Association for Behavior Analysis International

Current evidence supports that meeting critical, time sensitive language acquisition goals for children diagnosed with autism spectrum disorder (ASD) is best facilitated through Early Intensive Behavioral Intervention (EIBI) based on the principles of Applied Behavior Analysis (ABA). Although 47-48% of children receiving EIBI have been reported to experience optimal outcomes (i.e., they are indistinguishable from their typically developing peers by age 7), the responses of children who do not respond optimally vary widely. Recently, empirical questions in EIBI research have shifted towards attempting to identify the determinants of this variability rather than further demonstrations of general treatment efficacy. This symposium will explore some of the possible determinants of the variation in treatment response particularly as it relates to EIBI interventions informed by Skinners analysis of verbal behavior. Specifically, we will explore treatment delivery methodology (parent-implemented versus center-based) as well as the influence of the childs pretreatment verbal repertoire on treatment response. We will also discuss the measurement issues in detecting treatment response as well as the utility of a recently developed dynamic experimental design that informs adaptive treatment strategies and provides insight into matching treatments to children based on pretreatment child characteristics to further improve treatment outcomes.

Children diagnosed with autism may respond differently to early interventions based on Skinners analysis of verbal behavior as a function of their pretreatment characteristics. The purpose of this study was to evaluate if child baseline levels of verbal functioning predicted response to a parent-implemented ABA intervention based on Skinners analysis of verbal behavior (VBA). Consistent with the literature on rates of optimal treatment outcome in Early Intensive Behavioral Intervention, after the 3-month VBA treatment as part of a small, randomized pilot trial, the sample produced mixed outcomes in rates of verbal behavior (VB) and joint attention (JA) observed during parent-child interactions. Between 40-60% of the sample engaged in increased rates of VB after VBA, whereas only 20% of the sample engaged in increased rates of JA. Preliminary evidence indicated that children with relatively weak initial manding and strong initial listener repertoires responded more favorably to VBA than other participants, suggesting that the speed at which children respond to VBA treatment differs based on pre-treatment verbal repertoires. Further, evidence of treatment response differed across individuals, emphasizing the need for multiple dependent measures to assess treatment response (e.g., rates of verbal behavior, rates of joint attention, growth trajectories in VB-MAPP scores).

The Sequential Multiple Assignment Randomized Trial (SMART) design has been growing in popularity as a means of exploring how to optimize the effectiveness of an intervention by systematically adapting the intervention to an individuals characteristics and changing needs. The purpose of this study is to assess the use of the SMART design with two ABA-based interventions (i.e., Discrete Trial Instruction (DTI) and the Verbal Behavior Approach (VBA)) for preschool children with ASD. The study includes two stages of randomization where all children are randomly assigned to receive DTI or VBA for 8 weeks. At the end of this first stage, response to treatment is determined based on clinical global impressions and rates of skill acquisition. At the end of 8 weeks of treatment, responders to treatment continue with the assigned intervention for another 8 weeks while non-responders are randomly assigned to receive either an intensified version of the assigned intervention or the previously unassigned intervention for 8 weeks. Preliminary data for 8 participants will be presented to evaluate the methodology used to identify responders from non-responders. The SMART design may be a promising approach to improve EIBIs outcome success rate as well as the treatment outcomes for initial non-responders.