Teaching Advanced Verbal Behavior Using Speech- Generating Devices

Alice Shillingsburg, BCBA-D Author

04/20/2022 Added

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Tri State Webinar 2022

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[00:00:00.734]Hello everyone.
[00:00:02.110]My name is Alice Shillingsburg
[00:00:03.580]and today I'll be presenting a talk
[00:00:05.509]on teaching advanced verbal behavior
[00:00:07.880]to children with autism using speech generating devices.
[00:00:13.200]So, as most of us are well aware,
[00:00:14.800]autism is a developmental disorder characterized by deficits
[00:00:18.260]in both social communication and the presence
[00:00:21.390]of restricted and repetitive behaviors.
[00:00:24.820]It's also widely recognized now that the social deficits
[00:00:29.030]are really the hallmark feature of the disorder
[00:00:32.860]and that language deficits are no longer required
[00:00:36.160]for the diagnosis to be made.
[00:00:38.090]However, we do certainly still see deficits in language
[00:00:42.090]and language use and these deficits range
[00:00:45.870]from mild to severe.
[00:00:49.050]Studies have found approximately 65% to 75% of children
[00:00:53.490]with autism exhibit moderate to severe language delays.
[00:00:58.051]In a study by Anderson et al. in 2007,
[00:01:01.240]a sample of children diagnosed with autism at age two
[00:01:04.870]were then followed and assessed
[00:01:06.470]for their expressive language level at age nine.
[00:01:08.827]And the majority of the participants in this study
[00:01:11.360]did not have fluent language skills
[00:01:13.430]and almost 30% were not using spoken words consistently
[00:01:18.000]to communicate.
[00:01:22.090]So for children with more significant difficulties
[00:01:24.480]with spoken communication,
[00:01:26.110]augmentative and alternative communication systems
[00:01:28.740]are often successfully used.
[00:01:32.767]Augmentative and alternative communication systems
[00:01:37.610]provide a means for communicating when speech is delayed.
[00:01:41.190]And despite a common concern expressed by parents,
[00:01:44.271]there's no evidence to suggest
[00:01:46.330]that augmentative and alternative communication systems
[00:01:49.830]or AAC, will impede the development of spoken language.
[00:01:55.940]AAC includes both aided and unaided systems.
[00:02:01.600]Sign language is an example of an unaided system.
[00:02:05.230]Whereas picture exchange communication
[00:02:07.470]is an example of an aided system.
[00:02:10.400]There are also low tech and high tech AAC.
[00:02:14.313]A picture based system consisting of laminated icons,
[00:02:18.670]and a Velcro book for example,
[00:02:20.300]is an example of a low tech system,
[00:02:23.650]whereas a tablet or an iPad with an application on it,
[00:02:30.030]perhaps with an automated digitized speech output
[00:02:33.470]would be an example of a high tech option.
[00:02:39.170]High tech speech generating devices,
[00:02:41.820]or SGDs may be dedicated devices,
[00:02:45.560]such as a tablet or computer
[00:02:48.080]that are produced really exclusively
[00:02:49.990]for the use as a communication device,
[00:02:53.310]or they may be a commercially available tablet
[00:02:56.440]that's just equipped
[00:02:57.560]with some aftermarket speech generating apps,
[00:03:01.160]such as Proloquo2Go, TouchChat,
[00:03:04.740]any number of applications.
[00:03:07.610]Most SGDs offer touch screens
[00:03:10.810]and have what are called dynamic screen displays,
[00:03:14.050]meaning that the user's selection of one button
[00:03:17.200]causes the display to change
[00:03:19.241]and then they navigate to another screen
[00:03:22.580]with additional folder options.
[00:03:24.500]And this can facilitate faster communication
[00:03:27.130]and allows for a really a very large number of icons
[00:03:31.060]to be provided in one system.
[00:03:38.020]High tech speech generating devices on handheld tablets
[00:03:41.410]have been described as having some advantages
[00:03:44.300]over more low tech systems.
[00:03:47.530]Mobile devices are ubiquitous in society now
[00:03:51.610]and are relatively low cost.
[00:03:54.240]The systems are easy to modify and upload new icons
[00:03:58.370]that can take place very quickly.
[00:04:00.590]And they're pretty easy to carry and transport.
[00:04:03.330]I would guess pretty much everyone here today
[00:04:06.161]has a high tech device on them somewhere.
[00:04:10.840]And because of some of these advantages,
[00:04:15.370]some have started to really wonder
[00:04:18.370]if the widespread use of these devices
[00:04:20.980]as speech generating devices with autistic individuals
[00:04:26.560]has really gotten ahead of the research.
[00:04:33.570]The majority of research on the use of AAC
[00:04:37.170]with the autism population
[00:04:39.130]focuses on teaching requesting skills
[00:04:42.360]or what behavior analysts call mands.
[00:04:45.930]This holds true when examining
[00:04:47.820]high tech speech generating devices as well.
[00:04:50.960]In a recent meta-analysis of tablet use
[00:04:53.650]to teach communication skills to children with autism,
[00:04:56.910]the authors examined only 15 studies
[00:05:00.530]and the majority of these studies
[00:05:02.220]focused on simple manding or requesting,
[00:05:05.446]using a static icon display,
[00:05:08.320]as opposed to a dynamic display.
[00:05:11.340]A few studies also included single word tax,
[00:05:15.260]or what we call labeling, greetings,
[00:05:17.890]some social niceties, such as please and thank you.
[00:05:20.410]But for the majority of these studies,
[00:05:23.900]the skill that's being taught is requesting.
[00:05:27.580]And all but one study targeted single step communication.
[00:05:31.860]And this means that there's no navigation through screens
[00:05:34.850]on the devices at all.
[00:05:36.480]And instead, the participant in the studies
[00:05:38.520]simply had to select an icon
[00:05:40.290]from a display on a single screen.
[00:05:44.280]So, although most apps have dynamic screen displays,
[00:05:48.040]allowing for navigation to thousands of words,
[00:05:51.440]much of the research doesn't tell us how to teach this
[00:05:54.430]or how to move on to more complex communication skills
[00:05:57.063]over and above straightforward requests,
[00:06:01.390]particularly with the autism population.
[00:06:06.380]So in today's presentation, I'll present a set of studies,
[00:06:11.160]teaching advanced communication skills
[00:06:13.920]to children with autism
[00:06:15.610]who use high tech speech generating devices.
[00:06:19.710]And all three of these studies are actually replications
[00:06:23.050]of previous studies that were conducted
[00:06:25.030]with vocal participants, with autism.
[00:06:27.810]People who communicate predominantly
[00:06:29.980]with their vocal language.
[00:06:31.780]And we're gonna cover a study to teach mands for information
[00:06:36.710]procedures to teach individuals
[00:06:39.270]to report past experiences or past behaviors
[00:06:42.700]and labeling, expressive labeling
[00:06:45.329]or tacting using noun-verb combinations.
[00:06:48.080]So two word utterances using their speech generating device.
[00:06:54.420]Okay, so let's get started with the first set of studies.
[00:06:58.670]During typical child development,
[00:07:00.320]early mands include requests for preferred toys,
[00:07:03.940]snacks, or people.
[00:07:05.900]This repertoire becomes increasingly complex
[00:07:08.940]by beginning to include mands for items
[00:07:11.550]that maybe aren't present,
[00:07:12.780]mands for things in the future,
[00:07:15.180]such as when are we going to the playground,
[00:07:17.870]and mands for information.
[00:07:20.080]Although neurotypically developing children
[00:07:22.070]appear to learn to ask questions fairly effortlessly,
[00:07:25.810]some children with autism who also experience
[00:07:28.470]significant language and communication delays
[00:07:31.280]may require some specialized intervention
[00:07:33.650]to learn to mand or request for information from others.
[00:07:40.380]So a widely recognized key element
[00:07:43.000]of effective mand training in general
[00:07:45.880]is manipulating what are called motivating operations.
[00:07:49.430]Now, for those of you attending this presentation
[00:07:52.970]who maybe aren't behavior analysts,
[00:07:54.520]you can easily substitute the word motivation
[00:07:57.300]for the term motivating operations.
[00:08:01.330]But before we begin for the behavior analysts
[00:08:03.580]in the audience, as well as everyone else,
[00:08:07.810]we'll talk a little bit about a quick overview
[00:08:09.980]of how motivating operations or motivation
[00:08:13.630]is involved in mand training or request training.
[00:08:19.420]Okay, so quickly a definition of motivating operations,
[00:08:24.370]motivating operations really have two components to them.
[00:08:28.160]The first is that when a motivating operation is present
[00:08:31.880]or a motivation,
[00:08:33.150]there is a change in the reinforcing effectiveness
[00:08:36.100]of other stimuli.
[00:08:37.360]In other words,
[00:08:38.280]other stimuli the environment can become a reinforcer
[00:08:41.870]or lose that effect.
[00:08:43.930]And when that happens,
[00:08:45.390]the second part of a motivating operation
[00:08:47.560]is that we see a change in the frequency
[00:08:49.630]of the occurrence of behaviors
[00:08:51.110]associated with those reinforcers.
[00:08:53.500]In other words, if a reinforcer becomes more effective,
[00:08:56.440]it might evoke behaviors.
[00:08:57.860]And if a reinforcer loses its effectiveness
[00:09:00.392]then those behaviors might abolish or abate.
[00:09:06.730]Okay, let's look at an example.
[00:09:09.280]So in the behavior analytic literature,
[00:09:11.550]we talk about motivating operations in two ways,
[00:09:15.200]it can be an establishing operation,
[00:09:17.020]which is really the establishment of motivation.
[00:09:21.220]And when this happens,
[00:09:22.550]we see a change in the value
[00:09:24.120]of something in the environment.
[00:09:25.620]And when something becomes more valuable,
[00:09:27.450]we see a change in behavior.
[00:09:29.190]So for example,
[00:09:31.110]let's say there's been a period of time without food,
[00:09:34.530]food deprivation sounds a little bit harsh,
[00:09:36.600]but essentially it just means it's been a little while
[00:09:39.940]since you've had a snack.
[00:09:42.020]The value of that food,
[00:09:44.880]any kind of snack then would increase
[00:09:46.800]and it would increase any behaviors that lead to food.
[00:09:51.110]Alternatively, what might happen in the environment
[00:09:53.720]is that you have what's called an abolishing operation,
[00:09:56.720]where the value of something actually decreases
[00:10:01.300]so there's no motivation.
[00:10:02.580]And this might happen for example, when you're satiated.
[00:10:05.960]So instead of it being a long time
[00:10:07.570]since you've had something to eat,
[00:10:08.890]you're actually full or satiated.
[00:10:11.070]And when this happens,
[00:10:12.380]then the value of food actually decreases.
[00:10:15.270]And it makes it a little less likely
[00:10:17.360]that you're gonna engage in any behavior
[00:10:19.280]that might lead to food.
[00:10:20.990]So, a little bit more succinct here.
[00:10:23.980]Let's say it's been five hours since breakfast.
[00:10:26.680]Food now becomes valuable
[00:10:28.130]and you might engage in any of these types of behaviors
[00:10:31.050]in order to contact food.
[00:10:32.930]You might get up and walk over to the fridge.
[00:10:35.180]You might look up a menu on your phone,
[00:10:37.440]or you might ask somebody for a snack.
[00:10:40.310]Let's say you just finished a giant buffet lunch.
[00:10:44.190]In this case,
[00:10:45.023]there would be no motivation for additional snacks or food.
[00:10:49.430]So from a motivating operation perspective,
[00:10:52.431]there's a decrease in the value of that food.
[00:10:55.720]So the food loses value.
[00:10:57.250]And so you don't engage in behavior that leads to food.
[00:11:00.630]Instead, you might take a nap, watch a football game,
[00:11:03.170]and you certainly aren't gonna ask somebody for a snack.
[00:11:06.510]Okay, so in this example,
[00:11:08.630]the change in behaviors that we see
[00:11:10.440]only a couple of them are actually relevant
[00:11:12.520]to manding or requesting.
[00:11:15.720]When you're motivated
[00:11:16.880]only one of those three behaviors is a mand.
[00:11:19.520]The other two, you just get up and get it yourself.
[00:11:23.200]But in this case you might ask for a snack.
[00:11:25.940]When there's no motivation,
[00:11:28.390]what we would hope to see
[00:11:29.960]is that you wouldn't ask for a snack.
[00:11:34.890]So, when we set up intervention
[00:11:38.200]to teach requesting skills or manding skills
[00:11:43.170]to individuals who haven't acquired this skill,
[00:11:47.030]it might look something like this.
[00:11:48.860]So, we try to establish motivation
[00:11:53.630]for something that we're gonna teach a child to ask for.
[00:11:56.740]So for example, it's been a little while since we've eaten,
[00:11:59.910]it's now snack time.
[00:12:01.520]And at this point there's an increased value of snack.
[00:12:05.000]What we might see in individuals who have developed language
[00:12:07.920]is they might say chip or chip please,
[00:12:09.740]or I'd like some chips.
[00:12:11.030]And the reinforcer for that behavior is of course,
[00:12:13.410]to give somebody their chips for their snack.
[00:12:16.240]Now, with kiddos who haven't developed
[00:12:18.050]the ability to ask for things,
[00:12:19.810]to mand for things when they want it, the skill is absent,
[00:12:24.470]our intervention is gonna require
[00:12:26.270]that we do something right here.
[00:12:28.410]And in the case of behavior analytic, ABA services,
[00:12:32.300]what this might look like
[00:12:33.310]is we're actually gonna prompt them to mand.
[00:12:36.470]Now, with kiddos who use spoken language,
[00:12:38.470]we might prompt, say chip,
[00:12:41.180]with kids who use AAC or speech generating devices,
[00:12:45.130]we would prompt them to press the button on their device
[00:12:49.900]for that to give the output of chip.
[00:12:53.170]When that happens then we would reinforce with chips.
[00:12:56.250]Okay, so that's simple manding.
[00:12:57.930]Today we're gonna talk a little bit more
[00:12:59.590]about more advanced manding,
[00:13:01.630]or what's called manding for information,
[00:13:03.530]or requesting for information.
[00:13:05.340]And the setup is actually pretty similar.
[00:13:08.440]So imagine a child asks for something that he can't find,
[00:13:12.370]maybe he's doing an art project
[00:13:13.690]and he can't find his crayons
[00:13:15.130]or whatever it may be.
[00:13:17.201]He's told by the adult in the room,
[00:13:20.840]oh, they're in the cabinet,
[00:13:22.280]but potentially not told which specific cabinet.
[00:13:25.450]And so in this case,
[00:13:26.950]the child needs more information
[00:13:29.030]in order to get the thing that he wants.
[00:13:31.870]So, just like in the previous example,
[00:13:34.470]we've set up a motivation or an establishing operation.
[00:13:38.430]And this is that we've told him some information,
[00:13:41.890]but not enough information
[00:13:43.980]to access the thing that he's looking for.
[00:13:46.410]And so the motivation really is related to the fact
[00:13:49.810]that information is withheld or not known.
[00:13:52.790]And when that happens,
[00:13:54.040]that increases the value of knowing that information
[00:13:57.760]with an individual who has an intact
[00:14:00.077]requesting for information
[00:14:02.040]or manding for information repertoire,
[00:14:03.820]they may say, which cabinet or which one?
[00:14:06.950]And when that happens, the information,
[00:14:09.110]oh, the cabinet on the left or cabinet number two,
[00:14:12.840]might be provided,
[00:14:13.930]and the person can then use that in information
[00:14:16.240]to access the reinforcer that they were looking for
[00:14:19.090]in the first place.
[00:14:20.310]Now, again, with kiddos
[00:14:21.510]who don't have a manding for information repertoire,
[00:14:24.550]we've got to intervene.
[00:14:26.130]And similar to simple mand training,
[00:14:29.600]we're gonna do something right here.
[00:14:31.510]And that is, we're gonna prompt the mand to ask which one,
[00:14:35.850]and when that happens,
[00:14:37.168]we're essentially providing the information.
[00:14:40.970]They say which one, we provide the information,
[00:14:43.220]that's the reinforcer.
[00:14:44.690]And then they use that information
[00:14:46.590]to access that ultimate reinforcer.
[00:14:51.400]Now, just like with the simple mand training,
[00:14:56.080]there are situations
[00:14:56.913]where we don't want kids to ask for information
[00:15:00.090]because they've already got it.
[00:15:01.450]So in this case,
[00:15:02.340]a child might ask for something he can't find.
[00:15:04.860]And instead of being given sort of vague information,
[00:15:08.640]he's told the very specific cabinet where or the item is.
[00:15:12.160]In this situation,
[00:15:13.170]we've set up what's called an abolishing operation
[00:15:15.550]in the sense that we've already said
[00:15:17.010]it's in cabinet number two.
[00:15:18.600]And if that's the case, the information is already provided.
[00:15:22.400]There's no increase in the value of more information
[00:15:25.490]because we don't need any more information.
[00:15:27.940]And in this case, no mand is admitted, no request.
[00:15:31.300]There's no information additionally provided
[00:15:33.620]because we don't need it.
[00:15:34.900]And instead,
[00:15:36.910]the individual can just use the information
[00:15:38.940]that was already provided to access the item.
[00:15:43.150]Now functional mand training
[00:15:45.290]requires that a person be able to discriminate
[00:15:48.490]between those EO and AO conditions.
[00:15:51.410]When inform is needed,
[00:15:52.700]versus when information is not needed.
[00:15:55.470]And that's why when we teach mands,
[00:15:57.730]we typically conduct practice opportunities or trials
[00:16:03.890]where sometimes the information is needed
[00:16:06.200]and sometimes the information is not needed.
[00:16:09.090]Because if you see manding or requesting occur
[00:16:13.100]in that AO condition,
[00:16:14.880]when information is not needed,
[00:16:16.960]that's a signal to you
[00:16:18.500]that you haven't taught a discriminated mand.
[00:16:20.920]And the mand might actually be more of a rote response.
[00:16:25.120]So this is a really good opportunity
[00:16:26.940]to sort of check for that and program for that
[00:16:29.330]by alternating between EO and AO conditions,
[00:16:32.680]to make sure your mands or your requests are functional.
[00:16:37.230]Okay, so this is a study that I published in 2014
[00:16:42.310]with a couple of co-authors of mine,
[00:16:44.420]teaching mands, organ request for information,
[00:16:48.445]specifically teaching kiddos with autism
[00:16:51.540]to ask who and which questions.
[00:16:54.280]And we made sure that we alternated
[00:16:56.380]between establishing and abolishing operations.
[00:16:59.520]So when you need the information
[00:17:01.060]versus when you don't need the information.
[00:17:04.670]So just walk you through this.
[00:17:06.343]This study was actually published
[00:17:07.970]with kiddos who use spoken communication,
[00:17:10.000]and then I'll walk you through how we did it
[00:17:11.850]with kids using speech generating devices.
[00:17:14.600]So again,
[00:17:15.433]we created or contrived this sort of motivation
[00:17:18.800]and establishing operation
[00:17:20.740]and abolishing operation conditions.
[00:17:23.340]In the EO present condition,
[00:17:25.670]the information regarding the location of a preferred item
[00:17:29.250]was not given to the child.
[00:17:31.410]So we kind of gave some vague information.
[00:17:33.677]And this was how we were contriving motivation
[00:17:36.570]for that information,
[00:17:37.650]so that they would want to ask us questions.
[00:17:42.180]In the EO absent condition, this is abolishing operation,
[00:17:46.220]the information regarding the location of the thing
[00:17:49.080]that they were looking for was just given straight away.
[00:17:51.950]And so now there's no motivation for additional information.
[00:17:56.290]And what we were looking to measure are dependent variables,
[00:17:59.290]where we wanted to see did they ask who has it,
[00:18:02.790]or which one, when that EO was present,
[00:18:06.650]when the information was needed.
[00:18:08.170]But we also measured to make sure that they never asked
[00:18:11.290]when the motivation was absent,
[00:18:12.890]so that we could ensure we were not teaching rote responses.
[00:18:17.920]So it looked a little bit like this,
[00:18:19.976]in the EO present condition,
[00:18:21.840]we hid some preferred items in a container,
[00:18:26.290]and the containers were sort of a set of them.
[00:18:29.220]So there were similar containers and we didn't specify
[00:18:32.580]which container the item was hidden in.
[00:18:34.650]So if a kiddo was looking for a crayon
[00:18:36.480]or wanted a snack, something like that.
[00:18:41.150]In our AO condition,
[00:18:43.164]or when the motivation was gonna be absent,
[00:18:46.200]we hid a preferred item in the container, again,
[00:18:48.920]amongst similar containers.
[00:18:50.700]But in this case,
[00:18:51.533]we did tell them which container it was in.
[00:18:54.860]So the child's asked for a cookie, we say, sure,
[00:18:57.970]it's in one of those boxes,
[00:18:59.650]contriving the motivation to learn which box it's in.
[00:19:04.220]And then other condition, the child asks for a cookie
[00:19:07.270]and we say, sure, it's in the yellow box.
[00:19:09.560]And this indicates that there's or sets the stage
[00:19:13.610]for not needing any additional information.
[00:19:17.170]Okay, so let's look at some data from this study.
[00:19:20.230]Now these data are not percent correct.
[00:19:26.500]I know sometimes when we look at data for teaching skills,
[00:19:29.740]we're looking at, did he get 90% correct
[00:19:33.917]and that type of thing.
[00:19:34.980]But instead these data are presented cumulatively.
[00:19:39.320]What that means is that each one of these dots here
[00:19:46.210]represents an opportunity to request.
[00:19:48.820]It's just each single one is an opportunity.
[00:19:52.240]And if you see the lines start to go up,
[00:19:54.080]that means that the child engaged in the behavior
[00:19:57.020]we were looking for.
[00:19:58.540]And if it stays flat, that means that they didn't.
[00:20:02.970]Okay, so what we're seeing here
[00:20:05.170]are mands for information or requests asking which,
[00:20:10.660]so which cabinet, which box, which drawer,
[00:20:14.080]that type of thing, on this side.
[00:20:16.410]And over here is when I deliver that information.
[00:20:20.300]So I say, oh, it's in the yellow box.
[00:20:23.290]Does the child approach that box
[00:20:26.500]and access the thing that they were looking for?
[00:20:28.950]So basically this is that use of information.
[00:20:31.430]Do they use the information that they're told?
[00:20:34.400]Okay, so the black diamonds represent the EO condition.
[00:20:39.250]Now keep in mind that's when the information is needed.
[00:20:42.010]We want kids to ask us for information in that condition.
[00:20:46.320]The AO condition is when the information
[00:20:48.830]was already provided,
[00:20:50.130]we want this line to stay low
[00:20:53.000]because we've already told them the information.
[00:20:55.190]So we don't want them to ask.
[00:20:57.580]What you can see
[00:20:58.413]for all three of our participants with autism,
[00:21:00.640]that in baseline,
[00:21:01.559]whether we told them the information or not,
[00:21:04.420]they never asked which questions.
[00:21:08.050]And you can see that we're alternating
[00:21:10.570]between the two trial types and they never ask.
[00:21:13.940]Over here though,
[00:21:15.290]what you'll see is that
[00:21:16.820]when we don't provide them the information in these trials,
[00:21:21.460]they can't use the information to go find it
[00:21:24.630]in the yellow box.
[00:21:26.020]However, in these trials, right over here,
[00:21:29.940]we are providing the information right out of the gates.
[00:21:32.940]And they're able to use that information.
[00:21:37.190]So we know now that if this child
[00:21:40.130]could just ask for information, they could use it
[00:21:43.415]to find things better in their environment.
[00:21:47.510]Okay.
[00:21:48.520]So then we ran treatment trials,
[00:21:52.220]teaching them how to ask for information.
[00:21:55.300]And what you see here is,
[00:21:57.800]as we've taught contriving opportunities
[00:22:01.310]for them to ask for information
[00:22:02.870]and prompting them to request that information,
[00:22:05.560]we see all three of our participants ask for information
[00:22:09.240]only when the information is withheld
[00:22:11.730]and develop a functional manding repertoire,
[00:22:14.960]because they aren't asking when the information is withheld.
[00:22:19.420]Okay.
[00:22:20.253]And then you can also see over here
[00:22:22.290]now that these kids can use their language skills
[00:22:27.300]to ask for information,
[00:22:28.790]they're able to use information in both conditions
[00:22:31.570]to then go and find the item that they were looking for.
[00:22:35.230]Okay, so those data were with three children with autism
[00:22:39.960]who were vocal.
[00:22:41.020]We wanted to see if kids
[00:22:42.400]who were using speech generating devices
[00:22:44.350]could also mand for information under similar conditions.
[00:22:49.260]This study was published in 2019
[00:22:52.200]in the Journal of Applied Behavior Analysis.
[00:22:54.510]And we've essentially just replicated these procedures.
[00:22:58.240]So here are just some information about the participants.
[00:23:01.800]I typically get asked, okay, for which kiddos?
[00:23:04.561]So you can see here all of our participants
[00:23:07.010]were between the ages of three and six years old.
[00:23:09.550]If you're familiar with the VB-MAPP,
[00:23:11.540]or the verbal behavior milestones assessment,
[00:23:14.060]you can see that all of these kiddos
[00:23:16.860]were scoring in the upper level two and three
[00:23:19.250]of the VB-MAPP.
[00:23:22.010]They had really high mand scores,
[00:23:25.130]which means that they learned new mands
[00:23:27.220]without a lot of work.
[00:23:28.340]Now these are mands for items.
[00:23:30.950]But none of these kids were manding for information
[00:23:33.490]when we started this study.
[00:23:36.970]Okay, so here's how these mand for information trials
[00:23:40.490]would go for our kids using speech generating devices.
[00:23:44.160]This is just an example of the home screen
[00:23:47.430]that a child could initiate a mand for a preferred item.
[00:23:53.090]So the child would click on here.
[00:23:55.513]These are their preferred items that are in our clinic.
[00:23:59.160]And so they would go to that location.
[00:24:01.157]Then they might click on the folder labeled favorite things.
[00:24:04.820]When they got in there,
[00:24:06.010]then the child would mand a request
[00:24:08.560]by selecting the icon of that preferred item.
[00:24:11.440]Now they've asked for a specific item
[00:24:13.310]and the response here is, sure, one of your teachers has it.
[00:24:16.550]Now this is information, but it's vague.
[00:24:19.520]And so this is setting up the situation
[00:24:23.520]where a child actually needs more information.
[00:24:26.240]And so that sets the stage for manding for information.
[00:24:30.560]The child would then go back out to their home screen,
[00:24:34.100]select the questions folder,
[00:24:35.950]and then select the correct question out of an array.
[00:24:39.550]So in this case, it would be who has it?
[00:24:42.290]Asking about the particular teacher
[00:24:44.990]who has their preferred item.
[00:24:48.600]One participant,
[00:24:50.400]there was no navigation because he simply typed.
[00:24:55.180]So here are the data from our recently,
[00:24:57.040]this published study with the three participants
[00:25:00.530]who use speech generating devices.
[00:25:02.940]So here we taught mands for information using which.
[00:25:06.630]Now the data should look similar to you.
[00:25:08.990]It's presented the same way as the previous data set
[00:25:11.870]that we just went through.
[00:25:13.410]As you can see, none of the participants
[00:25:15.900]were manding for information or asking WH questions,
[00:25:22.350]whether they needed the information or not in baseline.
[00:25:25.720]But similar to the other kiddos,
[00:25:27.980]if we provided the information in that AO condition,
[00:25:31.960]all of them could use the information
[00:25:34.220]to access the thing that they were looking for.
[00:25:36.420]And that's critical to know
[00:25:39.090]since use of the information really is that reinforcer.
[00:25:44.020]All of these participants also learned to discriminate
[00:25:48.207]when they needed information to ask questions.
[00:25:51.200]And when they knew the information
[00:25:53.250]they refrained from emitting like a rote response,
[00:25:56.650]which is really also important to know.
[00:25:58.800]And then additionally,
[00:26:00.250]just like the kiddos who use vocal language,
[00:26:03.720]these kiddos, once they learned to request information,
[00:26:07.340]could then use that information
[00:26:09.170]to access the thing that they couldn't find originally.
[00:26:16.420]This is just the data for manding for information who,
[00:26:20.620]so we taught both which questions and who questions,
[00:26:26.020]similar results here.
[00:26:29.040]Now, we also wanted to make sure
[00:26:31.220]not only would the kiddos
[00:26:33.850]be able to functionally use their new language skill
[00:26:37.010]to ask which questions when they needed to know which,
[00:26:41.380]and who questions when they needed to know who
[00:26:44.070]and to refrain from using those questions
[00:26:46.520]when they didn't need to use them.
[00:26:48.360]We also then interspersed them together
[00:26:52.530]to make sure that they didn't accidentally
[00:26:54.950]ask which questions when they meant who,
[00:26:57.220]and who questions when they meant which.
[00:26:59.850]And this is an important thing to assess as well.
[00:27:04.380]So what you can see here is that every time,
[00:27:06.840]this is Justin had no problem
[00:27:10.280]selecting the correct question to fit the right scenario
[00:27:15.230]and never made mistakes here, neither did Emma.
[00:27:18.900]However, one of our participants,
[00:27:20.790]once we sort of started interspersing
[00:27:23.460]the different types of WH questions, did have some errors.
[00:27:29.110]Now, he didn't ask questions when he didn't need them,
[00:27:31.950]but he was using who and which kind of interchangeably.
[00:27:34.990]So we then taught that to kind of straighten that out
[00:27:37.730]a little bit for him.
[00:27:38.870]And that's important to know for any learner
[00:27:41.430]that you might be working on this skill with.
[00:27:46.230]So in conclusion,
[00:27:47.330]all three participants engaged in discriminated manding.
[00:27:50.190]They maned for information when it was needed,
[00:27:52.200]refrained from manding for information
[00:27:53.900]when it wasn't needed.
[00:27:54.930]And they used the appropriate mand frame, who or which,
[00:27:58.860]under the right conditions with the one little guy
[00:28:02.010]needing a little bit of training to help him with that.
[00:28:06.970]So let's move on to another series of studies
[00:28:11.980]to address another commonly identified parental concern.
[00:28:15.360]And that is teaching kids to be able to answer questions,
[00:28:20.370]or to describe events and things that have happened to them.
[00:28:24.960]And we've examined this through teaching kids
[00:28:27.410]to talk about the events in their day.
[00:28:29.800]Now in day to day interactions,
[00:28:31.720]children are frequently expected to report or recall
[00:28:34.300]their past behavior accurately.
[00:28:35.970]For example, that adult might ask,
[00:28:38.670]did you finish your homework?
[00:28:40.160]Or who did you see at school today?
[00:28:42.310]And having difficulty answering questions like this
[00:28:45.340]is really a common caregiver concern
[00:28:48.000]and can become more concerning when it's things such as,
[00:28:51.900]how did you get this bruise or did you get hurt today?
[00:28:56.030]Now the development of this repertoire
[00:28:58.280]could be conceptualized as what we call a self tact
[00:29:01.280]or a self label.
[00:29:02.880]Basically self tacting or self labeling is verbal behavior
[00:29:06.960]that's controlled by a current stimuli,
[00:29:09.440]including things that are going on
[00:29:11.420]inside the speaker himself
[00:29:14.630]that are sort of generated by the question
[00:29:16.580]that they've just been asked.
[00:29:18.470]And what you've been asked,
[00:29:20.470]what you're thinking about or feeling about on the inside,
[00:29:23.350]in combination with what has been conditioned
[00:29:26.690]through reinforcement really comes together
[00:29:30.215]to develop this skill.
[00:29:32.970]Now, Palmer describes this as,
[00:29:35.660]what we call intraverbal control.
[00:29:37.730]So for the behavior analysts in the audience
[00:29:40.760]that this might sound familiar,
[00:29:42.250]but essentially the difference is,
[00:29:45.920]let's say, I say Mary had a little.
[00:29:52.270]And if you're listening to this, you probably said lamb.
[00:29:55.570]That's an example of kind of answering a question
[00:29:59.110]or filling in something that's pretty rote, right?
[00:30:01.490]It's an intraverbal but it's pretty rote.
[00:30:04.030]Versus something like,
[00:30:05.910]tell me something, tell me what makes a good pet.
[00:30:09.880]And probably many of you might be saying dog, cat,
[00:30:12.750]bird, fish.
[00:30:14.220]And the reason we get different answers to that question
[00:30:17.630]is because your answer is evoked
[00:30:19.540]not only by the question that I asked
[00:30:21.550]or the words that I said,
[00:30:22.750]but also your thoughts and feelings about that,
[00:30:25.390]which are things that are going on inside of you.
[00:30:28.660]Now let's look at an example
[00:30:30.540]of reporting past behavior or events in children.
[00:30:34.430]So a caregiver may ask a question, oh,
[00:30:36.728]what did you eat for snack today?
[00:30:39.020]And essentially,
[00:30:42.454]what happens here is the child might think, hmm,
[00:30:47.570]say to himself, what did I eat for snack?
[00:30:49.420]And think back and maybe visually imagine
[00:30:52.950]the snack that they had that day.
[00:30:56.420]And then says gummy bears.
[00:30:59.070]And then the caregiver responds, oh, yummy gummy bears,
[00:31:03.360]to sort of reinforce that response.
[00:31:06.490]But what happens if a child doesn't ask, I'm sorry,
[00:31:11.100]answer correctly and just gives a rote answer?
[00:31:13.360]Maybe they just hear the word snack and say any snack,
[00:31:16.770]as opposed to thinking about their own personal experiences.
[00:31:22.130]Now, what typically happens in child development
[00:31:26.010]is that our verbal community really helps us learn
[00:31:29.950]how to respond correctly to questions.
[00:31:32.260]Essentially, if you may ask a question,
[00:31:37.700]who did you see at school today?
[00:31:39.240]And let's say that that question
[00:31:40.420]is a little too complicated,
[00:31:42.543]perhaps the child can't answer that question.
[00:31:45.150]We would swoop in with a little bit of help
[00:31:47.100]and say, was Jessica there?
[00:31:49.260]Now that might be a question that a child can answer
[00:31:51.990]and you can see through lots of interactions like this,
[00:31:55.510]that a child might learn that this more complicated question
[00:31:59.500]is actually referring to people,
[00:32:01.640]because you see the who, and then was Jessica.
[00:32:03.980]And over time,
[00:32:06.230]kids learn to be able to answer to more complex questions.
[00:32:09.680]And this is how reporting past behaviors
[00:32:11.660]is shaped in typical development.
[00:32:16.210]Now deficits in the development of reporting past events
[00:32:19.500]or behaviors may happen for a couple of reasons
[00:32:22.640]for kiddos with autism.
[00:32:25.140]One is just errors in stimulus control,
[00:32:28.810]meaning that the question is potentially too complicated.
[00:32:32.650]And the child just hasn't learned
[00:32:35.938]to be able to respond to questions like that.
[00:32:40.497]The second reason might be
[00:32:43.090]that a lot of these types of behaviors
[00:32:45.380]are sort of reinforced or developed
[00:32:48.780]through kind of natural social reinforcers.
[00:32:52.257]And if social stimuli aren't potent enough
[00:32:56.980]to really reinforce particular skills,
[00:33:01.310]then this may be more challenging for children with autism.
[00:33:05.753]So in order to overcome these deficits,
[00:33:08.430]interventions might focus on,
[00:33:10.420]specifically on improving the correspondence
[00:33:12.930]between non-verbal and verbal behavior.
[00:33:15.940]And this is known as do/say correspondence.
[00:33:20.100]So essentially the ability to accurately report
[00:33:25.570]or say what you just did.
[00:33:29.070]So in do/say correspondence,
[00:33:34.550]a non-verbal behavior, that's the due part,
[00:33:37.960]and an antecedent stimulus,
[00:33:40.050]so for example, saying, what did you eat for a snack,
[00:33:43.360]occurs, and then a verbal behavior is emitted.
[00:33:46.530]And that's the say part,
[00:33:48.090]cuz that's where we get sort of the do/say correspondence.
[00:33:50.520]Now, if we have correspondence
[00:33:52.130]in the response, I ate gummy bears,
[00:33:55.100]would then be reinforced.
[00:33:57.280]However, we have found that this strategy alone
[00:34:00.470]doesn't always work, just reinforcement.
[00:34:03.810]So, in two studies,
[00:34:07.320]we've looked at examining potential strategies
[00:34:10.040]to improve teaching kids to report past behavior.
[00:34:14.090]In one study, came out in 2017,
[00:34:17.270]we implemented the procedures with vocal children,
[00:34:20.090]and we've found that using vocal imitation prompts
[00:34:23.750]can be effective at teaching them
[00:34:25.950]to tell us what happened earlier in the day.
[00:34:28.220]And the study I wanna talk about today
[00:34:30.650]is a replication of this study that came out in 2019,
[00:34:34.120]where we used similar procedures
[00:34:36.160]to children who were not vocal,
[00:34:37.940]but who used high tech speech generating devices
[00:34:40.410]to communicate.
[00:34:43.380]So these kiddos were actually the same three kiddos
[00:34:45.820]that were in the last study that I talked about
[00:34:49.560]with manding for information.
[00:34:51.240]So you're familiar with their sort of skillset.
[00:34:54.360]They all use their device to mand, tact,
[00:34:56.640]and intraverbally respond.
[00:35:00.070]Now in this study, we scored a response as correct
[00:35:02.960]if the participant admitted the name of the activity
[00:35:06.110]that they completed in their specific location,
[00:35:09.610]using either a picture selection on their device
[00:35:12.540]or text selection,
[00:35:13.700]or for the one little guy who used typing on his device.
[00:35:20.070]So again, for the two kiddos who used icons,
[00:35:23.520]navigation was required,
[00:35:24.990]but for the kiddo who typed, he just typed on his screen,
[00:35:29.760]as you can see there on the bottom, something like that.
[00:35:33.290]Okay, so prior to starting this type of procedure,
[00:35:38.110]you're gonna potentially need to do some pre-assessment
[00:35:40.700]or pre-teaching to ensure that some prerequisite skills
[00:35:44.320]are in place.
[00:35:45.230]So, before we did baseline here,
[00:35:48.210]we taught the names of the activities
[00:35:50.750]and the locations where those activities
[00:35:53.270]were going to be done so that they could tell us about that.
[00:35:58.850]So basically we taught three different activities
[00:36:02.330]and three different locations
[00:36:04.620]that were gonna be used in this procedure.
[00:36:08.840]And in all of the conditions throughout this study,
[00:36:11.830]just so that you know,
[00:36:13.199]the order of the locations that we went
[00:36:16.070]and the different activities that we completed
[00:36:18.240]varied every single day.
[00:36:19.710]So there was nothing rote
[00:36:20.910]about any of the things that we did.
[00:36:23.300]So for example, on one day,
[00:36:25.420]a participant might have colored in the classroom,
[00:36:30.140]went bowling in the playroom and then read in the cafeteria.
[00:36:35.450]And then on the next day,
[00:36:36.980]he or she would've read a book in the playroom,
[00:36:39.690]colored in the cafeteria and so on.
[00:36:42.794]So that there was no way to sort of memorize
[00:36:45.190]the responses to the questions we were asking.
[00:36:48.710]Now, once we started the study,
[00:36:51.700]after they completed their activities,
[00:36:54.861]the kiddo would go about their regular daily routine.
[00:36:58.630]And then at the end of their day,
[00:37:00.630]which was about two hours later,
[00:37:02.590]the therapist would ask them,
[00:37:04.420]what did you do in the cafeteria?
[00:37:07.100]What did you do in the classroom?
[00:37:08.330]What did you do in the playroom?
[00:37:11.540]For all of the locations.
[00:37:13.630]Whoops, there we go.
[00:37:15.810]Now a correct response was reinforced.
[00:37:18.470]So we would give them a reinforcer to help teach them
[00:37:22.410]that these were correct responses.
[00:37:26.490]At the end of the day, what did you do?
[00:37:28.390]Sorry, I got a little behind there.
[00:37:30.420]Okay, now for one of our participants, Emma,
[00:37:33.010]she responded a little bit uniquely.
[00:37:34.650]So I'll show you her data a little bit separately.
[00:37:38.870]Now here,
[00:37:39.850]we're most interested in the open data path
[00:37:43.150]and the squares here,
[00:37:45.790]because this represents her responses at the end of the day,
[00:37:48.670]which is really the socially valid response, right?
[00:37:51.040]When a parent comes to pick you up at the end of the day,
[00:37:52.907]and you say, oh, what'd you do in the playroom today?
[00:37:56.320]Usually that's sort of after a pretty lengthy delay
[00:38:00.020]that you did that fun activity a couple hours earlier.
[00:38:06.070]So at the end of the day,
[00:38:07.040]each participant is asked about their activities
[00:38:09.070]completed in the three locations.
[00:38:10.880]So you can see here,
[00:38:12.100]they could have responded up to three times correctly.
[00:38:15.990]In baseline, Emma admitted no correct responses
[00:38:19.160]to past events.
[00:38:23.020]Okay, here we have the data for the other two participants,
[00:38:27.630]Justin and Bruce.
[00:38:28.720]Justin had low levels of correct responding in baseline
[00:38:32.270]while Bruce had zero.
[00:38:33.930]And for these two kiddos,
[00:38:35.880]we actually did have their caregiver
[00:38:37.490]do some probes for us as well
[00:38:39.720]to see how well it generalized to them.
[00:38:41.930]And you can see,
[00:38:42.763]they did not report past behaviors
[00:38:44.010]to their caregivers either using their devices.
[00:38:50.380]Now, the first phase that we implemented
[00:38:55.790]was really just the introduction of immediate probes
[00:38:58.570]instead of delayed probes.
[00:39:00.500]So this phase was identical to baseline,
[00:39:03.870]except that immediately after each activity was completed
[00:39:07.270]and cleaned up, we would say, hey,
[00:39:08.810]what did you just do in the, whatever?
[00:39:12.550]And one of the reasons we wanted to do that
[00:39:14.700]was we just needed to know
[00:39:16.140]could they tell us at all what they had just done?
[00:39:19.620]Or was it specifically the delay that was a challenge.
[00:39:23.880]So what did you do in the playroom.
[00:39:27.640]If it was,
[00:39:30.080]and then we would ask, do the next activity,
[00:39:32.520]ask them what did you do in the cafeteria?
[00:39:35.410]And then did the next activity,
[00:39:36.650]what did you do in, wherever location they were in.
[00:39:40.250]If they were correct, it was reinforced.
[00:39:43.100]If not, it was sort of neutral response.
[00:39:46.350]And then again,
[00:39:47.183]we would ask after an hour and a half,
[00:39:49.840]or two hours at the end of the day.
[00:39:52.670]Now, once we introduced an immediate probe with Emma,
[00:39:56.520]we actually saw her get the questions correct
[00:40:01.280]immediately following the activity.
[00:40:03.440]And then also got it correct at the end of the day.
[00:40:06.350]So really no intervention here whatsoever.
[00:40:09.950]We just sort of, I think,
[00:40:12.130]clarified what the task was was that we were doing with her.
[00:40:16.010]However, we don't typically ask kids immediately,
[00:40:19.290]what did you just do?
[00:40:20.220]And then again after an hour delay or two hours delay,
[00:40:23.290]so we wanted to make sure
[00:40:24.530]that she would retain this skill
[00:40:27.950]if we removed that immediate probe.
[00:40:30.120]And you can see once we went back
[00:40:31.790]to sort of not asking her immediately,
[00:40:34.960]she was now able to report all three activities,
[00:40:38.010]even when they varied, using her device.
[00:40:43.470]Okay, for Justin and Bruce, it was a little bit different.
[00:40:47.750]Now there was some increase in correct responding
[00:40:50.330]as soon as we added in that immediate probe,
[00:40:52.690]but it wasn't consistent.
[00:40:55.220]You can see for Bruce, there was-
[00:40:59.940]So for Justin,
[00:41:00.773]there was a little bit of a change.
[00:41:02.310]And for Bruce, there was really no improvement.
[00:41:04.440]So that makes it make a little bit more sense
[00:41:08.380]that they couldn't respond at the end of the day
[00:41:10.740]because they couldn't even tell us
[00:41:13.850]right after they did the activity.
[00:41:15.630]And so we knew we needed to intervene here
[00:41:17.870]and teach them how to report about things
[00:41:19.810]that they had just done.
[00:41:23.240]So this is where we added prompting.
[00:41:25.250]So if you have a kiddo who can't respond correctly,
[00:41:27.860]even after a teeny tiny, short delay,
[00:41:30.150]you'll probably wanna teach them
[00:41:31.630]how to immediately respond to that question.
[00:41:34.760]So again, we would do the activities,
[00:41:36.780]we would ask right after coloring,
[00:41:39.420]what did you do in the playroom?
[00:41:41.564]And then we would start prompting.
[00:41:43.540]So, if they got it correct, great.
[00:41:45.690]But if not,
[00:41:46.970]we would say you read a book,
[00:41:49.270]and the kid would say, read a book.
[00:41:51.830]Then we'd ask again, what did you do?
[00:41:53.719]And if their response was correct,
[00:41:57.460]we'd intersperse a distractor trial,
[00:41:59.440]then ask 'em one more time, what did you just do in there?
[00:42:02.700]And if they got that correct, we would reinforce.
[00:42:06.520]So really just giving them some practice,
[00:42:08.310]telling us what they just did
[00:42:10.720]in the location and getting that mastered.
[00:42:18.290]So you can see for both of these kids,
[00:42:20.510]as soon as we introduced prompting,
[00:42:22.500]they were able to tell us immediately
[00:42:24.730]after doing the activity,
[00:42:27.190]and also able to do it at the end of the day,
[00:42:30.100]and were able to report the activities that the did
[00:42:33.840]to their caregiver,
[00:42:34.810]which was really wonderful for them to be able to do.
[00:42:39.210]But just like with Emma,
[00:42:41.150]we wanted to make sure if we removed that immediate probe,
[00:42:44.380]that they would still be able to report the fun activities
[00:42:47.400]they did throughout the day after a lengthier delay.
[00:42:51.080]So we removed it and you can see
[00:42:54.625]when we probed again with the caregiver,
[00:42:56.760]both kiddos had a little bit of a dip,
[00:42:58.490]so we just kind of kept going.
[00:43:00.050]And by the end of this procedure,
[00:43:02.640]both participants were reporting accurately
[00:43:05.130]to their caregivers at the end of the day,
[00:43:08.570]using their speech generating device.
[00:43:12.860]So in general,
[00:43:13.750]all of our participants improved the accuracy
[00:43:15.860]of reporting past behavior at the end of the day.
[00:43:18.600]One participant, Emma,
[00:43:19.750]reported accurately following just the introduction
[00:43:22.400]of immediate probes.
[00:43:23.490]So that's a really simple thing
[00:43:25.120]that you could start interspersing into your day
[00:43:27.170]with learners, is just getting them into the habit
[00:43:29.750]of telling you, what did we just do?
[00:43:32.380]Two participants needed prompts.
[00:43:34.450]So if kiddos aren't reporting immediately
[00:43:37.160]just helping them to learn to be able to do that.
[00:43:40.240]And then once kiddos are able to report immediately,
[00:43:43.170]we saw a hundred percent reporting at the end of the day
[00:43:46.420]and generalization to their caregivers.
[00:43:50.050]Okay, in the last oh, I think 15 minutes,
[00:43:54.010]I'm gonna quickly go through one last study.
[00:43:56.870]We've talked about advanced manding
[00:43:59.210]or request for information.
[00:44:00.660]We've talked about advanced intraverbals,
[00:44:02.540]being able to answer questions
[00:44:04.240]about what we've done throughout the day.
[00:44:05.947]And the last study I wanna share
[00:44:07.690]is actually advanced tacting or labeling
[00:44:10.530]using a speech generating device.
[00:44:14.640]Now, research has found that children with autism
[00:44:16.970]do not combine words into multi-word utterances or phrases
[00:44:22.890]at the same time that typically neurotypically children do.
[00:44:26.880]And this is despite having a similar number of single words
[00:44:31.270]in their repertoire.
[00:44:32.600]So there seems to be something a little bit more challenging
[00:44:35.240]about word combinations.
[00:44:37.990]Instead, we often see rote and inflexible responding,
[00:44:42.546]and a lot of times kiddos with autism
[00:44:45.160]with significant language delays
[00:44:47.430]really are learning only language
[00:44:49.800]that's directly taught to them.
[00:44:52.690]Now, the work we're gonna talk about today
[00:44:56.289]is aimed at interventions
[00:44:59.130]that will promote word combinations that occur
[00:45:01.550]in flexible and novel ways,
[00:45:03.960]as opposed to just through direct teaching.
[00:45:06.370]And so I'm gonna go through a study,
[00:45:08.176]I'll show you some data
[00:45:09.480]with kiddos who use spoken vocalization,
[00:45:11.950]but also then how we replicated that
[00:45:14.030]with kiddos who use speech generating devices.
[00:45:17.930]Okay, so we've started to examine
[00:45:19.910]how to teach word combinations in such a way as to promote
[00:45:23.420]untaught, generative, responding, right?
[00:45:26.040]Flexible responding.
[00:45:28.740]So specifically this is with the kiddos with vocal language,
[00:45:35.070]we taught children to combine nouns and verbs together
[00:45:39.848]when they're sort of watching their instructor
[00:45:43.320]use a little figurine to perform an action.
[00:45:47.030]And we found that if you teach a subset of word combinations
[00:45:50.660]in a certain way,
[00:45:52.170]then you get a lot of novel word combinations
[00:45:55.160]that were never directly taught.
[00:45:57.780]And we do this through what's called matrix training,
[00:46:01.410]which sounds a little fancy,
[00:46:02.600]but it's actually fairly straightforward.
[00:46:05.120]So what do we know about teaching tacts to children with ASD
[00:46:08.490]who use speech generating devices?
[00:46:10.960]We know that there are a few studies that have taught tacts
[00:46:14.730]or expressive labels of pictures.
[00:46:18.810]There's at least one that focuses on labeling objects.
[00:46:23.390]But across these studies,
[00:46:26.000]the use of prompts and reinforcement
[00:46:28.010]have been shown to be effective in training these skills.
[00:46:32.080]But we need to further explore strategies
[00:46:35.690]that are specifically aimed at developing generativity
[00:46:38.680]for kids who are using speech generating devices.
[00:46:44.110]Okay, so we had three goals with this particular procedure,
[00:46:49.270]which was to directly teach noun-verb combinations, right?
[00:46:52.970]So I might ask, hey, what do you see here,
[00:46:55.760]or what's happening?
[00:46:56.930]And I'm acting out a particular action
[00:46:59.230]with a particular figurine, maybe an animal.
[00:47:03.170]Then I wanna assess
[00:47:04.300]what's called recombinative generalization.
[00:47:06.520]And this is, can a child then recombine
[00:47:09.910]those nouns and verbs in novel ways?
[00:47:13.230]And then I also also wanna assess,
[00:47:15.240]can they expressively label or tact
[00:47:17.700]using novel noun-verb combinations
[00:47:20.460]that were never included in any training scenarios.
[00:47:23.150]And we call this generalization.
[00:47:25.790]So, as I mentioned,
[00:47:26.623]recombinative generalization is a process in which
[00:47:29.080]individuals produce novel combinations
[00:47:33.450]when they put sort of known components together.
[00:47:37.370]So matrix training is a method to organize components
[00:47:43.940]so that we can try to promote
[00:47:46.130]this recombinative generalization.
[00:47:47.770]So it's a lot, let me me show you what it looks like.
[00:47:49.670]This is a matrix, essentially.
[00:47:51.840]You can see the nouns
[00:47:54.011]this might be dog, cat, pig,
[00:47:56.600]and then the verbs might be sleeping, eating, drinking,
[00:47:59.660]whatever it might be.
[00:48:00.990]Now, matrix training means that we train down the middle
[00:48:05.340]and then these ones that we probe,
[00:48:08.520]these combinations are recombinative skills.
[00:48:15.910]So, oh, I have some examples here.
[00:48:17.610]Sheep, bear and dog, jumping, sleeping, drinking.
[00:48:20.500]You've got kids who can do label those things individually,
[00:48:25.170]but can't combine them together very easily.
[00:48:28.330]So then we would teach, hey, what do you see here?
[00:48:30.630]What's happening here?
[00:48:32.010]And the kiddo would learn, sheep is jumping,
[00:48:34.510]or the bear is sleeping, dog is drinking.
[00:48:37.507]So our diagonal targets are directly taught.
[00:48:41.695]The non-diagonal targets are then probed
[00:48:44.680]for recombinative generalization.
[00:48:46.820]And we just see, like,
[00:48:48.220]if I just teach you these three things,
[00:48:49.960]can you get these other things correct
[00:48:52.180]on your own and by yourself?
[00:48:54.380]And then we're gonna probe a completely novel set of targets
[00:49:00.470]in what's called a generalization matrix.
[00:49:03.160]Now still the individual,
[00:49:05.355]nouns and verbs are known,
[00:49:07.090]but the kiddo has never combined them together
[00:49:11.250]into a word combination.
[00:49:13.980]So here are some data.
[00:49:15.080]Let me orient you to this graph.
[00:49:16.716]These are four vocal kids from our original study.
[00:49:20.870]You see three different data markers.
[00:49:24.460]The black diamonds are, let me see.
[00:49:29.860]I just lost my spot here.
[00:49:30.890]Yep, the black diamonds are our generalization targets
[00:49:33.910]from a completely novel matrix
[00:49:35.740]that never had any direct teaching.
[00:49:37.550]So that's our ultimate goal.
[00:49:39.430]The black circles are the diagonal targets
[00:49:42.400]from the first matrix that we're gonna directly teach.
[00:49:45.390]And the open data path are those non-diagonal targets
[00:49:48.750]that are the recombination targets.
[00:49:51.080]Those ones were we're hoping will recombine.
[00:49:54.820]So you can see here, we saw,
[00:49:56.840]sorry about that, with all three kids,
[00:49:59.380]no word combinations in baseline.
[00:50:02.170]Here you can see, we'll just look at the top one here,
[00:50:04.850]when we directly teach word combinations,
[00:50:07.300]all of our kids can learn that.
[00:50:08.990]And that's great.
[00:50:10.010]That's nothing to not be proud of,
[00:50:16.070]but if all they've learned is what we've directly taught,
[00:50:19.720]then we don't necessarily have generative language.
[00:50:22.370]So here in our post-test,
[00:50:24.770]we test all of those recombined combinations
[00:50:29.160]that I showed you in the matrix
[00:50:30.860]and that final generalization matrix
[00:50:33.700]that never even had the diagonal targets presented.
[00:50:36.820]And what you see with all of these kids
[00:50:39.452]is that just teaching that diagonal,
[00:50:42.850]those three targets down the diagonal and boom,
[00:50:45.810]they get all of these noun word combinations
[00:50:48.509]sort of for free.
[00:50:50.870]So, we replicated this study,
[00:50:53.420]matrix training to teach tacts or expressive labels
[00:50:56.630]using speech generating devices.
[00:50:59.120]And what did this look like?
[00:51:00.410]This study included three participants
[00:51:03.140]spanning the ages of four to 16.
[00:51:05.810]All of the participants had a diagnosis of autism
[00:51:08.640]and they were in sort of a focused ABA language program
[00:51:14.080]and really had limited vocalizations.
[00:51:18.020]This is what they looked like
[00:51:19.480]on their VB-MAPP administration.
[00:51:21.400]I get asked that sometimes, for the sake of time,
[00:51:23.750]I'm gonna go a little bit quickly through this part,
[00:51:26.430]but again,
[00:51:27.263]they had kinda level two or so on the VB-MAPP level,
[00:51:33.020]but no word combinations
[00:51:35.010]as shown on the tact milestone number nine.
[00:51:42.030]Okay, so all sessions were conducted in our program,
[00:51:45.630]in our clinic,
[00:51:47.813]the materials we used animals for those nouns,
[00:51:52.730]toy figurines,
[00:51:53.970]and they all had a little accessory item
[00:51:56.470]so that whatever action they were depicting
[00:51:59.390]could be kind of shown a little bit more clearly.
[00:52:03.380]The targets were selected for each participant
[00:52:05.470]based on the individual skills
[00:52:08.350]that they already had in their repertoire.
[00:52:10.100]So they could already tell us those nouns,
[00:52:12.120]they could label the animals
[00:52:13.310]and they could label the actions.
[00:52:14.810]They just couldn't put them together.
[00:52:17.970]So during baseline,
[00:52:20.880]each of the nine combinations
[00:52:22.720]within that matrix were tested,
[00:52:24.850]each trial consisted of the therapist selecting the animal
[00:52:27.930]or the toy figurine.
[00:52:29.280]And then having that figurine kind of act out
[00:52:32.700]what the action was and being asked, what's happening here,
[00:52:36.040]or what do you see?
[00:52:39.030]For each participant in the study,
[00:52:41.190]we developed two matrices, the matrix one,
[00:52:44.740]which we were going to teach the diagonal,
[00:52:47.270]probe the recombination cells,
[00:52:49.350]and then a completely novel generalization matrix
[00:52:53.710]that would never encounter any teaching.
[00:52:58.150]So both of these matrices had,
[00:53:00.910]these were mastered as individual nouns.
[00:53:03.590]These were mastered as individual actions or verbs.
[00:53:08.107]We taught the diagonal targets
[00:53:10.910]and then probed the non-diagonal targets
[00:53:13.620]for recombinative generalization.
[00:53:15.720]And then we probed the novel matrix
[00:53:18.350]that had known components,
[00:53:19.920]but had never been combined in any way.
[00:53:24.750]Okay, so here to be considered correct for a tact response,
[00:53:30.900]we would show the figurine doing the action,
[00:53:36.150]ask what's happening.
[00:53:38.510]The child would then go into their things folder,
[00:53:45.768]then to the particular category.
[00:53:49.050]In this case, animals,
[00:53:50.330]then navigate to the correct animal, dog.
[00:53:54.390]Pick the correct noun,
[00:53:55.430]whichever animal it was for that trial.
[00:53:57.930]Then they navigate back out
[00:53:59.550]to the corresponding actions folder here,
[00:54:03.360]go into there and select the correct verb
[00:54:06.203]of the action that was depicted.
[00:54:09.400]So in this case, dog jumping,
[00:54:11.890]and then they would then press the speech output device
[00:54:17.040]so that the voice output would occur
[00:54:20.210]with both the noun and the verb together.
[00:54:23.420]All right, these graphs show similar results
[00:54:25.610]to the one that I just showed you
[00:54:26.900]with our vocal participants in the first study.
[00:54:29.320]Again, this is a replication
[00:54:30.620]with kids who use speech generating devices.
[00:54:32.871]Again, the black diamonds
[00:54:34.780]are that completely untaught generalization matrix.
[00:54:37.770]That's like our ultimate.
[00:54:38.920]We really are looking for kids
[00:54:40.570]to now just be able to combine all the single nouns
[00:54:44.360]and single verbs in their repertoire,
[00:54:46.060]regardless of whether they've ever been combined together.
[00:54:50.006]Again, the black circles are those diagonal targets,
[00:54:53.690]which are really the only targets in that first matrix
[00:54:56.700]that get direct training or teaching.
[00:54:59.360]And then the open marker here
[00:55:01.200]represents those untaught recombined non=diagonal targets
[00:55:06.500]in that first matrix.
[00:55:08.640]As you can see, none of our kiddos,
[00:55:10.560]despite having those single words in their repertoire,
[00:55:14.330]none of them could engage in word combinations in baseline,
[00:55:19.300]for all three of our participants,
[00:55:20.800]we taught the diagonal targets,
[00:55:22.470]and no surprise, they learned them without any trouble.
[00:55:26.960]And when we tested the recombined non-diagonal targets
[00:55:32.050]and the generalization matrix for two of our participants,
[00:55:37.240]complete generative responding,
[00:55:39.080]which is exactly what we had hoped to see.
[00:55:41.770]Now with our third participant,
[00:55:43.690]we actually didn't see that.
[00:55:45.510]We saw the recombination.
[00:55:47.398]So the non-diagonal targets
[00:55:49.820]that were a part of this first matrix,
[00:55:52.350]but when we tested the novel generalization matrix,
[00:55:55.600]we didn't see that generalization.
[00:55:57.600]And it's a good thing that we tested this
[00:55:59.560]because this tells us we're not done.
[00:56:01.218]Ryan here is not able to sort of apply this
[00:56:04.750]to all the single words in his repertoire
[00:56:07.040]and combine them in novel ways.
[00:56:08.620]And so we don't wanna stop.
[00:56:10.470]So all we did at this point
[00:56:12.050]was engage in multiple exemplar instruction
[00:56:14.540]and we created a whole bunch of more matrices
[00:56:17.787]to just expose him to more teaching along the diagonal.
[00:56:22.410]So here you can see we developed another matrix.
[00:56:25.000]We taught here the diagonal, when we probed,
[00:56:29.130]we got the recombined skills, but again,
[00:56:32.040]the generalization matrix did not pop up.
[00:56:34.760]So we're not done.
[00:56:35.714]We taught another set of three targets,
[00:56:39.220]just down the diagonal.
[00:56:40.830]We saw some nice recombination
[00:56:43.260]but not the generalization matrix.
[00:56:45.860]So we taught one last one and here,
[00:56:48.590]all Ryan needed was a little bit more exposure.
[00:56:51.740]And so, teaching a series of sets here,
[00:56:55.920]and we were able to get that generalization.
[00:56:58.180]And what we love to see is generative flexible use
[00:57:03.090]of their speech generating devices.
[00:57:06.150]Okay, so in general,
[00:57:08.150]all three participants
[00:57:09.220]learned to emit noun-verb combinations when directly taught,
[00:57:12.470]all three emitted recombined responses.
[00:57:15.015]Two of the three showed immediate generalization
[00:57:18.240]to those novel combinations in the generalization matrix.
[00:57:21.800]And one participant eventually did,
[00:57:24.470]he just required multiple exemplars.
[00:57:28.130]So our goals were to replicate procedures
[00:57:31.580]that we've seen to be effective
[00:57:33.390]with children who use vocal language,
[00:57:35.850]children with autism,
[00:57:37.340]to those of a similar skill set,
[00:57:40.010]but who use speech generating devices instead.
[00:57:43.430]All of our studies required multi-step navigation
[00:57:46.360]with the exception of our typer.
[00:57:49.040]And what we see here is that children with autism
[00:57:52.070]presenting as level two,
[00:57:53.410]level three learners on the VB-MAPP who are non-vocal,
[00:57:57.040]can acquire complex skills using their SGDs.
[00:58:02.090]And we really need more research into the development
[00:58:05.120]of advanced verbal behavior
[00:58:06.470]using high tech speech generating devices.
[00:58:10.760]Thank you so much for your time today
[00:58:12.810]and looking forward to any questions that you might have.

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Teaching Advanced Verbal Behavior Using Speech- Generating Devices

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