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USING MODELING AND REHEARSAL TO TEACH FIRE SAFETY TO CHILDREN WITH AUTISM

DAVID GARCIA BEHAVIOR ANALYSIS, INC. AND FLORIDA AUTISM TREATMENT CENTERS

AND

CHARLES DUKES, MICHAEL P. BRADY, JACK SCOTT, AND CYNTHIA L. WILSON FLORIDA ATLANTIC UNIVERSITY

We evaluated the efficacy of an instructional procedure to teach young children with autism to evacuate settings and notify an adult during a fire alarm. A multiple baseline design across chil- dren showed that an intervention that included modeling, rehearsal, and praise was effective in teaching fire safety skills. Safety skills generalized to novel settings and maintained during a 5- week follow-up in both training and generalization settings. Key words: autism, fire safety, modeling, rehearsal

Many children with autism do not acquire essential safety skills without explicit instruc- tion, which poses significant concerns for care- givers. These basic safety skills are unlikely to be acquired by traditional teaching methods that rely on spoken instructions (Green, 2001). Unfortunately, the research literature provides little guidance on how to teach safety skills to individuals with autism. Dixon, Bergstrom, Smith, and Tarbox (2010) conducted a review of safety literature involving persons with devel- opmental disabilities over a 39-year span. Skills such as fire safety actions were sparsely repre- sented. Since 1970, only 10 studies examined methods for teaching fire safety skills, mostly with adults (e.g., Bannerman, Sheldon, & Sherman, 1991; Katz & Singh, 1986; Rowe & Kedesdy, 1988). This is concerning given the number of annual deaths by fires. In 2011 alone, over 3,000 people died in fires, and there were over 1,389,000 fires in the United States (United States Fire Administration, 2015). Although specific data involving fires and chil- dren with autism are not available, the rapid

increase in the number of children diagnosed with autism (Centers for Disease Control and Prevention, 2015) makes safety skills a priority. To date, only one study has evaluated fire safety instruction with participants with autism. Self, Scudder, Weheba, and Crumrine (2007) examined treatment packages that consisted of virtual reality and visual simulations (stories, mazes, comprehension questions) related to fire and tornado safety. Unfortunately, participants’ safety skills did not generalize to a schoolwide fire drill or maintain over time. Given the lim- ited research involving children with autism and fire safety, there is clearly a need for research on instructional procedures for these skills. Behavioral skills training (BST) holds merit

for teaching safety skills. BST typically consists of instructions, modeling, role-play, feedback, and in situ training. BST has been used to teach abduction prevention (Gunby, Carr, & LeBlanc, 2010) and gun safety (Miltenberger et al., 2005) to children with and without autism. Houvouras and Harvey (2014) demon- strated the utility of BST in teaching three ado- lescents the risk of using lighters to set fires. Participants learned to avoid contact with light- ers and to report their presence to an adult.

Address correspondence to David Garcia (e-mail: [email protected]). doi: 10.1002/jaba.331

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These responses maintained 4 weeks after training. The purpose of this study was to examine

the efficacy of an instructional procedure that incorporates several BST components to teach fire safety skills to children with autism. Specif- ically, instruction consisted of modeling, rehearsal, and praise. Safety skills consisted of evacuating a fire risk setting and notifying an adult contingent on hearing a fire alarm. Main- tenance and generalization of the safety skills were also evaluated.

METHOD

Participants Three children with autism (4 to 5 years

old) participated. Aaron, Walter, and Alec were able (a) to follow one- to two-step instructions, (b) to communicate vocally, and (c) to answer basic questions. To participate, all children met four criteria. First, parents expressed a desire for their child to learn fire safety skills and pro- vided informed consent. Second, each child scored at Level 3 in expressive and receptive language on the Verbal Behavior Milestones Assessment and Placement Program (Sundberg, 2008) demonstrating communication, social, and imitation skills found in typically develop- ing 30- to 48-month-old children. Third, no participant demonstrated fire safety skills when told, “Show me what you do when a fire alarm sounds.” Finally, participants did not exhibit problem behavior (e.g., self-injury or aggres- sion) other than noncompliance.

Setting Acquisition training was conducted in a

school classroom for Aaron, a therapy room in Walter’s home, and a treatment center therapy room for Alec. Generalization of the safety skills was assessed at home for Aaron, a treat- ment center for Walter, and at an office build- ing for Alec. No other children were present during any phase of the study; therefore, there

was no opportunity for observational learning. A commercially available, battery-operated smoke detector was used as a fire alarm; it was activated by pushing a button. The same alarm was used in all training and generalization settings.

Dependent Variables Dependent variables consisted of six safety

skills demonstrated in the following order: (a) walking or running to an exit door, (b) going through the exit door to arrive out- doors, (c) walking at least 20 footsteps from the building, (d) facing an adult outside the build- ing and saying, “fire” or “fire alarm,” (e) remaining at least 20 steps from the build- ing until given adult instructions to go else- where, and (f ) these steps had to be completed within 3 min of alarm activation.

Procedure Throughout all phases of the study, perfor-

mance was measured during a single daily probe trial. No comments or warnings invol- ving fire safety were given before the alarm was activated during probe trials. Probe trials. Probe trials were conducted

before training to serve as a baseline and to measure the effects of the intervention during training. Every probe trial began with a fire alarm that rang for 30 s. Participants were given approximately 5 s to initiate the response associated with each step. One probe trial was conducted daily, and no feedback or instruc- tion was provided. Training (modeling and rehearsal). Training

sessions consisted of modeling and rehearsing safety skills using a four-step training sequence. Before each step, the experimenter said, “When you hear a fire alarm, do all the safety steps quickly.” Step 1 consisted of alarm activation and an experimenter model of each vocal and physical response. Step 1 was repeated twice. Participants were not required to respond

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actively during Step 1, and no prompts were provided for paying attention. During Step 2, participants were required to label each response as it was modeled to ensure that parti- cipants attended to the experimenter’s models. Step 3 consisted of activating the alarm and allowing the participants to demonstrate the skills in sequence. The experimenter counted out the 20 paces for the participants during the first two steps of the training sequence. If a participant did not respond or responded

incorrectly, a correction procedure was imple- mented. Because Step 1 consisted of only modeling (participants were not required to respond), no correction procedure was used. The correction procedure for Step 2 (experi- menter models, participants label) consisted of the following: If a participant did not label the experimenter’s model within 3 s (vocal response for the fourth skill in the safety sequence) or responded incorrectly, the experi- menter said, “say, [skill].” When the participant repeated correctly, the experimenter said, “that’s right!” and continued to the next skill. For each skill that the participant performed correctly, the experimenter provided praise. At the end of the training sequence, if the partici- pant labeled all safety skills correctly and inde- pendently, the experimenter said, “Excellent, you did it!” No physical prompts were provided. The correction procedure for Step

3 (rehearsal) consisted of the following: If a participant did not start to demonstrate the skill within 3 s or responded incorrectly, the experimenter prompted the child by saying, “show me [skill].” If the participant performed the skill correctly, the experimenter said, “That’s right! Go ahead and continue.” If the participant did not respond correctly, the experimenter provided a partial physical prompt by gently placing an open hand on the child’s back, lightly moving the child forward as necessary. If the participant demonstrated the skill correctly, the experimenter said “That’s

right! Go ahead and continue.” This process was repeated whenever the participant did not begin to demonstrate the skill within 3 s of the previous step. If the participant demonstrated all skills correctly and independently, the exper- imenter said, “Excellent, you did it!” The duration of each step approximated real

time for skill performance during an actual fire drill. Each step was presented within 2 min of the previous step. The four-step training sequence was conducted once daily for approxi- mately 10 min. Training continued until each participant correctly and independently demon- strated each skill, in the proper sequence, for at least four consecutive probe trials.

Data Collection Experimenters presented a single probe trial

with a ringing fire alarm as soon as they arrived at scheduled therapy or generalization sessions. Data collectors recorded whether participants exhibited each skill correctly and independ- ently. During training, probe trials were con- ducted at least 5 min before any training to reduce potential practice effects that might occur after training.

Generalization and Follow-Up Follow-up probes were conducted 5 weeks

after training ended, in both training and gen- eralization settings. The purpose of the follow- up probes was to determine whether safety skills maintained in the absence of any further training (in the training setting) and generalized to a novel setting. No comments or warnings involving fire safety were given before activating the alarms; after activation, no instructions or feedback were provided.

Design A nonconcurrent multiple baseline design

across participants was used. Generalization measures were conducted during baseline, training, and follow-up.

701TEACHING FIRE SAFETY

Interobserver Agreement Two observers recorded 42%, 42%, and

65% of Aaron’s, Walter’s, and Alec’s probes, respectively. A second observer collected data in person or from a video recording. Observations were counted as agreements when both obser- vers scored each physical and vocal response. Agreement was calculated as dependent mea- sures with agreement divided by dependent measures with agreement plus dependent mea- sures with disagreement and converting the result to a percentage. Agreement scores aver- aged 100%, 98%, and 99% for Aaron, Walter, and Alec, respectively.

RESULTS AND DISCUSSION

Modeling and rehearsal were effective for teaching fire safety skills to all participants. Participants scored zero or near zero during baseline (Figure 1). Aaron demonstrated 17% of the skills correctly by uttering “fire” or “fire alarm” during baseline sessions. All participants scored zero during baseline generalization probes. During training, all participants demon-

strated 100% of the safety skills for at least four consecutive sessions. Because Alec (Figure 1, bottom) did not consistently say “fire” or “fire alarm,” brief booster training (Session 28) was provided. After the booster session, Alec demonstrated 100% of the safety skills during the next five sessions. All participants main- tained their skills during a 5-week follow-up in training and generalization settings. This study demonstrates that the combina-

tion of modeling, rehearsal, and praise can be an effective instructional procedure for estab- lishing fire safety skills in children with autism. It is also the first study that produced generali- zation and maintenance of fire safety skills in this population 5 weeks after training. There are several implications of our findings

for safety skill instruction for children with autism. First, although modeling, rehearsal, and

praise are effective for a variety of skills, this study demonstrated the efficacy of combining these strategies for teaching fire safety. Second, we provided training in different settings (i.e., clinic, school, and home) for all three chil- dren, demonstrating the effectiveness of the procedure in different environments. An important outcome of this study involves

the generalization findings. Each child demon- strated safety skills when a fire alarm was acti- vated in settings in which training had never been provided. Also, the skills were demon- strated in the presence of people who were not associated with training. No familiar training materials were present, and the alarms were activated as children freely engaged in typical activities in noninstructional locations. In the absence of any training activities or prompts during follow-up probes, the generalization findings are compelling, given the time elapsed since the last training session. This suggests that participants demonstrated the skills independ- ently when they encountered situations in which a fire alarm indicated the need to evacu- ate, regardless of the setting. Several limitations should be considered

when interpreting these results. First, the effec- tiveness of these procedures with less skilled participants is unknown. All participants had basic imitative and vocal repertoires. Imitation skills enabled children to see and then perform the safety skills that they observed. Their vocal skills enabled them to label the steps as they observed them. If participants did not imitate or speak, training might have resulted in slower or limited acquisition. A second limitation is that only one type of fire alarm was used dur- ing the investigation, and it was present in both training and generalization settings. Thus the type of alarm could have served as a common stimulus to promote generalization. Third, although experimenters were not near the parti- cipants during probes, they were visible at the beginning of each session. It is possible that the presence of the experimenter in both training

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and generalization settings could have influ- enced responding. There are also several implications for future

research. First, generalization should be

evaluated with different alarms that provide novel auditory stimuli. Second, the effectiveness of modeling and rehearsal should be examined with children of different ages and those with

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limited verbal and imitative repertoires. This would establish whether the instructional pro- cedure can be adapted for a wider range of chil- dren. Third, a future study should evaluate acquisition rates. These rates could vary depending on participants’ characteristics. Future studies should also isolate which steps of the instructional procedure result in skill acquisition. Certain steps may not be necessary to acquire these skills at an acceptable rate. Finally, Aaron showed rapid acquisition dur-

ing training, whereas Walter and Alec required substantially more training sessions to acquire the skills. As noted previously, each child was exposed to training once per session. Future studies should evaluate whether acquisition would occur more rapidly if the training sequence was implemented two or three times daily. This study adds to the limited fire safety lit-

erature with children with autism. An effective instructional procedure that required minimal implementation time was applied in a variety of settings. New skills generalized to novel envir- onments and maintained after a significant pas- sage of time. Results suggest that teaching important safety skills to children with autism might be simplified by teaching them what to do and when to do it. We believe that this study might spark other researchers to continue to investigate this important area and to begin to fill the safety skill instruction void that cur- rently exists.

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Centers for Disease Control and Prevention. (2015). Iden- tified prevalence of autism spectrum disorder. Retrieved from http://www.cdc.gov/ncbddd/autism/data.html

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Green, G. (2001). Behavior analytic instruction for lear- ners with autism: Advances in stimulus control tech- nology. Focus on Autism and Other Developmental Disabilities, 16, 72–85. doi: 10.1177/ 108835760101600203

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Miltenberger, R. G., Gatheridge, B. J., Satterlund, M., Egemo-Helm, K. R., Johnson, B. M., Jostad, C., & Flessner, C. A. (2005). Teaching safety skills to chil- dren to prevent gun play: An evaluation of in situ training. Journal of Applied Behavior Analysis, 38, 395–398. doi: 10.1901/jaba.2005.130-04

Rowe, M., & Kedesdy, J. H. (1988). Fire evacuation skills training for institutionalized mentally retarded adults. Behavioral Interventions, 3, 101–118. doi: 10.1002/ bin.2360030203

Self, T., Scudder, R. R., Weheba, G., & Crumrine, D. (2007). A virtual approach to teaching safety skills to children with autism spectrum disorder. Topics in Language Disorders, 27, 242–253. doi: 10.1097/01. TLD.0000285358.33545.79

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Received December 8, 2014 Final acceptance August 19, 2015 Action Editor, Jason Bourret

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