Research

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Discrete Trial Training (DTT) effect on children with ASD

Introduction

Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual.

According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017).

The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder is also proven to be difficult, given the complex nature and multiple variations that convert the diagnosis process into an arduous task. Thus, treatment of the wide array of symptoms that originate from the variety of ASD strains in the known spectrum proves to be difficult. Thus, there is a need for more research to broaden the scope of diagnosis and treatments with new methods to further enhance the information available on the condition while providing more knowledge that may contribute to the development of more accessible, less costly, and more efficient treatments for the disorder. Given the nature of the condition, it is hard for the researcher to find a pool of many affected individuals to perform trials and develop better treatment methods or determine the effectiveness of some of the existing methods. The use of discrete trial training (DTT) has also been under-explored, having been limited to clinical or university study settings (Ünlü et al., 2018). This outcome is because of the costly nature that impedes the conducting of research on such a scale. Thus, there is a need to explore the effectiveness of this intervention, especially in the growing children population, as it will serve to provide a larger pool of knowledge, increasing understanding of the condition, and eventually contributing to treatment data and developments to suit better the individuals affected, improving their quality of life.

Literature review

In a study conducted by Unlu et al., (2018), a group, family training program developed to upskill the parents to current discrete trial training (DTT) behaviours were assessed to establish its effectiveness. In this study, 42 participants were involved, 14 children and their parents. Half of the study sample for the parents represented members of each gender; 14 females and 14 males. In the study, measures for the DTT behaviours exhibited by the families were made. The family training program used was made up of two 120-minute weekly sessions for four weeks in total. In training, aids such as videos, lectures, video assessments, video feedback, written and visual materials, and role activities were used to teach parents discrete trial training behaviour. The training to several stages, starting from basic information and later graduating to examples of discrete trial training. A post-training interactive discrete trial training disk was issued to the families to enhance skill maintenance. The assessment was done using the Discrete Trial Training Forms to evaluate the parents' behaviour. The receptive language levels of the participating children were also measured. The imitation skill levels of the participating children were also quantified using the Imitation Skills Assessment Tool (ISAT). Evaluations were done before and after study completion. According to the results obtained, a difference was obtained when discrete trail training was given to the intervention group and control group, with an increase noted. Thus, it is evident that the training was effective in attaining the outcomes intended by the researcher. The study also established that the discrete trail training yielded effective outcomes outside the control group setting, which yielded no changes following the training. However, the learning and imitation skills in the children showed no dramatic changes but slightly improved their skills. This result was attributed to the slow speed of the process, which reflects in the results. The parents' performance was also not to differ when analyzed along gender lines. Parents also registered high satisfaction levels with the study and suggested recommending the program to other parents.

Similarly, another study tested two different discrete trial training programs, virtual classroom and individualized coaching, to assess the fidelity of execution by teachers when dealing with children diagnosed with ASD. In the study conducted by Garland et al., (2012), the multiple baseline approach was used in the testing for the existence of a functional relationship between individualized clinical coaching and TeachLiveE™ (TLE) virtual classroom laboratory and the fidelity of implementation discrete trial training showcased by teachers when working with a student diagnosed with ASD. It featured four Caucasian female students as participants who had tangible experience in the classroom setting. These individuals were then employed in the classroom environment, prior experience in the setting having been established to be absent. The sessions were thus conducted using the virtual classroom facilitated by cameras and microphones to bolster interaction. The teacher was shown to manipulate an avatar with a set of movements made to facilitate ten sessions with a student participant diagnosed with ASD symptoms. Thus, coaching was carried out using feedback and demonstrations. In the study, the participants' performance was the dependent variable measured by the discrete trial teaching evaluation rubric (DTTER). Tapes were reviewed, including those of non-participants in the study, to establish a baseline. Results demonstrated that the teacher demonstrated the existence of a functional relationship between individualized clinical coaching using the virtual classroom and fidelity of implementation of discrete trial training. During the sessions, participant discrete trial training accuracy was observed to improve by a 50% margin, from 37% to 87%.

The research by Siller et al., (2013) where underlying causal mechanisms were investigated to establish whether responsive parental behaviour was a good predictor of language gains in children with ASD. A randomized clinical trial using an experimental intervention was conducted to help enhance parental communication. Seventy children participated in the research, 64 boys and six girls, attending sessions with their mothers in tow. These participants were then divided into an intervention group and a control group with descriptive data and activities delivered separately. Data were collected over a three-year period, between 2004-2007. Assessment sessions were conducted in the lab and the family's home. After participating in the caching program, parents were assessed with invitations to follow-up being issued after one year. According to the results obtained, FPI had a significant effect on the parents' responsive behaviour. The study also revealed a conditional effect on the children's language outcome in a follow-up that was done after twelve months. This method was noted to be highly beneficial to children who exhibited low baseline language skills. Those below the twelve months mark were more likely to benefit than those above this mark.

In another study, research was conducted to determine if differences existed in the effects of traditional discrete trial training (T-DTT) and embedded discrete trial training (E-DTT) in response to the relevant targets of the instruction and problem behaviour for a child diagnosed with autism (Haq and Aranki., 2019). A single seven-year-old male was to receive three-hour sessions at home for four days every week. The boy was a level one learner, according to evaluations made using the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) made before the start of the study. The participant was also noted to have a history of problem behaviour such as aggression and elopement. The rate of problem behaviour was recorded as a frequency, and inter-trial observer agreement calculated from trial-by-trial methods were used to assess inter-trial observer agreement. T-DTT sessions were noted only to occur if the participant was seated at the table for thirty seconds. On the other hand, E-DTT was more flexible, occurring anywhere the participant was in the home. According to the results, E-DTT resulted in no problem behaviour and 75% correct responses compared to the use of T-DTT sessions, which featured a 90% correct response. Target accuracy for both studies was similar. However, higher levels of exposure and less problem behaviour were observed in the use of E-DTT.

In another study conducted by McKinney and Vasquez (2014), the “Bug in your Ear” (BIE) program was used to determine the accuracy of discrete trial teaching (DTT) implementation. The study involved three pre-service teachers, one majoring in exceptional education and two teachers majoring in elementary education. A Discrete Trial Teaching Evaluation Form (DTTEF) was used to measure the accuracy of the DTT implementation. The study was done in a room with a two-way mirror in an American university. The interactions were recorded on video and an over-the-table camera to record BIE feedback issued to the participants by the researcher. The dependent variable was identified as the accuracy of implementation measured by the DTTEF mentioned above. Participants were chronologically moved across several pre-arranged sessions, each session having its own set of rules. A significant increase between the participant's baselines, suggesting the existence of a functional relationship between accurate DTT implementation and BIE feedback.

In many of the articles reviewed (Garland et al.,2012; Unlu et al., 2018), the studies were used to determine the effects and the effectiveness of using DTT programs in promoting positive outcomes in children suffering from ASD. These articles add to the pool of knowledge, delving even further to identify the suitable adjustments made to improve the performance of communication skills in various age-groups. The articles also managed to exercise some groundbreaking innovations. The research also tested new methods and their effectiveness outside the lab setting, where most of the data is focused (Siller et al., 2013). These different setups contributed to creating a more practical and tech-savvy approach to the accurate and effective provision of DTT services using new methods that may become less costly and more accessible to the growing population of affected children.

In this paper, emphasis will be on establishing the potency of DTT on the acquisition of communication skills. The study design will assess the two factors to examine the existence of a functional relationship between the use of DTT programs and the gaining in language skills exhibited by children diagnosed with ASD. In this study, a high-level of cultural considerations will be done given the absence of some marginalized groups in the studies reviewed. This will provide a better reflection of the disorder in society.

Methods

Participants

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Setting/Materials

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Experimental Design

Dependent Variable and Response Measurement

Interobserver Agreement

Procedures

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Baseline. You would start your baseline information here, immediately after the subsection’s period.

(Name of your Intervention). You would start your intervention information here, immediate after the subsection’s period.

Treatment Integrity

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Social Validity

References

Autism Spectrum Disorder (ASD) | CDC. (2021). Retrieved 13 February 2021, from https://www.cdc.gov/ncbddd/autism/index.html

Garland, K., Pearl, C., & Vasquez, e. (2012). Efficacy of Individualized Clinical Coaching in a Virtual Reality Classroom for Increasing Teacher's Fidelity of Implementation of DTT. Education and Training In Autism And Development Disabilities, 47(4), 502-515.

Haq, S., & Aranki, J. (2019). Comparison of Traditional and Embedded DTT on Problem Behavior and Responding to Instructional Targets. Behavior Analysis In Practice, 12(2), 396-400. doi: 10.1007/s40617-018-00324-3

Masi, A., DeMayo, M., Glozier, N., & Guastella, A. (2017). An Overview of Autism Spectrum Disorder, Heterogeneity, and Treatment Options. Neuroscience Bulletin, 33(2), 183-193. doi: 10.1007/s12264-017-0100-y

NIMH » Autism Spectrum Disorder. (2021). Retrieved 13 February 2021, from https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

Siller, M. Swanson, M., Gerber, A., Hutman, T., & Sigman, M. (2014). A Parent-Mediated Intervention That Targets Responsive Parental Behaviors Increases Attachment Behaviors in Children with ASD: Results from a Randomized Clinical Trial. Journal Of Autism And Developmental Disorders, 44(7), 1720-1732. doi: 10.1007/s10803-014-2049-2

Ünlü, E., Vuran, S., & Diken, İ. (2018). Effectiveness of Discrete Trial Training Program for Parents of Children with Autism Spectrum Disorder. International Journal Of Progressive Education, 14(3), 12-31. doi: 10.29329/ijpe.2018.146.2