Participants

3.1.4.1 Dion

Dion, a Multiracial Caucasian and African American male, was 4-years, 4-months old at the beginning of the study. According to his diagnostic report he received the diagnosis of Autism and Receptive/Expressive Language Disorder (DSM-IV). According to the CARS, he met the criteria for Severe Symptoms of Autism Spectrum Disorder (score of 37 and higher) with a total score of 43. His mother reported he was not taking medications and did not have any significant medical conditions. He had received one hour of early intervention, speech language therapy, and occupational therapy per week when he was under three years of age. During the study, his mother reported he was attending a classroom program that used interventions grounded in ABA and received listening therapy through headphones two times per week for 20-minutes. The auditory intervention had been implemented for approximately one month when the study began. He was receiving no other services in the home during participation in the study.

The results of the DOCS assessment indicated that developmentally Dion was below average in all developmental areas (see Table 1). On the MIS, Dion received an object imitation score of 81% and a gesture imitation score of 93%. The results of the CSBS showed that Dion functioned below developmental level for his age in sounds, social interaction, gestures, words and language comprehension (see Table 2). Dion said seven single-words during the assessment to request items he desired. His use of gestures was limited, but he gazed in the direction of the researcher’s finger point two times. He demonstrated comprehension of object names “cup,

spoon, fork, bowl”; person name “mommy”; and body parts “mouth, eyes, ears, feet.” He engaged in seven actions with objects (e.g., put in, feed with utensil, stir) and stacked five blocks after the researcher modeled this behavior.

Dion’s mother, Jennifer was a 41-year-old African American with a graduate degree in interpersonal communication. She was the co-owner and president of a contracting company. She reported that she had not participated in parent training or distance-based instruction prior to the start of the study. She had a moderately high stress rating of 30 on the APSI. The most intense stressors included her child’s ability to communicate and concern for her child’s future. Dion lived with his mother, father, sister, and half sister in a rural area in a neighboring state. The school psychologist had recently provided his older sister with a diagnosis of Asperger’s Disorder.

3.1.4.2 Joshua

Joshua, a Caucasian male, was 2-years, 8-months old at the start of the study. According to his diagnostic report he received the diagnosis of Pervasive Developmental Disorder, Not Otherwise Specified (DSM-IV). According to the CARS, he met the criteria for Severe Symptoms of Autism Spectrum Disorder (score of 37 and higher) with a total score of 48.5. His mother reported he was not taking medications and did not have any significant medical conditions. He had received one hour of early intervention, speech language therapy, and occupational therapy per week for the six months prior to the study. During the study, early intervention and speech language therapy occurred one time per week in the home. Additionally, he was receiving 10 hours per week of Behavioral Health Rehabilitative Services (BHRS) direct therapy. His mother indicated that BHRS was using “repetition and modeling” to teach him skills.

The results of the DOCS assessment indicated that developmentally, Joshua was well below average in all areas (see Table 1). On the MIS, Joshua received an object imitation score of 6% and a gesture imitation score of 6%. The results of the CSBS showed that Joshua functioned well below developmental level for his age in sounds, social interaction, gestures, words, and language comprehension (see Table 2). Joshua said one sound (i.e., /m/) during the assessment to request an item he desired. To communicate his desire for items he reached out his hand towards the object. He did respond to the gaze/point following task when presented two times. The assessment showed significant deficits in comprehension of object names, play actions with objects and stacking blocks after the researcher modeled this behavior.

Joshua’s mother, Sarah, was a Caucasian 41-year-old who was working on her Bachelor’s degree in communication disorders. She was a single parent and homemaker. Sarah reported that she had not participated in parent training or distance-based instruction prior to the start of the study. She had a moderately low stress rating of 14 on the APSI. Specific stressors included her child’s social-communication development and concern for his future. Joshua lived at home in a suburban medium size Mid-Atlantic city with his mother and two brothers; both brothers were also diagnosed with ASD.

3.1.4.3 Nikhil

Nikhil, an Indian-American male, was 2-years, 5-months old at the start of the study. According to his diagnostic report he received the diagnosis of Pervasive Developmental Disorder, Not Otherwise Specified (DSM-V). According to the CARS, he met the criteria for Mild to Moderate Symptoms of Autism Spectrum Disorder (score between 30 – 36) with a total score of 34.5. His mother reported he was not taking medications and did not have any significant medical conditions. He had received one hour of speech language therapy, occupational therapy, and

physical therapy per week for one year prior to the study. Speech language therapy occurred one time per week during the study in the home.

The results of the DOCS assessment indicated that developmentally, Nikhil was slightly below average in cognition and language, average in social and above average in motor development (see Table 1). On the MIS, Nikhil received an object imitation score of 63% and a gesture imitation score of 69%. The results of the CSBS showed that Nikhil functioned below developmental level for his age in social interaction, and symbolic play and above developmental level in speech (see Table 2). Nikhil used over sixteen words and over eight combinations of words to request items he desired and communicate during the assessment. His use of gestures was limited (pointed only), but he responded to the gaze/point following task when presented two times. He demonstrated comprehension of object names “cup, spoon, fork, bottle”; person names “mommy, nanny, monkey”; and body parts “toes, hands, mouth.” He engaged in two actions with objects (i.e., put in, feed monkey with utensils) and quickly stacked five blocks after the researcher modeled this behavior.

Nikhil’s mother, Asha, was a 34-year-old Indian American medical doctor. She was four months pregnant when the pre-treatment measures were collected. Asha reported that she had not participated in parent training or distance-based instruction prior to the start of the study. She had a moderate stress rating of 23 on the APSI. Specific stressors included her child’s social- communication development and her lack of feeling close to her child. Nikhil lived at home in a Mid-Atlantic city with his mother and father.

3.1.4.4 Ryan

Ryan, a Caucasian male, was 3-years, 6-months old at the start of the study. According to his diagnostic report he received the diagnosis of Autistic Disorder (DSM-IV). The results of the

CARS indicated that he met the criteria for Severe Symptoms of Autism Spectrum Disorder (score of 37 and higher) with a total score of 41. His mother reported he was not taking medications and did not have any significant medical conditions. He had received one hour of speech language therapy and occupational therapy per week from the age of two to three. Speech language therapy occurred one time per week during the study in a outpatient setting. Ryan also received 15 hours per week of BHRS direct therapy service while participating in the study.

The results of the DOCS assessment indicated that developmentally, Ryan was below average in all areas of development (see Table 1). On the MIS, Ryan received an object imitation score of 6% and a gesture imitation score of 0%. The results of the CSBS showed that Ryan functioned below developmental level for his age in social interaction, speech, and symbolic play (see Table 2). Ryan used fifteen single-words to request items he desired and communicate during the assessment. He used three different conventional gestures (i.e., gives, pushes/pulls away) and responded once to the gaze/point following task. He demonstrated comprehension of object name “bowl”; person names “mommy, monkey.” He engaged in one action with objects (i.e., put in) and quickly stacked five blocks after the researcher modeled this behavior. It is important to note that Ryan engaged in challenging behaviors while the assessment was being conducted (e.g., crying, saying “no”); it is the opinion of the researcher that his scores may have improved if behaviors were absent.

Ryan’s mother, Susan was a 37-year-old Caucasian homemaker with an associate’s degree. Susan reported that she had not participated in parent training or distance-based instruction prior to the start of the study. She had a high stress rating of 38 on the APSI. Specific stressors included her child’s ability to communicate, self-injurious behavior, and concern for his future. Ryan lived at home in a Mid-Atlantic city with his mother and father.

Table 1. Pre-Treatment results: DOCS-Developmental checklist profile developmental age equivalent scores

Table 2. Pre-Treatment results: Composite and total CSBS behavior sample percentile ranks

Child Social Speech Symbolic Total

Dion 2 37 50 10

Joshua 1 2 1 1

Nikhil 2 91 63 50

Ryan 2 63 2 5

3.2 PROCEDURES