a na t i on f or t he de l a ye d ge ne r a l i z a t i on of t he c om m uni c a t i on r e s pons e s i s t he e m e r ge nc e of unpr om pt e d c om m uni c a t i on i n t he t r a i ni ng s e t t i ng. A s a f or e m e nt i one d, f o r t he m os t pa r t c om m uni c a t i on di d not ge ne r a l i z e t o t he unt r a i ne d s e t t i ng ( i e c l a s s r oom ) unt i l e a c h c hi l d be ga n t o u s e m or e unpr om pt e d c om m uni c a t i on i n t he t r a i ni ng s e t t i ng ( i e ho m e ) r e s pe c t i ve l y. D yc he s D a vi s L uc i do, a nd Y oung ( 2002) f ound s i m i l a r r e s ul t s i n a c a s e s t udy of a n a dol e s c e nt gi r l a nd he r us e of a voi c e out put c om m uni c a t i on a i d ( V O C A ) I n t h i s s t udy, t he r e s e a r c he r s f ound t ha t t he i ndi vi dua l ge ne r a l i z e d he r unp r om pt e d us e of t he V O C A onl y a f t e r unpr om pt e d c om m un i c a t i on w a s a c hi e ve d dur i ng t r a i ni ng S u f f i c i e n t e xe m p l ar s A not he r pos s i bl e e xpl a na t i o n i n t hi s s t udy f or t he de l a ye d ge ne r a l i z a t i on of t he c om m uni c a t i on r e s pons e s i s t he t r a i ni ng o f s uf f i c i e nt e xe m pl a r s pa r t i c ul a r l y s i nc e t he c om m uni c a t i on r e s pons e s ge ne r a l i z e d d ur i ng c ondi t i on 2. S t oke s a nd B a e r ( 1977) s ugge s t e d t ha t t r a i ni ng m ul t i pl e e xe m pl a r s unt i l ge ne r a l i z a t i on oc c ur s s uf f i c i e nt l y i n a n unt r a i ne d s e t t i ng m i ght be one s t r a t e gy f or i nc r e a s i ng ge ne r a l i t y of a ne w l y l e a r ne d s ki l l F or e xa m pl e G r i f f i t hs a nd C r a i g he a d ( 1972) pr ovi de d t r a i ni ng i n t w o s e t t i ngs a nd t he n obs e r ve d ge ne r a l i z a t i on t o a t h i r d unt r a i ne d s e t t i ng. T he y t r a i ne d a 30 ye a r ol d w om a n w i t h m e nt a l r e t a r da t i on c or r e c t a r t i c ul a t i on of w o r ds i n a c l i ni c a l s e t t i ng. H ow e ve r s he di d no t ge ne r a l i z e t hi s s ki l l t o t he r e s i de nt i a l c ot t a ge F i na l l y, a f t e r s he w a s t r a i ne d i n t he r e s i de nt i a l c ot t a ge s he ge ne r a l i z e d t o a t hi r d s e t t i ng ( i e c l a s s r oom ) S t oke s a nd B a e r s ugge s t e d t ha t t w o t o t hr e e e xe m p l a r s a r e s uf f i c i e nt f or i nc r e a s i ng t he ge ne r a l i t y of a ne w l y a c qui r e d s ki l l s uc h a s t ha t d e m ons t r a t e d i n G r i f f i t hs a nd C r a i ghe a ds s t udy. I n a ddi t i on, S t oke s a nd B a e r not e d t ha t ge ne r a l i z a t i on a c r os s r e s pons e s m i ght be a c c om pl i s he d by t r a i ni ng a s uf f i c i e nt num be r of r e s pons e s F or e xa m pl e L a s ki C ha r l op a nd S c hr e i bm a n ( 1988) t r a i ne d pa r e nt s t o us e m ul t i pl e e xe m pl a r s i n t he hom e dur i ng a n i nt e r ve nt i on

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128 a nd t he n obs e r ve d t o s e e i f t he c hi l d r e n ge ne r a l i z e d t he s ki l l s dur i ng f r e e pl a y i n a di f f e r e nt a r e a of t he hom e L a s ki a nd c ol l e a gue s not e d t ha t t he t r a i ne d ve r ba l i z a t i ons di d ge ne r a l i z e but di d not gi ve t he e xa c t num be r of m ul t i pl e e xe m pl a r s r e qui r e d t o a c c om pl i s h t he ge ne r a l i z a t i on. S i m i l a r t o pr e vi ous r e s e a r c h ( L a s ki e t a l 1988) t he c u r r e n t s t udy a l s o a c c om pl i s he d ge ne r a l i z a t i on t o a ne w s e t t i ng f ol l ow i ng t h e t r a i ni ng of m ul t i pl e e xe m pl a r s pa r t i c ul a r l y, t w o e xe m pl a r s N at u r al c on t i n ge n c i e s O ne f i na l pos s i bl e e xpl a na t i on f or t he ge ne r a l i z a t i on of t he c om m uni c a t i on r e s pons e s i n t hi s s t udy m a y be t he i nt r oduc t i on of na t ur a l c ont i nge nc i e s N a t ur a l c ont i nge nc i e s a r e c ons e que nc e s t ha t oc c ur i n t he p e r s on s na t ur a l e nvi r onm e nt t ha t m a i nt a i n s pe c i f i c be ha vi or s ( S t oke s & B a e r 1977) S t oke s a nd B a e r ( 1977) s ugge s t c hoos i ng be ha vi or s t o t e a c h t ha t nor m a l l y r e s ul t i n na t ur a l r e i nf or c e m e nt a f t e r t he t e a c hi ng c onc l ude s I ndi vi dua l s a r e t a ught be ha vi or s t ha t s ol i c i t na t ur a l l y r e i nf or c i ng c ons e que nc e s F or e xa m pl e H or ne r ( 1971 ) t a ught a 5 ye a r ol d boy w i t h m e nt a l r e t a r da t i on t o us e c r ut c he s i n a n e xpe r i m e nt a l s e t t i ng T he boy t he n ge ne r a l i z e d t he s ki l l t o a ne w s e t t i ng t o o bt a i n de s i r e d i t e m s I n t hi s ne w s e t t i ng, t he c a r e t a ke r s di d not gi ve hi m t he i t e m s he de s i r e d. R a t he r he ha d t o us e hi s c r ut c he s t o obt a i n t he i t e m S i m i l a r l y, C ha r l op, S c hr e i bm a n a nd T hi bode a u ( 1 985) t a ught c hi l d r e n w i t h a ut i s m t o r e que s t a n i t e m i n a t r a i n i ng s e t t i ng. A f t e r t he c hi l d r e n r e que s t e d t he i t e m c ons i s t e nt l y i n t he t r a i ni ng s e t t i ng, C ha r l op a nd c ol l e a gue s pr e s e nt e d t he i t e m t o t he c hi l d i n t he ge ne r a l i z a t i on s e t t i ng w i t hout pr ovi d i ng a ny ve r ba l pr om p t s S i x of t he s e ve n c hi l dr e n ge ne r a l i z e d t he c om m uni c a t i on r e que s t i ng t o t he ne w s e t t i ng. I n t h e c ur r e nt s t udy, pa r e nt s t a ught pa r t i c i pa nt s t o r e que s t pr e f e r r e d i t e m s w hi c h m a y ha ve s e r ve d a s na t ur a l r e i nf o r c e r s i n t he ge ne r a l i z a t i on s e t t i ng. S i m i l a r t o C ha r l op e t a l ( 1985) a nd H or ne r ( 1971 ) c a r e t a ke r s i n t hi s s t udy r e qui r e d t he

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129 pa r t i c i pa nt s t o us e t he i r ne w s ki l l ( i e us e of pi c t u r e c a r d f o r c om m uni c a t i on ) t o obt a i n a c c e s s t o a de s i r e d i t e m i n t he ge ne r a l i z a t i on s e t t i ng. M ai n t e n an c e D at a G e ne r a l l y, pa r t i c i pa nt s m a i nt a i ne d hi gh l e ve l s of c om m uni c a t i on a nd l ow l e ve l s of a be r r a nt be ha vi or du r i ng m a i nt e na nc e s e s s i ons w i t h t he e xc e pt i on o f D a vi d. S i m i l a r t o t he ot he r t w o pa r t i c i pa nt s D a vi d m a i nt a i ne d hi gh l e ve l s of c om m uni c a t i on, but he a l s o e nga ge d i n a be r r a nt be ha vi or du r i ng m a i nt e na nc e s e s s i ons T he r e a r e s e ve r a l pos s i bl e e xpl a na t i ons t ha t m a y b e a ppl i e d t o D a vi d s oc c ur r e nc e of pr obl e m be ha vi or s dur i ng t he m a i nt e na nc e c ondi t i on a l l r e l a t e d t o pot e nt i a l s e t t i ng e ve nt s O ne pl a us i bl e e xpl a na t i on m a y ha ve be e n t he oc c ur r e nc e of a t e m por a l l y d i s t a nt s e t t i ng e ve nt f o r D a vi d j us t pr i or t o t he m a i nt e na nc e pha s e of t he s t udy ( i e c ha nge of r out i ne a nd out o f t ow n vi s i t w i t h hi s f a m i l y) A ddi t i ona l l y D a vi d s pa r e nt s not e d t ha t hi s s l e e p pa t t e r ns w e r e i nt e r r upt e d ( i e s l e e p de pr i ve d dur i ng s e s s i ons ) dur i ng t hi s ou t of t ow n t r i p a nd c ont i nue d t o pos e a pr obl e m s i nc e r e t ur ni ng hom e E a c h of t he s e pot e nt i a l s e t t i ng e ve nt s i s r e l a t e d t o pe r s ona l c ont e xt s ( M c G i l l T e e r R ye a nd H ughe s 2005 ) P e r s ona l c ont e xt s r e f e r t o e ve nt s s uc h a s w he n s om e on e ha s be e n s l e e p de pr i ve d, i l l o r ha d a c ha nge i n r ou t i ne A c c or di ng t o M c G i l l a nd c ol l e a gue s s e t t i ng e ve nt s i n pe r s ona l c ont e xt s pa r t i c ul a r l y t he di s t ur ba nc e of s l e e p, a r e m o r e l i ke l y t o c ont r i but e t o t he oc c ur r e nc e of pr obl e m be ha vi or s t ha n ot he r s s uc h a s phys i c a l s e t t i ng or da y of t he w e e k. F o r e xa m pl e K e nne dy a nd I t kone n ( 199 3) e xpe r i m e nt a l l y de m ons t r a t e d t ha t s l e e p de pr i va t i on i n a n i ndi vi dua l w i t h m ode r a t e m e nt a l r e t a r da t i on a nd a ut i s t i c l i ke s ym pt om s w a s di f f e r e nt i a l l y a s s oc i a t e d w i t h i nc r e a s e d l e ve l s of pr obl e m be ha vi or I n s um m a r y, ge ne r a l i z a t i on oc c ur r e d f o r t he m os t pa r t be gi nni ng i n c ondi t i on 2 of t he i nt e r ve nt i on pha s e T hi s m a y be a t t r i but e d t o w he n unpr om pt e d c om m un i c a t i on oc c ur r e d i n t he

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130 t r a i ni ng s e t t i ng, s uf f i c i e nt e xe m pl a r s w e r e t r a i n e d a nd pa r t i c i pa nt s w e r e i nt r oduc e d t o na t u r a l c ont i nge nc i e s I n a ddi t i on t o ge ne r a l i z a t i on pa r t i c i pa nt s m a i nt a i ne d t he i r c om m uni c a t i on r e s pons e s but D a vi d c ont i nue d t o e nga ge i n a be r r a nt be ha vi or T hi s m a y be e xpl a i ne d by pe r s ona l c ont e xt s e t t i ng e ve nt s ( e g s l e e p de pr i va t i on) w hi c h r e s e a r c he r s ha ve de m ons t r a t e d t o be di f f e r e nt i a l l y a s s oc i a t e d w i t h i nc r e a s e d l e ve l s of pr obl e m be ha vi or ( K e nne dy & I t kone n, 1993) T h e or e t i c al or C on c e p t u al I m p l i c at i on s o f F i n d i n gs T he f i ndi ngs o f t he c ur r e nt s t udy ha v e t he or e t i c a l i m pl i c a t i ons f or F C T a nd m i l i e u t he r a py l i t e r a t ur e r e s e a r c h. R e s e a r c he r s i n t he f i e l d of F C T ha ve di s c us s e d t he i m por t a nc e o f l i nki ng c om m uni c a t i on r e s pons e s t o be ha vi or a l f u nc t i on. I n a ddi t i on m i l i e u t he r a py r e s e a r c he r s ha ve not e d t he i m po r t a nc e of us i ng m or e na t u r a l i s t i c pr oc e dur e s t o e nha nc e ge ne r a l i z a t i on a nd m a i nt e na nc e of e f f e c t s T hi s s t udy ha s t a ke n a n i ni t i a l s t e p i n f ur t he r i ng e a c h of t he s e l i ne s of r e s e a r c h a nd m e r gi ng t he t w o r e s e a r c h a r e a s t oge t he r I n r e ga r d t o F C T l i t e r a t ur e t he c ur r e nt s t udy de m o ns t r a t e s t he ut i l i t y o f t e a c hi ng m u l t i pl e r e s pons e s i n de c r e a s i ng de pe nde nc e on pr om pt s a nd i nc r e a s i ng t he l i ke l i hood of ge ne r a l i z a t i on. P r e vi ous F C T r e s e a r c h l a c ke d a n e m pha s i s on e i t h e r of t he s e c ons i de r a t i ons ( M a nc i l 2006) C a r r a nd D ur a nd ( 1985 ) D ur a nd a nd C a r r ( 1992) a nd W a c ke r a nd c ol l e a gue s ( 1990) t a ught one c om m uni c a t i on r e s pons e t o t he pa r t i c i pa nt s of t he i r r e s pe c t i ve s t udi e s F ur t he r t he m a j or i t y o f r e s e a r c he r s f or t he F C T s t udi e s di d no t f oc us on ge ne r a l i z a t i on t o ot he r pe r s ons or s e t t i ngs T he one r e s e a r c h t e a m w ho di d t e s t f or ge ne r a l i z a t i on o f t he one c om m uni c a t i on r e s pons e w i t h a gr a dua t e ps yc hol ogy m a j or ( D ur a nd & C a r r 1992) not a na t ur a l c ha nge a ge nt T hi s l a c k o f f oc us on ge ne r a l i z a t i on pa r t i a l l y m a y be be c a us e t he y di d not t r a i n s uf f i c i e nt e xe m pl a r s w hi c h a r e us e d t o pr om o t e ge ne r a l i z a t i on ( B a e r W ol f & R i s l e y, 1968) I n c ont r a s t t he r e s ul t s of t he

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131 c ur r e nt s t udy de m ons t r a t e t ha t w i t h s uf f i c i e nt e xe m pl a r s pr om p t de pe nde nc e de c r e a s e d a nd ge ne r a l i z a t i on oc c ur r e d i n a n unt r a i ne d s e t t i ng w i t h a n unt r a i ne d pe r s on. T he c ur r e nt s t udy a l s o e xt e nds t he m i l i e u t he r a py l i t e r a t ur e by p r ovi di ng a di r e c t f unc t i ona l c onne c t i on be t w e e n c om m uni c a t i on a nd a bnor m a l be ha vi or A l t hough a f e w m i l i e u t he r a py r e s e a r c he r s i n t he pa s t a ne c dot a l l y m e nt i o ne d de c r e a s e s i n a be r r a nt be ha vi or t he s e be ha vi or s w e r e not e xpe r i m e nt a l l y a na l yz e d ( Y ode r e t a l 1995) T he y di d no t s ys t e m a t i c a l l y a na l yz e a be r r a nt be ha vi or F or e xa m pl e C ha r l op S hr i e bm a n, a nd T hi bode a u ( 1985) H a nc oc k a nd K a i s e r ( 2002) R os s a nd G r e e r ( 2003) di d not m e nt i on a be r r a nt be ha vi o r F ur t he r Y ode r e t a l ( 1995 ) not e d t ha t m i l i e u pr oc e dur e s m a y de c r e a s e a be r r a nt be ha vi or but di d not e m pi r i c a l l y de m ons t r a t e a r e l a t i on be t w e e n t he i nt e r ve nt i on a nd t he de c r e a s e i n a be r r a nt b e ha vi or T he c ur r e nt s t udy, how e ve r pr ovi de s a m ode l f or i nc or por a t i ng f unc t i on of a be r r a nt be ha vi or a nd t e a c hi ng r e pl a c e m e nt c om m uni c a t i on r e s pons e s w hi l e e m pl oyi ng m i l i e u t he r a py pr om pt i ng t e c hni que s i n a na t ur a l e nvi r onm e nt I n a ddi t i on t o c ont r i but i n g t o t he F C T a nd m i l i e u t he r a py l i t e r a t ur e ba s e t he c ur r e nt s t udy a l s o c ont r i but e s t o t he ge ne r a l i z a t i on l i t e r a t u r e T h e f i ndi ngs of t hi s s t udy f ur t he r s uppor t t he c onc e pt t ha t t r a i ni ng s uf f i c i e nt e xe m pl a r s a nd t a r g e t i ng na t ur a l c ont i nge nc i e s i s ne e de d f o r ge ne r a l i z a t i on t o oc c ur S i m i l a r t o t he s t udi e s by G r i f f i t hs a nd C r a i ghe a d ( 1972) a nd L a s ki C ha r l op, a nd S c h r i e bm a n ( 1988 ) pa r t i c i pa nt s i n t h i s s t udy ge ne r a l i z e d a f t e r s uf f i c i e nt e xe m pl a r s w e r e t r a i ne d. F ur t he r t he us e of na t ur a l c ont i nge nc i e s m a y ha v e c ont r i but e d t o t he ge ne r a l i z a t i on a s i t di d i n t he s t udy by C ha r l op, T hi bode a u a nd S c hr i e bm a n ( 1985) I n a ddi t i on t he c ur r e nt s t udy de m ons t r a t e d t ha t unpr om pt e d c om m uni c a t i on m a y ne e d t o oc c ur i n one s e t t i ng be f o r e i t ge ne r a l i z e s t o a not he r s e t t i ng.

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132 I n s um m a r y, t he c ur r e nt s t udy s f i ndi ngs ha ve t he o r e t i c a l or c onc e pt ua l i m pl i c a t i ons f or t he F C T m i l i e u t he r a py, a nd ge ne r a l i z a t i on l i t e r a t ur e s T he c u r r e nt s t udy e xt e nds t he F C T l i t e r a t ur e by de m ons t r a t i ng t he ut i l i t y of ha vi ng na t ur a l c ha nge a ge nt s t e a c h m ul t i pl e c om m uni c a t i on r e s pons e s i n a na t ur a l e nvi r onm e nt S i m i l a r l y, t he f i ndi ngs e xt e nd t he m i l i e u t he r a py l i t e r a t ur e by p r ovi di ng a f unc t i ona l r e l a t i o ns hi p be t w e e n a n i nt e r ve nt i on w i t h m i l i e u pr oc e dur e s a nd t he de c r e a s e of a be r r a nt be ha vi or F i na l l y, t he s t udy s f i ndi ngs e xt e nds t he ge ne r a l i z a t i on l i t e r a t ur e by de m ons t r a t i ng t ha t us i n g na t ur a l c ont i nge nc i e s t r a i ni ng m u l t i pl e e xe m pl a r s a nd obt a i ni ng unpr om pt e d c om m uni c a t i on i n one s e t t i ng i nc r e a s e s t he c ha nc e of ge ne r a l i z a t i on oc c ur r i ng. I m p l i c at i on s f or F u t u r e R e s e ar c h T he pr i m a r y e xpe r i m e nt e r f ound pos i t i ve e f f e c t s o f t he i nt e r ve nt i on on t he s oc i a l c om m uni c a t i ve be ha vi or s of young c hi l dr e n w i t h A S D T he r e s ul t s a l ong w i t h t he l i m i t a t i ons of t he c ur r e nt s t udy pr ovi de i m pl i c a t i ons f or f ut u r e r e s e a r c h. F i r s t t he s t udy s f i ndi ngs s houl d be r e pl i c a t e d w i t h a l a r ge r g r oup o f i ndi vi dua l s w i t h A S D s ys t e m a t i c a l l y a c c ount i ng f or di ve r s e c ha r a c t e r i s t i c s ( e g. l a ngua ge l e ve l ) T he s e a na l ys e s m a y pr ovi de a ddi t i ona l i nf or m a t i on f o r i ndi vi dua l s a l ong t he a ut i s m c ont i nuu m w i t h di f f e r e nt di a gnos e s a ge a nd a bi l i t y l e ve l T hi s m a y a s s i s t r e s e a r c he r s i n i de nt i f yi ng A S D s ubgr oups t h a t a r e t he m os t r e s pons i ve t o t he i n t e r ve nt i on. F or e xa m pl e c hi l dr e n w i t h A S D w ho ha ve s oc i a l c ha r a c t e r i s t i c s t ha t a r e a l oof ( i e ha ve a n a bs e nc e of s pe e c h a nd poor s oc i a l i nt e r a c t i on, but s e e m t o e nj oy ot he r s ) m a y r e s pond be t t e r t ha n c hi l dr e n w ho a r e s oc i a l l y pa s s i ve ( i e a voi d e ye c ont a c t a nd ot he r s oc i a l s t i m ul i s uc h a s t ouc hi ng) F ur t he r c hi l d r e n w i t h A S D w ho ha ve a n a ve r a ge I Q a nd/ o r a r e c ons i de r e d hi gh f unc t i oni ng m a y de m ons t r a t e be t t e r r e s pons e s t o t he i nt e r ve nt i on.

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133 S e c ond, t he ut i l i t y o f t he i nt e r ve nt i on w i t h va r i ous t r a i ne r s s houl d be e xpl or e d R e s e a r c he r s c oul d e xa m i ne w he t he r s i m i l a r r e s ul t s w oul d oc c ur w he n f a t he r s t e a c he r s or pe e r s i m pl e m e nt t he i nt e r ve nt i on i n c om pa r i s on t o m ot h e r s w ho w e r e t he i m pl e m e nt e r s i n t he c ur r e nt s t udy. I n a ddi t i on, r e s e a r c he r s s houl d e xpl or e ge ne r a l i z a t i on w i t h pe e r s R e s e a r c he r s m a y w a nt t o de t e r m i ne i f s i m i l a r r e s ul t s w oul d oc c ur f ol l ow i ng t r a i ni ng w i t h a n a dul t or i f t r a i ni ng w oul d ne e d t o oc c ur w i t h one pe e r be f or e ge ne r a l i z i ng t o a not he r pe e r F ur t he r t r a i ni ng m a y ne e d t o oc c ur w i t h m ul t i pl e pe e r s be f o r e t he c om m uni c a t i o n r e s pons e s ge ne r a l i z e t o ot he r pe e r s T hi r d, t he e f f e c t s of us i ng di f f e r e nt i t e m s s houl d b e e xa m i ne d. F o r e xa m pl e r e s e a r c he r s c oul d e xa m i ne t he e f f e c t i ve ne s s of us i ng i t e m s i de nt i f i e d l a t e r i n t he s e que nc e of pr e f e r e nc e s a s t he f i r s t i t e m s t r a i ne d. S om e r e s e a r c he r s ha ve f oun d us i ng pr e f e r e nc e s i de nt i f i e d i n s ubs e que nt pr e f e r e nc e a s s e s s m e nt s t o ha ve s i m i l a r e f f e c t s a s t he f i r s t p r e f e r e nc e s ( C i c c one G r a f f & A he a r n 2006) F ur t he r D e L e on A nde r s R odr i gue z C a t t e r a nd N e i de r t ( 2000 ) f ound t ha t r ot a t i ng s e t s of t oys ha d a be t t e r e f f e c t on out c om e s t ha n us i ng a s i ngl e s e t of t oys F our t h, r e s e a r c he r s s houl d e xa m i ne ge ne r a l i z a t i on f ur t he r R e s e a r c he r s s houl d e xa m i ne ge ne r a l i z a t i on t o pe e r s a nd s i bl i ngs F or e xa m pl e r e s e a r c he r s s houl d e xa m i ne i f c om m uni c a t i on s ki l l s ge ne r a l i z e t o pe e r s a f t e r t r a i ni ng w i t h a n a dul t or i f t r a i ni ng s houl d oc c ur f i r s t w i t h one pe e r t o i nc r e a s e t he c ha nc e of ge ne r a l i z a t i on t o a n ot he r pe e r F i na l l y, r e s e a r c he r s s houl d e xa m i ne a ddi t i ona l out c om e s of t he m odi f i e d m i l i e u t he r a py i nt e r ve nt i on s uc h a s pos s i bl e e f f e c t s on t he m ot he r s us e of l a ngua g e F or e xa m pl e t he e xpe r i m e nt e r a nd t he e xpe r t bot h, obs e r ve d t ha t t h e m ot he r s be ga n t o s pe a k m or e w i t h pa r t i c i pa nt s s i m i l a r t o how t he y m a y i n t e r a c t w i t h t ypi c a l l y de ve l opi ng c hi l dr e n T he m ot he r s be ga n us i ng s pe e c h t ha t f oc us e d on r i c hl y de s c r i bi ng obj e c t s T he y t a l ke d a bout t he c ol or s s ha pe s a nd ot he r pr ope r t i e s of t he i t e m s T hi s c oul d pos s i bl y ha ve a n e f f e c t on t he ove r a l l

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134 out c om e s w i t h c om m uni c a t i on ( H a r t & R i s l e y, 19 99) F ur t he r r e s e a r c he r s s houl d e xa m i ne t he e f f e c t s i f a ny, t he i nt e r ve nt i on ha s on t he a m ount s of e ye ga z e s oc i a l s m i l i ng a nd/ o r ot he r w i s e i m pr ove t he de f i c i t s t ypi c a l l y a s s oc i a t e d w i t h A S D F o r e xa m pl e t he i nc r e a s e i n c om m uni c a t i on m a y r e s ul t i n i m pr ove m e nt i n j oi nt a t t e nt i on s ki l l s F ur t he r t he r e c i pr oc i t y of c om m uni c a t i on l e a r ne d m a y t r a ns f e r t o ot he r a r e a s s uc h a s pl a yi ng w i t h pe e r s I n s um m a r y, f ut u r e r e s e a r c he r s s houl d f oc us on f i v e a r e a s F i r s t t he f i ndi ngs s houl d be r e pl i c a t e d w i t h a l a r ge r g r oup o f c hi l dr e n w i t h A S D w ho ha ve di ve r s e c ha r a c t e r i s t i c s S e c ond t he i nt e r ve nt i on s houl d be e xa m i ne d w i t h va r i ous c ha nge a ge nt s ( i e t e a c he r s pe e r s ) T hi r d t he e f f e c t s of us i ng di f f e r e nt i t e m s s houl d be a na l yz e d. F our t h ge ne r a l i z a t i on s houl d be e xa m i ne d f ur t he r F i na l l y f ut ur e r e s e a r c he r s s houl d e xa m i ne di f f e r e nt out c om e s of t he m odi f i e d m i l i e u i nt e r ve nt i on s uc h a s m ot he r s us e o f l a ngua ge I m p l i c at i on s f or P r ac t i c e I n a ddi t i on t o f u t ur e r e s e a r c h i m pl i c a t i ons t he c ur r e nt s t udy ha s i m pl i c a t i ons f or pr a c t i c e R e s e a r c he r s ha ve de m ons t r a t e d e f f e c t i ve ne s s of F C T ( W a c ke r e t a l 2005) a nd m i l i e u t he r a py ( H e s t e r e t a l 1995 ) on a ddr e s s i ng a be r r a nt be ha vi or a nd c om m uni c a t i on r e s pe c t i ve l y. H ow e ve r r e s e a r c he r s of t he F C T l i t e r a t u r e ha ve not de m ons t r a t e d e f f e c t i ve ne s s by na t ur a l c ha nge a ge nt s i n na t ur a l e nvi r onm e nt s nor ha ve t h e y de m ons t r a t e d a n i nc r e a s e i n m ul t i pl e c om m uni c a t i on r e s pons e s ( M a nc i l 2006) I n a ddi t i on t he r e s e a r c he r s i n t he m i l i e u t he r a py l i t e r a t ur e ha ve not de m ons t r a t e d a n e m pi r i c a l c onne c t i on be t w e e n a n i nc r e a s e i n c om m uni c a t i on r e s pons e a nd a de c r e a s e i n a be r r a nt be ha vi or T h i s s t udy pr ovi de s s om e e vi de nc e t ha t us i ng m i l i e u p r oc e dur e s i n t he na t ur a l e nvi r on m e nt by na t u r a l c ha nge a ge nt s i s e f f e c t i ve i n i nc r e a s i ng unpr om pt e d c om m uni c a t i on a nd de c r e a s i ng a be r r a nt be ha vi or T hi s s t udy a l s o pr ovi de s e vi de nc e t ha t h a vi ng na t ur a l c ha nge a ge nt s us e m i l i e u pr oc e dur e s ( i e pr om pt s a nd t i m e de l a y) i n a na t ur a l

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135 e nvi r onm e nt i nc r e a s e ge ne r a l i z a t i on a nd m a i nt e na nc e T he s t udy by H a nc oc k a nd K a i s e r ( 2002) pr ovi de s r e l a t e d s uppor t t ha t t r a i ni ng i n t he na t ur a l e nvi r onm e nt i nc r e a s e s ge ne r a l i z a t i on a nd m a i nt e na nc e T he r e f o r e t he c ur r e nt s t udy ha s pr a c t i c a l i m pl i c a t i ons be c a us e i t pr ovi de s a ddi t i ona l e vi de nc e of t he i m por t a nc e o f i nt e r ve nt i ons i n t he na t ur a l e nvi r onm e nt by na t ur a l c ha nge a ge nt s ( e g. pa r e nt s ) T he ot he r pr a c t i c a l i m pl i c a t i on of t hi s s t udy i s t ha t i t de m ons t r a t e s t ha t t he m i l i e u pr oc e dur e s c a n ha ve t he s a m e e f f e c t on a be r r a nt be ha vi or a s t r a di t i ona l di s c r e t e t r i a l t r a i ni ng t ypi c a l l y us e d i n F C T but m a y be c ons i de r e d a m o r e na t ur a l i n t e r ve nt i on f or a c l a s s r oom o r hom e s e t t i ng ( M i r a nda L i nne & M e l i n 1992) T he t hr e e pa r t i c i pa nt s i nc r e a s e d t he i r us e of unpr om pt e d c om m uni c a t i on a nd de c r e a s e d t he i r e n ga ge m e nt i n a be r r a nt be ha vi or T he s e f i ndi ngs a r e c ons i s t e nt w i t h t he F C T l i t e r a t ur e i n r e ga r ds t o t he a be r r a nt be ha v i or ( C a r r & D ur a nd, 1985; W a c ke r e t a l 2005) a nd t he m i l i e u t he r a py l i t e r a t ur e i n r e ga r ds t o t he c om m uni c a t i on ( C ha r l op, S c hr e i bm a n & T hi bode a u, 1985; H e s t e r K a i s e r A l pe r t & W hi t e m a n 1995) but w i t h t he a dde d be ne f i t of be i ng one i nt e r ve nt i on. S u m m a r y P r e vi ous r e s e a r c he r s ha ve e xa m i ne d t he e f f e c t i ve n e s s of F C T a nd m i l i e u t he r a py w i t h c hi l dr e n w i t h A S D but F C T r e s e a r c he r s m or e s o. F C T r e s e a r c he r s ha ve de m ons t r a t e d pos i t i ve e f f e c t s on a be r r a nt be ha vi or a nd m i l i e u t he r a py r e s e a r c he r s ha ve de m ons t r a t e d pos i t i ve e f f e c t s w i t h c om m uni c a t i on. T he c u r r e nt s t udy e xt e nde d t he out c om e s a nd a ddr e s s e d t he l i m i t a t i ons of t he pa s t s t udi e s S i m i l a r t o pa s t F C T s t udi e s t he c u r r e nt s t udy s r e s ul t s de m ons t r a t e t ha t a be r r a nt be ha vi or de c r e a s e s w he n a c om m uni c a t i on s ki l l i s t a ught t ha t s e r ve s t he s a m e f unc t i on a s t he a be r r a nt be ha vi or T hi s s t udy e xt e nde d t he r e s e a r c h by t e a c hi ng m ul t i pl e e xe m pl a r s a nd de m ons t r a t i ng ge ne r a l i z a t i on t o a n unt r a i ne d s e t t i ng w i t h a n un t r a i ne d pe r s on. I n c ont r a s t t o t he

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136 m a j or i t y of pr e vi ous F C T s t udi e s t he e xpe r i m e nt e r of t hi s s t udy t r a i ne d na t ur a l c ha nge a ge nt s i n t he na t ur a l e nvi r on m e nt a nd a c hi e ve d s i m i l a r r e s ul t s a s pr e vi ous s t udi e s c onduc t e d i n c l i ni c a l s e t t i ngs I n a ddi t i on t o e xt e ndi ng t he F C T l i t e r a t u r e t he c ur r e nt s t udy a l s o e xt e nd e d t he m i l i e u t he r a py l i t e r a t ur e S i m i l a r t o pa s t m i l i e u t he r a py s t udi e s t hi s s t udy de m ons t r a t e d t he e f f e c t i ve ne s s of m i l i e u pr oc e dur e s on i nc r e a s i ng c om m uni c a t i on. I n c ont r a s t t he c ur r e nt s t udy de m ons t r a t e d t he ut i l i t y of m i l i e u t he r a py on de c r e a s i ng a b e r r a nt be ha vi or a nd pr ovi de d a f unc t i ona l r e l a t i ons hi p be t w e e n m i l i e u t he r a py pr o c e dur e s a nd a be r r a nt be ha vi or T he c ur r e nt s t udy a l s o a dde d t o t he m i l i e u l i t e r a t ur e ba s e by f o c us i ng on c hi l dr e n w i t h a ut i s m T he c ur r e nt s t udy c ont r i but e s t o r e s e a r c h a nd p r a c t i c e be c a us e i t a dds t o t he F C T a nd m i l i e u t he r a py l i t e r a t ur e by de m ons t r a t i ng t ha t a c om bi ne d i nt e r ve nt i on de c r e a s e s a be r r a nt be ha vi or i nc r e a s e s unpr om pt e d c om m uni c a t i on a nd pr om ot e s ge ne r a l i z a t i on t o unt r a i ne d s e t t i ngs a nd pe r s ons T hi s c ont r i but e s t o pr a c t i c e b e c a us e t he s t udy de m ons t r a t e s t he ut i l i t y of t he i nt e r ve nt i on w i t h i ndi vi dua l s w ho ha ve l i m i t e d t r a i ni ng ( e g pa r e nt s ) I n c onc l us i on, t he i m pl e m e nt a t i on of t he m odi f i e d m i l i e u t he r a py i n t e r ve nt i on by pa r e nt s i n t he na t u r a l s e t t i ng l e d t o a n i nc r e a s e i n unp r om pt e d c om m uni c a t i on c l i ni c a l l y s i gni f i c a nt de c r e a s e s i n a be r r a nt be ha vi or ge ne r a l i z a t i on t o unt r a i ne d s e t t i ngs a nd p e r s ons a nd m a i nt e na nc e of t he s e e f f e c t s

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137 LIST OF REFERENCES Alpert, C. L., & Kaiser, A. P. (1992). Trai ning parents as milieu language teachers. Journal of Early Intervention, 16 (1), 31-52. American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders (4th ed., Rev. ed.). Washington, D.C.: Am erican Psychiatric Association. Autism Society of America. (2006). All about autism. Retrieved June 6, 2006, from http://www.autism-society.org/site/P ageServer?pagename=allaboutAutism Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97. Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20, 313-327. Bailey, J. S., & Burch, M. R. (2002). Research methods in applied behavior analysis. London, England: Sage Publications. Bott, C., Farmer, R., & Rhode, J. (1997). Beha vior problems associated with lack of speech in people with learning disabilities. Journal of Intellectual Disability Research, 41, 3-7. Bourret, J., Vollmer, T. R., & Rapp, J. T. (2004). Evaluation of a vocal mand assessment and vocal mand training procedures. Journal of Applied Behavior Analysis, 37, 129-144. Brady, N. C., & Halle, J. W. (1997). Functional analysis of communicative behaviors. Focus on Autism and Other Developmental Disabilities, 12 95-104. Carr, E. G., & Durand, V. M. (1985). Reduci ng behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18 111-126. Centers for Disease Control and Prevention (2005, October 29). How common is autism spectrum disorder (ASD)? Retrieved March 2, 2006, from http://www.cdc.gov/ncbdd/autism/asd-common.htm Charlop, M. H., Schreibman, L., & Thibodea u, M. G. (1985). Increasing spontaneous verbal responding in autistic child ren using a time delay procedure. Journal of Applied Behavior Analysis, 18 (2), 155-166. Charlop, M. H., & Walsh, M. E. (1986). Incr easing autistic childr ens spontaneous verbalizations of affection: An assessment of time delay and peer modeling procedures. Journal of Applied Behavior Analysis, 19 (3), 307-314.

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143 S t oke s T F & B a e r D M ( 1977) A n i m pl i c i t t e c hnol ogy of ge ne r a l i z a t i on J our nal of A ppl i e d B e hav i or A nal y s i s 10, 349 367 V ol km a r F R S z a t m a r i P & S pa r r w o, S S ( 19 93) S e x di f f e r e nc e s i n pe r va s i ve de ve l opm e nt a l di s or de r s J our nal of A ut i s m and D e v e l opm e nt al D i s or de r s 23, 579 591 W a c ke r D P B e r g W K H a r di ng J W B a r r e t t o, A R a nki n, B & G a nz e r J ( 2005) T r e a t m e nt e f f e c t i ve ne s s s t i m ul us ge ne r a l i z a t i on, a nd a c c e pt a bi l i t y t o pa r e nt s of f unc t i ona l c om m uni c a t i on t r a i ni ng. E duc at i onal P s y c hol ogy 25 233 256 W a c ke r D P S t e e ge M W N or t hup J S a s s o, G B e r g W R e i m e r s T e t a l ( 1990) A c om pone nt a na l ys i s of f unc t i ona l c om m uni c a t i on t r a i ni ng a c r os s t h r e e t opogr a phi e s of s e ve r e be ha vi or pr obl e m s J our nal of A ppl i e d B e hav i or A nal y s i s 23 417 429. W a r r e n, S F & G a z da g, G ( 1990 ) F a c i l i t a t i ng e a r l y l a ngua ge de ve l opm e nt w i t h m i l i e u i nt e r ve nt i on pr oc e dur e s J our nal of E ar l y I nt e r v e nt i on, 14 ( 1 ) 62 86 Y ode r P J e t a l ( 1995) A n e xpl or a t o r y c om pa r i s on of m i l i e u t e a c hi ng a nd r e s pons i ve i nt e r a c t i on i n c l a s s r oom a ppl i c a t i ons J our nal of E ar l y I nt e r v e nt i on, 19 ( 3) 218 242. Y ode r P J & W a r r e n S F ( 2002) E f f e c t s of pr e l i ngui s t i c m i l i e u t e a c hi ng a nd pa r e nt r e s pons i vi t y e duc a t i on on dya ds i nvol vi ng c hi l dr e n w i t h i nt e l l e c t ua l di s a bi l i t i e s J our nal of Spe e c h, L anguage and H e ar i ng R e s e ar c h, 45 1 158 1174.

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144 A P P E N D I X A F U N C T I O N A L A N A L Y S I S P R O T O C O L F u n c t i on al A n al ys i s P r ot oc ol F our c ondi t i ons : A t t e nt i on, T a ngi bl e E s c a pe a nd F r e e P l a y ( c ont r ol ) 1. F r e e P l a y a H om e e nvi r onm e nt E nvi r onm e nt a l va r i a bl e s he l d c ons t a nt ( e g pe opl e r oom s f u r ni t ur e noi s e l e ve l s ) b. A c t i vi t y C hi l d i nt e r a c t s w i t h p r e f e r r e d i t e m s a s de t e r m i ne d by a pr e f e r e nc e a s s e s s m e nt c R e s e a r c he r be ha vi or R e s e a r c he r pr ovi de s nonc ont i n ge nt a t t e nt i on t o t he c hi l d N o t a s k de m a nds a r e pr e s e nt e d N o pr ogr a m m e d c ons e que nc e s a r e pr ovi de d f or pr obl e m a t i c be ha vi or d. A s s um pt i on N o pr obl e m be ha vi or s houl d oc c ur i n t hi s c ondi t i o n 2. A t t e nt i on a H om e e nvi r onm e nt E nvi r onm e nt a l va r i a bl e s he l d c ons t a nt ( e g pe opl e r oom s f u r ni t ur e noi s e l e ve l s ) b. A c t i vi t y C hi l d i nt e r a c t s w i t h a ne ut r a l t a s k a s de t e r m i ne d b y t he pa r e nt a nd pr e vi ous obs e r va t i ons c R e s e a r c he r be ha vi or R e s e a r c he r a t t e nds t o t he c hi l d s be ha vi or e a c h t i m e i t oc c ur s by gi vi ng t he c hi l d a t t e nt i o n a nd s t a t i ng P l e a s e don t do t ha t d. A s s um pt i on I f i nc r e a s e d pr obl e m be ha vi or oc c ur s c onc l ude pr obl e m be ha vi or i s t o ga i n a c c e s s t o a dul t a t t e nt i on 3. T a ngi bl e a H om e e nvi r onm e nt

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145 E nvi r onm e nt a l va r i a bl e s he l d c ons t a nt ( e g pe opl e r oom s f u r ni t ur e noi s e l e ve l s ) b. A c t i vi t y C hi l d i nt e r a c t s w i t h a p r e f e r r e d i t e m de t e r m i ne d pr e vi ous l y by a pr e f e r e nc e a s s e s s m e nt c R e s e a r c he r be ha vi or N o t a s k de m a nds a r e pr e s e nt e d R e s e a r c he r pr ovi de s nonc ont i nge nt a t t e nt i on t o t he c hi l d R e s e a r c he r r e m ove s t he pr e f e r r e d i t e m a f t e r a s hor t s e t pe r i od of t i m e o f a ppr opr i a t e be ha vi or ( 30 s e c onds ) d. A s s um pt i on I f i nc r e a s e d pr obl e m be ha vi or oc c ur s c onc l ude pr obl e m be ha vi or i s t o ga i n a c c e s s t o t a ngi bl e i t e m s 4. E s c a pe a H om e e nvi r onm e nt E nvi r onm e nt a l va r i a bl e s he l d c ons t a nt ( e g pe op l e r oom s f u r ni t ur e noi s e l e ve l s ) b. A c t i vi t y C hi l d i nt e r a c t s w i t h a de m a ndi ng t a s k a s de t e r m i ne d by t he pa r e nt a nd t hr ough obs e r va t i on c R e s e a r c he r be ha vi or R e s e a r c he r pr ovi de s nonc ont i nge nt a t t e nt i on t o t he c hi l d R e s e a r c he r r e pe a t e dl y di r e c t s c hi l d t o c om pl e t e t he de m a ndi ng t a s k ( one m i nut e i nt e r va l s ) R e s e a r c he r r e m ove s t a s k e a c h t i m e pr obl e m be ha v i or oc c ur s f o r a s e t pe r i od of t i m e ( 30 s e c onds ) a nd t he n r e t ur ns t he t a s k w he n a ppr opr i a t e be ha vi or oc c ur s d. A s s um pt i on I f i nc r e a s e d pr obl e m be ha vi or oc c ur s c on c l ude pr obl e m be ha vi or f unc t i ons t o e s c a pe de m a nds

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146 A P P E N D I X B M I S C E L L A N E O U S V A R I B L E S D A T A S H E E T S A d u l t S u r ve y S t ude nt : D a t e : A dul t : ( e g P ar e nt 1 ) 1. E d u c at i on : P l e a s e i ndi c a t e your hi ghe s t de gr e e obt a i ne d N one H i gh S c hool B a c he l o r s M a s t e r s P os t M a s t e r s 2. E xp e r i e n c e : P l e a s e i ndi c a t e t he num be r o f r e s e a r c h s t udi e s i n w hi c h you ha ve pa r t i c i pa t e d ___ N um be r o f R e s e a r c h S t udi e s 3. E xp e r t i s e : P l e a s e i ndi c a t e e a c h t ype of t r a i ni ng you ha ve r e c e i ve d. ( C he c k al l t hat appl y ) A ppl i e d B e ha vi or A na l ys i s F unc t i ona l C om m uni c a t i on T r a i ni ng M i l i e u T he r a py O t he r : ________ N one

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148 A P P E N D I X C B O A R D M A K E R C A R D S

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149 A P P E N D I X D C O D I N G M A N U A L C od i n g M an u al A b e r r an t b e h avi or : A be r r a nt be ha vi o r i s de f i ne d br oa dl y a s be ha vi or t ha t ne ga t i ve l y i m pa c t s t a r ge t c hi l d l e a r ni ng a nd i nde pe nde nc e a nd c a n i nc l ude m i l d be ha vi or a nd s e ve r e be ha vi or ( B a i l e y a nd B ur c h, 2002) T he de f i n i t i on w i l l va r y a nd be a dj us t e d ba s e d on e a c h t a r ge t c hi l d's f or m o f t he be ha vi or S om e pa r t i c i pa nt s m a y e nga ge i n t a nt r um s a nd ot he r s m a y e nga ge i n pr ope r t y de s t r uc t i on or a gg r e s s i on t ow a r ds ot he r s F or e xa m pl e s c r e a m i ng a nd hi t t i ng c l a s s m a t e s w oul d be c ons i de r e d a be r r a nt be ha vi or T he be ha vi or s w i l l be ope r a t i ona l l y de f i ne d i n obs e r va bl e a nd m e a s ur a bl e t e r m s a s out l i ne d by B a i l e y a nd B ur c h ( 2002) F or e a c h pa r t i c i pa nt t he a be r r a nt be ha vi o r t o t a r ge t w i l l be de t e r m i ne d f r om da t a obt a i ne d f r om pa r e nt a nd t e a c he r i nt e r vi e w s a nd di r e c t obs e r va t i ons A be ha vi or m us t be ove r f o r t h r e e s e c onds be f or e a not he r a be r r a nt be ha vi or c a n be c ount e d I f a c hi l d t a nt r um s s t ops f or 1 s e c ond, a nd r e s um e s t o t a nt r um t he e pi s ode i s c ount e d a s one be ha vi or A be r r a nt be ha vi or : T ypi c a l l y de f i ne d a s t a nt r um s t a s k r e f us a l s e l f i nj u r y, a ggr e s s i on, or pr ope r t y de s t r uc t i on ( H a r di ng e t a l 2001 ) 1. E xa m pl e s : A c hi l d l i e s on t he f l oo r ki c ks hi s f e e t a nd s c r e a m s f or a pe r i od e qua l t o or g r e a t e r t ha n 1 s e c ond ( i e t a nt r um ) W he n a s ke d t o do a t a s k, a c hi l d s c r e a m s ( i e t a nt r um t a s k r e f us a l ) A c hi l d l i e s on t he f l oo r a nd be g i ns ba ngi ng hi s he a d ( s e l f i nj ur y ) A c hi l d s c r e a m s a nd hi t s a n a dul t ( a ggr e s s i on) A c hi l d l i e s on t he f l oo r a nd ki c ks a hol e i n t he w a l l ( pr ope r t y de s t r uc t i on)

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150 2. N one xa m pl e s : A c hi l d l a ys on t he f l oo r a nd no t a s k de m a nd ha s b e e n m a de A c hi l d f a l l s a nd h i t s hi s he a d on t he f l oor C om m u n i c at i o n r e s p on s e : C om m uni c a t i on r e s pons e s a r e de f i ne d a s ha ndi ng pi c t ur e c om m uni c a t i on c a r ds t o t he t r a i ne r i nvol ve d i n t he s e s s i on w i t h or w i t hout a pr om pt P r om pt e d c om m uni c a t i on: P r om p t e d c om m uni c a t i on r e s pons e i s de f i n e d a s r e que s t i ng a n i t e m w i t h a phys i c a l ve r ba l or ge s t ur a l p r om pt 1. E xa m pl e s : I f a t e a c he r t e l l s a pa r t i c i pa nt T e l l m e w ha t you w a nt a nd t he pa r t i c i pa nt t he n ha nds t he p i c t ur e c a r d t o t he t e a c he r t he n pr om pt e d c om m uni c a t i on ha s oc c ur r e d. 2. N one xa m pl e s : I f a c hi l d ha nds a pi c t u r e c a r d t o a t e a c he r or o t he r c ha nge a ge nt w i t hout a ny pr o m pt t he n unpr o m pt e d c om m uni c a t i on ha s oc c ur r e d. U npr om pt e d c om m uni c a t i on: U npr om pt e d c om m uni c a t i on i s de f i ne d a s r e que s t i ng a n i t e m w i t hout a phys i c a l ve r ba l o r ge s t ur a l p r om pt ( i e unpr om pt e d c om m uni c a t i on) 1. E xa m pl e s I f a c hi l d ha nds a pi c t u r e c a r d t o a t e a c he r or o t he r c ha nge a ge nt w i t hout a ny pr o m pt t he n unpr o m pt e d c om m uni c a t i on ha s oc c ur r e d. 2. N one xa m pl e s : I f a t e a c he r t e l l s a pa r t i c i pa nt I f you w a nt t he c a r gi ve m e t he c a r d a nd t he pa r t i c i pa nt t he n ha nds t he c a r d t o t he t e a c he r t he n unpr om pt e d c om m uni c a t i on ha s not oc c ur r e d P r om p t s : P r om pt s c ons i s t of ve r ba l ge s t ur a l o r p hys i c a l pr om pt s l e a s t t o m os t i nt r us i ve r e s pe c t i ve l y. V e r ba l pr om pt s c ons i s t of ve r ba l l a ngua ge ( e g. T e l l m e w ha t you w a nt )

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151 1. E xa m pl e s : T he t e a c he r s a ys T e l l m e w ha t you w a nt 2. N one xa m pl e s : T he t e a c he r poi nt s t o a n obj e c t a nd t he n hol ds he r ha nd out G e s t ur a l pr om pt s c ons i s t of vi s ua l c ue s ( e g. t e a c h e r hol ds ha nd out w i t h pa l m up i n a nt i c i pa t i on of r e c e i vi ng a c a r d ) 1. E xa m pl e s : T he pa r e nt hol ds he r ha nd out T he pa r e nt hol ds he r ha nd out a nd po i nt s t o t he obj e c t 2. N one xa m pl e s : T he pa r e nt s a ys W ha t do you w a nt ? T he t e a c he r t ouc he s t he s t ude nt s ha nd P hys i c a l pr om pt s c ons i s t of ha nd ove r ha nd e xc ha nge s ( e g. t e a c he r l e a di ng a c hi l d s ha nd t o a c a r d ) 1. E xa m pl e s : T he pa r e nt g r a s ps t he c hi l d s ha nd a nd a s s i s t s i n pi c ki ng up t he c a r d 2. N one xa m pl e s : T he t e a c he r hol ds he r ha nd out f or t he p i c t ur e c a r d T he pa r e nt s a ys G i ve m e t he c a r d P l ay: P l a y c ons i s t s of t he pa r t i c i pa nt e nga ge d w i t h a pr e f e r r e d i t e m f or a pe r i od of t w o o r m o r e s e c onds i n w hi c h t he pa r t i c i pa nt a l s o m a ke s e ye c o nt a c t w i t h t he p r e f e r r e d i t e m 1. E xa m pl e s : I f a c hi l d pi c ks up a t oy c a r ( i e p r e f e r r e d i t e m ) b r i e f l y l ooks a t t he i t e m a nd ho l ds i t f or t w o s e c onds pl a y ha s oc c ur r e d.

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152 2. N one xa m pl e s : I f a c hi l d pi c ks up a t oy c a r ne ve r l ooks a t i t a nd w a l ks a r ound t he r oom w i t h t he c a r i n hi s ha nd f or f our s e c onds pl a y ha s not o c c ur r e d V e r b al i z at i on s V e r ba l i z a t i ons m a y be i m i t a t i ve or unpr om pt e d I m i t a t i ve ve r ba l i z a t i ons : D e f i ne d a s i m i t a t i ng a not he r s w or ds s uc h a s t he c a s e w i t h e c hol a l i a 1. E xa m pl e s : T he pa r e nt s a ys T e l l m e w ha t you w a nt T he c hi l d t he n s a ys T e l l m e T he t e a c he r s a ys D o you w a nt t he c a r ? a nd t he c hi l d s a ys C a r 2. N one xa m pl e s : T he c hi l d s a ys C a r w i t hout a n a dul t pr e s e nt s a yi ng t he w or d T he c hi l d s a ys he l p w i t hou t a n a dul t pr e s e nt s a yi ng t he w or d U npr om pt e d ve r ba l i z a t i ons : D e f i ne d a s ve r ba l w or ds e m i t t e d by pa r t i c i pa nt s t ha t a r e no t e c hol a l i c i n na t ur e T ha t i s a dul t w o r ds a r e not be i ng i m i t a t e d. 1. E xa m pl e s : T he c hi l d s a ys C a r w i t hout a n a dul t pr e s e nt s a yi ng t he w or d T he c hi l d s a ys he l p w i t hou t a nd a dul t pr e s e nt s a yi ng t he w or d 2. N one xa m pl e s : T he pa r e nt s a ys T e l l m e w ha t you w a nt T he c hi l d t he n s a ys T e l l m e T he t e a c he r s a ys D o you w a nt t he c a r ? a nd t he c hi l d s a ys C a r

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153 A P P E N D I X E D A T A C O L L E C T I O N A N D C O D I N G S H E E T S R e al t i m e D a t a C ol l e c t i on S h e e t D a t e : _ _ _ T i m e : _ _ N a m e : _ _ _ _ P r i m a r y O b s e r v e r : _ _ _ _ S e c o n d a r y O b s e r v e r : _ _ _ _ S e s s i o n N u m b e r ( s ) : _ _ S c h e d u l e : _ _ _ _ H i g h l y P r e f e r r e d S t i m u l u s : _ _ _ _ C o n d i t i o n : 0 : 0 0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 1 : 0 0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 2 : 0 0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 3 : 0 0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 4 : 0 0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 R e s u l t s : C o m m e n t s

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155 A P P E N D I X F T R A I N I N G M A N U A L T r ai n i n g M an u al I n t r od u c t i on : T h e t r ai n i n g w i l l c on s i s t o f t r ai n i n g p ar e n t s t o t e ac h t h e i r c h i l d r e n c om m u n i c at i o n s k i l l s t o r e p l ac e ab e r r an t b e h av i or s B e f or e i ni t i a t i ng t he i nt e r ve nt i on pa r e nt s w i l l be t a ught t he pr oc e dur e s f o r t e a c hi ng t he i r c hi l d t hi s s ki l l t h r ough vi e w i ng vi de os a nd r ol e pl a y t r a i ni ng s e s s i ons w hi c h w i l l oc c ur unt i l c a r e gi ve r s r e a c h 90% a c c ur a c y. F i r s t pa r e nt s w i l l r e a d t he c odi ng m a nua l T he pr i m a r y e xpe r i m e nt e r w i l l c l a r i f y a ny que s t i ons a bout c odi ng de f i ni t i ons T he n, pa r e nt s w i l l vi e w vi de os a nd m us t i de nt i f y a nd r e c or d i nt e r ve nt i on pr oc e dur e s P a r e nt s w i l l us e pa pe r a nd pe nc i l t o r e c or d a nd c l a s s i f y ( e g. ve r ba l phys i c a l ) e a c h pr om pt gi ve n t o t he c hi l d I n a ddi t i on t he pa r e nt w i l l w r i t e e a c h r e s pons e f r om t he c hi l d a nd r e c or d w he t he r t he r e s pons e w a s pr om pt e d or unpr om pt e d, c l a s s i f yi ng t he pr om pt F i na l l y pa r e nt s w i l l r ol e pl a y t he i n t e r ve nt i on p r oc e dur e s w i t h t he pr i m a r y e xpe r i m e nt e r T he pa r e nt w i l l p r a c t i c e t a ki ng a n i t e m a nd pl a yi ng w i t h t he i t e m a nd g i vi ng ve r ba l ve r ba l / ge s t ur a l a nd phys i c a l pr om pt s w i t h t he pr i m a r y e xpe r i m e nt e r ( s e e A ppe ndi x F f o r de t a i l e d t r a i ni ng m a nua l ) F or pur pos e s of ge ne r a l i z a t i on i n c ont r a s t t e a c he r s w i l l be t a ught a s i ngl e s ki l l T e a c he r s w i l l be t a ught t o pl a c e hi gh l y pr e f e r r e d i t e m s i n vi e w bu t out of r e a c h of t he c hi l d A ddi t i ona l l y, t h e t e a c he r s w i l l be i ns t r uc t e d t o gi v e t he hi ghl y p r e f e r r e d i t e m s t o t he c hi l d w he n gi ve n a pi c t ur e c a r d T he t e a c he r s w i l l p r a c t i c e t hi s t hr ough r ol e pl a y w i t h t he e xpe r i m e nt e r unt i l t he y a r e a bl e t o c om pl e t e t hi s s ki l l s uc c e s s f ul l y a s e va l ua t e d a nd de f i n e d by c a r e gi ve r s a nd t e a c he r s pe r f or m i ng t he pr oc e dur e s c or r e c t l y 10 c o ns e c ut i ve t r i a l s ( s e e A ppe ndi x F f or t r a i ni ng m a nua l a nd w or ks he e t s )

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156 P ar e n t s : P a r e nt s w i l l be t a ught t he p r oc e dur e s f or t e a c hi ng t he i r c hi l d t o c om m uni c a t e a nd i ni t i a t e c om m uni c a t i o n t h r ough r e a di ng t he c odi ng a nd e xpe r i m e nt a l m a nua l s vi e w i ng t r a i ni ng vi de os ( vi de os of t he pr i m a r y e xpe r i m e nt e r pe r f or m i ng t he i nt e r ve nt i on) a nd r ol e pl a y t r a i ni ng s e s s i ons w hi c h w i l l oc c ur unt i l t he y r e a c h c r i t e r i o n l e ve l 1. P a r e nt s w i l l r e a d t he m a nua l s a nd vi e w vi de os a nd m us t i de nt i f y a nd r e c or d i nt e r ve nt i on pr oc e dur e s a T he pa r e nt s w i l l r e a d t he c odi ng m a nua l a nd e xpe r i m e nt a l pr oc e dur e s m a nua l b. U s i ng pa pe r a nd pe nc i l a nd t he a t t a c he d da t a s he e t t he pa r e nt s w i l l r e c or d a nd i de nt i f y pr om pt s us e d ( ve r ba l ge s t ur a l a nd phys i c a l ) i n t he vi de o c l i ps c T he pa r e nt s w i l l i de nt i f y pl a y s i t ua t i ons a c c or di ng t o t he de f i ni t i on i n t he c odi ng m a nua l d. T he pa r e nt s w i l l i de nt i f y c om m uni c a t i on r e s pons e s e G i ve n vi de o c l i ps t he pa r e nt s w i l l c ode t he be ha vi or s us i n g t he da t a c ol l e c t i on s he e t s i n A ppe ndi x E T he pa r e nt s c od e s w i l l be c om pa r e d t o t he pr i m a r y e xpe r i m e nt e r T he pa r e nt s m us t obt a i n 90% I O A f I f t he pa r e nt s a r e be l ow 90% a c c ur a c y a f t e r vi e w i n g t e n 1 m i nut e vi de o c l i ps t he pr i m a r y e xpe r i m e nt e r w i l l r e vi e w t he c o di ng m a nua l g. T he pa r e nt s w i l l be gi ve n m or e vi de o c l i ps unt i l t h e pa r e nt s r e a c h 90% a c c ur a c y, w hi c h a ppr oxi m a t e l y w i l l be f our hour s a c r os s t w o da ys

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157 V i d e o C l i p P r om pt s P l a y S i t ua t i ons C om m uni c a t i on R e s pons e s I m pl e m e nt a t i on on V i de o C l i p C l i p 1 Y e s / N o C l i p 2 Y e s / N o C l i p 3 Y e s / N o C l i p 4 Y e s / N o C l i p 5 Y e s / N o C l i p 6 Y e s / N o C l i p 7 Y e s / N o C l i p 8 Y e s / N o C l i p 9 Y e s / N o C l i p 10 Y e s / N o

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158 2. D ur i ng t he r ol e pl a y, pa r e nt s m us t i m pl e m e nt t he i nt e r v e nt i on pr oc e dur e s w i t h t he pr i m a r y e xpe r i m e nt e r a nd/ o r g r a dua t e a s s i s t a nt a P a r e nt s w i l l r o l e pl a y t he pr oc e dur e s w i t h t he pr i m a r y e xpe r i m e nt e r b. T he pa r e nt s w i l l pr a c t i c e t he s e s s i on us i ng t he pr oc e dur e s out l i ne d i n t he e xpe r i m e nt a l pr oc e dur e s s e c t i on. c A f t e r c om pl e t i ng t he s e s s i on, pa r e nt s w i l l v i e w t he vi de os w i t h t he pr i m a r y e xpe r i m e nt e r a nd de t e r m i ne i f t he p r oc e dur e s w e r e i m pl e m e nt e d c or r e c t l y. d. T hi s w i l l c ont i nue unt i l t he pa r e nt pe r f or m s t he pr oc e dur e s c or r e c t l y 10 c ons e c ut i ve t i m e s T e ac h e r s : T e a c he r s w i l l be t a ught t o pl a c e hi ghl y pr e f e r r e d i t e m s i n vi e w but out o f r e a c h o f t he c hi l d. A l s o, t he t e a c he r s w i l l be i ns t r uc t e d t o gi ve t he hi ghl y p r e f e r r e d i t e m s t o t he c hi l d w he n gi ve n a pi c t ur e c a r d 1. T e a c he r s w i l l pr a c t i c e t hi s t hr ough r ol e pl a y w i t h t he e xpe r i m e nt e r 2. T hi s t r a i ni ng w i l l oc c ur da i l y unt i l pa r e nt s a nd t e a c he r s pe r f or m t he pr oc e dur e s c or r e c t l y 10 c ons e c ut i ve t r i a l s ( s e e A ppe ndi x E f o r t r a i ni ng w or ks he e t )

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159 A P P E N D I X G S O C I A L V A L I D I T Y F O R M S I N T E R V E N T I O N A C C E P T A B I L I T Y F O R M D a t e : _________________________ C a r e gi ve r : ______________________________ S c hool ( i f a ppl i c a bl e ) : _____ _________________ ______ A ge of c hi l d: ____ ye a r s ____ m ont hs S E C T I O N I : P l e as e c om pl e t e t he i t e m s be l ow by c i r c l i ng t he num be r unde r t he que s t i on t hat be s t f i t s how y ou f e e l about t he i nt e r v e nt i on. 1. H ow t i m e c ons um i ng w a s t he t r a i ni ng? N o t a t a l l S o m e w h a t V e r y 1 2 3 4 5 2. D i d t he i nt e r ve nt i on i m pr ove your e ve r yda y r out i n e s ( e g. di nne r e t c ) ? N o t a t a l l S o m e w h a t V e r y 1 2 3 4 5 3. H ow m uc h i nc r e a s e di d you s e e i n your c hi l d s c o m m uni c a t i on? N o t a t a l l S o m e w h a t V e r y 1 2 3 4 5 4. D i d you s e e a n i nc r e a s e i n you r c hi l d s a ppr opr i a t e be ha vi or ? N o t a t a l l S o m e w h a t V e r y 1 2 3 4 5 5. H ow l i ke l y i s i t t ha t you w i l l us e t he i nt e r ve nt i on i n t he f ut u r e ? N o t a t a l l S o m e w h a t V e r y 1 2 3 4 5 S E C T I O N I I : P l e as e t e l l m e about y ou and y our f am i l y 1. H ow m a ny c hi l dr e n do you h a ve ? ___ C hi l dr e n 2. W ha t i s your c ur r e nt l e ve l of e duc a t i on? P l ac e a c he c k ne x t t o y our c hoi c e ___ H i gh s c hool ___s om e c ol l e ge ___ba c he l or s ___ gr a dua t e s c hool 3. H a ve you pa r t i c i pa t e d i n r e s e a r c h s t udi e s i n t he pa s t ? ____ S E C T I O N I I I : T hank y ou f or c o m pl e t i ng t h i s que s t i onnai r e Y our i nput i s v e r y appr e c i at e d. I f t he r e i s any t hi ng e l s e y ou m ay l i k e t o s har e pl e as e do s o i n t he s pac e pr ov i de d be l ow

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160 E xp e r t S oc i al V al i d i t y F or m D a t e : ____________________ P a r t i c i pa nt : _______________ N a m e : __________________ S c or i ng C ode : _____________ A f t e r vi e w i ng t he 10 m i nu t e vi de o c l i p pl e a s e us e t he l i ke r t s c a l e s be l ow t o i ndi c a t e t he c hi l d s di s pl a y of s oc i a l be ha vi or P l e a s e r e m e m be r t o ba s e your a ns w e r s on t he s oc i a l be ha vi or of t he t a r ge t e d c hi l d. 1. H ow a ppr opr i a t e w a s t he c hi l d s c om m uni c a t i on? N ot a t a l l S om e t i m e s V e r y 1 2 3 4 5 6 2. H ow i na ppr opr i a t e w a s t he c hi l d s be ha vi or ? N ot a t a l l S om e t i m e s V e r y 1 2 3 4 5 6 3. H ow of t e n di d t he c hi l d c om m uni c a t e ? N ot a t a l l S om e t i m e s V e r y 1 2 3 4 5 6 4. O ve r a l l do you t hi nk t he c hi l d s c om m uni c a t i on a nd be ha vi or i m p r ove d? N ot a t a l l S om e t i m e s V e r y 1 2 3 4 5 6 C om m e nt s :

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161 B I O G R A P H I C A L S K E T C H M y de c i s i on t o w or k i n t he f i e l d o f s pe c i a l e duc a t i on w a s by ha ppe ns t a nc e A f t e r pr ovi di ng s uppor t s f or a m ot he r a nd he r c hi l d w ho ha d bi pol a r di s or de r I w a s of f e r e d a j ob a t a c e nt e r f or c hi l dr e n w i t h s e ve r e e m ot i ona l be ha vi or di s or de r s a nd a ut i s m c a l l e d t he C e da r w ood pr ogr a m w hi c h w a s a pa r t of t he G e or gi a P s yc hoe duc a t i ona l N e t w or k. P r i or t o t hi s I t a ught hi gh s c hool m a t he m a t i c s but w a s not s a t i s f i e d w i t h m y j ob. I t ook t he j ob a nd s t a r t e d t e a c hi ng c hi l dr e n w i t h a ut i s m i n A ugus t o f 1999 T he pr ogr a m e m pl oye d m e f or f i ve ye a r s D ur i ng t hi s t i m e I w or ke d i n t he c l a s s r oom f or f our ye a r s di r e c t l y w i t h t he s t ude nt s T he pr og r a m s e nt m e t o num e r ous w o r ks hops i nc l udi ng a s t i nt a t D i vi s i on T E A C C H ( t r e a t m e nt a nd e duc a t i o n of a ut i s t i c a nd c om m uni c a t i on ha ndi c a ppe d c h i l dr e n) a s t a t e w i de or ga ni z a t i on i n N or t h C a r ol i na f or i ndi vi dua l s w i t h a ut i s m I n a ddi t i on t he y s e nt m e t o v i s i t w i t h T e m pl e G r a ndi n, a f a m o us i ndi vi dua l w i t h a ut i s m F r om t ha t poi nt on, I kne w w or ki ng w i t h i ndi vi dua l s w i t h a ut i s m w a s m y pa s s i on a nd w oul d e nc om pa s s m y c a r e e r M y l a s t ye a r w or ki ng f or t he C e da r w ood P r ogr a m w a s s pe nd a s t he s c h ool l i a i s on. I t r a ve l e d t o va r i ous s c hool s t o c onduc t f unc t i ona l a s s e s s m e nt s a nd he l p t e a c he r s de ve l op be ha vi or a l pr ogr a m s f or c hi l dr e n w i t h a ut i s m a nd be ha vi or di s or de r s W hi l e w or ki ng a t C e da r w ood, I w or ke d on a m a s t e r s de gr e e i n be ha vi or di s or de r s a t G e or gi a S out he r n U ni ve r s i t y a nd r e c e i ve d t he de gr e e i n 2002 A f t e r c om pl e t i ng m y m a s t e r s p r ogr a m I c ont i nue d w or ki ng f or t he C e da r w ood P r ogr a m a nd s t a r t e d t e a c hi ng unde r gr a dua t e a nd gr a dua t e c our s e s a t G e or gi a S out he r n U ni ve r s i t y. T ha t e xpe r i e nc e c oup l e d w i t h t hos e ga i ne d w i t h t he C e d a r w ood P r ogr a m he l pe d c onf i r m m y de c i s i on t o pur s ue a doc t or a l de gr e e M y e xpe r i e nc e s w i t h t he C e da r w ood P r ogr a m ga ve m e m y de s i r e t o w or k w i t h c hi l d r e n w i t h a ut i s m w hi l e t he e xpe r i e n c e s I ha d a t G e or gi a S out he r n U ni ve r s i t y

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162 ki ndl e d m y de s i r e t o be c om e pa r t of a c a de m i a K e e pi ng i n m i nd m y de s i r e t o w or k di r e c t l y w i t h pa r e nt s a nd t he i r c hi l d r e n, a nd a c know l e dgi ng m y gr ow i ng a s pi r a t i on t o c onduc t r e s e a r c h a nd t e a c h a t t he c ol l e ge l e ve l I c hos e t o pur s ue a doc t o r a l de gr e e i n s pe c i a l e duc a t i on. W i t h a doc t or a l de gr e e f r om t he U ni ve r s i t y o f F l o r i da I p l a n t o c ont i nue t o c a r r y out r e s e a r c h i n t he f i e l d of a ut i s m be c a us e i t i s m y pa s s i on, a nd t o he l p pa r e nt s a nd t e a c he r s of t he s e c hi l dr e n be t t e r unde r s t a nd a nd m e e t t he i r uni que n e e ds