Lending a Hand:Lending a Hand:Teaching Children with AutismTeaching Children with Autism

to Give Assistanceto Give AssistanceSummary of Reeve Reeve et al 2007Summary of Reeve Reeve et al 2007

Definition of AutismDefinition of Autism Autism is a neurological disorder that affects a Autism is a neurological disorder that affects a

person's ability to person's ability to a) communicate (impairments in speech and a) communicate (impairments in speech and

language development)language development)b) form relationships (qualitative impairment b) form relationships (qualitative impairment

in in social skills and interactions with others)***social skills and interactions with others)***c) respond appropriately to the environment c) respond appropriately to the environment

(sensitivity to stimulation and repetitive patterns (sensitivity to stimulation and repetitive patterns of of behavior, interests, and activities)behavior, interests, and activities)

Onset typically before the age of three, which makes Onset typically before the age of three, which makes early and accurate diagnosis very important. early and accurate diagnosis very important.

May affect as many as 1/150-200 individualsMay affect as many as 1/150-200 individuals

Social Impairments of AutismSocial Impairments of Autism

Many children with autism exhibit severe and persistent Many children with autism exhibit severe and persistent deficits in social behavior (Baron-Cohen, Leslie, & deficits in social behavior (Baron-Cohen, Leslie, & Frith, 1985; Rutter, 1978; Volkmar, Carter, Sparrow, Frith, 1985; Rutter, 1978; Volkmar, Carter, Sparrow, & Cicchetti, 1993; Wing, 1988). Examples include:& Cicchetti, 1993; Wing, 1988). Examples include: inappropriate affect (emotional displays)inappropriate affect (emotional displays) absent or delayed social smileabsent or delayed social smile absent or delayed eye contactabsent or delayed eye contact social isolationsocial isolation failing to initiate to peers and/or adultsfailing to initiate to peers and/or adults **pro-social behavior (see next slide)**pro-social behavior (see next slide)

Definition of Definition of Prosocial BehaviorProsocial Behavior

Any act intending to benefit another, such asAny act intending to benefit another, such as responses responses associated with: associated with: helpinghelping cooperatingcooperating sharingsharing turn-takingturn-taking exhibiting empathy, and/or sympathyexhibiting empathy, and/or sympathy

Observed in children of typical development as early as 1 ½ Observed in children of typical development as early as 1 ½ to 3 years of age (but often absent in children with autism)to 3 years of age (but often absent in children with autism)

  (Eisenberg & Fabes, 1998; (Eisenberg & Fabes, 1998; Rheingold & Hay, 1980Rheingold & Hay, 1980))

Negative Outcomes of Negative Outcomes of Prosocial Behavior DeficitProsocial Behavior Deficit

Parents, peers, and teachers may be Parents, peers, and teachers may be discouraged from attempting to interact with discouraged from attempting to interact with the childthe child

In fact, peers often reject children who exhibit In fact, peers often reject children who exhibit low levels of prosocial behavior (Vitaro, low levels of prosocial behavior (Vitaro, Gagnon, & Tremblay, 1990) Gagnon, & Tremblay, 1990)

Further reduces the opportunities for learning Further reduces the opportunities for learning (Lovaas, Koegel, Simmons, & Long, 1973). (Lovaas, Koegel, Simmons, & Long, 1973).

Positive Outcomes of Positive Outcomes of Prosocial Behavior ProficiencyProsocial Behavior Proficiency

  Children who engage in appropriate prosocial behavior:Children who engage in appropriate prosocial behavior: (a) tend to be viewed by adults as more socially (a) tend to be viewed by adults as more socially

competent (Eisenberg, Fabes, Karbon, Murphy, competent (Eisenberg, Fabes, Karbon, Murphy, Wosinski, Polazzi, Carlo, & Juhnke, 1996; Wosinski, Polazzi, Carlo, & Juhnke, 1996; Peterson, Ridley-Johnson, & Carter, 1984)Peterson, Ridley-Johnson, & Carter, 1984)

(b) are more likely to frequently engage in positive (b) are more likely to frequently engage in positive and cooperative social interactions with peers and cooperative social interactions with peers (Dunn & Munn, 1986; Farver & Branstetter, 1994)(Dunn & Munn, 1986; Farver & Branstetter, 1994)

(c) are more likely to have strong peer friendships (c) are more likely to have strong peer friendships (Coie, Dodge, & Kupersmidt, 1990; Farver & (Coie, Dodge, & Kupersmidt, 1990; Farver & Branstetter, 1994)Branstetter, 1994)

Prior Research to Teach Prosocial Prior Research to Teach Prosocial Behavior to Children with AutismBehavior to Children with Autism

A number of studies have taught prosocial behavior A number of studies have taught prosocial behavior but the behavior failed to generalize beyond teaching but the behavior failed to generalize beyond teaching conditions, or showed minimal generalization conditions, or showed minimal generalization ((Charlop & Walsh, 1986; Harris, Handleman, & Charlop & Walsh, 1986; Harris, Handleman, & Alessandri, 1990; Kamps, Leonard, Vernon, Dugan, Alessandri, 1990; Kamps, Leonard, Vernon, Dugan, Delquadri, Gershon, Wade, & Folk, 1992; Kohler, Delquadri, Gershon, Wade, & Folk, 1992; Kohler, Strain, Hoyson, Davis, Donina, & Rapp, 1995; Strain, Strain, Hoyson, Davis, Donina, & Rapp, 1995; Strain, Kerr, & Ragland, 1979)Kerr, & Ragland, 1979)

Strategies included instruction, peer models, a small Strategies included instruction, peer models, a small number of examples, and reinforcementnumber of examples, and reinforcement

Failure to generalize reduces functionality of the skill Failure to generalize reduces functionality of the skill

Purpose of the Present StudyPurpose of the Present Study

To determine the extent to which children with To determine the extent to which children with autism can learn to engage in prosocial responses, autism can learn to engage in prosocial responses, in this case, behavior commonly labeled as in this case, behavior commonly labeled as helpinghelping..

To determine the extent to which To determine the extent to which helpinghelping responses responses generalizegeneralize from training to novel from training to novel situations in which there is an opportunity to situations in which there is an opportunity to engage in helping behavior.engage in helping behavior.

Strategies to Increase LearningStrategies to Increase Learning

Increasing salience of stimuliIncreasing salience of stimuli Use of promptingUse of prompting Use of reinforcementUse of reinforcement Use of correction procedureUse of correction procedure

Strategies to Increase GeneralizationStrategies to Increase Generalization

Use of video modelingUse of video modeling

(Charlop, Schreibman, & Tyron, 1983; Haring, (Charlop, Schreibman, & Tyron, 1983; Haring, Kennedy, Adams, & Pitts-Conway, 1987)Kennedy, Adams, & Pitts-Conway, 1987)

Teaching multiple exemplars of the target Teaching multiple exemplars of the target behavior using common stimuli behavior using common stimuli

(Stokes & Baer, 1977)(Stokes & Baer, 1977)

Participants & SettingsParticipants & Settings

Four children with autism (Irene, Tom, Eddie, Four children with autism (Irene, Tom, Eddie, and Nathan) who attended classes at the and Nathan) who attended classes at the Institute for Educational Achievement (IEA).Institute for Educational Achievement (IEA).

Most experimental sessions took place in a Most experimental sessions took place in a small classroom at IEA. Approximately once small classroom at IEA. Approximately once every week, sessions were conducted in the every week, sessions were conducted in the staff room at IEA.staff room at IEA.

Categories of “Helping”Categories of “Helping”

CleaningCleaning Replacing Broken MaterialsReplacing Broken Materials Picking Up ObjectsPicking Up Objects Sorting MaterialsSorting Materials Locating ObjectsLocating Objects Carrying ObjectsCarrying Objects Putting Items AwayPutting Items Away Setting Up an ActivitySetting Up an Activity

Category StructureCategory Structure

Response Response CategoryCategory

General General DescriptionDescription

Nonverbal SNonverbal SDD Verbal Verbal

SSDD

Verbal Verbal ResponseResponse

(dependent (dependent measure)measure)

Motor Motor

ResponseResponse

(dependent (dependent measure)measure)

  

  

  

  

CleaningCleaning

  

  

  

adult wipes adult wipes messy messy

surfaces surfaces

1. Wiping a 1. Wiping a black boardblack board

    

2. Wiping a 2. Wiping a wipe-off boardwipe-off board

  

3. Wiping a 3. Wiping a desk desk

    

4. Wiping a 4. Wiping a chair chair

  

5. Wiping a 5. Wiping a tabletable

1. “1. “OhOh, time to , time to clean the black clean the black board.”board.”

  2. “2. “BoyBoy, how did , how did this get messy?”this get messy?”

3. “3. “OopsOops, I have to , I have to clean this desk.”clean this desk.”

  4. “4. “Uh ohUh oh, what a , what a dirty chair.”dirty chair.”

  5. “5. “WowWow, this table , this table is messy.”is messy.”

  

  

  

  

  

““May I help?”May I help?”

  

1. Wiping a 1. Wiping a black board black board

    

2. Wiping a 2. Wiping a wipe off boardwipe off board

  

3. Wiping a 3. Wiping a desk desk

    

4. Wiping a 4. Wiping a chairchair

  

5. Wiping a 5. Wiping a table table

Categories for Each ChildCategories for Each Child

  IreneIrene

  

  TomTom   EddieEddie NathanNathan

  

TrainedTrained

CategoriesCategories

LocatingLocating

CarryingCarrying

Putting AwayPutting Away

Setting UpSetting Up

CleaningCleaning

ReplacingReplacing

Picking UpPicking Up

SortingSorting

Putting AwayPutting Away

Setting UpSetting Up

CleaningCleaning

ReplacingReplacing

Picking UpPicking Up

  SortingSorting

LocatingLocating

CarryingCarrying

Non-Non-trainedtrained

CategoriesCategories

(Probes)(Probes)

CleaningCleaning

ReplacingReplacing

LocatingLocating

CarryingCarrying

Picking UpPicking Up

  SortingSorting

Putting AwayPutting Away

Setting UpSetting Up

Assignment of Trials (for Tom)Assignment of Trials (for Tom)CategoryCategory Non-Verbal Stimuli forNon-Verbal Stimuli for

Training TrialsTraining Trials

Within CategoryWithin Category

Probe TrialsProbe Trials

CleaningCleaning Wiping:Wiping:

11. backboard . backboard 22. wipe-off . wipe-off 33. Desk . Desk 44. Chair. Chair

Wiping:Wiping:

1. 1. Table Table

Replacing Replacing Broken MaterialsBroken Materials

Replacing broken or tornReplacing broken or torn

5.5. Paintbrushes Paintbrushes 6.6. Forks Forks 7.7. Pencils Pencils 8.8. Crayons Crayons

Replacing:Replacing:

2.2. Paper Paper

Picking up Picking up ObjectsObjects

Picking up:Picking up:

9.9. Paper clips Paper clips 10.10. Money Money 11.11. LM LM 12.12. Pict cards Pict cards

Picking upPicking up

3 3 CompComp DisksDisks

Sorting MaterialsSorting Materials Sorting:Sorting:

13.13. Scissors/glue Scissors/glue 14.14. markers markers 15.15. sticks sticks 16.16. Utensils Utensils

SortingSorting

4. 4. paper/brushpaper/brush

Across-CategoryAcross-Category

Probe TrialsProbe Trials

Locate ObjectsLocate Objects LocatingLocating

5.5. Puzzle piece Puzzle piece

Carry ObjectsCarry Objects CarryingCarrying

6.6. See & says See & says

Baseline & Treatment TrialsBaseline & Treatment Trials

BaselineBaseline Both training and probe trials presentedBoth training and probe trials presented NeitherNeither trial type associated with treatment or trial type associated with treatment or

reinforcementreinforcement Token reinforcement and verbal praise provided only for Token reinforcement and verbal praise provided only for

on-taskon-task behavior behavior

TreatmentTreatment Both training and probe trials presentedBoth training and probe trials presented Training trials associated with treatmentTraining trials associated with treatment Probe trials Probe trials notnot associated with treatment associated with treatment

Error-Correction ProcedureError-Correction ProcedurePresentation of Live Discriminative StimuliPresentation of Live Discriminative Stimuli

(non-verbal & verbal)(non-verbal & verbal)

Incorrect Verbal and/or Motor Response by childIncorrect Verbal and/or Motor Response by child

Presentation of Video ModelPresentation of Video Model

Re-presentation of Live Discriminative StimuliRe-presentation of Live Discriminative Stimuli

Incorrect Verbal and/or Motor Response by childIncorrect Verbal and/or Motor Response by child

Presentation of Motor and/or Verbal PromptsPresentation of Motor and/or Verbal Prompts

Re-presentation of Live Discriminative StimuliRe-presentation of Live Discriminative Stimuli

Correct Verbal and Motor Responses by childCorrect Verbal and Motor Responses by child

ReinforcementReinforcement (token + praise)(token + praise)

Additional Strategies Used to Additional Strategies Used to Promote GeneralizationPromote Generalization

Treatment sessions were conducted once Treatment sessions were conducted once every eight sessions in the staff room (not the every eight sessions in the staff room (not the typical experimental session room)typical experimental session room)

Treatment sessions were conducted once Treatment sessions were conducted once every 10 sessions by a secondary every 10 sessions by a secondary experimenter (not the primary experimenter)experimenter (not the primary experimenter)

Pre- and Post-Intervention MeasuresPre- and Post-Intervention Measures For each child, three pre-intervention sessions were For each child, three pre-intervention sessions were

conducted before treatment was introduced.conducted before treatment was introduced.

Three post-intervention sessions were conducted after all Three post-intervention sessions were conducted after all participants had achieved mastery criterion.participants had achieved mastery criterion.

   Combination of novel trials, probe trials, and training Combination of novel trials, probe trials, and training

trial types trial types

Conducted in the child’s regular school classroom (not Conducted in the child’s regular school classroom (not the experimental setting) with their regular school the experimental setting) with their regular school instructor (not the experimenter). instructor (not the experimenter).

Mean Percentage of Correct Helping Responses Across Mean Percentage of Correct Helping Responses Across Pre- and Post-Intervention MeasuresPre- and Post-Intervention Measures

(Combination of Trial Types in Child’s Regular Classroom with their (Combination of Trial Types in Child’s Regular Classroom with their Regular Instructor)Regular Instructor)

Pre-Pre-InterventionIntervention

Post-Post-InterventionIntervention

IreneIrene 00 100.0100.0

TomTom 00 95.695.6

EddieEddie 00 97.497.4

NathanNathan 00 96.596.5

ConclusionsConclusions Systematic application of multiple exemplar training Systematic application of multiple exemplar training

using video modeling, prompting, and reinforcement using video modeling, prompting, and reinforcement taught children to use helping responses in training and taught children to use helping responses in training and novel situationsnovel situations

Children demonstrated a generalized repertoire of Children demonstrated a generalized repertoire of helping behavior. They responded with appropriate helping behavior. They responded with appropriate helping behavior helping behavior in the presence of discriminative in the presence of discriminative stimuli from novel trials, from novel categories of stimuli from novel trials, from novel categories of helping, in novel settings, and in the presence of novel helping, in novel settings, and in the presence of novel persons.persons.

Programs for children with autism should include Programs for children with autism should include training in prosocial behavior. Such training should lead training in prosocial behavior. Such training should lead to increased opportunities for learning.to increased opportunities for learning.

Percentage of Trials in Which Video Presentation Occasioned a Percentage of Trials in Which Video Presentation Occasioned a Correct Helping Response on Subsequent Presentation of the Correct Helping Response on Subsequent Presentation of the

Discriminative StimuliDiscriminative Stimuli

Treatment SessionTreatment Session

11 22 33 44 55 66 77 88 99 1010

IreneIrene 4646 5050 -- 100100 100100 100100 -- -- 100100 100100

TomTom 6767 8080 3333 7575 00 -- 7575 5050 -- 100100

EddieEddie 4040 100100 00 100100 -- 100100 -- -- -- 100100

NathanNathan 6767 7575 8383 100100 5050 -- -- -- -- 100100

Note: dashes indicate a child emitted no errors during that sessionNote: dashes indicate a child emitted no errors during that session