beatleyweb.simmons.edu · Web viewFor Ariel, the tasks involved placing blocks of corresponding colors on a template. The investigator provided Suzanna and Jonah with activity packets

EFFECTS OF PRESESSION PAIRING ON COMPLIANCE 1

Running head: EFFECTS OF PRESESSION PAIRING ON COMPLIANCE

EFFECTS OF PRESESSION PAIRING ON CHALLENGING BEHAVIOR AND

ACADEMIC RESPONDING FOR CHILDREN WITH AUTISM

Dissertation

In Partial Fulfillment of the Requirements for the Degree of

Doctor of Philosophy in the Department of Behavior Analysis of Simmons College

By:

Amanda N. Kelly, M.S.Ed, BCBA

*****

Simmons College

April 24, 2013

Dissertation Committee:

Dr. Ronald Allen, AdvisorDr. Judah AxeDr. Russell Maguire

Approved By:

___________________________________

Ronald Allen, Advisor

College of Arts and Sciences Graduate Studies



ABSTRACT

As a result of pairing with work demands, the presence of an instructor may signal a worsening

set of aversive conditions (i.e., reflexive conditioned motivating operation; CMO-R). The

purpose of this study was to examine the effects of presession pairing of the instructor with

preferred stimuli on disruptive behavior and correct academic responding. Functional analyses

indicated a primary or combined escape function for three children diagnosed with autism. For

participants with multiply-maintained challenging behavior, attention was a co-occurring

function. Preference assessments were completed to identify preferred items for each participant.

The discrete-trial-training used to teach math and spelling skills was the same across the baseline

and presession pairing sessions. In the presession pairing phase, the investigator engaged

playfully with the participant with a highly preferred item for 2-4 minutes immediately before

the instructional session. Results in a multiple baseline across participants design indicated that

presession pairing was effective in reducing disruptive behaviors and increasing inter-response

times of challenging behaviors. Results also indicated that presession pairing had little effect

(either positive or negative) on the percentage of correct academic responses. In the context of

discrete trial teaching, presession pairing was an effective antecedent procedure that increased

opportunities for reinforcement and reduced self-injurious behavior, aggression, property

destruction, and negative statements related to task demands. When challenging behaviors

occurred in presession pairing conditions, many occurred during error correction procedures.

Future researchers should investigate the effects of errorless teaching procedures in conjunction

with presession pairing. Future researchers should also replicate presession pairing procedures


and continue investigating its mechanism by directly testing the reinforcing value of the adult

paired with strong reinforcers.

ACKNOWLEDGEMENTS

I would like to extend thanks to the participants of this study, the school district, and the

dedicated teachers and team involved in the successful execution of my dissertation –a special

thanks to Kim and Sue.

To my friends and colleagues at the SEEM Collaborative, particularly Ryan: your assistance has

been invaluable. You may never know how truly grateful I am for all that you do.

To Will, Behaviorbrain: You have taught me more than I could learn from reading a million

books. You are the coolest B.A.I.T. that I know. May you keep on growing and evolving.

Always remember: You are capable of anything you set your mind to!

To all of my friends and colleagues who encouraged and supported me throughout this

remarkable journey: I am eternally indebted to you –a special thanks to Shari, Bridget, Becca,

Molly, Matt and Robyn and to my Simmons Sisters, my second family: Nitzyah, Cathy, Aditi,

Terri, Colleen, Becky, Amanda, and Nicole.


Lastly, I would like to extend my sincerest gratitude to my parents, Joan and John Kelly and my

sister, April for helping me become who I am today. I love you.

VITA

June 10, 1981 …………………………………………..... Born – Fort Riley, Kansas

2002……………………………………………………… B.A., Elementary Education,Shepherd College, WV

2003……………………………………………………… Teacher, The New England Center for Children, Southborough, MA

2003-2005 ………………………………………………. Inclusion Facilitator, Melmark New England, Woburn, MA

2004 ……………………………………………………... ABA Certificate, University of Massachusetts, Boston, MA

2005-2006……………………………………………….. Special Ed. Teacher, North Shore Education Consortium, Beverly, MA

2006-2008 ……………………………………………… District-wide Behavior Specialist, Cambridge Public Schools, MA

2007 ……………………………………………………. M.S.Ed, Behavioral Education, Simmons College, Boston, MA

2008-2009 ……………………………………………… District-wide BCBA, Triton Regional District, Byfield, MA

2009-2010……………………………………………….. Adjunct Faculty, Antioch New England, ABA Program, Keene, NH

2010-2011……………………………………………..… Adjunct Faculty, Bay Path College, Special Education Program, Sturbridge and Longmeadow, MA

2013 (4 years)…………………………………….……… Coordinator of ABA Consultation Services, SEEM Collaborative, Stoneham, MA


2013 ……………………………………………………… Adjunct Faculty, Granite State, Special Education Program, Portsmouth, NH

PUBLICATIONS

Kelly, A. N. and Mayes, C. (Spring 2010). Don't Forget to Invite the Student! Including Students with AS in Meetings. Asperger's Association of New England (AANE), p 37-38.

Hassert, D., Kelly, A. N., Pritchard, J. T., and Cautilli, J. (2008). The Licensing of Behavior Analysts: Protecting the Profession and the Public. Journal of Early and Intensive Behavior Intervention. (September 2008).

Introduction

Children with autism often have difficulty learning through exposure to typical social

settings which can be extremely damaging to their social and academic development (Koegel,

1998; Smith, 2001). In order to address these potential deficits, children with autism generally

require explicit instruction to learn to attend to relevant stimuli (Drash & Tudor, 1993). Evidence

exists that early intensive interventions guided by behavior analytic principles produce

substantial benefits for children with autism, as outlined in comprehensive reviews (Rimland,

1994; Rogers, 1998). There have been long-term, positive effects achieved with intensive

behavioral intervention (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Smith, 1999).

Specifically, instructional procedures based on applied behavior analysis (ABA) are

recommended for children diagnosed with autism (National Research Council, 2001; Surgeon

General, 1999). In addition, over the past 30 years, several thousand published research studies

have documented the efficacy of applied behavior analysis (ABA) across a wide range of

populations, interventionists, settings, and behaviors (MADSEC, 2000; NRC, 2001; Surgeon

General, 1999). These positive effects have been successfully applied to school and community

environments, as well as to home settings (Eikseth, Smith, Jahr, & Eldevik, 2002). Cost-benefit

estimates suggest significant cost-aversion or cost-avoidance may be possible with early


intensive behavioral intervention (EIBI). This model estimates that cost savings could range

from $187,000 to $203,000 per child for ages 3-22 years, and from $656,000 to $1,082,000 per

child for ages 3-55 years (Jacobson, Mulick, & Green, 1998).

Applied behavior analysis is the science of systematically studying variables that

influence behavior (Sulzer-Azaroff, Mayer, & Wallace, 2012) and is the teaching methodology

that generates the most effective outcomes for individuals with autism (Zager, 2005). Behavior

analytic teaching procedures include strategies based on positive reinforcement to increase

academic and social skills (e.g., Jones, Feeley, & Takacs, 2007; Tarbox, Ghezzi, & Wilson,

2006), extinction to reduce challenging behavior (e.g., Neidert, Iwata, & Dozier, 2005; Waters,

Lerman, & Hovanetz, 2009), and prompting strategies to teach new skills (e.g., Fisher, Kodak, &

Moore, 2007; Kurt & Tekin-Iftar, 2008). A number of manuals have outlined these teaching

techniques (Leaf & McEachin, 1999; Lovaas, 2003; Maurice, Green & Foxx, 2001; Maurice,

Green & Luce, 1996, Sundberg & Partington 1998).

Typically, 25 to 40 hours per week of intensive behavior analytic intervention is

recommended for children with autism (Leaf & McEachin, 1999; Lord & McGee, 2001; Green,

1996; Myers & Johnson, 2007). One important component of this intensive treatment model,

and perhaps the most recognized is the use of discrete-trial-teaching, also known as discrete-trial-

training and discrete-trial-instruction (Zager, 2005). The discrete-trial-teaching (DTT) approach

is typically one-on-one instruction (Gabriels, 2002) that requires skills to be broken into small,

teachable steps (Baker, 2005; Cavendish, 2004). During DTT: 1) an instruction is presented

(e.g., an array of three picture cards with the instruction to “find the ball”) 2) a response occurs

or is prompted to occur (e.g., teacher points to the correct picture card) 3) a consequence is

delivered (e.g., token or preferred item) 4) the instructor pauses before presenting the next


instructional demand, also referred to as the inter-trial interval (Anderson, Taras, & O’Malley-

Cannon, 1996; Dib & Sturmey, 2007; Herscovitch, 2011; Smith, 2001, 2007; Zager, 2005).

Discrete-trial teaching programs have been successful in assisting with the development

of social and academic skills (Dib & Sturmey, 2007; Lafasakis & Sturmey, 2007). Correct

implementation of DTT can reduce interfering behaviors (e.g., Dib & Sturmey, 2007) because it

is an effective tool for simplifying instruction (Downs, Downs, Johansen & Fossum, 2007) and

provides students with multiple opportunities to practice skills (Zager, 2005). For some children,

DTT can serve as the catalyst for language development that the child can then continue to

expand on their own (Siegel, 2003). In addition, DTT researchers have demonstrated DTT to be

helpful for skills that have not been acquired through more naturalistic learning opportunities

(Baker, 2005).

Some critics of DTT claim that it produces rote or robotic responses; this may be true of

applications that fail to include multiple exemplars in training or neglect training in the natural

environment (Zager, 2005). As noted by Zager, when applied correctly, current behavior analytic

teaching programs rarely rely exclusively on DTT, even in early, intensive behavior intervention

(EIBI). Each variable of DTT (e.g., antecedents, behaviors, and consequences) is an appropriate

unit of analysis within the science of behavior analysis. Given the intricacies of the units of

instruction, it is imperative that educators accurately employ focusing on these discrete

instructional variables (Herscovitch, 2011). Despite some criticism, researchers demonstrate

DTT to be an effective teaching procedure because it allows children to learn skills through

explicit instruction, prompting, and reinforcement (Smith, 2001; Garfinkle & Schwartz, 2002).

Challenging Behavior


Two functions of problem behavior that may be present during DTT are escape and

attention. The intensity of DTT in EIBI programs requires many instructional demands. The

presence of these demands and the stimuli associated with them may evoke avoidance or escape

behavior for children with autism, sometimes in the form of self-injury or aggression (McComas,

Hoch, Paone, & El-Roy, 2000; McCord et al., 2001; Michael, 2000; Mildon, Moore, & Dixon,

2004) or noncompliance (Smith, 2001). Carbone, Morgenstern, Zecchin-Tirri, and Kolberg,

(2010) suggested multiple sources for the aversive aspects of educational demands including

sessions that begin with the removal of positive reinforcement/termination of preferred activity,

sessions that offer low rates of positive reinforcement to students, and situations that expose

students to frequent social disapproval. Additionally, high rates of demands, frequent learner

errors, delayed positive reinforcement, and low magnitudes of positive reinforcement are

considered aversive conditions that may be associated with teaching for children with autism

spectrum disorders (ASD) (Carbone et al.). As a result of being paired with and preceding the

presentation of work demands, the presence of the teacher, the teacher’s voice, instructional

materials, and/or actual demands may become stimuli that evoke challenging behavior.

Alternatively, challenging behavior is often more likely to occur in environments with

low levels of social contact (McGill, 1999), and evidence suggests that many varying

topographies of challenging behavior are maintained by attention from others (Carr, 1977;

Hanley, Piazza & Fisher, 1997; McGill, 1999). Naturally, behavior maintained by attention is

most likely to occur when a caregiver’s attention is diverted away from the child (Hanley et al.,

1997; Vollmer, Borrero, Wright, Van Camp, & Lalli, 2001).

Assessment of Challenging Behaviors


Skinner (1957) used the term functional analysis to indicate empirical demonstrations of

“cause-and-effect relations” between environment and behavior. Behavior analysts and

psychologists have extended the term to describe a wide range of procedures and operations that

differ from one another in many different ways (Hanley, Iwata, & McCord, 2003). In 1982,

Iwata, Dorsey, Slifer, Bauman, and Richman published the seminal article on functional analysis.

Using a multi-element design, Iwata et al. conducted functional analyses for nine participants

with diagnoses of developmental delays who exhibited self-injurious behavior. Four functional

analysis conditions were evaluated: social disapproval, academic demand, unstructured play, and

alone. Eight sessions (two per condition) were conducted each day. Each session lasted for 15

minutes. Results indicated that the occurrence of self-injury fluctuated considerably, both

between and within individuals. However, the within-subject variations were not random.

Results from this study provided empirical evidence that self-injury may be a function of

distinctive sources of reinforcement (Carr, 1977). Results of Iwata el al. (1982) revealed

several patterns (1) low levels of self-injury during unstructured play conditions, and (2) for four

participants, self-injury was greatest during the alone condition, suggesting a form of self-

stimulation as a motivational variable. For six of the nine participants, higher levels of self-

injury were reliably associated with a specific condition. For four of the six participants, self-

injury was highest during the alone condition, suggesting a form of self-stimulation as a

motivational varibale. Two participants exhibited increased self-injury during academic

instruction, suggesting that the challenging behavior functioned to terminate demands. One

participant displayed higher levels of self-injury during the social disapproval condition,

suggesting a function of attention. This study offers direct empirical supprt that self-injury may

be a function of different sources of reinforcement, an outcome that has important implications


for treatment. Since this initial examination of a functional analysis, a multitude of replications

and extensions across populations, settings and topographies of challenging behavior have been

conducted. Reviews of functional analysis methodology have suggested that functional analyses

result in a determination of behavioral function in about 94% of the cases in which they are

applied (Hanley et al. 2003).

Treatment of Challenging Behaviors

Although it may not always be possible to control the reinforcer maintaining the

behavior, it may be possible to set the occasion for desirable behavior to occur, and to

subsequently avoid the use of extinction or punishment through the use of antecedent procedures

(McComas et al., 2000). For example, if attention is delivered noncontingently, it may be

possible to satiate the individual on attention. In this scenario, attention-maintained challenging

behavior would be less likely, following the noncontingent access condition (Hanley et al.,

1997). It suggested that deprivation of attention establishes some increased motivation for

attention-maintained challenging behavior (McGill, 1999).

Noncompliance is another common challenge children with autism present (McCord et

al., 2001). Wilder et al. (2010) demonstrated that providing rationales, either before or after an

instruction, were ineffective in increasing compliance in preschool children. Additionally, visual

schedules alone were demonstrated by Waters et al. (2009) to be ineffective in reducing

challenging behavior. Although these experiements demonstrated little effect on challenging

behaviors, other manipulations of antecedent events have been shown to be effective in

decreasing occurrences of challenging behavior (McCord et al., 2001).

Behavior analytic strategies for addressing escape-motivated challenging behavior have

included functional communication training (FCT) plus extinction (Hanley, Iwata & McCord,


2003), noncontingent escape (Carr & Le Blanc, 2006) and differential reinforcement of other

behavior (DRO) (Vollmer, Iwata, Zarcone, Smith & Mazaleski, 1993).

A consequence-based teaching procedure described as effective in reducing challenging

behavior is functional communication training (FCT) plus extinction (Hanley, Iwata & McCord,

2003). Functional commnication training is an intervention that involves teaching behaviors that

are functionally equivalent to the challenging behavior. Functional communication training uses

“communicative behavior as the functionally equivalent response” (Durand & Carr, 1991, p.

252) and has been assessed as an intervention for a variety of challening behaviors. Researchers

found using FCT with behaviors such as severe aggression, self-injury and tantrums, resulted in

substanital reductions of challenging behavior (Durand & Carr). When effects of FCT-alone

were evaluated against the effects of FCT plus extinction, research showed how reinforcement of

a functionally equivalent communicative response may prevent escalation of behavior (i.e.

extinction burst) particularly when instructors were able to apply extinction to less severe

challenging behaviors (Shukla & Albin, 1996). If individuals can access similar or more dense

schedules of reinforcement with a simple communicative response, more severe topographies of

challenging behaviors may be less likely to emerge when less severe responses are placed on

extinction (Shukla & Albin). Although FCT is documented to be effective in reducing the

occurrence of challenging behaviors, it is often criticized as it sets the stage for escape from

work to become potentially strengthened as a reinforcer, while reducing the number of learning

trials presented (Carbone et al., 2010; McGill, 1999).

Though negative reinforcement plays an important role in the maintenance of challenging

behavior (Iwata, 1994), research demonstrates positive reinforcement of alternative behavior as

effective in the treatment of escape-maintained behavior (DeLeon, Neidert, Anders, &


Rodriguez-Catter, 2001). Skinner (1953) and others (McGill, 1999; Michael, 1993, 2000) have

argued that the challenge is to make work itself “motivating” and to increase opportunities for

teaching, providing increased opportunities for access to reinforcement.

Conceptual Analysis of Challenging Behavior during Demands: Motivating Operations

In recent years, the motivating operations (MOs) have been added to the conceptual

analysis of the antecedent and consequent stimuli controlling challenging behavior during

instruction. An MO is defined as a stimulus or event that (1) momentarily alters the effectiveness

of a reinforcer or punisher (in either a positive or negative direction) and (2) evokes or abates

behaviors that have led to that consequence in the past (Michael, 1993; 2000). Laraway,

Snycerski, Michael, and Poling (2003) distinguished between processes that increase or decrease

the reinforcing effects of stimuli, referring to situations that increase reinforcer effectiveness as

establishing operations (EOs) and those that decrease reinforcer effectiveness as abolishing

operations (AOs). In addition to these value-altering effects of MOs, events or stimuli increase

(evocative) or decrease (abative) the current frequency of behavior associated with a given

consequence in an effect termed behavior-altering (Laraway et al).

The difference between a discriminative stimulus (SD) and an MOs is that a SD signals the

availabilty of reinforcement, whereas MOs momentarily alter the value of reinforcement

(Michael, 1993; 2000). To be classified as an SD, the presence of a stimulus must be

accompanied by the availability of reinforcement for a particular response or group of responses

and its absence must be associated by the reduction or lack of availability of reinforcment for the

same response (Catania, 1961; Skinner, 1953). Motivating operations can be further classified as

unconditioned or conditioned (Michael, 1993).


Unconditioned motivating operations (UMOs). The value-altering and behavior-

altering effects of a stimulus or event may be learned or unlearned. If these relations are

unlearned, the MO is referred to as an Unconditioned Motivating Operation (UMO) (Michael,

1993). UMOs have a behavior-altering effect, in that they alter the current magnitude, frequency,

or latency of any behavior that has been reinforced by the stimulus that is altered in value by the

same UMO (Michael, 2005). The behavior altering effect can be either evocative or abative

(Laraway, et al., 2003). Recall that MOs alter the current reinforcing effectiveness of a stimulus,

object, or event. If these relations are unlearned, then the MO is a UMO (Michael). Michael

identified nine UMOs: five related to states of deprivation and satiation (e.g., food, water, sleep,

activity, and oygen), one related to sex (also related to deprivation and satiation, though

parameters are unclear), two UMOs related to uncomfortable temperatures (e.g., being too cold

or too warm), and a UMO consisting of an increase or decrease in painful stimulation.

Conditioned motivating operations (CMOs). Although many form of reinforcement do

not require learning histories (i.e., related to UMOs), conditioned motivating operations (CMOs)

alter the reinforcing effectiveness of othr events as a result of the individual organism’s history.

Michael (1993) has described three types of CMOs: surrogate, transitive, and reflexive. The

surrogate conditioned motivating operation (CMO-S), is developed through a correlation in time,

when the neutral event is paired with an UMO or another CMO. McGill (1999) provided the

example of seeing snow outside and putting on a sweater, without actually coming in contact

with a decrease in temperature. In one’s history, the sight of snow has been correlated with cold

temperatures and an increase in layering of clothing. Now, the site of snow may act

motivationally in a manner similar to temperature reduction.


Transitive CMOs (CMO-T) are stimuli in whose context the reinforcing or punishing

effectiveness of existing conditioned reinforcers or punishers is altered. For example, flashlights

are available in most home settings, but typically are not sought after until current lighting

becomes inadequate, as with a power failure. Unexpected darkness, is a CMO-T, that evokes

getting a flashlight. The sudden darkness is often interpreted as an SD for looking for a

flashlight. But flashlights are no more available in the dark, rather they are more valuable

(Michael, 2000). The CMO-R is a more complex relation where a stimulus precedes some form

of worsening or improvement (Michael 1993; 2000). Michael (1993) suggested that the so-

called warning stimulus in a signaled avoidance paradigm serves as an experimental analog to

the CMO-R.

Conceptual Analysis of Challenging Behavior during Demands: Signaled Avoidance

In basic research on signaled or discriminated avoidance (Hoffman, 1966), participants

are presented with discrete trials in which the presentation of an identified aversive event (e.g.,

electric shock) is reliably preceded or signaled by an extroceptive stimulus (e.g., a tone).

Typically, the occurrence of a particular response by the participant during the tone or warning

stimulus both terminates the warning stimulus and cancels the impending electric shock. Under

such contingencies, consistent avoidance responding is quickly generated and maintained.

Responding during the signaled avoidance paradigm was initially conceptualized as

respondent in nature, because the warning stimulus reliably signaled the electric shock

(Herrnstein, 1969). Using this analysis, electric shock was conceptualized as an unconditioned

stimulus (US) and the warning stimulus as a conditioned stimulus (CS). Early studies often

employed a “shuttle box” apparatus, recording running from one side of the box to the other as

the response. Running was assumed to be a conditioned response (CR) elicited by the CS


(warning stimulus), which was conceptualized as being similar to the jumping or running elicited

by the US (shock). Mowrer and Lamoreaux (1946) demonstrated that the response produced by

the warning stimulus (CS) did not have to be identical to that elicited by the electric shock (US).

Instead, they suggested that, as a result of the pairing of the warning stimulus and shock, the

warning stimulus acquired fear-eliciting properties from shock. Responses terminating the

warning stimulus were hypothesized to be negatively reinforced through the reduction of fear

(Mowrer & Lamoreaux).

This interpretation became known as the Two Factor Theory of avoidance; the two

factors being respondent conditioning forming the warning stimulus as a CS eliciting fear and

operant conditioning in the form of negative reinforcement of the “avoidance” response by the

termination of the warning stimulus and fear. Under two-factor theory what appeared to be

avoidance (reinforcement by a nonevent) was conceptualized as escape behavior from the

synchronous warning stimulus. Subsequently, Schoenfeld (1950) suggested that rather than

eliciting fear, the warning stimulus itself became aversive as a result of pairing with shock,

thereby reinforcing any response resulting in termination of the warning stimulus as well.

Michael’s conceptualization of the CMO-R follows the logic of two-factor theory in that the

CMO-R acquires aversive properties when it signals worsening conditions (i.e., is paired with

aversive events) and reinforces responding leading to its own termination (removal is

reinforcing).

Other studies have failed to support the suggestion that the warning stimulus is aversive.

For example, avoidance behavior can be shaped and maintained without extroceptive warning

stimuli (e.g., Herrnstein and Hineline, 1966; Sidman, 1953). Additionally, rats prefer signaled,

rather than comparable, unsignaled avoidance procedures. Badia, Culbertson, and Lewis (1971)


investigated the aversiveness of signaled versus unsignaled avoidance in rats by providing a

“change-over” lever in addition to the avoidance lever during comparable signaled and

unsignaled avoidance conditions. Responding on the change-over lever allowed participants to

transition between or choose conditions. Under these circumstances all participants chose

signaled over unsignaled avoidance. Thus, rather than respond to avoid or escape the warning

stimulus, lever pressing was reinforced by the presentation of the warning stimulus. Similarly,

Badia and Culbertson (1972) showed that rats chose schedules of signaled rather than unsignaled

inescapable shock. Thus, rats responded to produce warning stimuli even when no access to a

formal escape or avoidance response was available. Under the conditions described by Badia and

colleagues, the warning stimulus operates as a positive rather than negative reinforcer.

Nevertheless, despite the potential translational disconnect, several studies have employed the

conceptualization of the CMO-R in the design and interpretation of results obtained from applied

settings.

Relation of signaled avoidance and CMO-R. The concept of the CMO-R has been

particularly discussed in the interpretation of the occurrence of escape-maintained challenging

behavior during instruction. As suggested above (Carbone et al, 2010), several aspects of

instructional tasks may have aversive properties. Activities or events at the beginning of or

preceding the instructional session may serve as a signal that movement towards later stages of

the session (i.e., toward the aversive properties) is progressing (Michael 1993, 2000). Because of

this history, such activities or events may be established as a CMO-R, the removal of which

would serve as negative reinforcement (Michael, 2000). Presentation of the CMO-R is likely to

evoke challenging behavior, if those behaviors have produced removal of the CMO-R (and the

avoidance of the instructional task) in the past. The presence of a CMO-R would be suggested by


high rates of challening behavior occurring in the presence of stimuli just prior to the presenation

of instructional demands, suggesting the function of the challenging behavior is to escape the

stimuli preceding the demands (McGill, 1999). Failure to recognize the role of the CMO-R in the

development of avoidance and escape behaviors during instruction of children with autism may

also reduce the likelihood that the necessary instructional methods for counteracting its effects

will be implemented (Carbone et al., 2010). As noted earlier, the effects of escape-extinction

may reduce challenging behavior, although the aversive conditions may remain. This would

only be practical if the aversive nature of the demands could not be reduced (Michael, 2000).

Conversely, behaviors that result in the onset events signaling the improving of

conditions are established as positive reinforcers. The presence of the CMO-R for an improving

set of conditions, would also be illustrated by high rates of appropriate behavior occuring, just

prior to the presentation of this type of stimulus event. However, the current discussion focuses

on CMO-Rs that signal the worsening of conditions.

Treatments that Alter the CMO-R

Hanley, Iwata, and McCord (2003) noted that “…by identifying contingencies that

currently maintain challenging behavior, relevant consequences and their associated

discriminative stimuli (SD s) and establishing operations (EOs) may be altered to reduce

challening behavior” (p. 147). Similarly, in situations in which consequence-based strategies are

difficult to arrange, practitioners may be more likely to obtain an effect if they design

interventions aimed at reducing the evocative effects of the suspected MO for challenging

behavior (O’Reilly et al., 2007; Rispoli, O’Reilly, Land, Machalicek, Davis, Lancioni, and

Sigafoos, 2011). Numerous alterations of instructional tasks have been demonstrated to reduce

the occurrence of challenging behavior. Such alterations have included errorless instruction


(Ebanks & Fisher, 2003; Weeks & Gaylord-Ross, 1981), stimulus demand fading (DeLeon et al.,

2001; Lalli et al., 1999), interspersing events such as storytelling and social comments within

instructional tasks (Neef et al., 1980). increasing pacing of instruction (Carnine, 1976; Dyer et

al., 1982; Smith, Iwata, Goh, & Shore, 1995) and adjusting session duration (Dunlap et al.,

1981). Negatively reinforced behavior is less likely to occur during activities that are easily

completed than those that require higher response efforts (Cameron, Ainsleigh, & Bird, 1992). In

each of these studies, the evocative characteristics of stimuli associated with the onset of

instructional demands (CMO-R) were abolished by manipulations designed to reduce the

aversive aspects of the tasks themselves.

Weeks and Gaylord-Ross (1981) implemented errorless instruction in the assessment of

the effect of task difficulty on challenging behavior for three children with developmental

delays. Errorless learning (Terrace, 1966) refers to procedures in which instructional stimuli are

faded gradually in and out so that stimulus control is established with an insignificant amount of

errors. Weeks and Gaylord-Ross found that simple discrimination tasks produced few

challenging behaviors, whereas more difficult tasks resulted in high rates of challenging

behavior. In addition, simple discrimination tasks, modified through errorless learning

procedures, led to fewer errors and lower rate of challenging behaviors. Weeks and Gaylord-

Ross suggested that errors made during task performance exerted a strong influence on other

behaviors, and recommended further examining the relationship between antecedent events and

changes in behavior

Similarly, antecedent manipulations not involving alterations of the instructional task

have also demonstrated effectiveness for increasing general compliance and decreasing

challenging behavior. Such manipulations include noncontingent reinforcement (NCR) (Vollmer


et al., 1993), high-probability (high-p) request sequence (Lee, 2003; Mace & Belfiore, 1990),

neutralizing routines (Horner et al., 1997), and presession pairing (Barbera, 2007; Sundberg &

Partington, 1998).

Noncontingent reinforcement is the time-based or response-independent delivery of

stimuli with known reinforcing properties. Vollmer et al. (1993) compared the effects of

experimenter-delivered attention under schedules of NCR and differential reinforcement of Other

(DRO) behavior in the treatment of attention-maintined self-injurious behavior (SIB) for three

adult females. Both schedules comparably reduced challenging behavior, however several

advantages of NCR over DRO were noted including attentuation of extinction-induced behavior,

a higher rate of reinforcer delivery, and ease of implementation. Noted limitations of NCR

treatment included possible accidental or adventitious reinforcement via response independent

reinforcement sand failure to promote alternative, adaptive behavior. Additionally, the effects of

NCR are, by definition, temporary in nature.

Some interventions involve the use of procedures that explicitly precede task demands.

For example, the likelihood that a challenging behavior will occur following a particular

demand may be reduced by first presenting demands with which the individual is highly likely

to comply (Mace & Belfiore, 1990). The high-p procedure is an antecedent procedure

consisting of a rapid series of short, easy requests delivered just prior to a request that in the

past has occasioned challenging behaviors. In a meta-analysis by Lee (2005), the high-p request

sequence was determined to be an effective method to increase compliance. Similarly, Horner,

Day, and Day (1997) demonstrated a reduction in challenging behaviors when demands were

preceded by activities designed to counter the MOs associated with reinforcement for

challenging behavior previously identified through functional analysis. This operation was


trermed a neutralizing routine. One such routine may involve having students engage in

preferred activities prior to an instructional demand (Carbone et al., 2010; Horner et al.)

Presession Pairing. Sundberg and Partington (1998) suggested that if therapists first

freely deliver preferred items as a way to condition the themselves as a reinforcer, challenging

behaviors are less likely to occur. In contrast to the effects of task manipulations described

above, the effects of manipulations preceding task may be conceptualized as abolishing CMO-

R directly by pairing them directly with a higher rate of reinforcement.

For individuals with autism, challenging behaviors during instruction may occur when

either demands are too high (e.g., require excessive effort) or reinforcement (rate, magnitude,

quality) is too low (Barbera, 2009). When challenging behaviors are evoked in the presence of

a therapist/teacher, the therapist/teacher may have placed or increased demands too abruptly

(Barbera). To counteract the situation, Barbera (2007; 2009) recommends in her practitioner

manual that therapists pair themselves, the materials, and the environment with added stimuli

identified as reinforcers. Presession pairing is defined as a therapist freely delivering preferred

items or activities to a child and engaging with the child in a fun way before presenting

academic demands (Barbera, 2007, 2009; Sundberg & Partington, 1998). Pairing allows the

therapist to associate herself with preferred items and possibly decrease escape-motivated

behaviors during the instructional session. If a child is not running towards the therapist,

therapy room, and/or the materials, pairing most likely needs to be addressed (Barbera, 2009).

In the context of managing challenging behavior, presession access to attention alters

behavior in the teaching session for individuals whose behavior is attention-maintained

(McComas, Thompson, & Johnson, 2003; O’Reilly, Edrisinha, Sigafoos, Lancioni, Machalicek,

& Antonucci, 2007; Roantree & Kennedy, 2006). Similarly, O’Reilly (1999) demonstrated the


effects of manipulating access to attention prior to attention FA sessions. When O’Reilly

withheld attention one hour prior to the attention condition, an increase in challenging behavior

occurred during the session. When he provided attention one hour prior to the attention FA

session, less challenging behaviors occurred. In a follow-up study, Berg et al. (2000) evaluated

ordering effects of FA conditions on challenging behavior. An increase in challenging behaviors

occurred when escape and alone FA sessions preceded the attention condition. Conversely, a

decrease in challenging behaviors occurred when free play sessions preceded the attention FA

condition.

McComas et al. (2003) replicated results of O’Reilly (1999) and Berg (2000). However

these studies did not evaluate the effects of pre-session access to attention on escape-maintained

challenging behavior. O’Reilly et al. (2007) demonstrated higher levels of attention-maintained

challenging behavior occurring during alone and attention conditions when preceded by the no-

attention presession condition of an FA. Similar effects were not obtained for escape-maintained

challenging behavior. These results were interpreted as demonstrating the behavior-altering

effects of the motivating operation (MO); specifically, presession access or restriction seemed to

influence behavior during the alone condition when both discriminative and reinforcing stimuli

were absent, suggesting a direct effect of the MO on the behavior.

Purpose

Research evaluating the effects of presession pairing on performance during academic

instruction, DTT specifically, has not been reported. Additionally, little is known about the

effects of presession pairing on escape-maintained challenging behavior. The purpose of the

present study was to examine the effects of presession pairing of the instructor with preferred


stimuli on challenging behaviors (either escape- or attention-maintained) and accurate academic

responses for children with autism during DTT sessions.

Research Questions

Specially, the present study evaluated:

1. What effect does presession pairing have on challenging behaviors for children with

autism during discrete-trial-teaching?

2. What effect does presession pairing have on inter-response time (IRT) (i.e., time between

each occurrence of challenging behavior) for, children with autism during discrete-trial-

teaching?

3. What effect does presession pairing have on percentage of accurate academic responding

for children with autism during discrete-trial-teaching?

4. To what extent does the function of challenging behavior (escape or attention) alter the

effects of presession pairing for children with autism during discrete-trial-teaching?


METHOD

Participants

The investigator forwarded packets explaining the study as well as letters of consent to

families whose children enrolled in one of five Functional Communication programs within a

public elementary school (see Appendix A for endorsement and consent letters). The Functional

Communication programs are substantially separate classrooms that provide specifically

designed instruction for children with autism spectrum disorders (ASD) or other related

disabilities. Of the 22 consent forms distributed, 15 families returned consents to the investigator.

In order to select individuals to participants in the study, the investigator conducted brief

interviews, as well as record reviews and brief observations with parents and teachers of

prospective participants. The investigator excluded individuals who had a history with the

experimenter and individuals who did not reliably exhibit challenging behaviors during the

screening period. Participants recruited for this study reportedly exhibited attention- or escape-

maintained challenging behaviors surrounding instructional situations. Based on these criteria,

the investigator selected 5 participants from the 3rd- to 5th-grade Functional Communication

program, ages 9-11 years old, for inclusion in the study. The investigator discontinued two

participants from the study due to an absence of challenging behaviors during baseline

conditions for one participant and unstable responding during baseline related to medication

changes for the second participant.

Ariel, a 9-year-old female diagnosed with autism, received nearly all of her instruction in

the self-contained Functional Communication classroom. Ariel communicated in the form of

gesturing or through a limited repertoire of picture exchange (e.g., help, all done, more)

primarily in response to yes/no questions. As stated in her 2012-2013 Individualized Education


Program (IEP), the Assessment of Basic Language and Learning Skills (ABLLS) was completed

as part of Ariel’s three year re-evaluation in January 2012. The results, as summarized on the

IEP, suggested receptive language, motor imitation, cooperation and reinforcer effectiveness, and

fine motor skills to be relative areas of strength. Results from the Wechsler Nonverbal Scale of

Ability (WNV), as summarized in Ariel’s IEP indicated significant delays in development,

particularly in language processing, communication, and social skills. The summary of results

(direct scores were not available) indicated difficulty in performance impacted by reduced

attention to adult-directed tasks and requests, difficulty expressing needs, and issues surrounding

the regulation of emotions. Goals on Ariel’s IEP included toileting, meal expansion,

communication and reduction of challenging behaviors. Challenging behaviors for Ariel

included self-injury; bites to wrist, face slaps, or table hits, as well as high-pitched crying.

Jonah, an 11-year-old male diagnosed with autism, received instruction in both the self-

contained classroom and his general education 5th-grade classroom. As reported in his 2011-

2012 IEP, strengths for Jonah included reading, following directions, and identifying

items/concepts and explaining how they go together. Educational testing, reported on his IEP,

indicated that Jonah’s overall academic ability was within the average range. Areas of strength

included decoding, numerical operations, math reasoning, and spelling. Areas of difficulty

included reading comprehension, written expression, and oral expression. Goals on Jonah’s IEP

included social interactions, academic organization, reading, written language and reduction of

challenging behaviors. Challenging behaviors for Jonah included task refusal (e.g., pushing

materials away), non-responsiveness (e.g., sitting still), and negative statements related to the

task including swearing. Jonah engaged in more intense challenging behaviors with his


classroom teachers, including aggression, property destruction, and leaving the designated space.

However, behaviors at this intensity did not occur during the study.

Suzanna, an 11-year-old female diagnosed with autism, received her instruction in both

the self-contained classroom and the general education, 5th-grade classroom. Strengths for

Suzanna included flexibility with schedule changes and engagement with peers. As reported in

educational testing as part of her 2011-2012 IEP, Suzanna scored in the above average range in

word reading, pseudo-word decoding, and spelling. She scored in the high average range in oral

reading in fluency and accuracy and in the average range for listening comprehension, reading

comprehension, math problem solving, sentence composition, numerical operations and math

multiplication fluency. On psychological testing, also reported in her IEP, Suzanna scored in the

average range in the verbal comprehension, perceptual reasoning, and working memory domains.

She performed in the borderline range in the processing speed domain. As reported in her IEP,

Suzanna’s limited understanding of feelings and what others are attempting to communicate

suggested difficulty using descriptive language to explain how to solve a problem, communicate

wants and needs, persuade someone, and advocate for herself. Goals on Suzanna’s 2011-2012

IEP included speech and language, written language, academic organization, and reduction of

challenging behaviors. Challenging behaviors for Suzanna included task refusal (e.g., pushing

materials away), non-responsiveness (e.g., sitting still), negative statements related to the task,

and property destruction (e.g., ripping tissues, slamming writing boards, pressing hard on marker

tips).

Setting and Materials

The investigator conducted instructional sessions in an office space, approximately 10 x

15 feet, in the participants’ school setting. The room contained at two chairs, a table, and a break


space (identified by a rug on the floor), as well as materials necessary for instructional sessions.

For Ariel, instructional materials included letter tiles and picture cards. In the novel task

condition, instructional materials included manipulatives and flashcards. For Jonah and

Suzanna, materials included flashcards with fractions, dry erase boards and markers. For all

participants a timer, token board and tokens were present. Prior to delivery, tokens and preferred

items were out of view of the participants.

Dependent Variables

In the functional analysis, the dependent variable was the percentage of intervals with

challenging behavior for Ariel, and the frequency of challenging behavior for Jonah and

Suzanna. In the evaluation of presession pairing, the dependent variables were the percentage of

intervals of challenging behavior and the percentage of correct academic responses, and the

interresponse time (IRT) of challenging behaviors. Challenging behaviors were individually

defined for each participant. For all participants, the investigator reported challenging behavior

as a composite of multiple topographies. Correct responses were defined as accurately

responding within 5 seconds for Ariel and within 10 seconds for Jonah and Suzanna.

Ariel’s challenging behaviors included crying, defined as high-pitched vocalizations

emitted for 3 consecutive seconds or longer, as well as high-pitched vocalizations persisting for

10 seconds, with no more than 1 second between occurrences. Ariel’s challenges also included

self-injurious behaviors consisting of bites to the wrist, slaps to the face from a distance of 6

inches or greater, and elbow-to-table hits, also from a distance of 6 inches or greater. Ariel’s

academic task involved the presentation of a picture card of the consonant-vowel-consonant (C-

V-C) word that the investigator sounded out phonetically. Correct academic responding,

described as word construction, required Ariel to accurately spell the stated word, using the A-Z


letter tiles provided. If Ariel provided an expectant look or produced a delay in responding, the

investigator sounded out the word again. If Ariel constructed the word accurately, after the

repetition, the investigator considered the response as correct.

Jonah’s challenging behaviors included non-responsiveness when presented with

demands (for 10 seconds or longer), task refusal (i.e., moving the materials or himself away),

negative statements related to the task (e.g., “this is stupid”), and swearing. Jonah’s academic

task involved the presentation of fractions on a flashcard. The investigator asked Jonah to

reduce, add, or subtract the fraction(s) provided. The investigator defined accurate, academic

responding for Jonah as writing the accurate numerical solutions on a dry erase board, without

prompting or instructor-delivered corrections.

Suzanna’s challenging behaviors included non-responsiveness when presented with

demands (10 seconds or longer), task refusal (i.e., moving the materials or herself away),

negative statements related to the task (e.g., “I hate this”), and property destruction (e.g., ripping

tissues, breaking tips on markers). Suzanna’s academic task involved the presentation of

fractions on a flashcard. Like Jonah, the investigator asked Suzanna to reduce, add, or subtract

the fraction(s). The investigator defined correct academic responding for Suzanna as writing the

accurate numerical solutions on a dry erase board without prompting or instructor-delivered

corrections.

Response Measurement and Interobserver Agreement

In the functional analysis, the investigator measured challenging behavior as the

percentage of intervals with challenging behavior for Ariel, and the frequency of challenging

behavior for Jonah and Suzanna. During baseline and pairing treatment sessions, the

investigator used 10-second partial interval recording to measure the percentage of intervals


with challenging behaviors. The investigator calculated the percentage of correct academic

responding by recording the frequency of demands delivered, dividing by the frequency of

accurate responses emitted, and

multiplying by 100%.

Two observers assessed interobserver agreement (IOA) by watching video-recorded

sessions and noting intervals when participants emitted challenging behaviors, when the

investigator presented demands, and when participants emitted correct responses. The

investigator calculated IOA by dividing the number of intervals with agreements by the number

of intervals with agreements plus disagreements and multiplying by 100%. Interobserver

agreement was collected on 33% of sessions across participants and conditions and averaged

97.6% (SD=2.8).

Experimental Design

The investigator used a multi-element design to evaluate the effects of four functional

analysis conditions for each participant (Cooper, Heron, & Heward, 2007). Specifically, the

investigator followed procedures as described by (Wilder, Masuda, O’Connor, & Baham,

2001). Modifications to the assessment procedures included the addition of work-related

materials (e.g., blocks, number cards, letter tiles, flashcards) to each of the conditions assessed,

similar to procedures described by Tiger, Hanley, and Bessette (2006).

To assess the effectiveness of the presession pairing, a multiple baseline (MBL) across

participants design was employed (Cooper et al., 2007). In the baseline condition, instructional

sessions occurred without presession pairing. In the presession pairing condition, the

investigator spent 2-4 minutes engaged with a preferred activity with the participant preceding

the instructional session. On average, the investigator conducted sessions three times per week,


as long as needed to establish steady responding. Following the presession pairing condition,

the investigator introduced a novel task to assess for generalization of results to a second

academic task. The investigator conducted a follow-up, return to baseline session for Ariel to

evaluate the maintenance of the effect.

Independent Variable

The experimental condition involved the investigator delivering highly preferred

activities and/or interactions (identified through a brief free operant preference assessment) for 2-

4 minutes, prior to introduction of instructional demands. The investigator allowed for a natural

ending to the pairing activities (e.g., end of song, level on game). Therefore, the amount of time

for the pairing varied, depending on the activity.

Procedures

Functional Analysis

General procedures. Prior to conducting a functional analysis (FA), the investigator

generated hypotheses about the maintaining functions of challenging behavior for each

participant from historical data and completion of indirect methods of assessment. The

investigator then conducted a brief FA with each participant to identify possible maintaining

functions of challenging behavior. Procedures were based on Wilder et al. (2001). The

investigator conducted two 10-minute sessions of each condition: control, attention, alone, and

demand. However, the investigator ran the attention and demand conditions three times with

Jonah due to inconsistent results within the first two sessions.

A colored square taped to the door and to the corner of each table in separate rooms was

correlated with each condition (office: green/control; speech office: blue/alone; empty

classroom: yellow/attention; conference room: red/demand). Modifications to the assessment


procedures included the addition of work related materials (e.g., blocks, number cards, letter

tiles, flashcards) to each of the conditions assessed, similar to procedures described by Tiger,

Hanley, and Bessette (2006). The investigator included work-related materials in all assessment

conditions to 1) simulate situations reported to evoke challenging behavior and 2) evaluate the

effects of the presence of work-related materials on challenging behavior in the absence of

teacher demands.

Condition-specific procedures. The attention condition involved the investigator

sitting across from the student without making eye contact while the student completed

independent, mastered work tasks. For Ariel, the tasks involved placing blocks of

corresponding colors on a template. The investigator provided Suzanna and Jonah with activity

packets that consisted of word finds, crosswords, and activities with word banks. The

investigator responded to appropriate questions or statements with one-word answers. When

challenging behaviors occurred, the investigator made eye contact, leaned forward, and made a

statement related to the behavior (e.g., “Stop it. Put your hands down. No hitting”).

The control condition involved a familiar teaching staff person sitting across from the

participant while asking the participant questions about conversational topics of interest (e.g.,

upcoming events). The teaching staff responded to appropriate interactions (e.g., responses to

questions, bids for attention) with complete sentences and eye contact. Upon the occurrence of

aberrant behavior, the staff withdrew eye contact and did not speak. The investigator placed

work materials off to the side of where the therapist and each participant sat.

In the alone condition, the student sat unaccompanied in a therapy room, with work

materials placed on a table in the room. The investigator refrained from providing any

programmed consequences upon the occurrence of targeted behavior. The investigator


monitored participants from a window in the door, which was too high for participants to see

through.

In the demand condition, the investigator required the participant to perform a variety of

instructional demands. The investigator responded to appropriate behaviors (e.g., gestures

toward items) with brief answers or statements. When the participant requested assistance, the

investigator provided support using a least-to-most prompting hierarchy. If a target behavior

occurred, the investigator stated, “Okay, this may be too hard for you. Take a break.” Upon

occurrence of the challenging behavior, the investigator provided a 30-second break from work

demands.

Preference Assessments

Brief free operant preference assessment. Prior to implementation of the experimental

phases, the investigator interviewed the participants’ parents and/or teachers to identify a pool of

at least 10 preferred items or activities. The investigator obtained a list of potential preferences

and conducted a brief free operant preference assessment, consistent with the procedures

outlined by Roane, Vollmer, Ringdahl, and Marcus (1998). The preference assessment began

with a sampling session, followed by a 5-minute free operant assessment. For the sampling

session, a behavior specialist placed the participant’s hand on the items, named the items, or

modeled appropriate manipulation of the item. After each participant sampled the items, the

behavior specialist escorted the participant from the assessment area. After a brief (1-2 minute)

absence from access to the items, the participant reentered the area. With the items arranged in a

circle on a table, the participant could manipulate any item or none at all; the behavior specialist

left all items on the table during the 5-minute session. The investigator videotaped all sessions

for scoring later. The investigator used a 10-second partial-interval recording procedure to score


the percentage of intervals the participants spent manipulating each item. Based on the partial-

interval recording system, the participants could manipulate multiple stimuli during a given

interval. The investigator selected the top 2-3 highly preferred items for use in the baseline and

treatment phases.

Paired-choice preference assessment. The brief free operant preference assessment did

not adequately identify sufficient preferences for Suzanna. After the special education teacher

demonstrated proficiency with procedures, she conducted a paired-choice preference assessment

with Suzanna. The special education teacher ruled out conducting a multiple-stimulus without

replacement (MSWO) because removing items would likely agitate Suzanna. The special

education teacher conducted a paired-choice preference assessment similar to the procedures

outlined by Fisher et al. (1992). During the assessment, the teacher paired six stimuli, at least

once with every other stimulus, in a randomized order, for 60 stimulus-pair presentations. For

each trial, the teacher placed items approximately 6 inches in front of the participant. The

special education teacher provided Suzanna access to the selected item for 10 seconds, while

removing the second item. The special education teacher blocked responding when Suzanna

approached both stimuli simultaneously. If Suzanna refrained from selecting an item

independently, her special education teacher prompted her to sample each for 5 seconds. After

sampling, the teacher placed both stimuli in front of Suzanna. Approaching the item resulted in

access for 10 seconds, while the teacher removed the other item. If Suzanna did not approach

either item, the teacher removed both items and presented the next trial.

General Teaching Procedures

Prior to each participant entering the room, the investigator aligned the video camera and

pressed record. In every session, upon entering the room, the investigator cued the participant to


an identified break space on a rug on the floor, and provided access to neutral or slightly-

preferred toys, activities, or games (i.e., items selected 10%-30% of the time during the

preference assessments). The participant accessed the items for 3-4 minutes prior to the

instruction, “Come here.” The investigator responded to appropriate questions or statements

from the participant with one-word answers. For example, if Suzanna asked “Did you know that

we have an assembly today” the investigator responded with “Oh” or “Yeah” or “No”.

During instruction, the participant and the investigator sat at a table with two chairs,

approximately 2-3 feet apart. The investigator stored all instructional materials (data sheets,

pens, timer, flashcards, picture cards, tokens) and preferred tangible (e.g., toy car, ball) or edible

items (e.g., little pieces of candy, potato chips, raisins) in plastic bins with lids, out of sight of the

participants. Before delivering instructions, the investigator placed the academic materials and

token board on the table in front of the participant.

After setting a 5-minute timer, the investigator placed the materials on the table and

stated a direction (e.g., “Do this,” “Reduce,” “Spell”) while presenting corresponding materials.

For Ariel, the investigator presented a picture card and sounded out the word; Ariel used letter

tiles to construct words. For Jonah and Suzanna, the investigator presented a flashcard with a

fraction (e.g., 15/30) and instructed them to “Reduce,” or provided a flashcard with an equation

(e.g., 2/4 + 3/4) and instructed them to “Solve.” Jonah and Suzanna used dry erase boards and

markers to construct their responses. They were provided with tissues for erasing their answers

between trials.

For correct responses, the investigator provided positive social praise (e.g., “That’s

right,” “Way to go”) and a round, yellow token to the participant. Once participants obtained five

tokens velcroed on the token board, the investigator paused the timer and allowed him or her to


exchange for a moderately preferred item (i.e., items identified through individual preference

assessments presented in Table 1). After consumption of the edible or 30-seconds with

tangibles, the investigator removed the item, reset the timer, and presented the next instruction.

For incorrect responses, the investigator stated, “That’s not right, let’s try this together,”

re-presented the instruction, and modeled the correct response. For Ariel, the investigator held up

a picture card, stated the word, “sun,” sounded the word out, “s-uh-n,” and then placed the

corresponding letter tiles in the correct order (s-u-n). For Jonah and Suzanna, the investigator

held up the flashcard and wrote and stated aloud the steps for solving the equation. The

participants imitated the model. The investigator refrained from providing a token and presented

the next instruction. When the 5-minute timer sounded, the investigator told the participant it

was time to go back to class. The investigator stopped the timer, but allowed the participant to

continue working if he or she was in the middle of constructing a response when the timer

sounded. At the end of each session, the behavior specialist escorted the participant back to

class.

Baseline

Once seated in the designated chair at the table, the investigator instructed the participant

to, “Tell me what you want to earn,” while holding up preferred objects or pictures representing

those items. Once a participant selected, the investigator put the item aside and started the 5-

minute session timer (see general teaching procedures).

Presession Pairing

The investigator started each session with the direction to “Come here” while gesturing to

the table. Once the participant sat in the designated chair at the table, the investigator stated,

“Tell me what you want to play with” or “Tell me what you want to talk about,” while holding


up preferred objects (identified through preference assessment, see Table 1) or pictures

representing those items. Once the participant selected an item, the investigator set a timer, for 2

minutes. For Ariel, highly requested items were music (Lady Gaga, Rihanna, Katy Perry),

Angry Birds™, and playing with a string of beads. Jonah often selected playing games on the

iPad™ (Plants versus Zombies™, Fruit Ninja™). Suzanna often selected bouncing, rolling or

catching a ball as well as discussion or engagement with laminated Mario™ characters.

During the time prior to the presentation of academic demands, the instructor playfully

engaged with the participant in the self-selected, preferred activity (e.g., ball, iPad™) or

conversational exchange (e.g., preferred topics, singing songs, etc.). When Ariel selected the

string of beads, the investigator would give her the string but would keep the bowl of beads.

Beads were freely offered to Ariel (she did not have to work for them). On some occasions,

Ariel would accept the bead and thread the string though it. On other occasions, she would offer

the string to the investigator who would thread the string through before handing back to Ariel.

The investigator did not require individuals to request or “earn” the presession activities. The

preferred activities were given to the participants for “free.” During presession pairing, the

investigator spoke to each participant, but did not expect him/her to talk back (e.g., “This is fun”

“I really like playing this game”). If the participant selected to listen to music, the investigator

sang and danced along, if the participant was also doing so. If the participant requested to

change activities, the investigator honored these requests. For example, when Jonah asked to

switch to a single player game on the iPad, the investigator allowed it, and shifted the activity

from playing with Jonah to commenting on the game Jonah played individually (e.g., “Oh, watch

out!” “Good one” “Man, you are talented” “I bet you can’t beat my high score”).


The investigator allowed for a natural end to the pairing activities by allowing

participants to hear the rest of a song or complete the level on a game; therefore, the amount of

time for pairing ranged between 2-4 minutes, depending on the activity selected. When the

activity ended, or at the end of two minutes, whichever occurred second, the investigator

requested the preferred item from the participant, removed the item at a natural transition and

immediately presented the first academic instruction (see general procedures section). For

example, Suzanna often selected to roll and bounce a ball and to play catch with the investigator

during the presession pairing period. Rather than reaching out and removing the ball from

Suzanna, the investigator would wait until the ball was rolled to her. The investigator then

caught the ball and placed it in a bin next to the table, before presenting instruction.

Table 1. Procedures for general teaching and presession pairing conditions.


Procedural Integrity

An observer with previous behavior analytic training collected data on the procedural

integrity of interactions during baseline and pairing conditions via a task analysis for both

baseline and pairing conditions. The trained observer reviewed recordings for all three

participants and recorded whether the investigator completed the steps as written or whether the

investigator added, omitted, or completed steps out of order (for DTT and pairing conditions).

The observer assessed integrity on 30% of sessions, which averaged 98.5% (SD=1.1)

Social Validity

When assessing the social significance of treatments, it is important to consider that

individuals may be satisfied or dissatisfied with a) the behavior targeted for change b) the

amount of change, or c) the treatment process itself (Cooper et al., 2007; Foster & Mash, 1999;

Schwartz & Baer, 1991). To assess the social validity of the procedures, the investigator

conducted semi-structured interviews with a sample of school personnel involved or impacted

by the study. Specifically, the investigator conducted interviews with the behavior specialist,

the special education classroom teacher, a paraprofessional in the classroom, the speech and

language pathologist, and the principal. In addition, the investigator interviewed two of the

three participants in regards to their opinions regarding the procedures of the study. These

respondents commented in regards to their opinion on the goals, procedures, and outcomes of

the study. The investigator conducted interviews to assess the teachers’ and administrators’

perceptions of the relevance of the questions being investigated, the ease of implementation,

and the degree of satisfaction with procedures and results.



RESULTS

Ariel

Functional Analysis

Figure 1 shows the results of the functional analysis for each of the participants. For

Ariel, the percentage of intervals of SIB and crying were highest in the demand condition (M =

90%, SD = 0) relative to the low, decreasing trend in the control condition (M = 5%, SD =

3.53). SIB and crying were not observed during the attention and alone conditions (M = 0%).

Ariel engaged in high levels of SIB and crying during the demand condition, suggesting that

her behaviors were sensitive to escape as a reinforcer.


Figure 1. Functional analyses for each of the three participants. Ariel’s behaviors are reported as percentage of challenging behaviors (partial interval recording; 10 second intervals) due to the high frequency of self-injurious behavior. Challenging behaviors for Jonah and Suzanna are reported as frequency of occurrence.


Preference Assessment

The results of the brief free operant preference assessment for each participant are

displayed in Table 2. Top ranking items for Ariel were playing with beads on a string (77%),

listening to music on the iPad™ (73%), interacting with a familiar adult (10%), and playing

with a spiky ball (7%).

Table 2. Items selected during brief free operant preference assessment when run for each participant. The numbers in parentheses indicate the number of 10-second intervals (out of 30) in which the item was selected/manipulated.

Challenging Behaviors

In baseline, the investigator collected data on the percentage of 10-second intervals

containing challenging behaviors, using a partial interval recording system (Figure 2). For

Ariel, challenging behaviors occurred at a steady level (M = 50%, SD = 12.51). In baseline,

correct responses for Ariel were low (M = 5%, SD = 8.5). The investigator first implemented

presession pairing with Ariel, while the other two participants remained in baseline. During

presession pairing sessions, when presented with highly preferred materials, Ariel selected the

string of beads and games on the iPad™ (Angry Birds™) as well as music and dancing. In the

first treatment session, Ariel’s percentage of challenging behavior decreased from 60% in the

previous baseline session to near 0%. Ariel’s percentage of challenging behavior remained low


(M = 9.3%, SD = 7.24), with the exception of the fourth pairing session. During this session,

behavior returned to elevated baseline levels (70%). It should be noted that this session

occurred on a Monday following surgery, two days prior. The inter-response time (IRT)

between challenging behaviors increased from 2.5 seconds in baseline to an average of 22

seconds during presession pairing sessions. The investigator evaluated the effects of presession

pairing using a novel task. During this condition, Ariel’s percentage of challenging behavior

remained at 0%. The investigator conducted a follow-up session with Ariel five months post

treatment. During this one session, the investigator interacted with Ariel consistent with

baseline procedures previously described. During this follow-up session, Ariel exhibited

challenging behaviors in one of the 30 (3%) 10-second intervals observed.

Academic Responding

The percentage of accurate academic responses across conditions is shown in Figure 3

for each participant. For Ariel, correct responding during presession pairing sessions reflects a

slight increase (M = 18.1%, SD = 26.8) when compared to baseline levels. However, correct

responding during the novel task probe increased dramatically (70%). The investigator

conducted a follow-up session with Ariel five months post treatment. Accurate academic

responding occurred 1 out of 6 (16%) opportunities.


Figure 2. The percentage of 10-second intervals in which challenging behaviors occurred across baseline and treatment and when a novel task was presented, as well as a follow up session (Ariel).


Figure 3. The percentage of accurate, academic responding across baseline and treatment and experimental conditions for each participant.


Figure 4. These graphic displays depict average inter-response time (IRT) measures for challenging behaviors across all three participants.


Jonah

Functional Analysis

Levels of challenging behaviors were highest in the attention condition (M = 9, SD =

3.0) and in the demand condition (M = 5, SD = 1.41; Figure 1). Challenging behaviors did not

occur during the control and alone conditions. Jonah engaged in challenging behaviors the

most during the attention condition, suggesting that his behaviors were maintained primarily by

attention. Due to an elevated occurrence of challenging behavior in the demand condition,

relative to the control and alone conditions, it is likely that Jonah’s behaviors were also

sensitive to escape as a reinforcer.


For Jonah, highly preferred items (Table 2), as indicated by the brief free operant

preference assessment, included interaction with a familiar adult (100%), playing the “Who

Wants to be a Millionaire™” board game (67%), and eating Starbursts™ (17%) and yogurt

raisins (7%).


Baseline data for Jonah’s challenging behaviors indicate a steep, upward slope during

baseline (M = 42 %, SD = 16.33; Figure 2). The time between instances of challenging

behavior averaged 19 seconds in baseline (Figure 3). Due to a steady increase in the percentage

of occurrence and intensity of challenging behaviors, the intervention was implemented with

Jonah after only one session with Ariel. As reflected in Table 2, during presession pairing

sessions, when presented with highly preferred materials, Jonah selected games on the iPad™

(Fruit Ninja™, Plants versus Zombies™). In the first treatment session, Jonah’s percentage of

challenging behavior decreased from 70% in the previous baseline session to 10% (Figure 2).


Percentage of challenging behaviors remained low for the remainder of the presession pairing

condition (M = 7.1%, SD = 5.79). The inter-response time (IRT) between challenging

behaviors increased from 19 seconds in baseline to an average of 31 seconds during presession

pairing sessions. Effects of presession pairing during a novel academic task involving the

identification of nouns and verbs was also conducted. During this condition, the investigator

asked the participants to “write the nouns in blue and the verbs in black” on the dry erase board

provided. The occurrence of challenging behaviors remain at 0% during exposure to the novel

task.

Academic responses

Correct responses in baseline represented in Figure 3, reflected an initially increasing,

then sharply decreasing trend (M = 62.4%, SD = 29.42). Correct responding during presession

pairing sessions for Jonah reflected a steep increase from baseline levels (M = 84.8%, SD =

12.44). Correct responding during the novel task probe remained high (88%). For Jonah, the

IRT, time between challenging behaviors averaged 19seconds during baseline, increasing to 31

seconds in presession pairing conditions (Figure 4).

Suzanna

Functional Analysis

Levels of challenging behaviors in Suzanna’s functional analysis were highest in the

attention condition (M = 6, SD = 1.41) and in the demand condition (M = 3, SD = 4.24; Figure

1). Challenging behaviors did not occur during the control and alone conditions. Suzanna

engaged in challenging behaviors at highest levels during the attention condition, suggesting

that her behaviors were maintained primarily by attention. Due to elevated behavior levels in


the demand condition, relative to the control and alone conditions, it is likely that Suzanna’s

behaviors were also sensitive to escape as a reinforcer.


As reflected in Table 2, Suzanna indicated a strong preference for the item selected:

spiky ball (100%) and interaction with a familiar adult (73%); however the assessment

suggested an overall limited number of preferences. Therefore, Suzanna’s special education

teacher conducted a paired-choice preference assessment. The assessment suggested magnets

(100%) and Starbursts™ (80%) as preferred items for Suzanna. The spiky ball ranked third

(50%) for Suzanna during the paired-choice preference assessment.

Figure 5. The percentage of opportunities each item was selected during a paired-choice assessment for Suzanna.



Baseline data for Suzanna’s challenging behaviors reflect steady, yet somewhat variable

responding during baseline (M = 51%, SD = 11.10; Figure 2). During presession pairing

sessions, when presented with highly preferred materials, Suzanna often selected bouncing a

ball on top of upside-down Mario™ icons, with the goal of flipping them right side up. In the

first treatment session, Suzanna’s percentage of challenging behaviors decreased from 45% in

the previous baseline session to 0%. Suzanna’s behaviors remained low, near zero for the

remainder of the pairing sessions (M = 9%, SD = 6.83). The inter-response time (IRT) between

challenging behaviors increased from 10.6 seconds in baseline to an average of 51.7 seconds

during presession pairing sessions. Effects of presession pairing during a novel academic task

involving the identification of nouns and verbs was also conducted. During this condition,

Suzanna’s challenging behavior remained at 0%. During presession pairing sessions, when

presented with highly preferred materials, Suzanna often selected bouncing a ball on top of

upside-down Mario™ icons, with the goal of flipping them right side up.

Correct Responses

Correct responses in baseline represented in Figure 3, varied, reflecting an overall

increasing trend (M = 38%, SD = 14.88). Correct responding during presession pairing sessions

for Suzanna reflected overall increase in accuracy (M = 66%, SD = 20.36), than when

compared to baseline rates. Correct responding during the novel task probe for Suzanna

increased to 100%.

Overall Results

Experimental Design

The experimental design used for the present investigation was a multiple-baseline

(MBL) across participants’ design. In a MBL design, baseline conditions are presented


concurrently for all participants. In the first leg of the MBL design, the investigator

implemented presession with Ariel on the fifth session. The intervention for Jonah was then

implemented on the sixth session. Traditionally, researchers attempt to obtain an effect for one

participant before introducing treatment to subsequent participants. However, given the steady

and intense increase in challenging behaviors presented by Jonah, it was decided to implement

presession pairing earlier than anticipated. Once presession pairing was implemented and

demonstrated to be effective (i.e., low levels for 3 sessions) for Jonah, it was introduced to

Suzanna on the ninth session. Overall, this design demonstrates that presession was effective

(i.e. significant change in level, low to none overlap) in reducing challenging behaviors for all

three participants.

Social Validity

The investigator interviewed the participants’ teachers and administrators in regards to

their opinion on the goals, procedures, and outcomes of the study. All five respondents

indicated that they found the questions of interest and worthy of investigation. Additionally, all

respondents identified the pairing procedure as something teachers can feasibly implement in

the classroom setting. The principal and special education director requested trainings for

district teachers based on the outcomes of the present study. The principal noted specifically,

“If two minutes of play will prevent a meltdown, it’s definitely something the teachers in

district programs should be doing.”

The investigator interviewed two of the participants, Jonah and Suzanna, in regards to

their participation in the teaching lessons. When asked, “What did you like better, when we did

work right away or when we played with the iPad™ and then did work after,” Jonah responded,

“iPad™.” When asked “Why?” he relayed, “Because it’s just much better.” When presented


with the same question, Suzanna replied, “Playing with Mario and the ball and then work.”

When asked “Why?” she responded, “It was fun.”


DISCUSSION

Summary of Results

The results of the present study are summarized below with respect to the four research

questions outlined above. Potential interpretations of the results, as well as limitations,

implications for practice, and recommendations for future research follow thereafter.

1. What effect does presession pairing have on the level of challenging

behaviors for children with autism during discrete-trial-teaching?

For each of the three participants, preceding instructional sessions with a short (2-4

min) interactive engagement between the experimenter and the participants in an

experimentally determined preferred activity (presession pairing) led to a substantial reduction

of challenging behaviors during subsequent instructional demands. For each of the participants

the reduction of challenging behavior occurred during the first experimental session and was

sustained throughout the experimental condition (with the exception of a single session with

Ariel corresponding to a medical condition). When challenging behavior did occur its onset was

later in the instructional session than during baseline. However, no systematic increase in

challenging behavior was observed as the session progressed. Finally, an additional instruction

session was conducted for Ariel 5 months following the termination of the presession paring

condition, but without presession pairing. Challenging behaviors remained low despite the

withholding of the presession pairing procedure.

Interestingly, in addition to reduced levels of challenging behavior during the presession

pairing condition, participants began to initiate termination of presession activities (e.g.,

cleaning up) and initiate the onset of instructional demands (e.g., retrieval of academic work

materials).


2. What effect does presession pairing have on inter-response time (IRT) (i.e., time

between each occurrence of challenging behavior) for children with autism during discrete-

trial-teaching?

Consistent with the reduction in levels of challenging behaviors during the presession

pairing condition, the time between challenging behavior increased significantly for all

participants in comparison to baseline

3. What effect does presession pairing have on percentage of accurate academic

responding for children with autism during discrete-trial-teaching?

During presession pairing sessions, there was either no change or a slight increase in

accuracy of academic responding for each of the participants.

4. To what extent does the function of challenging behavior (escape or attention)

alter the effects of presesion pairing for children with autism during discrete-trial-

teaching?

Presession pairing effectively led to a reduction in the level of challenging behaviors for

participants who exhibited escape-maintained challenging behavior, as well as and those who

exhibited escape- and attention-maintained challenging behavior. The results suggest that for the

three participants of this study, presession pairing was effective for reduction of escape-

maintained challenging behavior, in a manner similar to that previously demonstrated for

attention-maintained challenging behavior given pre-session access to attention (e.g., McCormas

et al, 2003).

Interpretation of Results

Based on existing research, there are at least two possible interpretations of the

reduction in challenging behaviors during instructional sessions with presession pairing.


Under the first interpretation, presession pairing might be conceptualized as abolishing

the aversive properties of potential CMO-R’s in the instructional session. As described above, a

CMO-R is defined as an object or event that reliably precedes or signals a worsening or

improvement in conditions. When signaling a worsening of conditions such as impending

aversive aspects of instructional demands, the CMO-R is conceptualized as itself becoming

aversive and thus negatively reinforcing any behavior leading to its termination. Possible

candidates for CMO-R functioning in the present experiment might include the experimenter,

the table area, and instructional materials. Thus, if the experimenter or other objects in the

current study functioned as CMO-R, any challenging behavior that removed the CMO-R (or

delayed the onset of instructional demands) would be reinforced.

In previous studies demonstrating the abolishing of motivating operations without

modifications of task demands or consequences (McComas et al, 2003; O’Reilly, 1999),

preceding an instructional session with attention reduced the rate of challenging attention-

maintained behavior during the immediately ensuing instructional session. Presession access

was thought to temporarily reduce the reinforcing properties of attention resulting in the

decreased levels of challenging behavior during instruction. However, the challenging behavior

exhibited by Ariel in the current study was determined to be escape-maintained (recall that

Jonah’s and Suzanna’s challenging behaviors were identified as both escape and attention

maintained) during pre-experimental functional analyses. Thus, an interpretation based upon

temporary satiation of the reinforce maintaining challenging behavior would not be relevant.

Arguing against a CMO-R abolishment interpretation is the maintenance session

conducted with Ariel five months following the conclusion of experimental sessions. During

the maintenance session, Ariel continued to exhibit substantially reduced levels of challenging


behavior despite the absence of presession pairing procedures. By definition, the effects of

procedures thought to modify motivating operations are temporary in nature. The continuation

of reduced challenging behavior during the maintenance sessions suggests an interpretation of a

more durable change in the contingencies maintaining challenging behavior.

It is common practice during behavior change procedures in which primary or token

reinforcers are delivered to precede such delivery with verbal praise (e.g., good job, excellent,

nice work, etc.). Such procedures are implemented in an effort to increase or establish the

verbal praise as a reinforcer. Presession pairing of the experimenter with interactive, fun

activities may have established or enhanced the reinforcing properties of the experimenter’s

praise, thereby improving the contingencies maintaining academic behaviors. From a stimulus

control analysis, the experimenter would then signal that academic responding would be

followed by both token reinforcement and enhanced social reinforcement (praise). Such an

interpretation would be consistent with the observations that following several exposures to

presession pairing participants began to seek out the experimenter, initiated termination of

presession pairing materials, and retrieved instructional materials. It is difficult to differentiate

between the CMO-R and enhanced reinforcement interpretations experimentally. The

interpolation of instructional sessions without presession pairing (as in the maintenance session

presented for Ariel) or examination of pairing of experimenter with interactive, reinforcing

activities at various times with the exception of immediately presession might be informative. If

challenging behaviors were not reduced when pairing occurred at times other than immediately

presession, the CMO-R interpretation might be supported. However, at present, data from the

maintenance session with Ariel, coupled with the lack of experimental support for the

laboratory analog of the CMO-R analysis described above suggests that the enhanced reinforcer


interpretation offers a more parsimonious and conceptually systematic account of the present

data than a CMO-R interpretation.

Extension of the Research

The present study addresses several gaps in current research. First, this study serves as

the first formal exploration of the effects of presession pairing on challenging behaviors and

academic responding during instruction. Previous researchers have evaluated the effects of

presession attention on levels of challenging behavior during attention FA conditions (O’Reilly

et al., 1999). This study extends the previous research by evaluating the effects of presession

pairing of the instructor with preferred items on the levels of challenging behavior during DTT

sessions. Secondly, this extends previous research by providing preliminary evidence of the

effects of presession pairing for individuals who exhibit escape-maintained challenging

behavior and escape- and attention- maintained challenging behavior.

Antecedent manipulations, as reviewed by Carbone et al. (2010), include programming

competing reinforcers, providing errorless instruction (Ebanks & Fisher, 2003; Weeks &

Gaylord, 1981), employing stimulus demand fading procedures (DeLeon et al., 2001; Lalli et

al., 1999), increasing the pacing of instruction (Carnine, 1976; Dyer et al., 1982), interspersing

events such as storytelling and social comments (Neef, Iwata, & Page 1980), and adjusting the

session duration (Dunlap et al., 1981). Consequential based procedures include functional

communication training (FCT) plus extinction (Hanley, Iwata, & McCord, 2003) and

differential reinforcement of other behavior (DRO) (Vollmer, Iwata, Zarcone, Smith, &

Mazaleski, 1993). The present study extends existing research on antecedent manipulations by

providing support for a procedure effective at reducing challenging behavior exhibited during

demands.


Lastly, the present study provides a protocol for utilizing presession pairing as part of

teaching procedures, specifically for children with autism during DTT (Barbera, 2007; Dib &

Sturmey, 2007; Lafasakis & Sturmey, 2007; Smith, 2001; Zarcone, 2005). This study

contributes to possible ways to structure DTT sessions, particularly for children with ASD. For

children who present with challenging behaviors pertaining to the presentation of task demands,

teachers can minimize aberrant responding by (a) determining preferences for the student, (b)

pairing themselves with the items/activities, and (c) delivering well-crafted, appropriately

paced, instruction

Limitations

These results are promising, however limitations exist within the present investigation.

One potential limitation is the omission of a tangible condition in the functional analyses. The

rationale for its exclusion was to avoid premature exposure to highly preferred items prior to

the preference assessment, and to avoid inadvertent pairing with the investigator with preferred

items prior to pairing (recall that the behavior specialist or special education teacher conducted

preference assessments). In addition, because the investigator selected participants with known

challenging behaviors around instruction, the investigator focused on that variable during

functional analyses.

A second limitation is that experimental control of the independent variable was not

obtained by withdrawing it. Reasons for conducting the study in a multiple baseline across

participants design rather than a reversal were primarily attributed to the intensity and

frequency of challenging behavior assessed (particularly for Ariel). Removing an effective

intervention and influencing behavior to potentially return to high levels demonstrated in

baseline conditions presented ethical concerns. If an effective, unobtrusive alteration to DTT


results in substantially lower levels of challenging behavior, it would be unethical to remove

the intervention, merely for the sake of demonstrating experimental control.

A third possible limitation is that despite effects on levels of challenging behaviors,

presession pairing resulted in little to no effect on correct academic responding for the

participants when compared to baseline measures. One possible explanation for this is that the

investigator steadily increased the difficulty of items presented to participants during the study

to account for learning occurring. However, the percentage of accurate responding remained

steady or slightly improved for all three participants, from baseline to presession pairing

conditions.

Another potential limitation of the present study is the limited demonstration of the

maintenance of effect of presession pairing procedures across participants and time. Ideally,

follow up sessions for all three participants would have been conducted; however, only one

participant (Ariel) remained available for evaluation. Finally, the investigator did not obtain

direct test scores for participants; rather background information was obtained via record

review.

Implications for Practice

Presession pairing is a teaching procedure that is effective at reducing challenging

behaviors associated with task demands for children with autism, during DTT. It is a cost

effective modification to current teaching practices that is also easy to implement. Positive

effects were obtained for all three participants, despite functions varying between escape and

escape- and attention- maintained. This lends further support that presession pairing is a

procedure that should be a regular component of instruction for all children who present with

challenging behaviors when presented with demands, particularly during discrete-trial-teaching.


After obtaining preferences for students, teachers and therapists can start each session by

pairing themselves with highly preferred items prior to delivering instructional demands or

prior to introducing novel or difficult demands. Doing so will reduce the likelihood that

challenging behaviors may occur and/or may reduce the intensity of challenging behaviors that

do occur. Pairing may take several sessions and is not something that should be rushed. If the

student requests to switch items during the pairing portion, it is important to allow them to do

so. As previously noted, it is important to refrain from placing demands during pairing, to

remain engaged and paired with preferred items/activities, and for the therapist to select

preferred items/activites that are salient for the individual (Barbera, 2007; 2009).

The investigator derived participant preferences from the preference procedures

previously described. Items classified as strong preferences were selected more often by

participants than those classified as moderately preferred. However, participants varied the

highly preferred items that they selected to engage with the investigator. For example, some

days Jonah selected the iPad™ games and other days he would request the Millionaire™ game;

Ariel fluctuated between the string of beads with iPad™ games such as Angry Birds™. During

the last several sessions of the study, Ariel consistently selected games and music on the iPad™

over her originally most highly rated item. These results provide support for the concept that

preferences are dynamic and can change moment to moment, therefore suggesting that informal

preference assessments should be a regular part of teaching interactions (e.g., “What do you

want to earn today” or “What do you want to work for now” or “What would you like to talk

about”).


Future Research

The present study had a limited number of participants, participants with varying

maintaining functions of challenging behavior and consisted of follow up for only one

participant. Future research should aim to replicate this initial investigation of the effects of

presession pairing on occurrences of challenging behavior, particularly with participants’

behaviors maintained by escape alone. Future researchers should also continue to investigate

the mechanisms responsible for these effects by directly testing the reinforcing value of the

adult paired with strong reinforcers. Using a multi-element, future researchers could compare

effects between high-p procedures to those associated with presession pairing. Furthermore,

future investigations should include multiple follow-up sessions per participant or allow for

follow up sessions across multiple participants to better evaluate the maintenance of effects

obtained. In addition, reporting on the latency to challenging behavior may provide additional

insight as to the durability of the effects obtained through presession pairing. Additionally,

future research may examine the effectiveness of pairing temporally distant from the start of an

instructional session. If reduction of challenging behaviors during the instructional session were

reduced under such procedures, that might further argue against abolishment of the CMO-R as

central to the current results.

The present study lacks a reversal. The determination whether to include a reversal was

again an ethical one. Future researchers may be able to account for potential increases in

challenging behavior and therefore may be able to evaluate the effects of presession pairing

using a reversal as the experimental design. Replications that utilize a reversal may be done so

ethically, possibly if they seek to reduce behaviors other than intense self-injury. Results from

a reversal design would strengthen conclusions about the efficacy of the procedures, potentially


leading to more effective modifications for improving instruction. Future research may decide

to include a tangible condition during the FA. The rationale for its exclusion from the present

study was to avoid premature exposure to highly preferred items prior to the preference

assessment and to avoid inadvertent pairing with the investigator with preferred items prior to

pairing (recall that the behavior specialist or special education teacher conducted preference

assessments). For future researchers, including a tangible condition in the functional analysis

may lend strength to assertions made about maintaining functions of challenging behavior.

Future research could also look at improving academic responding or accounting for

and reporting on increased level of difficulty of demands presented across conditions. For the

participants in this study, several instances of challenging behavior occurred during error

correction procedures. As noted earlier, Weeks and Gaylord-Ross (1981) demonstrated

errorless learning to be effective for increasing general compliance and decreasing challenging

behavior since many challenging behaviors are reported to occur during error correction

procedures (Carbone et al., 2010). Future researchers could evaluate the effects of presession

pairing compared to those of errorless teaching procedures, or possibly focus on evaluating the

cumulative effects of these combined interventions.

The present study assessed the effects of presession pairing on accurate academic

responding. Perhaps a more sensitive and appropriate measure would be to assess the effects

on compliance (e.g., responding, attempts –even if incorrect). Future research should look at

defining and determining a means of measuring the effects of presession pairing on compliance

with DTT tasks for individuals with ASD. Lastly, future researchers should conduct parametric

analyses (e.g. number of sessions, number of minutes) in order to assess the amount of

presession pairing that is need to achieve an effect.


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Appendix A

Letter to Parents/Guardians

Dear parent/guardian,

My name is Amanda N. Kelly, M.S.Ed, BCBA, and I am a doctoral student in applied behavior analysis at Simmons College. I am conducting a research project evaluating a teaching procedure called “Presession Pairing” which is used to increase motivation during instructional sessions. Your child’s teacher suggested your child as someone who would benefit from this research. I am writing to you to explain the research and invite you to include your child in the study.

Background

Many students with autism engage in numerous instructional sessions each day. Teachers and therapists’ use preferred rewards and token systems to give to students after they perform desired skills. Many students lose motivation and do not respond adequately to instructional prompts and occasionally engage in disruptive behaviors. A strategy that has the potential to help these problems is presession pairing. This is the teacher or therapist identifying preferred items, such as toys or games, and engaging the student with the items for 2 minutes before presenting instructional trials. The idea is that the student learns that the teacher does not only present work but also presents fun activities so the student will be more likely to comply with the teacher. This strategy has the potential to help many students with autism engaged in intensive instructional sessions.

General Procedures

Prior to the instructional sessions, I will conduct a functional analysis with your child to determine the reason for his/her challenging or disruptive behavior. Each session will be 10 minutes long. I will conduct 2-4 sessions per day, 2-3 times per week. I will implement four types of sessions: demand, attention, alone and control. In the demand-type of session, I will present a variety of instructional demands. I will respond to appropriate behaviors (e.g., gestures toward items) with brief answers or statements. If a disruptive behavior occurs, I will state, “Okay, this may be too hard for you. Take a break,” and provide a 30-second break. In the attention-type session, I will sit across from the student without making eye contact. I will respond to appropriate questions or statements with one-word answers. If disruptive behaviors occur, I will make eye contact with your child, lean forward and make a statement related to the behavior (e.g., “Stop it,” “That’s not nice”). In the alone-type session, your child will be in a therapy room by him/herself while I watch through a window. I will not interact with your child unless his/her safety is at risk. Finally, in the free play-type session, I will sit with your child and engage him or her in preferred conversational topics (e.g., comment on activity in the room, the weather, something that happened earlier). I will respond to appropriate interactions (e.g., responses to questions, requests for attention) with


complete sentences and eye contact. If your child engages in disruptive behavior, I will remove eye contact and not speak until the behavior has ceased for 10 seconds.

I will also conduct a preference assessment to determine some of your child’s most highly preferred items or activities to be used as rewards in the teaching sessions.

In coordination with your child’s teacher, I will select skills based on your child’s IEP. Target skills will most likely be receptively or expressively identifying pictures, letters, or numbers. I will also identify preferred items for your child. Each day, I will conduct 5-minute instructional sessions with your child using the same teaching techniques your teacher or therapist uses. On some days, I will do presession pairing in which I engage with preferred items with your child before instructional sessions. I will compare how much work your child does and how many disruptions he or she has when I use presession pairing versus when I do not. I will meet with your child for about 20 minutes, 3 days per week, for 3 months.

Potential Risks and Benefits

There would be minimal risk to your child’s safety in this study, but any time your child appears uncomfortable, the teaching session would be paused until your child regains his or her typical comfort level. This research has the potential to benefit your child by identifying a teaching technique that results in increased motivation, increased academic performance, and decreased negative behavior. If the strategy proves to be highly effective, the staff in your child’s school program will be trained on using the technique. There is also the potential to benefit other educators and researchers working with children with disabilities through presentations and publications of the results.

Records Review and Videotaping

I would review psychological and educational evaluations to describe your child’s disability and current level of functioning for the purpose of presenting the project. I would videotape all sessions for two reasons. One is to be able to watch the videos to collect data on your child’s behavior. The other reason is to share short clips of the procedure with other educators and researchers at conferences and workshops. Your specific written permission will be sought if I would like to use a video clip of your child in a public presentation of this research. Your child’s name would never be shared in any presentations or publications.

Your Rights

Participation as a human subject in this research program is voluntary, and your participation, or non-participation, will not affect other relationships (e.g., employer, school, etc.) You may discontinue your participation as a human subject in this research program at any time without penalty or costs of any nature, character or kind.

Every precaution shall be taken to protect your privacy and the confidentiality of the records and data pertaining to you in particular and the research program in general, disclosure of


which may contribute to identifying you specifically to persons not related to this research program.

Attached are two copies of the consent form. By signing this consent form, you grant permission for your child to participate in this study. You should return a signed copy of the consent form to me and keep the second copy for your records. After the study is completed, I will be happy to share the results of the prompting strategy evaluation with you if you would like.

Thank you for reading this letter. If you have any questions or would like more details of the project, please contact me, Amanda N. Kelly, by phone at 617-439-9405 or by email at [email protected]. If you have questions about your child’s rights as a research participant, please contact the Human Protections Administrator in the Office of Sponsored Programs of Simmons College at 617-521-2414.

Thank you for your cooperation.

_________________________________Amanda N. Kelly, M.S.Ed, BCBADoctoral Candidate, Simmons College

Enclosure: 2 copies of Consent Form for Participation in Educational Research

mailto:[email protected]


Appendix B

CONSENT FOR PARTICIPATION IN EDUCATIONAL RESEARCH

I consent to my child’s participation in the research project entitled, “The effects of presession pairing on compliance of children with autism”.

Doctoral candidate, Amanda Kelly has explained the purpose of the study, the procedures to be followed, and the expected duration of my child’s participation (3 months).

- I acknowledge that I have had the opportunity to obtain additional information regarding the study and that any questions I have raised have been answered to my full satisfaction.

- Furthermore, I understand that I am free to withdraw consent at any time and to discontinue participation in the study without prejudice to me or my child.

The general procedures of the research involve targeting skills on my child’s IEP (e.g., receptive and expressive language and academic skills). Prior to the experiment, a functional analysis was conducted to evaluate the reasons for my child’s challenging behaviors. In addition, a preference assessment was conducted in order to assess which items or activities are viewed by my child as motivating. Each instructional session was 5 minutes. In the presession pairing condition, this was preceded by 2 minutes of engagement with preferred items.

I grant permission to Amanda Kelly to videotape the teaching sessions.

- My written permission was sought if video clips of my child are to be shared in a public presentation of this research.

- If severe challenging behavior occurs during a session, the session was terminated and that video footage was immediately erased and not publicly presented.

- Upon completion of the study, the videotapes was erased before they are discarded. At that point, all identifiers will have been separated from the data.

I also grant permission for the investigators to review my child’s confidential educational records and to obtain test scores and other information from myself or my child’s teacher and school principal to describe my child’s disability and current level of functioning for the purpose of presenting the project.

I understand my child’s and my own identity will not be revealed to anyone not directly involved in conducting the project, or by means of publication, documentation, computer storage, or any other form of report developed from this project.


I understand that after my child has completed the project; I will be contacted by an investigator to learn the results relative to my child, and to discuss any implications for teaching strategies that may be helpful for my child. In addition, I understand that results of the study were shared with my child’s teaching staff and other school personnel.

This consent will expire 12 months from the date of signature.

If I have any questions with regard to this study, I can contact Amanda Kelly by phone at 781-439-9405 or by email at [email protected]. If I have questions about my child’s rights as a research participant, I can contact the Human Protections Administrator in the Office of Sponsored Programs at Simmons College at 617-521-2414.

I acknowledge that I have read and fully understand the consent form. I sign it freely and voluntarily. A copy has been given to me.

Child’s Name: ________________________________ Date: _________________

Signed: ____________________________________ ______________________________ (Person authorized to consent for participant) (Please print name)

Signed: _____________________________________ (Investigator)


Appendix C

PAIRED CHOICE PREFERENCE ASSESSMENT

Date:Student Name:Teacher:

Instructions:1. Present both numbered items simultaneously. Place the first item on your left, the second on your right.2. If the student doesn’t select one, say, “Take one.”3. Record as a selection any touch to an item. Circle the selected items.4. If the item is an edible, allow the student to consume it before going on.5. If the item is an activity, let the student play with it for 30 seconds.6. Block any attempts to touch both items simultaneously.7. If no response is made in 10 seconds, record “NR” and move to the next trial.8. Be sure the student has tasted or played with all items before assessing them.9. Calculate the percentage of trials that each item was selected. Those items selected 80% or more of

opportunities are most probably going to function as positive reinforcers.

TRIAL LEFT RIGHT TRIAL LEFT RIGHT TRIAL LEFT RIGHT1 1 2 11 5 2 21 3 52 3 2 12 4 3 22 6 23 2 6 13 1 5 23 1 44 1 3 14 5 3 24 4 55 6 5 15 4 1 25 6 36 3 6 16 2 5 26 2 4 7 2 3 17 4 2 27 2 18 5 1 18 5 4 28 6 49 4 6 19 6 1 29 3 110 5 6 20 3 4 30 1 6

SUMMARYITEM 1 SELECTED _____ OUT OF 10 OR _____% OF OPPORTUNITIESITEM 2 SELECTED _____ OUT OF 10 OR _____% OF OPPORTUNITIESITEM 3 SELECTED _____ OUT OF 10 OR _____% OF OPPORTUNITIESITEM 4 SELECTED _____ OUT OF 10 OR _____% OF OPPORTUNITIESITEM 5 SELECTED _____ OUT OF 10 OR _____% OF OPPORTUNITIESITEM 6 SELECTED _____ OUT OF 10 OR _____% OF OPPORTUNITIES

Sources:Fisher, Piazza, Bowman, Hagopian, Owens, & Slevin. (1992). Journal of Applied Behavior Analysis, 25, 491-498. Modified and

adapted by Melmark New England (2002).Fisher, W., Piazza, C. C., Bowman, L. G., Hagopian, L. P., Owens, J.C., & Slevin, I. (1992). A comparison of two approaches

for identifying reinforcers for persons with severe and profound disabilities. Journal of Applied Behavior Analysis, 25, 491-498.

Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B. A., & Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded individuals. Journal of Applied Behavior Analysis, 18, 249-255.

Roane, H. S., Vollmer, T. R., Ringdahl, J. E., & Marcus, B. A. (1998). Evaluation of a brief stimulus preference assessment. Journal of Applied Behavior Analysis, 31, 605-620.

# ITEM # ITEM1 42 53 6


Appendix D

Fidelity Checklist - Ariel

General Teaching Procedures - Ariel

1. Student enters room and is cued to break2. Ignore/do not engage with student, 1-3 word responses

3a. Call to the table3b. Restate direction if student does not come to table

4. Have materials (letter tiles, picture cards, token board) prepared and provided to student

5. State rule “5 tokens”6. Hold up picture card and phonetically state word (e.g., “S-Uh-N”)7a. If student begins working, do not disrupt

7b. If student is non-responsive, restate instruction7c. If student makes an error, provide correction

8a. If error is made, interrupt and state, “let’s do this one together” or “let me show you how”8b. Model response and have student write correct answer

9. Provide a token for each correct response.

10. Provide praise for each correct response.

11. Allow student to trade in after obtaining 5 tokens.

12. Stop timer when tokens are exchanged.13. If challenging behaviors occur, block and restate instruction every 10-seconds

14. Resume session after break behaviors/Start timer

15. After 5-8 minutes have elapsed, end session

Tally/Note any extra stepsTotal Correct

Total Incorrect/Omissions or AdditionsPercentage adhere to procedures

Appendix E


Fidelity Checklist – Jonah & Suzanna

General Teaching Procedures – Jonah and Suzanna

1. Student enters room and is cued to break

2. Ignore/do not engage with student, 1-3 word responses

3a. Call to the table

3b. Restate direction if student does not come to table

4. Have materials (cards, marker, eraser, dry erase board) prepared and provided to student

5. State rule “5 tokens”

6. Present instruction, “do this” or “reduce”

7a. If student begins working, do not disrupt

7b. If student is non-responsive, restate instruction

7c. If student makes an error, provide correction

8a. If error is made, interrupt and state, “let’s do this one together” or “let me show you how”

8b. Model response and have student write correct answer

9. Provide a token for each correct response.

10. Provide praise for each correct response.

11. Allow student to trade in after obtaining 5 tokens.

12. Stop timer when tokens are exchanged

13. If challenging behaviors occur, block and restate instruction every 10-seconds

14. Resume session after break behaviors – Start timer

15. After 5-8 minutes have elapsed, end session

Tally/note any extra steps.

Total Correct

Total Incorrect/Omissions or Additions

Percentage adhere to procedures

Appendix F

Interval Recording Sheet with IOA


Participant: _______________________________ Assessor: ___________________________________________Recording system: _______________________ Session #: ___________ Date: ___________________Challenging behavior: ______________________________________________________________________________________________________________________________________________________________________________________________

:10 :20 :30 :40 :50 :00 CommentsChallengingWork PresentedToken Delivered








Behavior Rater #1 Rater #2 Agreements Disagreements Total X 100%ChallengingWork Completion

Documents

beatleyweb.simmons.edu · Web viewFor Ariel, the tasks involved placing blocks of corresponding colors on a template. The investigator provided Suzanna and Jonah with activity packets