Applied Principles that Contribute to the Development of a Child with Autism
Kayleigh Turner
Liberty University
PSYC 565: Psychology of Learning
Dr. Wilmouth
March 3, 2024
Abstract
Autism Spectrum Disorder is a common developmental disability and can start from an extremely young
age. Autism does not discriminate against anyone and there is no cure for this disability as well. The
current paper discusses and examines how applied behavioral analysis and verbal behavioral analysis
principle techniques help support and aid autistic children. Three studies discussed within the paper
focus on applied behavior analysis impacts, while three more studies examined focus on verbal
behavioral analysis impacts on children with autism. Further research is needed for intervention
techniques in larger groups as well as understanding the rate of tacting in children with autism. It is
important for parents, educational institutions, and behavioral health professionals to gain knowledge
on this topic in order to help guide children with autism throughout their lives.
Keywords: Autism, Applied Behavioral Analysis, Verbal Behavioral Analysis, Support
Applied Principles that Contribute to the Development of a Child with Autism
This research paper will compare and contrast the effects of applied principles that contribute to
the development of a child with autism, such as applied behavioral analysis and verbal behavioral
analysis. Autism is a common disorder that does not discriminate against any race or gender. Autism
does not have a cure and accompanies an individual throughout their lifespan (Narzisi et al., 2023). It is
important to be aware of the symptoms in order to receive as much help and support to manage this
developmental disability as early in life as possible.
B. F. Skinner first reported applied behavioral analysis. Later research revealed that reinforcing
desired behaviors and discouraging unwanted behaviors can encourage communication, social,
language, and behavioral skills in children who have autism. Verbal behavioral analysis was also first
reported by B. F. Skinner based on the principles of applied behavioral analysis. While verbal behavioral
analysis developed from applied behavioral analysis principles, there are several differences in verbal
operants that focus on therapy teaching communication and language (May et al., 2013).
Applied behavioral analysis principles tend to be used in order to help improve speech,
behavior, social, and overall developmental skills in children with autism (Sundberg & Michael, 2001).
Some applied behavioral analysis techniques include positive and negative reinforcements, task analysis,
picture exchange, or social skills training. Verbal behavioral analysis is used to specifically focus on
enhancing language and communication skills by connecting words to their purposes by using mand,
tact, or intraverbal operants. Applied behavioral analysis and verbal behavioral analysis are learning
principles developed from behavior theory however, they have distinct concentrations that can
contribute to the development of children with autism.
These intervention methods are put in place in order to increase adaptive behaviors such as
communication or social skills to improve the quality of life for a child with autism (Mazumdar et al.,
2021). There are several different studies that have been reviewed and examined within this research
paper in order to provide better insight into the impact that applied behavioral analysis and verbal
behavioral analysis learning principles have on the development of children who are autistic.
Literature Review
Behaviorism theory provides a perspective that all behaviors are learned through interactions
with others within our community. Behaviorism theory was introduced by John Watson who wanted to
understand behavior based on measures and observations. According to Watson, a key goal of
behaviorism is to understand how certain behaviors develop as a consequence of conditioning to
external stimuli. Behaviorists tend to believe that behaviors are influenced by our environment. Applied
behavioral analysis principles are scientifically proven to help improve or change behaviors in children
who have autism. Verbal behavioral analysis is primarily used for developing language and speech in
order to help with verbal issues and complications in autistic children. Verbal behavioral analysis was
developed in order to help language deficits in children with autism by using verbal operants like tact,
mand, and intraverbal to identify several different verbal behaviors. The comparison between applied
behavioral analysis and verbal behavioral analysis is that both of these principles use behaviorism and
how behavior can be measured or changed.
Applied behavioral analysis methods are ultimately developed from behaviorism. These
interventions include direct observation of the behavior in the setting in which it is occurring, collection
and analysis of data, as well as identifying possible reinforcement subjects to the demonstration of
socially appropriate behaviors in children with autism. Verbal behavioral analysis methods are
considered an extension of applied behavioral analysis methods. This extension means that both applied
behavioral analysis and verbal behavioral analysis consist of relevant information based on behavioral
theory. These theories provide an important influence on children diagnosed with autism or even other
developmental delays.
Behaviorism has provided a large contribution to applied behavioral methods that have
impacted the development of autistic children. The learning principles of both applied behavioral
analysis and verbal behavioral analysis tend to be strongly used in understanding and improving
behavior, communication, language, speech, and overall social skills of a child who has autism spectrum
disorder.
Applied Behavioral Analysis
Applied behavioral analysis is the practice of systematically applying psychological principles of
learning theory in order to change socially meaningful behaviors. A study conducted at the Shri Ram
School focuses on applied behavioral strategies that can help to communicate deficits in autism
(Dhawan, 2021). Play therapy and neuro-linguistic programming is one strategies when it comes to
applied behavioral analysis. This is done in order to get an idea of the intervention technique that is
most effective when it comes to rehabilitating the issues when communicating in early childhood.
This study focuses on comparing and contrasting applied behavioral analysis techniques with
other methods that can also be used to help develop communication issues in early childhood. Applied
behavioral analysis techniques are effective in helping children who have developmental delays, but
when it comes to certain symptoms of communication deficits speech and occupational therapy tend to
be the better choice over applied behavioral analysis learning principles (Dhawan, 2021). The compare
and contrast approach was used in order to express different uses of applied behavioral analysis as well
as how other techniques are either similar or different in the way that they influence a child’s
developmental delay. Applied behavioral analysis learning principles and the discussion of techniques
used to help developmental delays in children who have autism are key findings within this study. This
information on applied behavioral analysis and how it contributes to communication issues is essential
to understanding children with autism.
A second study conducted at the University of California examined different patient outcomes
for autistic children who receive applied behavioral analysis interventions where the children were
covered by a state autistic mandate (Choi et al., 2022).
In order to evaluate how autism mandates affect patients and their patient outcomes more
detailed data on applied behavioral analysis intensity and patient functional status in an implementation
context is needed. Clinical reports were used in order to determine patient adaptive behavior and
applied behavioral analysis service use characteristics in autistic children at ages 6, 12, 18, and 24
months in their treatment (Choi et al., 2022). The examination of the relationship between children with
autism who are covered by autism mandates and their adaptive behavior is one key finding of this study.
The improvement of adaptive behavior such as socialization, communication, and language when a child
with autism is treated with applied behavioral analysis is essential when discovering effective treatment
options.
Applied behavioral analysis-based interventions play a significant role in the treatment of
children with autism. In a third study conducted researchers investigated the effect of comprehensive,
intensive interventions based on applied behavioral analysis for autism versus the treatment as usual,
minimal, or no treatment when it comes to adaptive behavior, intellectual functioning, language
abilities, symptom severity, and parental stress (Eckes et al., 2023).
The ultimate goal of this study was to find out if comprehensive applied behavioral analysis-
based interventions improve adaptive behavior, intellectual functioning, language abilities, and
symptom severity as well as whether or not this kind of intervention has an impact on parental stress of
parents who have children with autism. The meta-analysis for this study assessed the effects of these
treatments on the developmental outcomes of children who have autism as well as on parental stress
based on 11 studies with 632 participants total (Eckes et al., 2023).
Autistic children who receive comprehensive applied behavioral analysis-based treatments tend
to express significant improvements in adaptive behavior and intellectual functioning compared to
autistic children who receive treatment as usual, with minimal, or no treatment. Knowing the
effectiveness and moderators would be beneficial for professionals to determine different treatment
options. This knowledge would also be beneficial to parents of children with autism to make informed
decisions when it comes to their child and their child’s treatment.
Verbal Behavioral Analysis
Verbal behavioral analysis is a method of teaching language that focuses on the idea that the
meaning of a word is found in its functions. This method encourages children with autism to learn
language by connecting words with their purpose that way they learn that words help them get their
desired results or objects. In a study conducted at The Chicago School of Profession Psychology,
researchers examined the effect of a tact correction procedure on stereotypic vocalizations in children
with autism (Guzinski et al., 2017). This study expresses verbal operants that are used when it comes to
verbal behavioral analysis in order to help speech and language in children who have autism. Tact helps
reduce stereotypic vocalizations in autistic children.
Researchers observed an intervention with four children who suffer from autism with language
and speech deficits through different sessions of activities. During these sessions, the examiner
observed and recorded stereotypic vocalizations where these were ignored and independent tacts were
praised (Guzinski et al., 2017). One key finding of this study is that verbal behavioral analysis learning
principles are used to help with communication and speech deficits in a child who has autism. Verbal
behavioral analysis learning principles can help with speech and language delays in children who are
autistic.
A second study conducted at the University of Oviedo examined the effects of observing adult
emitting tacts on the rate of uninstructed tacts in children with autism (Pérez-González et al., 2013). The
goal of this study was to find out if a teacher’s tacting objects in the presence of a child with autism
would increase their rate of uninstructed tacts. Two different conditions were separated into four
settings that contained items the participant could already tact.
Tact is a method that is used in verbal behavioral analysis in order to help children with autism
with their verbal issues. Uninstructed tacts can be defined as tacts that are initiated without specific
requests from a listener (Pérez-González et al., 2013). Autistic children emitted twice as many
uninstructed tacts when the teacher emitted tacts than when the teacher did not. This finding inevitably
helps prove the involvement of verbal behavioral analysis.
Mand is a technique under verbal behavioral analysis principles that helps to increase verbal
communication in children who are autistic. A third study conducted at Caldwell University instructed
children with autism to mand “why” in three different circumstances (Patil et al., 2021). A multi-baseline
design for three scenario types was used in order to assess the effects of the intervention on each
participant. It is necessary to teach mand to children with autism because it allows them to receive
unfamiliar information within a different setting which can inevitably help increase their language and
social skills. Having an understanding of the applications for the verbal operant, Mand can be effective in
helping with language issues in children with autism. Overall, information on verbal behavioral principles
is an important influence on speech and language for an autistic child.
Discussion
The studies that used applied behavioral analysis principles ultimately concluded that applied
behavioral analysis techniques are beneficial to children with autism commutatively and socially. The
studies that used verbal behavioral analysis principles ultimately concluded that verbal behavioral
analysis techniques have an important influence on speech and language in order to help with delays in
autistic children.
The research can provide important information to people who are unaware of autism and the
effects that it can have on a child throughout their life. It provides support for parents who have a child
experiencing developmental delays and require an understanding of the difference between service and
therapies in order to assist their child correctly. Some children with autism need more services in certain
areas compared to other children with autism. Implications for autism in children tend to be verbal
issues, issues socializing with their peers, behavioral issues, as well as difficulty empathizing or relating
to others. Autistic children may not start speaking as soon as children with typical development and they
may not make eye contact with other people around them, which can ultimately hinder a child with
autism from developing the social skills that a child with typical development may have naturally.
The recommendations in these studies are relevant to parents, educational institutions, as well
as behavioral health professionals when it comes to supporting and identifying assistance for children
who are diagnosed with autism. Having a child with autism is an extremely difficult thing to endure.
Sometimes it is unknown what the day may hold, however with knowledge, it increases the parent’s
understanding and allows them to better help their child with understanding their child’s reactions. The
sooner that an individual recognizes these symptoms in a child, the sooner that the child can begin the
necessary steps in order to get through their day-to-day lifestyle. Recognizing these principles can make
the strongest impact on a child’s overall development and understanding of which learning principle is
best used for certain areas of developmental delays.
When it comes to applied behavioral analysis principles, more research is still needed in order to
understand what intervention techniques could work best on a larger scale given that all children with
autism are different and are not one size fits all. When it comes to verbal behavioral analysis principles,
more research is still needed in order to understand the rate that produces the highest rate of
uninstructed tacting by children who are autistic. Studying more data allows for identification of
treatments that are the most effective while being able to rule out treatments that are ineffective or
potentially harmful to children with autism.
The importance of the topic of autistic children, as stated before, is that autism disorder does
not discriminate against anyone. There also is no cure for autism, so given that, it is important to know
and understand the symptoms in order to support and help children manage this developmental
disability as soon as possible. These findings supported the thesis statement due to the fact that the
findings showed the distinct concentrations of applied behavioral analysis and verbal behavioral analysis
principles that contribute to the development of children who are autistic. Based on information derived
from this literature, it can be concluded that both applied behavioral analysis and verbal behavioral
analysis principles are extremely significant when it comes to the development of autistic children.
While there are different techniques used by both principles, overall applied behavioral analysis and
verbal behavioral analysis still provide the necessary contributions in order to help and support children
who are autistic.
Writing Process Assessment
One thing that worked best during the process of writing this research paper was to take the
outline section by section in order to try not to get too overwhelmed with everything that needed to be
covered. Outlines are essential to writing a big paper for a class, so this needed to be focused on the
most. Each study was examined and completed in its entirety before moving on to the next study which
was very beneficial. This allowed for no confusion between articles given that one was being focused on
before the next one was even examined.
As soon as the topic was chosen, finding the articles, and reading them were the next step in
order to complete the outline which allowed for answering all of the parts and questions better.
At first, this research paper seemed too overwhelming and seemed as if there were too many
sections that were not going to able to be fully completed. Also, it appeared as if similar information
tended to be repeated due to the way the sections were laid out and the types of questions that were
being asked.
One thing that could be done differently would be how the outline is approached. The outline
seemed to be too much, but once it started to be completed it seemed in the long run the outline was
going to be extremely beneficial when it came to writing the final paper. After completing the outline, it
was much easier to focus and complete the PowerPoint presentation for this research assignment. The
PowerPoint essentially had all of the information that was included already in the outline, making the
process for the presentation flow given that all of the ideas were written down already. When it came to
the article review assignments it was particularly easy to find peer-reviewed articles that pertained to
the topic at hand. The article reviews allowed for more context into the techniques that help aid
children who are autistic.
Choosing this topic allowed for a deeper dive into children with autism. Before this paper, there
was a vague idea of the disorder from information that comes across, whether it be in life or
academically, but reading the different articles and putting everything into words on the outline, it gave
an opportunity to learn and better understand different techniques in order to help support these
children or see symptoms in children early on in their life. This research assignment can impact the
career goals of an individual who wants to be a children’s counselor. Many children suffer from some
form of autism whether it be mild or severe. By knowing and understanding this knowledge, it will allow
for a better insight into the most effective ways to help them long-term.
References
Choi, K. R., Bhakta, B., Knight, E. A., Becerra-Culqui, T. A., Gahre, T. L., Zima,
B., & Coleman, K. J. (2022). Patient outcomes after applied behavior
analysis for autism spectrum disorder. Journal of Developmental &
Behavioral Pediatrics, 43(1), 9–16.
Dhawan, S. (2021). Applied behaviour analysis in autism spectrum disorder. Indian Journal of
Health and Wellbeing, 12(3).
Eckes, T., Buhlmann, U., Holling, H.-D., & Möllmann, A. (2023). Comprehensive ABA-based
interventions in the treatment of children with autism spectrum disorder – a meta-
analysis. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-022-04412-1
Guzinski, E. M., Cihon, T.M., & Eshleman, J. (2017). The effects of tact training on stereotypic
vocalizations in children with autism. The Analysis of Verbal Behavior, 28(1).
May, R. J., Hawkins, E., & Dymond, S. (2013). Brief Report: Effects of Tact Training on
Emergent Intraverbal Vocal Responses in Adolescents with Autism.BJournal of Autism
and Developmental Disorders,B43(4), 996-1004. https://doi.org/10.1007/s10803-012-
1632-7
Mazumdar, A., Banerjee, M., Chatterjee, B., Saha, S., & Gupta, G. S. (2021). Mobile application
based early educational intervention for children with autism – a pilot trial. Disability and
Rehabilitation: Assistive Technology, 18(6), 819–826.
https://doi.org/10.1080/17483107.2021.1927208
Narzisi, A., Alonso-Esteban, Y., & Alcantud-Marín, F. (2023). Autism and children: Diagnosis,
functional profiles and Intervention. Children, 10(3), 522.
https://doi.org/10.3390/children10030522
Patil, P., Sidenet, T.M., Pane, H., Reeve, S.A., & Nirgudkar, A. (2021). Teaching children with
autism spectrum disorder to mand “Why?”. The Analysis of Verbal Behavior, 37(1).
Pérez-González, L. A., Pastor, A., & Carnerero, J. J. (2013). Observing tacting increases
uninstructed tacts in children with autism. The Analysis of Verbal Behavior, 30(1), 62–
68.
Sundberg, M. L., & Michael, J. (2001). The benefits of Skinner’s analysis of verbal behavior for
children with autism. Behavior Modification, 25(5), 698–724.
https://doi.org/10.1177/0145445501255003
Indian
Journal
of
Health
and
Well-being
2021,
12(3),
380-385
https:/iahrw.org/our-services/journals/indian-joural-of-health-wellbeing/
©
2021
Indian
Association
of
Health,
Research
and
Welfare
ISSN-p-2229-5356,e-2321-3698
Applied
Behaviour
Analysis
in
Autism
Spectrum
Disorder
Saanya
Dhawan
The
Shri
Ram
School,
Moulsari,
Gurugram,
Haryana
The
paper
will
look
at
how
ABA
has
been
effective
in
treating
the
symptoms
of
communication
deficits of
Autism
Spectrum
Disorder
by
looking
at
the
various
types
of
ABA
therapies
and
their
specific
impacts
(Lerman
et
al.,
2016;
Koegel
et
al.,
2006).
Further,
we
will
understand
how
there
may
a
difference
due
to
the
environmental
and
social
changes
as
seen
in
developed
and
developing
countries
(Keenan
et
al.,
2014;
Mohammadzaheri
et
al.,
2014).
This
paper
will
also
look
at
how
behaviour
management
in
autism
is
a
skill
achieved
through
an
alternative
practice,
namely
Neuro
Linguistic
Programming,
in
comparison
to
ABA.
NLP
was
used
as
a
comparative
intervention
because
it
is
known
to
work
effectively
in
changing
behavioural
patterns
that
can
be
used
to
establish
a
communication
framework
(Sturt
et
al.,
2012;
Walter
&
Bayat,
2003).
In
addition
to
exploring
the
effectiveness
of
NLP
in
comparison
to
ABA,
this
paper
will
also
briefly
explore
the
effectiveness
of
Play therapy
in
enhancing
social
communication
in
children
with
autism
(Solomon
et
al.,
2014).
Finally,
this
paper
will
draw
a
conclusion
about
the
intervention
technique
that
is
most
effective
in
rehabilitating
communication
deficits,
namely
social
communication
and
interaction,
for
the
autism
population
during
early
childhood.
Keywords:
autism
spectrum
disorder,
communication
deficits,
applied
behaviour
therapy,
early
childhood,
play therapy
Autism
Spectrum
Disorder
is
characterized
as
one of
the
most
prevalent
neurodevelopmental
disorders
in
the
world
today,
affecting
all
classes
and
groups
(Faras
et
al.,
2010).
Statistically,
1
in
160
children
in
the
world
today
are
diagnosed
with
Autism
Spectrum
disorder
(WHO,
2019).
While,
the
number
for
developing
countries
is
also
high,
at
0.09%
in
children
0-15
years
in
India
today being
diagnosed
with
Autism
(Singh
et
al.,
2019).
Since
the
prevalence
rates
are
rising
constantly,
itis
even
more
crucial
to
understand
which
method
of
intervention
would
work
the
best
for
individuals
with
autism.
Also,
this need
is
even
greater
because
of
autism's
relevance
in
causing
impairments
in
the
growth and
development
of
the
brain,
specifically
in
functions
of
self-control
and
emotion
regulation
among
others
as
explained
in
the
DSM-V
(APA,
2013).
Also,
according
to
the
DSM-V,
the
major
deficits
of
autism
are
known
to
be
social
communication
and
interaction
impairments
(APA,
2013).
Similarly,
in
the
context
of
ICD-11,
Autism
is
characterized
by
persistent
deficits
in
initiating
and
maintaining
social
interaction
and
communication,
ranging
from
repetitive
language
to
poor
verbal
skills
(WHO,
2019).
This
paper
will
explore
To
what
extent
is
Applied
Behavioural
Analysis
technique
effective
in
treating
the
symptoms
of
communication
deficits
in
Autism
during
early
childhood?
This
research
is
relevant
considering
the
high
and
widespread
prevalence
rate
of
the
disorder
as
mentioned
above.
Further,
since
autism
begins
in
childhood
and
is
mostly
apparent
from
2-3
years
of
age,
and
persists
throughout
thelifetime,
early
intervention
is
crucial
for therapists to
gain
a
deeper
insight
towards
a
developmental
Author
Note
Saanya
Dhawan,
The
Shri
Ram
School,
Moulsari
Gurugram,
Haryana
Ihave
no
known
conflict
of
interest
to
disclose
Correspondence
concerning
this
article
should
be
addressed
to
Saanya
Dhawan,
The
Shri
Ram
School,
Moulsari
Gurugram,
Haryana
E-mail:
approach
and
understand
the
deficits
that
need
to
be
worked upon
(Johnson
&
Myers,
2007).
Hence,
it
is
relevant
for
the
target
population
of
this
paper
is
early
childhood,
i.e.,
children
who
are
2
to
6
years
old
because
autism
is
detected
mostly
in
that
age
group.
Deficits
in
the
ability
to
communicate,
verbally,
preverbally,
or
non-
verbally,
in
addition
to
play
and
symbolic
behaviours
are
among
many
indications
of
Autism
Spectrum
Disorder
in
children
(Gray
&
Tonge,
2001).
Now,
in
order
to
work
on
these
deficits,
several
psychosocial
therapies
have
been
developed
over
the
years,
including
Applied
Behaviour
Therapy
(ABA),
Cognitive
Behaviour
Therapy
(CBT),
and
Pivotal
Response
Treatment
(PRT),
that
are
used
for
treatment
of
ASD
in
children
(DeFilippis
&
Wagner,
2016).
Among
these,
Applied
Behavior
Analysis
has received a
great
deal
of
attention
due
to
its
excellent
results
with
the
autism
population
(Lerman
et
al.,
2016;
Smith,
2001).
Numerically,
ABA
accounts
for
45%
of
therapies
that
provide
long
term
and
clearly
observable
results
("Autism
Training,
ABA
Training
Education-Special
Learning",
2020).
Even
though
there
are
great
misrepresentations
and
misunderstandings
about
the
use
of
ABA
with
Autism,
the
findings
reflect
a
huge
increase
in
skills
like
behaviour
management,
cognitive
skills
and
receptive
language
etc.
for
children
with
autism.
Autism
spectrum
disorder
According
to
the
latest
DSM-5,
persistent
deficits
in social
communication
and
interaction
is
one
of
the
major
criterias
of
individuals
diagnosed
with
autism
(APA,
2013).
Social
communication
and
interaction
criteria
includes
three
different
areas,
namely,
social
emotional
reciprocity,
non-verbal
communication,
and
restricted
or
repetitive
patterns
of
behaviour
(APA,
2013).
These
communication
deficits
in
early
childhood
are
characterized
by
limited
responsiveness,
low
communication
rates,
and
reduced
symbolic
behaviours
and
imitation
skills
(Paul,
2008).
This
also
include
a
range
of
characteristics for
non-verbal
communication:
shared
gaze,
mutual
gaze,
writing,
gestures,
and
eye
contact
(Prelock
et
al.,
2012).
The
first
criteria
of
social
communication
and
interaction
is
what
will
be
focused
upon
in
this
essay.
Autism
Spectrum
Disorder
is
categorized
now
as
a
The
Analysis
of
Verbal
Behavior
2012,
28,
101-110
The
Effects
of
Tact
Training
on
Stereotypic
Vocalizations
in
Children
With
Autism
Erin
M.
Guzinski,
Traci
M.
Cihon,
and
John
Eshleman,
The
Chicago
School
of
Professional
Psychology
This
study
was
a
systematic
extension
of
Karmali,
Greer,
Nuzzulo-Gomez,
Ross,
and
Rivera-Valdes
(2005)
and
Ahearn,
Clark,
MacDonald,
and
Chung
(2007).
We
investigated
the
effects
of
a
tact
correction
procedure
on
stereotypic
vocalizations
in
4
children
diagnosed
with
autism
who
ranged
in
age
from
6
to
16
years.
Participants
had
limited
vocal
verbal
repertoires
and
were
primarily
dependent
on
prompts
for
the
emission
of
appropriate
vocalizations.
A
multiple-baseline
design
across
participants
was
used.
Data were
collected
on
instances
of
stereotypic
vocalizations
and
independent
tacts
during
baseline
conditions
and
on
instances
of
stereotypic
vocalizations,
independent
tacts,
and
echoic-tacts
during
intervention.
Procedural
integrity
and
social
validity
data
were
also
obtained.
The
results
indicated
a
decrease
in
stereotypic
vocalizations
for
3
of
the
4
participants
and
slight
increase
in
appropriate
vocal
verbal
behavior
(i.e.,
tacting)
for
all
participants.
The
study
provides
support
for
the
use
of
tact
correction
procedures
to
decrease
stereotypic
vocalizations
and
increase
appropriate
vocalizations
in
children
with
autism.
Key
words:
autism,
echoics,
stereotypic
vocalizations,
tacts,
tact
correction,
verbal
behavior
The
acquisition
of
verbal
behavior
marks
a
critical
developmental
milestone
for
chil-
dren.
Children
diagnosed
with
autism
often
display
deficits
in
verbal behavior,
leading
caregivers
to
seek
professional
assistance
to
increase
functional
communication.
More-
over,
children
diagnosed
with
autism
often
demonstrate
repetitive
behaviors
and
may
commonly
repeat
or
echo
language
they hear
(Wing
&
Gould,
1979).
These
behaviors
can
become
problematic
by
interfering
with
the
development
of
intraverbal
behavior
(Foxx,
Faw,
McMorrow,
Kyle,
&
Bittle,
1988),
and
delaying
the
development
of
academic
and
social
behaviors
(Schreibman
&
Carr,
1978).
They
can
also
become
socially
stigmatizing
(Cunningham
&
Schreibman,
2008).
Learn-
ing
is
inhibited
because
the
individual
is
repeating
phrases,
statements, or
responses
and
is,
therefore,
not
attending
to
the
events
Traci
Cihon
is
now
at
The
University
of
North
Texas.
This
study
is
based
on
the
first
author’s
thesis
completed
under
the
supervision
of
the
second
and
third
authors
in
partial
fulfillment
of
the
master
of
science
degree
at
The
Chicago
School
of
Profes-
sional
Psychology.
The
study
was
presented
at
the
2009
ABAI
conference
in
Phoenix,
AZ.
Address
correspondence
to
Traci
M.
Cihon,
Department
of
Behavior
Analysis,
The
University
of
North
Texas,
1155
Union
Circle
#310919,
Denton,
TX
76203.
(e-mail:
that
are
occurring
in
the current
environment.
Moreover,
the
student
may
miss
key
concepts
being
taught.
When
an
individual
engages
in
these
behaviors
at
a
high
rate,
the
probability
of
actively
engaging
in
learning
opportunities
within
the
classroom
may
decline.
Two
interventions
that
have
been
exam-
ined
to
reduce
stereotypic
vocalizations
include
tact
correction
procedures
(Karmali,
Greer,
Nuzzulo-Gomez,
Ross,
&
Rivera-
Valdes,
2005;
Pistoljevic
&
Greer,
2006)
and
response
interruption
and
redirection
(RIRD;
Ahearn
et
al.,
2007;
Liu-Gitz
&
Banda,
2010; Miguel,
Clark,
Tereshko,
&
Ahearn,
2009).
Karmali
ct
al.
(2005)
studied
the
effects
of
a
tact
correction
on
palilalia
(defined
as
the
delayed
form
of
echolalia
or
stereotypic
vocalizations)
in
5
preschoolers
with
autism.
During
the
tact
correction
procedure,
the
experimenter
immediately
tacted
an
object
in
the
environment
or
an
activity
the
participant
was
engaged
in
(e.g.,
“T’m
coloring,’
‘‘This
is
the
color
purple’’)
when
a
participant
emitted
palilalic
behavior
(e.g.,
‘‘I
will
huff
and
puff
and
blow
your
house
down’’).
If
the
participant
continued
to
engage
in
palilalia,
experimenters
prompted
a
tact
of
another
item
or
activity
in
the
participant’s
immediate
environment
(e.g.,
“T
am
still
coloring’’).
If
the
palilalia
ceased
after
the
second
tact,
the
prompting
stopped.
101
The
Analysis
of
Verbal
Behavior
(2021)
37:1-16
aS
A
B
|
A
|
I
https://doi.org/10.1007/s40616-020-00138-x
Associaton
for
Behavior
Analysis
International
RESEARCH
ARTICLE
®
Check
for
updates,
Teaching
Children
With
Autism
Spectrum
Disorder
to
Mand
“Why?”
Priya
Patil’
-
Tina
M.
Sidener'@
-
Heather
Pane'
-
Sharon
A.
Reeve!
-
Anjalee
Nirgudkar?
Accepted:
18
September
2020/
Published
online:
14
January
2021
©
Association
for
Behavior
Analysis
International
2021
Abstract
For
most
children
with
autism
spectrum
disorder
(ASD),
manding
for
information
is
an
important
skill
that
must
be
systematically
taught.
Although
previous
studies
have
evaluated
interventions
for
teaching
other
mands
for
information,
to
date
no
studies
have
demonstrated
effective
procedures
for
teaching
the
mand
“why?”
The
purpose of
the
present
study
was
to
teach
3
children
with
ASD
to
mand
“why?”
under
relevant
establishing
operation
conditions
in 3
distinct
scenarios.
A
trial-unique
multiple-exem-
plar
procedure
was
used
to
promote
generalization
and
increase
the
value
of
informa-
tion
provided
across
trials.
All
3
participants
learned
to
mand
“why?”
in
all
3
scenarios
within
a
mean
of
18
sessions
(range
14-21
sessions),
demonstrated
generalization
to
novel
stimuli
and
settings,
and
maintained
this
skill
over
time.
Social
validity
for
the
intervention
had
an
overall
mean
of
5.88
(range
1—7).
Keywords
Mand
-
Information
-
Trial-unique
-
Why
Typically
developing
children
are
often
proficient
with
many
mands
for
information
by
preschool
(Rowland
&
Pine,
2000;
Sundberg,
Loeb,
Hale,
&
Eigenheer,
2002).
The
American
Speech-Language-Hearing
Association
(ASHA)
asserts
that
typically
devel-
oping
children
ask
“why?”
between
2
and
3
years
of
age
and
ask
“when?”
and
“how?”
between
4
and
5
years
(ASHA,
n.d.).
Rowland,
Pine,
Lieven,
and
Theakston
(2003)
This
study
is
based
on
a
thesis
submitted
by
the
first
author,
under
the
supervision
of
the
second
author,
to
the
Department
of
Applied
Behavior
Analysis
at
Caldwell
University
for
the
Master
of
Arts
in
Applied
Behavior
Analysis.
bX
Tina
M.
Sidener
:
Department
of
Applied
Behavior
Analysis,
Caldwell
University,
120
Bloomfield
Ave.,
Caldwell,
NJ
07006,
USA
2
Behavior
Analysts
of
New
Jersey,
Paramus,
NJ,
USA
®
Springer
Original
Artide
Patient
Outcomes
After
Applied Behavior
Analysis
for
Autism
Spectrum
Disorder
Kristen
R.
Choi,
PhD,
MS,
RN,*t
Bhumi
Bhakta,
MPH,+
Elizabeth
A.
Knight,
MPH,
Tracy
A.
Becerra-Culqui,
PhD,
MPH,
OTR/L,t§
Teri
L.
Gahre,
MSCCC-SLP,§
Bonnie
Zima,
MD,
MPH,]|
Karen
J.
Coleman,
PhD,
MSt§
ABSTRACT:
Objectives:
The
purpose
of
this
study
was
to
examine
patterns of
service receipt
and
patient
outcomes
for
children
receiving
applied
behavior
analysis
(ABA)
for
autism
spectrum
disorder
(ASD)
in
an
integrated
health
care
system
in
which
commercially
insured
children
were
covered
by a
state
autism
mandate.
Methods:
This
retrospective,
observational
study
used
a
random
sample
of
children
with
ASD
(3-17
yrs)
who
were
members
of
a
large
integrated
health
care
system
in
Southern
California
and
referred
for
ABA
between
January
2016
and
November
2018.
From
the
4145
children
referred,
a
random
stratified
sample
of
334
was
selected
to
extract
data
from
clinical
reports
over
24
months
of
services.
The
primary
outcome
measures
were
time
in
ABA
and
child
adaptive
behavior.
Results:
Thirteen
percent
of
the
sample
never
received
ABA
after
referral.
Of
those
who
were
referred
for
ABA,
66%
initiated
ABA
and
remained
in
services
for
12
months,
whereas
less
than
half
(46%)
remained
in
services
for
24
months.
Having
history
of
special
education
was
associated
with
longer
time
spent
in
ABA,
whereas
having
a
single
parent
was
associated
with
discontinuation
of
ABA.
A
minority
of
children
received
a
full
ABA
dose
(28%),
but
the
lowest
functioning
children
still
experienced
clinically
significant
adaptive
behavior
gains
after
24
months
of
ABA
(p
=
0.02).
Conclusion:
In
a
health
system
implementation
of
ABA
for
children
with
ASD,
there
were
high
rates
of
ABA
discontinuation
and
low
ABA
dosing.
These
challenges
may
diminish
the
potential
benefits
of
ABA,
even
ina
context
in
which
there
is
mandated
commercial
insurance
coverage.
(
Dev
Behav
Pediatr
43:9-16,
2022)
Asem
spectrum
disorder
(ASD)
is
a
developmental
disorder
characterized
by
impairments
in
social
skills,
behavior,
and
communication
that
affects
2.5%
of
children
between
the
ages
of
3
and
17
years
in
the
United
States.’
It
is
4
times
more
common
in
boys
than
girls
and
often
co-occurs
with
other
developmental,
psychiatric,
chromosomal,
or
genetic
disorders.''?
Applied
behavior
analysis
(ABA)—a
therapeutic
in-
From
the
*School
of
Nursing,
University
of
California,
Los
Angeles,
Los
Angeles,
CA;
Department
of
Research
&
Evaluation,
Kaiser
Permanente
Souther
California,
Pasadena,
CA;
Kaiser
Foundation
Health
Plan,
Oakland,
CA;
§Southern
California
Permanente
Medical
Group,
Kaiser
Permanente,
Pasadena,
CA;
and
||Center
for
Health
Services
and
Society,
Jane
and
Terry
Semel
Institute
for
Neuroscience
and
Human
Behavior,
University
of
California,
Los
Angeles,
Los
Angeles,
CA.
Received
September
2020;
accepted
April
2021.
This
research
was
supported
by
a
K12
(K12HS26407-01)
career
development
award
from
the
Agency
for
Healthcare
Research
and
Quality
(AHRQ)
and
the
Patient
Centered
Outcomes
Research
Institute
(PCORD.
The
award
was
provided
through
the
Stakeholder-Partnered
Implementation
Research
and
Innovation
Translation
(SPIRIT)
Program
at
UCLA
and
Kaiser
Permanente,
Southern
California.
Funding
was
also
provided
by
the
Southern
California
Permanente
Medical
Group.
The
authors
declare
no
conflict
of
interest.
Supplemental
digital
content
is
available
for
this
article.
Direct
URL
citations
appear
in
the
printed
text
and
are
provided
in
the
HTML
and
PDF
versions
of
this
article
on
the
journal’s
Web
site
(www
jdbp.org).
Address
for
reprints:
Kristen
R.
Choi,
PhD,
School
of
Nursing,
University
of
Cal-
ifornia,
700
Tiverton
Avenue,
Room
3-238,
Los
Angeles,
CA,
90095;
e-mail:
Copyright
©
2021
Wolters
Kluwer
Health,
Inc.
All
rights
reserved.
Vol.
43,
No.
1,
January
2022
Copyright
©
2021
Wolters
Kluwer
Health,
Inc
tervention
for
ASD
that
uses
principles
of
behavioral
theory,
learning
theory,
and
positive
reinforcement
to
achieve
behavioral
goals—is widely
considered
to
be
a
gold-standard,
evidence-based
intervention
for
ASD
that
can
improve
functional
status,
behavior,
and
communication.*-*
There
is
evidence
that
early
and
intensive
ABA
intervention
can
improve
outcomes
for
children
with
ASD.
Meta-analyses
suggest
that
ABA
results
in
small-to-moderate
improvement
in
adaptive
behavior,
including
socialization,
communication,
and
expressive
language.”
Such
improvement
follows
a
dose-response
relationship
with
a
number
of
ABA
in-
tervention
hours,
and
generally,
12
to
24
months
of
ABA
or
more
are
needed
to
produce
clinically
mean-
ingful
progress.>->
However,
the
appropriate
amount
of
ABA
can
vary
considerably,
and
more
intense
or
lengthy
services
do
not
necessarily
always
translate
to
better
outcomes
for
all
children
with
ASD
in
real-world
settings.©”
ABA
is
an
expensive
and,
at
times,
intensive
intervention,
sometimes
requiring
as
much
as
40
hours
per
week
of
intervention
to
achieve
such
adaptive
behavior
gains.”*
Historically,
the
cost
of
ABA
has
created
access
chal-
lenges
for
children
and
families,
and
there
has
been
limited
or
inconsistent
coverage
of
ABA
by
commercial
insurers.
Some
ABA
services
have
been
paid
for
by
Medicaid
Home
and
Community-Based
Services
1915(c)
www.jdbp.org
|
9
.
Unauthorized
reproduction
of
this
article
is
prohibited.
Analysis
Verbal
Behav
(2014)
30:62-68
DOI
10.1007/s40616-013-0003-6
BAIBIAII
‘Association
for
Behavior
Analysis
interational
BRIEF
REPORT
Observing
Tacting
Increases
Uninstructed
Tacts
in
Children
with
Autism
Luis
Antonio
Pérez-Gonzalez
+
Ana
Pastor
-
José
Julio
Carnerero
Published
online:
30
December
2013
©
Association
for
Behavior
Analysis
International
2014
Abstract
The
effects
of
observing
an
adult
emitting
tacts
on
children’s
rate
of
uninstructed
(i.e.,
“spontaneous”)
tacts
were
examined
in
three
children
diagnosed
with
autism.
Each
participant
was
exposed
to
two
conditions
in
four
settings
each:
in
condition
1,
participants
received
20
trials
of
teacher-initiated
interactions
in
which
the
child
was
asked
to
tact
20
objects
during
5
min.
Condition
2
was
identical
to
condition
1
except
that
the
teacher
also
tacted
20
objects
interspersed
with
the
20
tact
trials.
The
number
of
uninstructed
tacts
was
recorded
in
both
condi-
tions.
Children
emitted
between
1.58
and
2.68
times
more
uninstructed
tacts
in
condition
2
than
in
condition
1.
These
results
indicate
that
teachers’
emission
of
tacts
increases
the
emission
of
uninstructed
tacts
in
children
with
autism.
Keywords
Tacts
-
Uninstructed
tacts
-
Modeling
-
Language
observing
-
Spontaneous
speech
-
Induction
-
Autism
A
tact
consists
of
emitting
a
verbal
response,
such
as
saying
a
name,
in
the
presence
of
an
object
or
event,
or
a
L.
A.
Pérez-Gonzalez
(D4)
-
J. J.
Carnerero
Department
of
Psychology,
University
of
Oviedo,
Plaza
Feijoo
s/n.
Despacho
209,
33003
Oviedo,
Spain
e-mail:
J. J.
Camerero
e-mail:
L.
A.
Pérez-Gonzalez
A.
Pastor
«
J. J.
Carnerero
Centro
Al-Mudaris,
Avda.
de
los
Aguijones,
s/n
local
3,
14001
Cérdoba,
Spain
A.
Pastor
e-mail:
property
of
an
object
or
event,
that
results
in
generalized
social
consequences
(Skinner
1957).
Uninstructed
tacts
can
be
defined
as
tacts
initiated
without
a
specific
request
from
a
listener
(they
are
also
called
pure
tacts;
e.g.,
Pistoljevic
and
Greer
2006).
This
type
of
tacting
corre-
sponds
to
what
is
often
identified
as
a
type
of
“spontaneous
language”
and
is
contrasted
with
what
occurs
when
addi-
tional
antecedent
verbal
stimuli
are
presented,
such
as
asking
the
speaker
to
say
the
name
of
an
object—the
latter
tacts
may
be
referred
to
as
instructed
tacts
(or
impure
tacts
or
intraverbal
tacts;
e.g.,
Greer
and
Ross
2008).
Sometimes,
children
with
autism
do
not
acquire
a
tacting
repertoire
without
these
additional
sources
of
verbal
stim-
uli;
thus,
procedures
to
establish
prompt-free
tacting
are
an
important
linguistic
step
(Krantz
and
McClannahan
1998).
Early
studies
on
incidental
teaching
(e.g.,
Hart
and
Risley
1975)
demonstrated
that
children
with
autism
can
initiate
instances
of
verbal
behavior
after
being
taught
specifically
to
do
so
through
prompting
(e.g.,
Koegel
et
al.
1987;
McGee
et
al.
1985).
More
recently,
Williams
et
al.
(2006)
demonstrated
that
teaching
chil-
dren
with
autism
to
tact
adult
actions
in
the
absence
of
cues
(e.g.,
the
teacher asking,
“What
is
she
doing?”)
resulted
in
increases
in
uninstructed
tacts.
The
children
in
that
study
tacted
on
occasions
that
an
adult
performed
an
action,
but
the
rate
of
emission
of
uninstructed
tacts
beyond
that
specific
situation
was
not
studied.
It
seems,
however,
that
many
factors
involved
in
the
emission
of
uninstructed
tacts
at
a
rate
similar
to
that
of
typically
developing
children
have
not
yet
been
studied.
Recently,
several
studies
have
demonstrated
that
the
emission
of
uninstructed
tacts
can
be
increased
indirectly
with
other
interventions.
Pistoljevic
and
Greer
(2006)
showed
that
an
intensive
tact-teaching
program
for
Eckes
et
al.BMC
Psychiatry
(2023)
23:133
https://doi.org/10.1186/s12888-022-04412-1
BMC
Psychiatry
Comprehensive
ABA-based
interventions
®
Check
for
updates
in
the
treatment
of
children
with
autism
spectrum
disorder
-
a
meta-analysis
Theresa
Eckes',
Ulrike
Buhlmann!,
Heinz-Dieter
Holling’
and
Anne
Méllmann'2”
Abstract
Background
Many
studies
display
promising
results
for
interventions
that
are
based
on
Applied
Behavior
Analysis
(ABA)
in
the
treatment
of
autism
spectrum
disorder
(ASD).
Methods:
This
meta-analysis
assessed
the
effects
of
such
treatments
on
developmental
outcomes
in
children
with
ASD
and
on
parental
stress
based
on
11
studies
with
632
participants.
Results:
Compared
to
treatment
as
usual,
minimal
or
no
treatment,
comprehensive
ABA-based
interven-
tions
showed
medium
effects
for
intellectual
functioning
(standardized
mean
difference
SMD
=0.51,
95%
Cl [0.09;
0.92])
and
adaptive
behavior
(SMD
=
0.37,
95%
Cl
[0.03;
0.70]).
Language
abilities,
symptom
severity
or
parental
stress
did
not
improve
beyond
the
improvement
in
control
groups.
Moderator
analyses
indicate
that
language
abilities
at
intake
could
influence
the
effect
sizes
and
the
influence
of
treatment
intensity
might
decrease
with
older
age.
Conclu-
sions:
Practical
implications
and
limitations
are
discussed.
Keywords
Autism
Spectrum
Disorder,
Applied
Behavior
Analysis,
Behavioral
Treatment,
Early
Intensive
Behavioral
Interventions,
Meta-Analysis,
Parental
Stress
Autism
spectrum
disorder
(ASD)
is
a
neurodevelopmen-
tal
disorder
characterized
by
(a)
difficulties
in social
com-
munication
and
interaction
across
multiple contexts
and
(b)
restricted,
repetitive
behavior,
activities,
and
interests.
It
is
often associated
with
intellectual
impairment,
lan-
guage
impairment,
and
motor
deficits,
such
as
odd
gait
or
clumsiness
[1].
According
to
the
clinical criteria
of
ASD
laid
out
in
the
Diagnostic
and
Statistical
Manual
of
Mental
Disorders
(DSM-5;
[1]),
the
prevalence of
ASD
is
approximately
1.0%
and
people
on
the
autistic
spectrum
need
intensive,
sometimeslife-long
care
and
support
[2].
*Correspondence:
Anne
Méllmann
‘Institute
of
Psychology,
University
of
Miinster,
Fliednerstr.
21,
48149
Minster,
Germany
2
Institute
of
Psychology,
Clinical
Psychology
and
Psychotherapy,
University of
Bremen,
Grazer
Str.
6,
28359
Bremen,
Germany
BMC
Behavioral
interventions
for
ASD
target
the
increase
of
functional
independence
of
individuals
on
the
autistic
spectrum.
They
are
firmly
linked
to
Applied
Behavior
Analysis
(ABA)
[2,
3].
ABA
is
the
science
of
analyzing
how
the
individual’s
environment
influences
their
behavior
[4]
and
describes
interventions
apply-
ing
the
findings of
such
analyses
to
change
behavior
[5,
6].
It is
theoretically
based
on
operant
conditioning
and
aims
to
assess
and
change
challenging
behavior
as
well
as to
promote
and
generalize
more
adaptive
behav-
ior,
for
example,
by
using
systematic
reinforcement
[5].
While
ABA-based
methods
can
be
used
to
target
specific
behaviors
(e.g,.
toilet
training),
comprehen-
sive
ABA-based
interventions
are
characterized
by
(a)
beginning
in
early
childhood,
when
possible
between
3
to
4
years
of
age;
(b)
having
a
high
intensity
(20
—
40
h/
week);
(c)
being
personalized
to
meet
the
individual
needs
of
each
child;
(d)
addressing
several
skills
at
the
same
time
instead
of
promoting
just
one
specific
skill
©The
Author(s)
2023,
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