J. H,,hav. Ther. R l3p. P.~ychinr. Vol 4. pp. 171-176. Perpamon Press, 1973. Printed in Great Britain.

TEACHING AND GENERALIZATION OF INSTRUCTION-FOLLOWING IN AN “AUTISTIC” CHILD*

W. EDWARD CRAIGHEAD, K. DANIEL O’LEARY and JON S. ALLEN

Pennsylvania State University State University of New York at Stony Brook

and Kenyon College

Summary-A Cyr-old boy, diagnosed as “autistic”, very seldom followed instructions. A program, utilizing operant reinforcement procedures designed to increase instruction-following, succeeded dramatically and the behavior generalized across people and novel instructions, and persisted when the primary treatment intervention was withdrawn.

WHATEVER theoretical or conceptual model one uses to describe a child who exhibits behaviors labelled autistic, there is agreement that such a child is characterized by a number of language deficits, one of which particularly is his failure to follow instructions without extensive prompt- ing or cajoling. Recently, research has demon- strated that reinforcement procedures can be used to teach instruction-following in children (Zimmerman, Zimmerman and Russell, 1969 ; Whitman, Zakaras, Chardos, 1971). However, only one study (Whitman et al., 1971) has assessed the extent to which the instruction- following behavior persists across time and generalizes to other instructions which had not been taught. Essentially, Whitman er al. (1971), working with two retarded children, found generalization to new instructions. The present study was designed to assess (1) how readily this child could be taught to follow instructions using reinforcement procedures, and more importantly (2) whether instruction-following would (a) per- sist across time, (b) generalize to new instruc- tions similar to and different from the instruc- tions that he had been taught to follow and (c) generalize to the instructions given by various other people.

METHOD

Subject

Mark, a 4-yr-old, was referred to the Univer- sity Psychological Clinic for assessment of mental retardation. During observations of Mark he acted as if the experimenter (EJ did not exist (e.g. autistic aloneness), therefore assessment was obtained primarily by means of parent interviews. It was then determined that the child displayed the following behaviors (1) repetitive behavior with mechanical objects; (2) insistence on sameness, e.g. marked disturb- ance at changes in furniture in a room; (3) im- mediate echolalia; (4) pronoun inversion (I- you); (5) yes-no inversion; (6) very little spontaneous speech; (7) frequent encopresis; and (8) excellent memory, e.g. delayed echolalia of entire television commercials. Given the similarity of these behaviors with those Rimland (1964) suggests as being indicative of “infantile autism”, if the authors had been inclined to assign a diagnostic label to Mark, it would have been “autism”. A problem of utmost concern to the parents was Mark’s refusal to follow instructions, and thus it was decided to teach this skill first.

*Reprints can be obtained from Edward Craighead, 512 Psychology Building, The Pennsylvania State University, University Park, Pennsylvania 16802 or K. Daniel O’Leary, Psychology Department, SUNY-Stony Brook, Stony Brook, New York 11790. This study was completed at the University of Illinois (Champaign-Urbana) as part 01 clinical assessment course taught by the second author.

171

172 W. EDWARD CRAIGHEAD, K. DANIEL O’LEARY and JON S. ALLEN

Procedure TABLE 2. LIST OF 36 INSTRUCTIONS

The experiment was conducted in a 12 ft x 15 ft 1. playroom at the Psychological Clinic of the University of Illinois. An adjacent observation booth, connected to the playroom via a one-way glass, allowed observers to score all Mark’s responses throughout the study. Mark and E sat at a small, round table at the end of the room opposite the one-way glass. The objects to be used in the study were placed either on the table or on a toy counter one-half the distance between the table and one-way glass. Each instruction was preceded by the boy’s name, e.g. “Mark, instruction 1.” If the subject initiated the correct response-the behavior prompted by the instruction-within 5 set, the observer scored it _I-; if he did not initiate the correct response within 5 set, it was scored 0.

2. 3. 4. 5. 6. 7. 8. 9.

10. 11. 12.

Put your head on the table Put your hand on the table Put your hand on your head Put your finger on your nose Put the hammer back Put the hat back Bring the tractor Bring the block Bring the doll Bring the hat Bring the ball Stand up

13. Turn around in your chair

The sessions were conducted late in the after- noon. Mark was not given his evening meal until after the session, and therefore had no food during the 3-4 hr preceding the sessions. An outline of all experimental conditions appears in Table 1.

Phase 1. Baseline 1. During Phase I a baseline was conducted on the 36 instructions presented in Table 2. Each instruction was given once

14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.

*27. *28. *29. *30. *31. *32. *33. *34. *35. *36.

Open the door Pull vour chair close to the table Walk around the table Pull up your socks Clap your hands Put the truck back Put your finger on your ear Put your hands over your eyes Put your finger on your shoulder Put your hand on your knee Put your hand on your foot Bring the gun Bring the box Bring the phone Bring the train Bring the hammer Bring the crayon Bring the car Put the phone back Put the horse back Put the ball back Put the car back Put the train back

during each of the first two experimental sessions. *Ten instructions on which Mark was trained during If Mark followed the instruction, El gave Phase II.

Phase 1. Phase II.

Phase III.

Phase IV.

Phase V.

TABLE 1. SUMMARYOFEXPERIMENTAL DESIGN

Baseline I Training A Trainina B

Consequence for No. of instructions correct presented

instruction-following per session

Praise 36 Praise and Food 20 Praise 20

Training C Generalization I Trained instructions Generalization instructions Baseline II Generalization II Generalization III Retraining New experimenter Retraining Father Retraining

Praise and Food

Praise and Food Praise

20 40

Praise 46

Praise and Food Praise Praise and Food Praise Praise and Food

36 36 36 36 36 __

Mother Praise 36

INSTRUCTION-FOLLOWING IN AN “AUTISTIC” CHILD 173

praise. In order to assess interobserver reliability, two observers independently rated Mark’s instruction-following responses during this base- line condition of 2 days.

Phase ZZ. Training. Phase II-A consisted of five 30-45-min sessions during which Mark was trained to follow 10 of the original 36 instruc- tions (see Table 2). Each training instruction was presented twice during each of the five sessions. Every completion of an appropriate response was followed with an M 8~ M candy or a “Shapie”, (a dry, corn snack) and verbal praise. Phase II-B consisted of three 30-45 min sessions during which each of the 10 training instructions were given twice, but the completion of an appropriate response resulted only in verbal praise (no primary reinforcers). Phase II-C consisted of two 30-45 min sessions during which each of the 10 training instructions was presented twice. Completion of an appropriate response was followed by both praise and pri- mary reinforcers.

Phase ZZZ. Generalization,. Phase III was designed to test for generalization to a set of nontrained instructions. Seven similar instruc- tions and seven different instructions were chosen from the 26 nontrained instructions. The 14 generalization instructions are presented in Table 3.

TABLE 3. LIST OF INSTRUCTJONS FOR PHASE III

Similar instructions Session I

1. Bring the ball 2. Bring the block 3. Bring the hat

Session II 1. Bring the doll 2. Put the hammer back 3. Put the truck back 4. Put the hat back

Different instructions Session I

1. Put your finger on your ear 2. Put your hand on your head 3. Open the door 4. Clap your hands

Session II 1. Put your hand on your knee 2. Turn around in your chair 3. Stand UD

During each of two 30-45 min sessions, each of the 10 trained instructions was presented twice, and six (randomly chosen) were presented for an additional trial, making a total of 26 trained instruction presentations. Three similar and four different generalization instructions were pre- sented for two trials each during the first general- ization session. In the second session, the other seven were presented twice each. The trained and generalization instructions were presented in random order. During this phase, each com- pleted trained instruction was followed with praise and primary reinforcers, and each com- pleted generalization instruction was followed by social reinforcers only.

Phase Z V. Baseline, and Generalization 2. During the two 30-45 min sessions of Phase IV, a second baseline was conducted on the original 36 instructions. Each instruction was presented once. If Mark followed the instruction, he was praised; no primary reinforcers were used. At the end of each Phase IV sessions, Mark was presented with 10 completely new instructions (not in the original list of 36 instructions). Each new instruction was presented once in each Phase IV session and correct responses were praised. These new instructions constituted a second test for generalization. The instructions are listed in Table 4.

TABLE 4. LIST OF NEW INSTRUCTIONS FOR PHASE IV

1. Get a paper towel 2. Sit on the table 3. Turn off the light 4. Pick up the eraser and put it on the chalkboard 5. Put the paper in the wastebasket 6. Put water into the paper cup 7. Put a mark on the paper with the pencil 8. Put the chairs up to the table 9. Put the hat into the closet

10. Put all the toys on to the toy shelf

Phase V. Generalization,. Phase V was designed to test for generalization to different E’s. During each of six sessions (again 30-45 min), each of the 36 original instructions was presented once. During the first, third, and fifth sessions, El trained Mark on all of the 36 instructions using primary and social reinforcers.

174 W. EDWARD CRAIGHEAD, K. DANIEL O’LEARY and JON S. ALLEN

In the second session, a clinical psychology During Baseline, Mark followed 24 per cent of graduate student (&J2, never seen before by all the instructions, but during Baseline, he Mark, presented each of the 36 instructions for one trial each. Praise followed each correct response. The fourth and sixth sessions followed the same procedures, with Mark’s father being the E, in session four and his mother the E, in session six.

RESULTS

The interobserver reliability of instruction- following during baseline, calculated as the number of agreements divided by total number of agreements plus disagreements, was -92.

The data presented in Fig. 1 indicate that Mark did learn (in five training sessions) to follow the 10 training instructions. Mark obeyed only 35 per cent of the 10 instructions, on which he was to be trained, during the baseline condition, but on the fifth day of training he followed 95 per cent of them. During Phase II-B (praise only) the rate dropped to 67 per cent but upon the re- FIG. I. Phase I and

Baseline training training training

n B C

Phase II. Percentage of trained institution of the training conditions (Phase II-C; instructions followed under Baseline, Phase I, and

praise and food) it returned to 92 per cent. Phase II: Training A, Praise and Food; Training B,

There were fewer instructions given in Phase Praise; and Training C, Praise and Foe Id.

II (Training) than Phase I (Baseline), and one might argue that the decrease in number of instructions given led to the increase in per- centage of instructions followed. While such an argument seems plausible, the percentage of instructions followed did not differ from the first half of a session during the baseline to the percentage of instructions followed during the second half of the baseline. In short, number of instructions given cannot account for the differences noted in Fig. 1.

Figure 2 presents the data from Phase III

IOO-

go-

80-

D b 70-

concerning generalization of instruction-follow- ing to similar and different instructions. Mark obeyed 90 per cent of “trained” instructions, 20.

85 per cent of similar instructions (of approxi- mately equal difficulty) and 77 per cent of

IO-

different instructions (of somewhat greater diffi- 0 culty in terms of length). Trained similar different

_ ~.

As can be seen from Fig. 3, generalization to FIG. 2. Phase III. Percentage of instructions followed of

the 26 nontrained original instructions did occur. (a) trained instructions, (b) similar instructions and

(c) different instructions.

INSTRUCTION-FOLLOWING IN AN “AUTISTIC” CHILD 175

obeyed 73 per cent. The largest absolute increase was from 35 per cent to 90 per cent on the trained instructions, while the change on the non-trained instructions was from 17 per cent to 67 per cent.

FIG.

go-

80-

&s 70-

& 2 60-

0 - 50-

? .o ; 4 0 -

:

z 3O- c

zo-

IO-

i: il Ql 61

All

b, 8,

Non-trained

3. Percentage of instructions followed during Base- line 1 (B,) and Baseline 2 (B2).

The next test was for generalization to 10 new instructions, which Mark had never been given. Mark followed 80 per cent of the entirely new instructions during Phase IV, despite the fact that these instructions were obviously of greater difficulty than instructions given earlier in the study.

During Phase V, training sessions (with primary and social reinforcement) were inter- spersed with generalization sessions in which a different experimenter (E,), the child’s father (E3, and finally the child’s mother (EJ presented each instruction and simply praised the child if he followed it. Mark followed 70 per cent of the instructions when presented by E,, 64 per cent when presented by his father, and 84 per cent when presented by his mother.

DISCUSSION Clearly, this “autistic” child was rapidly taught

to follow instructions. It is likely that the slight afternoon food deprivation facilitated the speed of acquisition of his appropriate responses. Additionally, it appeared that the pairing of the primary reinforcers with praise resulted in the establishment of the experimenter as a positive social reinforcing stimulus.

While there were differences in the total number of instructions given between the base- line and training phases, since the 10 “training” instructions were presented first in the sequence during baseline, change in number of instruc- tions per session cannot account for the observed differences between baseline and training phases. More importantly, comparing only the instruc- tion following behaviors during parts A, B, and C of Phase III reveals the marked influence of the use of primary reinforcement in producing instruction-following.

The data also indicated that the response of “Instruction-following”, generalized to instruc- tions which Mark had not been trained to follow. Support for the notion of stimulus generalization came from the data on the responses to similar and different instructions. The data followed the usual stimulus generalization pattern in that the stimuli most similar to the “trained” stimuli had the highest percentage of correct responses. Namely, in the generalization test involving instructions from the original 36, Mark correctly responded to the trained instructions most frequently. He followed “non-trained” instruc- tions of a similar nature less frequently, and he followed “non-trained” instructions of adifferent nature least frequently. Furthermore, this ex- periment clearly indicates that there was persistence of instruction-following across time as noted by the comparison of instruction- following during the baseline (praise alone) period and during the praise alone period of Phase II.

Instruction-following taught by one individual seemed to generalize to other people. Mark’s parents reported during the initial interview that Mark followed very few instructions. Had there

176 W. EDWARD CRAIGHEAD, K. DANIEL O’LEARY and JON S. ALLEN

been a baseline condition prior to training for the pruents and additional experimenters, a more definite conclusion could have been drawn. Nonetheless, Mark rapidly learned to obey instructions, and this response pattern appeared to generalize to new instructional stimuli and a new experimenter. At the conclusion of the study the parents were trained in operant procedures and a home training program for desired

behaviors was established. While no data w&e taken in that situation, the program seems to have been effective and at last report the subject was a student in a “normal” public school class- room. In sum, this child was taught to follow instructions in a manner that generalized across people, and to varied and novel instructions, and persisted over several days when the opening treatment intervention was withdrawn.

Ackrlowledgement-Appreciation is expressed to Dr. David Kuypers who served as the E, for this session.

REFERENCES instruction-following behavior of severely retarded

RIMLAND B. (1964) Infantile Aufisrn, Appleto?-Century- children, J. appt. Behav. Anal. 4, 283-290.

Crofts, New York. ZIMMERMAN E. H., ZIMMERMAN J. and RUSSELL C. D.

WHITMAN T. L., ZAKARAS M. and CHARDOS S. (1971) (1969) Differential effects of instruction-following

Effects of reinforcelnent and guidance procedures on behavior in retarded students instructed as a group, J. uppf. Behav. Anal. 2, 101-112.

(Received 4 August 1972)