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Child choice is defined as the incorporation of child-preferred or child-chosen materials, activities, topics, and toys into learning opportunities. Although the clinician follows the child's lead, the environment remains structured such that desired target behaviors are incorporated into the activities, while maintaining the child's attention, and decreasing the likelihood that the child will avoid the interactions and engage in disruptive behaviors (cf. Dyer, Dunlap, & Winterling, 1990; Kern et al., 1998; R. L. Koegel et al., 1998; Moes, 1998; Sigafoos, 1998). Motivation can also be improved by varying the task sequencing and interspersing previously mastered tasks with new acquisition tasks during a learning activity (Carr, Newsom, & Binkoff, 1980; Davis, Brady, Williams, & Hamilton, 1992; Dunlap, 1984; Winterling, Dunlap, & O'Neill, 1987). The child thus experiences a higher rate of success, a greater likelihood of reinforcement, and consequently, increased responsivity (R. L. Koegel, Carter, et al., 1998).
Broadening shaping criteria to reinforce the children's appropriate attempts
to make social and communicative responses, as compared to a stricter shaping
criterion wherein only responses that are as good or better than previous responses
are reinforced, has been shown to increase the children's acquisition of language
and academic tasks (R. L. Koegel, Carter, et al., 1998; R. L. Koegel & Egel,
1979; R. L. Koegel, O'Dell, & Dunlap, 1988). This may be especially important
for acquisition of first words in nonverbal children (R. L. Koegel et al, 1988),
particularly because related areas such as phonology, pragmatics, and semantics
may not yet be strongly established due to lack of practice of these complex
multiple components that comprise appropriate social interactions (cf. Camarata,
1996; Camarata & Leonard, 1986).
Incorporating the motivational variables described earlier, as a group, into an intervention approach can significantly improve language, academic, and social functioning, while simultaneously decreasing disruptive behavior in children with autism as well as other populations (Dunlap, Kern-Dunlap, Clarke, & Robbins, 1991; Kern & Dunlap, 1998; L. K. Koegel, Koegel, & Carter, 1998; R. L. Koegel, Dyer, & Bell, 1987; R. L. Koegel, Koegel, & Schreibman, 1991; Moes, 1998; Schreibman et al., 1996).
Individuals who are not showing widespread generalization of newly learned skills or autonomy of responding can be taught to self-manage behavior. The general procedure involves teaching individuals to discriminate between appropriate and inappropriate behaviors, then to actively record correct responses, and in some cases to administer self-rewards. This procedure can foster generalization of appropriate behaviors across settings and interactions with others while decreasing the need for constant and long-term vigilance by a clinician (Jones, Nelson, & Kazdin, 1977; Kazdin, 1974; Kern, Marder, Boyajian, Elliot, & McElhatten, 1997; R. L. Koegel, Koegel, & Parks, 1995; Pieree & Schreibman, 1994; Stahmer & Schreibman, 1992). Interventions using self-management have been shown to result in increases in personal competence, problem solving, and independence (L. K. Koegel & Koegel, 1995) and have been successful in targeting a variety of behaviors such as stereotypy (R. L. Koegel & Koegel, 1990), social skills (L. K. Koegel et al., 1992; R. L. Koegel & Frea, 1993; Reese, Sherman, & Sheldon, 1984), disruptive behavior (Newman, Tuntigian, Ryan, & Reinecke, 1997), appropriate play (Stahmer & Schreibman, 1992), and academic skills (Harris, 1986). In addition, implementing a self-management program can promote a cycle of increasing positive interactions, as the children leam to self-recruit reinforcement for appropriate behaviors in the natural environment, thus increasing the likelihood of obtaining reinforcement from individuals outside the intervention setting (Baer, Fowler, & Carden-Smith, 1984; Todd, Horner, & Sugai, 1999).
Summary of Conceptual Framework
Addressing core behaviors during intervention is an emerging strategy in reducing proxy behaviors or symptoms that show an indirect relation with core symptomatology of children with autism. As can be noted in Figure 1, the major or core area in this conceptual framework relates to increasing the child's motivation to engage in social communicative interactions. This involves motivating the child to initiate social interactions, to self-regulate behavior, and to respond to complex interactions involving multiple cues. Thus, specific procedures designed to increase motivation are incorporated into all teaching and learning interactions. Research has shown that addressing this core area may result in large improvements not only in the core areas of social communication, initiations, and self-management but also in many proxy behaviors including reductions in disruptive and stereotypic behavior and improvements in vocabulary and language, speech intelligibility, and play interactions with peers.
Brief Review of Recent Outcome Studies
The following brief review of outcome studies is divided into (a) examples
of studies reporting data on collateral and generalized improvements in multiple
observable behavioral symptoms that are characteristic of children with autism
and (b) examples of global long-term outcome studies.
Therapies for Children with Autism Spectrum Disorder:
- Vanderbilt Evidence-based Practice Center. (2014). Therapies for Children with Autism Spectrum Disorder: Behavioral Interventions Update. Agency for Healthcare Research and Quality.
Reflection Exercise #6
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