STUDY 1

As described in Chapter 4, the EBIC was designed to provide a comprehensive framework for intervention for children with autism who received University-led EIBI during SCAmP.

Although derived from principles of behaviour analysis and verbal behaviour (Horne &

Lowe, 1996; Lowenkron, 1998, 2006; Skinner, 1957) and other published EIBI curricula (Leaf & McEachin, 1999; Lovaas, 1981/2003; Partington & Sundberg, 1998; Taylor &

McDonough, 1996; see Chapters 2 to 4) the EBIC had not, itself, been previously subjected to empirical evaluation. For these reasons, and to identify potential practical considerations relating to implementation and evaluation of the EBIC that might require revision prior to the latter phases of SCAmP, pilot research was carried out involving the first six children to receive University-led EIBI during the initial six months of SCAmP. All participating children received additional SCAmP intervention beyond the period during which pilot data were collected and resultant changes to the EBIC and its implementation made. Because these children had, however, in some respects initially received a materially different intervention from those children who participated subsequently in SCAmP, complete data from the former children’s 24 months of intervention are reported in the present study and not during Study 2.

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5.2.1.1 Participants.

Six boys with autism (M _age = 39.6 months, age range: 30-48 months) participated in the present research. Each child had been referred by his LEA to take part in SCAmP and had previously received an independent diagnosis of autism from a specialist paediatrician or clinical psychologist, in addition to a LEA Statement of Special Educational Needs. No psychometric assessment data were available for any children. Prior to intervention, each child’s level of skills in every domain of the EBIC was evaluated (see Table 2).

Table 2. All children’s skills in every EBIC domain prior to intervention. Note. Dashes indicate absence of domain-specific skills.

5.2.1.2 Materials.

All materials were provided by children’s parents or by LEAs consequent to advice from the SCAmP clinical team. Because each child’s intervention was individually targeted to

establish and develop a comprehensive range of skills, a wide variety of materials was used throughout the research, including toys, household objects, and flashcards. Individual materials required to teach specific skills were detailed in every Programme Sheet and Item List used during intervention.

Domain David Leo Giles Corey Callum Reece

Motor Imitation 20 Imitations 10 Imitations 18 Imitations 24 Imitations -

-Visual Performance 2D and 3D Identity Matching

-Echoic Single words Single words 5 sounds - -

-Mand 20 items Pointing Pointing 5 PECS pictures -

-Tact 30 items 30 items - - -

-Intraverbal 3 songs 3 animal sounds - - -

-Play 9-piece puzzles

and imitation 20-piece puzzles 12-piece puzzles 12-piece puzzles -

-Social Eye-contact with

mands - - - -

-86 5.2.1.3 Procedure.

The present research was carried out over an intervention period of 26 months, during which each child received a maximum duration of 24 months intervention. Figure 4 shows the intervention month of introduction and duration of each child’s intervention within the overall period of University-led SCAmP EIBI delivery, during the first six months of which data were collected as a basis for subsequent alterations to be made, as required, both to the organisation of the EBIC and to the practicalities of its implementation and evaluation. Each child’s scores on the EBIC were recorded both prior and subsequent to the intervention period. Hours of intervention delivered by tutors and by parents were separately recorded throughout each child’s intervention. The following sections detail practical considerations specific to implementation and evaluation of the EBIC.

Figure 4. Intervention month of introduction and duration of each child’s intervention within the overall period of University-led SCAmP EIBI delivery.

5.2.1.3.1 Intensity.

Each participating LEA signed a contract with the University of Southampton to deliver 30 hrs of EIBI per week, for 50 weeks per year, for a period of 2 years, for each child referred by them to receive intervention during SCAmP. The parents of each participating child also agreed personally to deliver an additional 10 hrs of EIBI to their child each week. Together, therefore, a total of 40 hrs EIBI per week was determined for every child participating in the research. For the first 12 months, each child’s intervention was delivered in his own home.

For the second 12 months, however, all children attended either Nursery, or Primary School, if they were of statutory school age. Although each child was supported by an ABA tutor during the latter period to ensure participation in educational activities, no EIBI was delivered in those environments.

5.2.1.3.2 Treatment fidelity.

On the basis of geographical location, each child was allocated an individual SCAmP Supervisor, and a team of three or four tutors recruited by his LEA. Although LEAs were

Child 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Corey Giles Leo David Callum Reese

Months

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responsible for line-management of tutors, the SCAmP clinical team was responsible for training both tutors and parents in the principles and techniques of ABA and for overall programme delivery. To ensure that all tutors and parents were able to provide EIBI delivery, each tutor and participating parent attended a 3-day workshop conducted by the SCAmP clinical team. In addition, prior to intervention, all parents and tutors received a 2-day home-based initial workshop run by the present author accompanied by the parents’ allocated Supervisor. During this workshop, each child’s level of skills in all EBIC domains was evaluated and initial curricular targets within the EBIC assessed. To ensure treatment fidelity, tutors’ implementation of key EIBI techniques (i.e., DTT, NET, prompting, and fading) was assessed after 10 sessions (approximately 30 hrs of intervention delivery) using the SCAmP Tutor Assessment Tool (STAT; see Appendix D). Subsequent to assessment, Supervisors provided tutors with additional training, if required.

5.2.1.3.3 Frequency of supervision.

To evaluate children’s progress within the EBIC, and to update curricular targets, each Supervisor conducted a fortnightly 3-hr team meeting for each of their assigned children individually, each of which was attended by all that child’s tutors and one or both

participating parents. Each Supervisor additionally provided between 6 and 9 hrs of direct training in EIBI delivery to tutors and parents every month. To assess each child’s progress, and to provide clinical advice to Supervisors, the present author oversaw all children’s programmes and additionally attended each child’s team meeting every 6 weeks.

5.2.1.3.4 Teaching procedures.

Each child’s intervention was individually tailored to meet his specific ongoing learning needs, and, for each child, teaching procedures involved use of both DTT and NET, dependent on the nature of individual skills taught (see Sections 4.3.6 and 4.3.7).

5.2.1.3.5 Scoring the EBIC.

The EBIC consists of 190 finite and generalised skills, for each of which a unique mastery criterion was specified, determined by whether the skill was generalised or finite, and

whether it related to a limited or unlimited number of items (see Section 4.6.4). For purposes of determining children’s levels of skills within the EBIC, one of three scores (“2”, “1”, or

“0”) was assigned for each skill, depending on each child’s demonstration of those skills, defined as follows:

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 Score of “2”. Skill mastered (i.e., mastery criterion met).

 Score of “1”. Skill present (i.e., child can respond appropriately to five items in random rotation; cf. Weiss & Delmolino, 1999).

 Score of “0”. Skill absent (i.e., neither present nor mastered).

The maximum score that can be achieved on the EBIC is therefore 380 (i.e., mastery of 190 skills).

5.2.2 Results

Of the six children who participated in the research, three (David, Leo, Giles) received 24 months intervention. Intervention for the three other children (Corey, Callum, Reece) was terminated at 22, 16, and 18 months, respectively, because these children left SCAmP to attend full-time specialist schools. Table 3 shows all children’s EBIC scores before and subsequent to intervention.

Table 3. All children’s EBIC scores before (Pre) and subsequent to (Post) intervention. Note. Figures for months indicated in parentheses indicate duration of intervention for children who did not complete the full 24 month intervention.

Table 4 shows intervention week of introduction and teaching duration for major skills (cf. Green et al., 2002; Lechago & Carr, 2008) for all children across curricular levels within the EBIC. Only two children (David and Leo) progressed sufficiently to learn advanced skills within the EBIC. Although these children had not mastered all advanced skills by the end of intervention, all skills at this level were present and progressing towards mastery. David and Leo both mastered all beginner skills within the first four months of intervention, and both of these children achieved mastery of the majority of intermediate skills during the first year of intervention, by the end of which a range of advanced skills were also mastered or present. Both of these children had been able to produce vocal verbal behaviour (i.e., tacting, echoics, basic listener and intraverbal responding) prior to

intervention. Giles, however, was not able to produce verbal behaviour prior to intervention and spent the first 18 months of his intervention learning to mand and tact using sign language and to produce vocal verbal behaviour, while learning other beginner skills.

Subsequent to mastering naming, Giles was able to progress to learning intermediate skills,

Corey Callum Reece

(22 months) (16 months) (18 months)

Pre-intervention 12 8 5 5 0 0

Post-intervention 298 302 112 98 128 42

EBIC score David Leo Giles

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Table 4. Intervention week of introduction (Int) and teaching duration in weeks (Dur) for major EBIC skills in all curricular levels for all children who achieved learning of advanced skills within the EBIC. Note. Dashes indicate that a skill was not introduced. Duration figures in italics indicate that a skill was present but not mastered at the end of intervention.

Curriculum Level & Skill Int Dur Int Dur Int Dur Int Dur Int Dur Int Dur

Advanced

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but continued to learn beginner skills of echoing words, and tacting common nouns and colours, until the end of intervention. Callum, Corey, and Reece each finished intervention early, after 16, 22, and 18 months, respectively. None of these children had been able to produce vocal verbal behaviour prior to intervention, although Corey possessed basic receptive labelling and limited use of PECS. Within the first year of intervention, Callum mastered echoing sounds and a range of other beginner skills including naming, tacting actions, motor imitation, and manding visible reinforcers. At this point, Callum had been ready to start learning intermediate skills but was withdrawn from SCAmP before being able to do so. Although Corey began intervention with more advanced receptive skills than either Giles or Callum, he was not able to achieve mastery of echoics and finished intervention with a lower EBIC score than either of those two children. Although, by the end of the first year intervention, Reece demonstrated the presence of echoing sounds and words and limited manding, listener behaviour and tacting remained absent despite intensive teaching. Reece achieved the lowest level of skills gains of any child in the present research.

Table 5 shows all children’s mean weekly intervention hours delivered by tutors and parents throughout intervention. No child received 40 hrs weekly intervention as determined prior to SCAmP. The highest mean total hours received by any child was 29 (SD = 4.7;

(Giles) and the lowest was 18 (SD = 6; Reece). Overall, children received a mean of 23.9 hrs of intervention (SD = 4.22).

Table 5. Mean weekly intervention hours delivered by tutors and parents throughout intervention for all children. Note. Months indicated in parentheses indicate duration of intervention for children who did not complete the full intervention.

5.2.3 Discussion

The present research was conducted to address three principal aims. Firstly, to obtain initial process data for children receiving University-led EIBI during SCAmP, and, secondly, by doing so, to provide pilot evaluation of the EBIC’s effectiveness as a framework for EIBI.

Thirdly, the present research sought to identify potential practical considerations relating to the implementation and evaluation of the EBIC to be addressed prior to full-scale

implementation during the latter phases of SCAmP.

Corey Callum Reece

(22 months) (16 months) (18 months)

Tutors 19.1 18.5 21.2 22.2 19.2 17.1

Parents 3.4 7.5 8 5 1.3 1.1

Mean intervention hours David Leo Giles

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Regarding the first aim, detailed process data for intervention were obtained through description and recording of children’s curricular targets, acquisition rates of a range of skills across curricular levels, teaching techniques employed, and hours of intervention delivered (cf. Lechago & Carr, 2008). Regarding the second aim, the EBIC scores of five of six children indicated wide-ranging skills gains, thereby provided strong initial support for the EBIC as an effective framework for organising and delivering EIBI. Overall, data indicated that five of six children progressed sufficiently to learn skills beyond the beginner level, although variability in outcomes and rates of skills acquisition was observed across children.

Importantly, however, results observed suggested that children who had acquired vocal verbal behaviour rapidly during the early stages of intervention also mastered subsequent skills more rapidly, and in greater number, than those who had acquired vocal verbal behaviour less rapidly (cf. Weiss, 1999; Weiss & Delmolino, 2006). It should be noted, however, that, owing to absence of psychometric assessment data, formal analyses could not be carried out to evaluate whether rate of acquisition of vocal verbal behaviour was

associated with observed gains in intellectual functioning.

Regarding the organisation of the EBIC, data suggested refinement prior to full-scale implementation. Because previous curricula (Leaf & McEachin, 1999; Lovaas, 1981/2003;

Taylor & McDonough, 1998) had classified “Two-step Labelling” and “Two-step

Instructions” as “Receptive” skills to be taught subsequent to mastery of “One-step Receptive Labelling” and “Single-step Instructions”, this order had been maintained within the initial structure of the EBIC. Data indicated, however, that non-vocal children were unable to learn the former skills within this framework. In addition, it was observed that vocal children were able to master these skills only after they had mastered “Joint Control” within the EBIC. For these reasons, it was decided to place the former skills subsequent to the latter within the organisation of the EBIC.

Regarding practical considerations of implementation and evaluation, parents reported that familial demands had made it difficult to provide their child with the teaching hours agreed prior to intervention (the parents of Corey and Giles had even privately employed tutors to increase teaching hours delivered to their children). The present research also indicated serious practical concerns regarding tutor turnover and training. At the start of intervention, 20 tutors had been trained, but, because of turnover, by the end of 24 months, an additional 16 tutors had had to be recruited and trained. Because of the demands thus placed on SCAmP clinical staff, and the increased number of children that would subsequently be

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participating in University-led EIBI during SCAmP, an additional part-time member of staff was recruited specifically to provide training for new tutors. It was also evident that no LEA was able to provide the number of teaching hours agreed prior to intervention. Unfortunately, no action was possible to rectify this situation during SCAmP.