Discrete Trial Teaching and Naturalistic Teaching Approaches

1. Discrete Trial Teaching and Naturalistic Teaching Approaches

2. “There are many behavior analytic procedures for arranging learning opportunities, some adult-initiated, some learner-initiated, some embedded in typically occurring activities or sequences of responses, and some that are hybrids or permutations of these. Each type of procedure has its uses and advantages. ABA programming uses any and all procedures to accomplish the job of skill development and skill generalization with each individual learner” (Green, 2001, p. 74).

3. What is Discrete Trial Teaching?(Smith, 2001) • The term discrete trialdescribes the following procedure: SD – Response – Consequence – Intertrial Interval • As opposed to free-operantprocedure: • Organism is “free” to respond at various frequencies • There’s not intertrial interval • Discrete Trial Teaching/Training (DTT) or Discrete TrialInstruction (DTI) is one of dozens of behavior analytic teaching strategies • It’s a method for individualizing and simplifying instruction to enhance learning • Skills are taught in small, structured steps • Instruction is typically conducted one-to-one in a distraction-free setting • DTT is “one of the most important instructional methods for children with autism” (p. 86)

4. Five Parts to a Trial in DTT(Smith, 2001) • Teacher presents brief, distinctive instruction or question • e.g., “do this”, “what is it?” • If needed, a prompt is provided after or along with the instruction • Child responds correctly or incorrectly • Teacher provides a consequence (reinforcer, ignore, or correction) • Intertrial Interval • Teacher pauses 1-5 s before presenting the next trial • Data may be recorded at this time

5. Some History… (Ghezzi, 2007) • 1950s & 60s - Sidney Bijou at U of Washington • Inspired to use discrete trial teaching with children with autism by the Wisconsin General Test Apparatus • WGTA was being used at the time to study visual discrimination learning with young children in labs • They tried to bring this tight control in the lab to a teaching situation for children with DD

6. WGTA http://psych.wisc.edu/primatelab/primatelabhistory.html

7. Some History… (Ghezzi, 2007) • Wolf, Risley, and Mees (1964) • One of the first ABA studies and earliest demonstrations of DTT • “Dicky”, a boy with autism • Although shaping worked to help him keep his glasses on, it didn’t work to teach him to talk because he rarely vocalized - shaping would be too time-consuming! • Used DTT instead, using models of sounds, blends, whole words

8. Some History… (Ghezzi, 2007) • First well-known model of early behavioral intervention for children with autism was developed by (Ole) Ivar Lovaas in the ’60s and ’70s • Trained in behavior analysis while doing a postdoc with Sidney Bijou in 1958 • Lovaas (1993) credits Bijou with helping him bridge “the gap between behavioral psychology and clinical application” (p. 618) • Psychology professor at the University of California at Los Angeles (UCLA) • Applied the science of behavior analysis to the treatment of people with autism in a new way, which he now calls the Lovaas Model of ABA (www.lovaas.com) • Video

9. Limitations of Early DTT(Lovaas & Smith, 2003) • “Teaching one skill did not by itself lead to improvements in other skills” (p. 327) • “Gains tended to be situation-specific; despite improving with therapists in clinical settings, children’s behavior often remained unchanged with caregivers in everyday settings such as home or school” (p. 327) • Cites Lovaas, Koegel, Simmons, and Long (1973) • How did YAP deal with these limitations? • These limitations drove research and development of other behavioral approaches

10. UCLA Young Autism Project (YAP; Lovaas & Smith, 2003) • Stage 1 (2-4 weeks) - DTT • Establish “instructional control” • Extinguish escape-maintained behavior • Establish history of reinforcement for following directions • Stage 2 (1-4 months) - DTT • Direction following • Imitation • Matching, Receptive Object ID • Dressing • Toy play • Stage 3 (6+ Months) - DTT, IT • Verbal Im • Expressive labels • Receptive Picture/Action ID • Expand SH and play • Augmentative system if vocal language is not acquired

11. UCLA Young Autism Project (YAP; Lovaas & Smith, 2003) • Stage 4 (12 months) - DTT, IT, dyads with typical peers • Expressive labels - colors, shapes • Beginning “language concepts” • Recognizing emotions • Beginning sentences (“I want____”; “I see ____”) • Pretend play and peer interaction • Toilet training • Stage 5 (12 months) - DTT, IT, small group, typ PK • Using “language concepts” • Conversation • Comprehending stories • Perspective-taking • Learning from models • Working independently • Helping with chores

12. The “Lovaas Model of ABA” • Was widely disseminated as a treatment for children with autism in the 80s • Manuals • Program evaluations • 1981 • 2003

13. A Reaction to DTT(LeBlanc, Esch, Sidener, & Firth, 2006) • In the ’70s and ’80s, a community of researchers heavily influenced by Stokes and Baer (1977) began developing interventions for children with autism • Stokes and Baer… • Reviewed the ABA research on generalization • Categorized 9 techniques for assessing and training generalization

14. Naturalistic Teaching Approaches (NTAs) (LeBlanc et al., 2006) • Approach to intervention was characterized by a strong emphasis on • Promoting skill generalization • Incorporating parents, teachers, siblings, peers • Conducting teaching during play, at home, in daycare (not in “work” or separate teaching environments) • From the beginning of instruction (not an afterthought or added at the end after tight stimulus control was attained)

15. NTAs – 3 Important Characteristics(LeBlanc et al., 2006) • Linguistic Framework • Goal of increased “motivation” • Goal of “spontaneity”

16. NTA Conceptual Framework for Language(LeBlanc et al., 2006) • Tendency to describe and categorize language according to form • Receptive/expressive • Advantage: Language is more easily shared with special educators and speech therapists • Pubs are in JABA but also special ed and speech journals

17. NTA and “Motivation”(LeBlanc et al., 2006) • One goal of NTA interventions is to have the child demonstrate willingness to participate in instruction and become more responsive to others • Signs of motivation: • Response latencies are shorter • Frequencies of verbalizations increase • Positive affect is clearly evident in the teaching environment (problem behavior rarely occurs during teaching) • Techniques designed to enhance motivation: • Interspersal of maintenance with acquisition trials • Reinforcement of attempts (looser shaping criterion) • Incorporation of child choice and child-initiated activities • Use of natural or “functional” reinforcers

18. NTA and “Spontaneity”(LeBlanc et al., 2006) • Definition: Stimuli embedded within the child’s ongoing activities, interactions, and general environment set the occasion for Language. • A spontaneous response would be in the absence of explicit adult-mediated prompts such as • Say, “I want juice” • “What do you want?”

19. Halle (1987)Teaching Language in the Natural Environment: An Analysis of Spontaneity Continuum of controlling or discriminative stimuli in the presence of which responses appear more or less spontaneous

20. NTA and Stimulus Control(LeBlanc et al., 2006) • Training context to natural environment • DTT-Only Programs: Little correspondence • NTA Programs: High correspondence • Controlling stimuli during training and in natural environment • Some correspondence, but in NTA there is typically not an emphasis on determining what the controlling stimuli are in either situation • Not an issue that is often discussed/valued

21. Incidental Teaching (IT) • IT is an NTA used “to get elaborated language by waiting for another person to initiate conversation about a topic and then responding in ways that ask for more language from that person” (Hart & Risley, 1982, p. 5) • Developed by Hart and Risley (1968, 1974, 1975) • Disadvantaged preschool children in Kansas

22. Steps of ITFenske, Krantz, and McClannahan (2001) • Arrange a setting that contains materials of interest to the child • Wait for the child to initiate an interaction about an object of interest • Ask for more elaborate language, or approximations to speech • Provide the object for which the child initiated Practice!

23. Differences Between IT and DTTFenske et al. (2001) Does this comparison mean you should do only one and not the other?

24. McGee, Krantz, and McClannahan (1985) “Traditional Training” • Teacher asks, “Where is the candy?” • Errors are followed by verbal prompts • Descriptive praise follows both prompted and unprompted responses • Reinforcement = turtle (a preferred item, but not the candy) • On the next trial, the turtle is under the box and the candy is the reinforcer

25. McGee, Krantz, and McClannahan (1985) Incidental Teaching • Child initiates for preferred item, “candy” • Teacher asks, “Where is the candy?” • Errors are followed by verbal prompts to say, “the candy is under the box”, but later changed to a prompt to say, “I want the candy under the box” • Descriptive praise follows both prompted and unprompted responses • Reinforcement = candy Question: What is an appropriate antecedent to someone’s specifying location?

26. Research on IT • Has been used to teach • Children with autism to receptively identify items required to make lunch (McGee, Krantz, Mason, and McClannahan, 1983) • Children with autism to request using prepositions (McGee et al., 1985) • Children with autism to read sight words on tokens before exchanging them (Fabry, Mayhew, & Hansen, 1984) • Children with autism to select the name of the toy desired (McGee, Krantz, & McClannahan, 1986) • Children with autism and profound MR to sign (Schepis, Reid, Fitzgerald, Faw, Van Den Pol, & Welty, 1982) • Adults with autism and MR to request food during peer tutoring (Farmer-Dougan, 1994) • Studies have shown facilitation of acquisition AND generalization • Variations of IT: MITS, “Mand Model” (not the same as mand training!)

27. IT Researchers • Todd Risley • PhD at U of Washington • Co-founder of JABA • Taught at U of Kansas and U of Alaska • Pat Krantz • PhD at U of Kansas • Director of PCDI • Lynn McClannahan • PhD at University of Kansas • Director of PCDI • Gail McGee • PhD at Auburn University • Research at PCDI • Professor at Emory University in Atlanta • Director of Emory Autism Center

28. Analysis of Spontaneous LanguageIndentifying Natural Cues IT occurs in the context of a situation where language is naturally appropriate Identify the antecedent stimuli that set the occassion to engage in the following language skills: • Greeting • Asking for help • Question asking (wh) • Commenting about what just happened • Small talk • Expressing emotions

29. Pivotal Response Training • Multi-component intervention package developed by Robert Koegel and Laura Schreibman • Targets “pivotal” behaviors to produce changes across a variety of areas of functioning • Because this could save time and money (Koegel, Koegel, & Brookman, 2003) • Targets in PRT (“Pivotal” behaviors) • Motivation to respond to social and environmental stimuli • Self-regulation/Self-monitoring • Responsivity to multiple cues • Self-initiation of social interactions • e.g., What’s that? – initially taught with preferred items in bag and faded to neutral items around the room • e.g., Where is it? – favorite items hidden around room; answer is given with preposition • e.g., Whose is it? – Use items that the child “clearly associates” with a particular member of the family • Child is prompted to say, “Whose is it?” • Parent says, “It’s yours” • Child is prompted to say, “Mine” • Also, Look! Help!

30. Behavioral Cusps • “What makes a behavior or change a cusp is that it exposes the individual’s repertoire to new environments, especially new reinforcers and punishers, new contingencies, new responses, new stimulus controls, and new communities of maintaining or destructive contingencies. When some or all of those events happen, the individual repertoire expands; it encounters a differentially selective maintenance of the new as well as some old repertoires, and perhaps that leads to some further cusps” (Rosales-Ruiz & Baer, 1997, p. 534) • Not the same as prerequisites • Examples • Crawling • Reading • Generalized imitation

31. PRT Procedures • Natural Language Paradigm (NLP) – 1st step • PRT applied to language intervention specifically • Developed first and then applied to nonlanguage and called PRT • Interspersal of maintenance and acquisition tasks • Using child-preferred activities and stimuli in the natural environment (e.g., not flashcards) • Allowing child to make choices during activities • Turn-taking • Use of natural reinforcers (e.g., not tokens) • Training parents to implement procedures - parents implement much of the therapy • Taught A-B-C pattern of behavior • Taught about motivation • Taught how to identify learning opportunities in the natural environment • Given parent training manual • Lots of practice with feedback • Reinforcing attempts • Much of the training is done in natural environment settings

32. NLP • PRESENT A REASONABLE ARRAY: Therapist holds up or lays on floor 2 to 3 items and says “Pick one”. • PREVENT ACCESS TO TOY:Therapist prevents learner from removing toy from his or her hands. • MODEL:Therapist provides an appropriate play activity and verbal model with the toy the learner reached for. • PAUSE:Therapist waits 5 seconds for learner to respond. • REINFORCE:If the learner says something relevant, intelligible, and meeting the current criterion, the therapist gives the toy to him or her, or produces reinforcement with the toy. • CONTINUE TO MODEL:Therapist continues to provide verbal and physical models during the play interval. • PROVIDE A NEW MODEL:After the learner plays with the toy for a brief period (e.g., about 15s), the therapist returns to step 2 with new verbal model, and continues following remaining steps for several cycles.

33. Gillett and LeBlanc (2006): http://homepages.wmich.edu/%7eleblancl/pub/GL.pdf LeBlanc, Geiger, Sautter, and Sidener (2006): http://homepages.wmich.edu/%7eleblancl/pub/LGSS.pdf

34. Koegel, Koegel, and Brookman (2003)

35. PRT Research (Koegel et al., 2003) • Most parents reach 80% mastery criterion within about 25 hours • Research on individual components of PRT • Choice reduces problem behavior maintained by escape, increases accuracy • Interspersal of maintenance tasks increases child affect and accuracy • Reinforcement of attempts improves speech production and affect • Many other procedures evaluated without label of NLP/PRT • Research on PRT as a package • “Empirically supported treatment” (p. 351) • Both group and single-case designs • Multiple labs • Multiple settings • Manualized procedures • Treatment integrity data • Independent diagnoses • More effective than a “traditional, analogue individual target behavior approach” • Improved gains when parents rather than clinicians implement procedures • Reduction of parent stress

36. Video Clip of PRT http://brookespublishing.com/autism/prt/video.htm

37. PRT • Intervention is manualized (Koegel, Schreibman, Good, Cerniglia, Murphy, & Koegel, 1989) • 3 levels of certification, books, workshops, conference, SuperNanny, US and Canada government support • http://www.education.ucsb.edu/autism/index.html • http://www.education.ucsb.edu/autism/pdf/PRT%20Training%20and%20Dissemination.pdf • PRT is included in Evidence-Based Psychotherapies for Children and Adolescents • Recent review by Humphries (2003)showing effectiveness of PRT

38. PRT Researchers • Robert Koegel • PhD with Lovaas at UCLA • Professor at UC Santa Barbara • Director of Koegel Autism Center • Editor of Journal of Positive Behavioral Interventions • Lynn Kern Koegel • Trained in psychology and as a speech & language pathologist • Professor at UC Santa Barbara • Director of Koegel Autism Center • Laura Schreibman • Professor at UC San Diego • Autism Research Program (funded by NIMH) • Works in collaboration with the Koegels • Glen Dunlap • BA in Psychology at UCSB • PhD in Speech and Hearing Sciences at UCSB • Professor at University of South Florida • Director of Research and Training Center on Positive Behavior Support • Lee Kern-Dunlap • BA at UCSB • PhD in Special Ed at University of South Florida • Professor at Lehigh University (social, emotional, behavioral needs/ADHD) • Marjorie Charlop-Christy • BA at UCLA • Professor at Claremont McKenna College in Claremont, CA • Director of Claremont Autism Center

39. PRT and Lovaas Model • Are these things different than ABA? • Positive Behavioral Support and ABA (Carr & Sidener, 2002) • Person-centered planning • Focus on individualized ax & tx for the client • Functional assessment • Positive intervention strategies • Multifaceted interventions (tx packages) • A focus on the environment • Change environment vs. change the person • Meaningful outcomes • Ecological validity • Generalization and maintenance • Systems-level intervention