JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2020, 53, 1111–1129 NUMBER 2 (SPRING)

Assessment to identify learner-specific prompt and prompt-fading

procedures for children with autism spectrum disorder
LAUREN K. SCHNELL
HUNTER COLLEGE

JASON C. VLADESCU
CALDWELL UNIVERSITY

APRIL N. KISAMORE
HUNTER COLLEGE

RUTH M. DEBAR
CALDWELL UNIVERSITY

SUNGWOO KAHNG
RUTGERS UNIVERSITY

KATHLEEN MARANO
CALDWELL UNIVERSITY

Few studies have evaluated the use of assessment to identify the most efficient instructional prac-
tices for individuals with autism spectrum disorder. This is problematic as these individuals
often have difficulty acquiring skills, and the procedures that may be efficient with one individ-
ual may not be for others. The experimenters conducted instructional assessments to identify
the most efficient prompt type (model, partial physical, full physical) and prompt-fading proce-
dure (progressive delay, most-to-least, least-to-most) for teaching auditory–visual conditional dis-
criminations for individuals with autism spectrum disorder. Each assessment was conducted at
least twice, and a final generality test combined the most and the least efficient prompt type and
prompt-fading procedure for teaching novel auditory–visual conditional discriminations. The
results demonstrated learner-specific outcomes for the prompt type assessment, whereas the
least-to-most prompt fading procedure was most efficient for all participants.
Key words: assessment, auditory–visual conditional discrimination, instructional efficiency,
prompt fading, prompt type

This article is based on a dissertation submitted by the Assessment plays a vital role in the program-
first author, under the supervision of the second author,
at Caldwell University in partial fulfillment for the ming and education of students with autism
requirements of the Doctor of Philosophy in Applied spectrum disorder (ASD). Assessment proce-
Behavior Analysis. dures typically involve the systematic collection
We thank Alexandra Campanaro, Ashley Centrella,
Ashley Kremmer, and Meghan Stenziano for their help and interpretation of data on which to base
with various aspects of this study. instructional decisions (Pierangelo & Giuliani,
Address correspondence to: Jason C. Vladescu, Depart- 2012). Behavior analysts could use assessment
ment of Applied Behavior Analysis, Caldwell University,
120 Bloomfield Avenue, Caldwell, NJ 07006. Email: outcomes to identify educational goals for stu-
[email protected], or Lauren K. Schnell, Depart- dents, provide input on how a teacher should
ment of Special Education, Hunter College, 695 Park arrange instruction to achieve these goals, and
Avenue, New York, NY 10065. Email: ls2875@hunter.
cuny.edu evaluate the extent to which students make
doi: 10.1002/jaba.623 progress toward and meet these goals.
© 2019 Society for the Experimental Analysis of Behavior
1111
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1112 LAUREN K. SCHNELL et al.

Recently, a handful of studies have begun to efficient than LTM prompt fading for all three
examine the use of assessment procedures to participants.
identify the most efficient learner-specific These previous studies on the use of instruc-
instructional procedures for individuals with tional assessment have primarily evaluated effi-
ASD (e.g., Bourret, Vollmer, & Rapp, 2004; ciency of instruction by comparing relative
Carroll, Owsiany, & Cheatham, 2018; Cen- training trials to mastery (Cengher et al., 2015;
gher et al., 2015; Johnson, Vladescu, Kodak, & Seaver & Bourret, 2014). One potential ques-
Sidener, 2017; McGhan & Lerman, 2013; tion is whether this measurement scale is the
Seaver & Bourret, 2014). Broadly speaking, the most accurate way to determine efficiency,
purpose of these studies is to identify learner- especially if there are differences in the amount
specific instructional components that would of total training time across conditions. For
lead to the most efficient learning outcomes. example, for one participant in Black et al.
The hope is that by identifying the most effi- (2016), one condition was judged more effi-
cient instructional components, individuals cient when relative training sessions were con-
with ASD will acquire skills quicker, maximiz- sidered, whereas another condition was more
ing instructional time and resources. efficient when training time was evaluated.
For example, Seaver and Bourret (2014) Although the use of assessment holds prom-
conducted separate assessment phases to iden- ise to identify learner-specific instructional
tify the most efficient prompt type (verbal plus components for individuals with ASD, general-
gestural, model, or physical) and prompt-fading ity across tasks remains a concern. While previ-
procedure (least-to-most, most-to-least, or pro- ous studies have examined the effects of
gressive prompt delay) for teaching building instructional assessment to identify prompt
block structures for 10 participants with ASD. type and prompt-fading procedures as they
The experimenters demonstrated that the most relate to block building (Seaver & Bourret,
efficient prompt type and prompt-fading proce- 2014) and one-step direction following
dure was learner specific. Efficiency was deter- (Cengher et al., 2015), no studies to date have
mined by analyzing the number of training examined the usefulness of such assessment to
trials required to mastery. In addition, Seaver identify prompt type and prompt-fading proce-
and Bourret demonstrated generality of the dures on acquisition of auditory–visual condi-
assessment outcomes by comparing the most tional discriminations (AVCDs) during
and least efficient prompt type and prompt- discrete-trial teaching for individuals with ASD.
fading procedure on the acquisition of various Early intensive behavioral intervention pro-
domestic and vocational skills with the same grams commonly target AVCDs (Cubicciotti,
participants. Vladescu, Reeve, Carroll, & Schnell, 2018;
Cengher et al. (2015) replicated and Schneider, Devine, Aguilar, & Petursdottir,
extended Seaver and Bourret (2014) by using 2018). This is not surprising considering many
an assessment procedure to identify the prompt skills require individuals to differentially
type that resulted in the most efficient acquisi- respond to the verbal behavior of others. Addi-
tion of responses to one-step directions for tionally, it is not uncommon for teachers to
three preschool-age participants with ASD. observe responding during conditional discrimi-
Once the most efficient prompt type was iden- nation tasks that is indicative of faulty stimulus
tified, the experimenters compared the most-to- control (e.g., stimulus overselectivity, stimulus
least (MTL) and least-to-most (LTM) prompt biases, position biases; Pilgrim, 2015). Future
fading procedures. The results of Cengher et al. research is needed as differences in the prompt
demonstrated that MTL fading was more type or prompt-fading procedure may
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1113

ultimately influence the development of stimu- 2008). He scored a 32 on the Barriers Assess-
lus control. ment of the VB-MAPP.
Therefore, the purpose of this study was to Alex was a 4 year, 3-month-old boy who
replicate and extend Seaver and Bourret received services based on the principles of
(2014). We replicated the procedures of Seaver applied behavior analysis beginning at
and Bourret by conducting prompt type and 24 months of age. He had an approximate one-
prompt-fading assessments designed to deter- and-a-half-year history with AVCD instruction.
mine the most efficient instructional compo- Alex obtained standard scores of 88 (Low Aver-
nents for learners with ASD. We extended the age) and 69 (Extremely Low) on the EVT-2
procedures of Seaver and Bourret by evaluating and the PPVT-4, respectively. Alex scored into
these assessments on the acquisition of AVCDs Level 2 on the imitation domain and into Level
as measured by total training sessions and total 3 on the listener and visual perceptual/match-
training time required prior to mastery. Addi- to-sample domains of the VB-MAPP. He
tionally, data were collected on the occurrence scored a 22 on the Barriers Assessment of the
of problem behavior across prompt-type and VB-MAPP.
prompt-fading procedures to evaluate whether Zelda was a 5 year, 7-month-old boy who
participants would differentially respond with received services based on the principles of
elevated levels of problem behavior across con- applied behavior analysis beginning at
ditions, potentially leading to increases in train- 20 months of age. He had an approximate two-
ing time and resulting in less efficient year history with AVCD instruction. Zelda
outcomes. The most efficient and least efficient obtained standard scores of 62 (Extremely
instructional components were combined into Low) and 45 (Extremely Low) on the EVT-2
treatment packages applied to teaching a novel and the PPVT-4, respectively. Zelda scored
set of AVCDs with participants. into Level 2 on the imitation domain and into
Level 3 of the listener and visual
perceptual/match to-sample domains of the
VB-MAPP. He scored a 32 on the Barriers
METHOD
Assessment of the VB-MAPP.
Participants All participants had educational histories
Ethan was a 3 year, 11-month-old boy who (as reported by their teachers) that included all
received services based on the principles of of the prompt types and prompt-fading proce-
applied behavior analysis beginning at dures included in the current study.
29 months of age. He had an approximate one-
year history with AVCD instruction. Ethan
obtained standard scores of 79 (Moderately Setting and Materials
Low) and 70 (Moderately Low) on the Expres- The study was conducted in an empty class-
sive Vocabulary Test-Second Edition (EVT-2; room at the suburban public school attended
Williams, 2007) and the Peabody Picture by all participants. The classroom contained a
Vocabulary Test-Fourth Edition (PPVT-4; table, chairs, paper data sheets, pencils, stimuli
Dunn & Dunn, 2007), respectively. Ethan binders, a digital timer, a choice board, edibles,
scored in Level 1 on the imitation domain and and a video camera. The experimenter sat
into Level 2 on the listener and visual across from the participants and recorded ses-
perceptual/match-to-sample domains of the sions using the video camera.
Verbal Behavior-Milestones Assessment and Stimulus binders were created for each con-
Placement Program (VB-MAPP; Sundberg, dition to present trials for each session. The
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1114 LAUREN K. SCHNELL et al.

experimenter created each stimulus binder by session, calculated by dividing the number of
affixing a blank piece of colored paper (based trials where problem behavior occurred by the
on a color preference assessment) to the cover total number of trials and multiplied the
of a three-ring binder. Inside each binder were resulting ratio by 100. The experimenter
six trial sheets. Each trial sheet consisted of a recorded session duration in minutes using a
piece of colored (specific to the condition) digital timer. The experimenter started the
paper containing three pictures (comparison timer immediately prior to the presentation of
stimuli). Comparison stimuli were each approx- the antecedent stimuli on the first trial of the
imately 8.89 cm by 10.16 cm, spaced 1.27 cm session and stopped the timer immediately fol-
apart and aligned horizontally in the middle of lowing the completion of the last trial of the
the page. Additionally, a blank piece of colored session.
paper (specific to the condition) was placed on Total training time was calculated by adding
top of each trial sheet to provide an opportu- the session durations in minutes for each train-
nity for an observing response. ing session per condition. The total number of
incorrect responses was also calculated by
adding all unprompted and prompted incorrect
Dependent Variables, Interobserver Agreement, responses during each training session per
and Procedural Integrity condition.
The experimenter scored unprompted cor- A second observer independently scored par-
rect, unprompted incorrect, prompted correct, ticipants’ unprompted correct, unprompted
and prompted incorrect responses on data incorrect, prompted correct, and prompted
sheets prepared for each session. The percent- incorrect responses, as well as session duration
age of trials with problem behavior and and problem behavior during a minimum of
unprompted correct responses are depicted in 33% of sessions across conditions and phases
the figures. Unprompted correct responses were in vivo or from video for interobserver agree-
defined as the participant emitting the ment (IOA) purposes. IOA was calculated on a
predefined target response prior to the delivery trial-by-trial basis by dividing the number of
of a prompt. Unprompted and prompted agreements by the number of agreements plus
incorrect responses were defined as the partici- disagreements and multiplying by 100. Mean
pant selecting an incorrect comparison stimulus IOA scores for Ethan, Alex and Zelda were
(i.e., error of commission) or not emitting a 95%, 98%, and 98% for the prompt-type
response within 5 s (i.e., error of omission) that assessments, respectively (range across partici-
occurred prior to or following the delivery of a pants, 90% to 100%); 96%, 93%, and 97%
prompt, respectively. Prompted correct for the prompt-fading assessments, respectively
responses were defined as the participant emit- (range across participants, 69% to 100%); and
ting the target response following the delivery 95%, 95%, and 93% for the most versus least
of a prompt. The experimenter recorded the efficient comparisons, respectively (range across
occurrence of problem behavior during each participants, 86% to 100%).
trial. Problem behavior was scored if any of the Total duration IOA for session duration was
following topographies were observed: aggres- calculated by dividing the shorter duration by
sion, self-injurious behavior, property destruc- the longer duration and multiplying by 100.
tion, disruptions, tantrum, elopement, and Mean duration IOA scores for Ethan, Alex and
stereotypy (definitions available from the first Zelda were 90%, 94%, and 90% for the
author) and summarized as the percentage of prompt-type assessments, respectively (range
trials in which problem behavior occurred per across participants, 83% to 100%); 94%, 94%,
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1115

and 90% for the prompt-fading assessments, versus least efficient comparison were 100%,
respectively (range across participants, 83% to 100%, and 95% (range, 86% to 100%),
100%); and 94%, 94%, and 94% for the most respectively. Mean procedural integrity IOA
versus least efficient comparisons, respectively scores for Zelda for the prompt-type assess-
(range across participants, 83% to 100%). ment, prompt-fading assessment, and the most
An independent observer collected proce- versus least efficient comparison were 100%,
dural integrity data during a minimum of 25% 100%, and 95% (range, 86% to 100%),
of sessions for each participant in vivo or from respectively.
video (a list of steps for which PI was collected
is available from the first or second author).
Preference Assessments
Procedural integrity was calculated by dividing
The experimenter conducted a color prefer-
the number of correctly implemented steps by
ence assessment (Heal, Hanley, & Layer,
the number of correctly implemented steps plus
2009) using colored pieces of paper and items
the number of incorrectly implemented steps
to determine participant preference for
and multiplying by 100. Mean procedural
10 colors. Five colors that were approached
integrity scores for Ethan for the prompt-type
during an equal percentage of trials were
assessment, prompt-fading assessment, and the
assigned as condition-correlated stimuli in an
most versus least efficient comparison were
attempt to increase the discriminability of the
93%, 93%, and 95%, respectively (range across
conditions. Additionally, the experimenter
assessments, 86% to 100%). Mean procedural
conducted a paired-stimulus preference assess-
integrity scores for Alex for the prompt-type
ment (Fisher et al., 1992) using 10 edibles
assessment, prompt-fading assessment, and the
selected through interviews with the partici-
most versus least efficient comparison were
pants’ teacher and parents. The experimenter
93%, 97%, and 95%, respectively (range across
then conducted a brief edible multiple stimu-
assessments, 86% to 100%). Mean procedural
lus without replacement (MSWO; Carr, Nic-
integrity scores for Zelda for the prompt-type
olson, & Higbee, 2000) preference assessment
assessment, prompt-fading assessment, and the
using the top five edibles identified from the
most versus least efficient comparison were
paired-stimulus preference assessment with
93%, 91%, and 93%, respectively (range across
each participant prior to each session in an
assessments, 72% to 100%).
attempt to control for shifts in preference.
A secondary observer measured procedural
The first three edibles selected from the
integrity during a minimum of 25% of all ses-
MSWO were used as the putative reinforcers
sions across participants for IOA purposes. An
for the subsequent session.
agreement was scored if both observers
recorded the same responses during a step of
the procedure. Procedural integrity IOA was Target Identification and Assignment
calculated by dividing the number of agree- The experimenter identified a large pool of
ments by the number of agreements plus dis- potential AVCD targets based on the partici-
agreements and multiplying by 100. Mean pants’ individual education goals. The experi-
procedural integrity IOA scores for Ethan for menter presented the sample stimulus and
the prompt-type assessment, prompt-fading allowed 5 s for a response. No differential con-
assessment, and the most versus least compari- sequences were provided for unprompted cor-
son were all 100%. Mean procedural integrity rect or incorrect responses. The experimenter
IOA scores for Alex for the prompt-type assess- presented the next trial after a 3- to 5-s inter-
ment, prompt-fading assessment, and the most trial interval. Each potential target was tested
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1116 LAUREN K. SCHNELL et al.

three times. If a participant engaged in an trial sheet. The experimenter waited 3 s in

unprompted correct response to a potential tar- the absence of responding and delivered the
get at least twice, it was discarded. Following prompt as outlined in the condition.
the target identification, the experimenter Prompt-type assessment. The purpose of the
assigned three targets to each condition based prompt-type assessment was to identify the
on a logical analysis (Wolery, Gast, & Ledford, participant-specific prompt type that resulted in
2014). One additional group of targets was the most efficient acquisition of AVCDs. We
assigned to each condition of each assessment conducted each comparison at least twice to
and validation comparison for replication pur- establish the reliability and generality of the
poses. The logical analysis considered the fol- assessment outcomes. Flow charts detailing pro-
lowing dimensions: number of syllables in each cedural steps for each condition are available as
target name, physical similarity (e.g., orienta- online supporting information.
tion, color, size), and redundancy of phonemes We compared model, partial physical, and
across target names across the comparison stim- full physical prompt types during the
uli. A list of targets is available as online prompt-type assessment. The experimenters
supporting information. presented and faded the prompt using a pro-
gressive prompt delay (0 s, 2 s; Seaver &
Bourret, 2014). The experimenters initially
Design and General Procedure implemented all prompts using a 0-s prompt
The experimenter used an adapted alternat- delay and increased the prompt delay one
ing treatments design (Sindelar, Rosenberg, & level (2-s prompt delay) after the participant
Wilson, 1985) with a no-treatment control demonstrated prompted correct responses for
condition. We conducted all comparisons twice 100% of trials for two sessions. The experi-
(an initial comparison and one replication), menters decreased the prompt delay one level
each with a novel set of targets, for each partici- (2 s, 0 s) if the participant responded with
pant to establish the reliability and generality of unprompted incorrect responses for 50% or
the results. Had the results of the initial com- more of trials. Training continued in a condi-
parison for an assessment or most versus least tion until the participant engaged in two con-
efficient comparison not been replicated, we secutive sessions with 100% unprompted
would have conducted additional comparisons correct responses. Training continued in the
until similar results were achieved for two con- additional conditions until the mastery crite-
secutive comparisons (this was not necessary for rion was achieved or the total training time
any participant). We conducted up to 15 ses- was 25% longer than the initial mastered
sions per day, in a random without replacement condition overall training time.
order, at least 10 min apart, and up to 5 days Baseline and control. The experimenter pres-
per week based on the experimenter and partic- ented the sample stimulus and allowed 5 s for a
ipant’s availability. The experimenter presented response. No differential consequences were
the sample and comparison stimuli using a provided for unprompted correct or incorrect
comparison-first arrangement (Cubicciotti responses. The experimenter presented the next
et al., 2018). The experimenter required the trial after a 3- to 5-s intertrial interval.
participant to touch the condition-specific stim- Model prompt. During sessions with trials
ulus binder and tact the condition-correlated conducted at a 0-s prompt delay, the experi-
color before each session. The experimenter menter presented the sample stimulus after the
then removed a blank piece of paper, white for 3-s wait time and immediately presented the
baseline and colored for training, to reveal the model prompt by touching the correct
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1117

comparison stimulus with her pointer finger for experimenter removed the materials and pres-
3 s. The participant had 5 s to respond. The ented the next trial. If the 2-s delay passed with
experimenter delivered an edible and praise for no response, the experimenter simultaneously
prompted correct responses. If the participant re-presented the sample stimulus and the partial
engaged in a prompted incorrect response, the physical prompt and allowed 5 s for a response.
experimenter removed the materials and pres- The experimenters delivered an edible and
ented the next trial. praise contingent upon the prompted correct
During sessions with trials conducted with a response. If the participant engaged in a
2-s delay, the experimenter waited 3 s in the prompted incorrect response, the experimenter
absence of responding, then presented the sam- removed the materials and presented the next
ple stimulus and allowed 2 s for a response. trial.
The experimenter delivered an edible and praise Full physical prompt. During sessions with
for unprompted correct responses. If the partic- trials conducted at a 0-s prompt delay, the
ipant engaged in an unprompted incorrect experimenter presented the sample stimulus
response, the experimenter removed the mate- after the 3-s wait time and immediately pres-
rials and presented the next trial. If the 2-s ented the full physical prompt by placing her
delay passed with no response, the experi- hand completely on top of the participant’s
menter simultaneously re-presented the sample right hand and guiding it so that the palm of
stimulus and the model prompt and allowed the participant’s hand touched the correct com-
5 s for a response. The experimenters delivered parison stimulus for 3 s. The 5-s response inter-
an edible and praise contingent upon the val was not implemented during the full
prompted correct response. If the participant physical prompt as the nature of this prompt
engaged in a prompted incorrect response, the (a full hand over hand prompt to select the cor-
experimenter removed the materials and pres- rect comparison) required the participant select
ented the next trial. the correct comparison immediately using full
Partial physical prompt. During sessions with hand over hand guidance. The experimenter
trials conducted at a 0-s prompt delay, the delivered an edible and praise for prompted
experimenter presented the sample stimulus correct responses. If the participant engaged in
after the 3-s wait time and immediately pres- a prompted incorrect response, the experi-
ented the partial physical prompt by placing menter removed the materials and presented
her hand on the participant’s right hand and the next trial.
guiding it so that it hovered approximately During sessions with trials conducted with a
15.24 cm over the correct comparison stimulus 2-s delay, the experimenter presented the sam-
for 3 s. The participant had 5 s to respond. ple stimulus after the 3-s wait time and deliv-
The experimenter delivered an edible and praise ered an edible and praise for unprompted
for prompted correct responses. If the partici- correct responses. If the participant engaged in
pant engaged in a prompted incorrect response, an unprompted incorrect response, the experi-
the experimenter removed the materials and menter removed the materials and presented
presented the next trial. the next trial. If the 2-s delay passed with no
During sessions with trials conducted with a response, the experimenter simultaneously re-
2-s delay, the experimenter presented the sam- presented the sample stimulus and the full
ple stimulus after the 3-s wait time and deliv- physical prompt. The experimenters delivered
ered an edible and praise for unprompted an edible and praise contingent upon the
correct responses. If the participant engaged in prompted correct response. If the participant
an unprompted incorrect response, the engaged in a prompted incorrect response, the
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1118 LAUREN K. SCHNELL et al.

experimenter removed the materials and pres- lightly holding between the elbow and shoulder
ented the next trial. area with the experimenter’s index and thumb
Prompt-fading assessment. During the until the participant’s hand makes physical con-
prompt-fading assessment three different tact with the correct comparison stimulus for
prompt fading procedures (i.e., least-to-most, 3 s), (c) forearm (guiding the participant’s arm
most-to-least, progressive prompt delay) were by lightly holding between the wrist and elbow
compared. For each participant, the prompt area with the experimenter’s index and thumb
type identified as most efficient during the until the participant’s hand makes physical con-
prompt type assessment was used during the tact with the correct comparison stimulus for
prompt-fading assessment (Seaver & 3 s), (d) partial hand over hand physical guid-
Bourret, 2014). ance (guiding the participant by placing the
The experimenters developed prompt hierar- experimenter’s hand on top of the participant’s
chies for the model, partial physical, and full right hand until the participant’s hand makes
physical prompts (Seaver & Bourret, 2014). physical contact with the correct comparison
For the model prompt, in least-to-most intru- stimulus for 3 s), and (e) full physical guidance
sive order the hierarchy included: (a) no (the experimenter places her hand on the par-
prompt, (b) partial model (the experimenter ticipant’s right hand and guides it so that the
pointing to the correct response by hovering palm of the participant’s hand touches the cor-
her pointer finger approximately 15.24 cm over rect comparison stimulus for 3 s). Training
the stimulus card for 5 s), (c) brief model (the continued in a condition until the participant
experimenter touching the correct stimulus engaged in two consecutive sessions with 100%
card with her pointer finger for 1 s), and unprompted correct responses. Training con-
(d) full model (the experimenter touching the tinued in the additional conditions until the
correct stimulus card with her pointer finger mastery criterion was achieved or the total
for 3 s). For the partial physical prompt, in training time was 25% longer than the initial
least-to-most intrusive order, the hierarchy mastered condition overall training time.
included: (a) no prompt, (b) upper arm (guid- Baseline and control. Procedures were identi-
ing the participant’s arm by lightly holding cal to those in the prompt-type assessment.
between the elbow and shoulder area with the Least-to-most. During all trials, the experi-
experimenter’s index and thumb, hovering menter presented the sample stimulus after the
approximately 15.24 cm over the correct com- 3-s wait time, initially provided the least intru-
parison stimulus for 3 s, (c) forearm (guiding sive prompt (i.e., no prompt), and allowed the
the participant’s arm by lightly holding participant 5 s to respond. The experimenter
between the wrist and elbow area with the delivered an edible and praise if the participant
experimenter’s index and thumb, hovering engaged in an unprompted correct response. If
approximately 15.24 cm over the correct the participant engaged in an unprompted
comparison stimulus for 3 s, and (d) partial incorrect response, the experimenter moved up
hand-over-hand physical guidance (guiding the the relevant prompt hierarchy (i.e., re-
participant by placing the experimenter’s hand presented the sample stimulus and provided a
on top of the participant’s right hand so that it more intrusive prompt topography). If the par-
hovers approximately 15.24 cm over the correct ticipant engaged in a prompted correct
comparison stimulus for 3 s). For the full phys- response the experimenter delivered praise and
ical prompt, in least-to-most intrusive order, an edible. If the participant engaged in a
the hierarchy included: (a) no prompt, prompted incorrect response the experimenter
(b) upper arm (guiding the participant’s arm by moved up the relevant prompt hierarchy again.
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1119

The experimenters continued to move up the identical to the procedures from the prompt
prompt hierarchy until the participant engaged type assessment previously described.
in a prompted correct response or until the Most efficient versus least efficient comparison.
most intrusive prompt was provided. The The purpose of this comparison was to evaluate
experimenters moved to the next trial if the whether the results of the prompt type and
participant engaged in a prompted incorrect prompt-fading assessments could collectively
response following the most intrusive prompt. inform learner-specific instructional compo-
No other consequences were provided. nents that would lead to efficient acquisition of
Most-to-least. Initially, the experimenter pres- AVCDs. To evaluate this, we compared a con-
ented the sample stimulus after the 3-s wait dition that involved a combination of the most
time and provided the most intrusive prompt. efficient instructional components from the
The experimenter provided an edible and praise two assessments to a condition that involved a
contingent upon a prompted correct response. combination of the least efficient instructional
The experimenters moved to the next trial if components. For example, if the model prompt
the participant engaged in a prompted incorrect and the LTM prompt-fading procedure
response following the most intrusive prompt. resulted in the most efficient acquisition of
The experimenters moved down the relevant AVCDs, they were combined into one treat-
prompt hierarchy (i.e., provided a less intrusive ment package. Similarly, if the partial physical
prompt) following two consecutive sessions prompt and the MTL prompt-fading procedure
with 100% prompted correct responding. The resulted in the least efficient acquisition, they
experimenter delivered an edible and praise fol- were combined into one treatment package.
lowing all unprompted (during sessions with These packages were then implemented to
no prompt provided) or prompted correct teach novel sets of AVCDs. We conducted this
responses. If the participant engaged in a comparison at least twice to determine the gen-
prompted incorrect response at any other erality of the assessment outcomes.
prompt level (other than the most intrusive), Baseline and control. Procedures were identi-
the experimenter re-presented the sample stim- cal to those used in the prompt-type and
ulus and provided the most intrusive prompt of prompt-fading assessments.
the hierarchy that allowed for a prompted cor- Training with most efficient arrangement. The
rect response. The experimenter removed the experimenters arranged an instructional condi-
materials and re-presented the next trial if the tion consisting of the prompt type and prompt
participant engaged in a second prompted fading procedure associated with the most effi-
incorrect response following the most intrusive cient instruction for each participant. The most
prompt. The experimenter moved up the rele- efficient combination for Ethan was the full
vant prompt hierarchy (i.e., provided a more physical prompt plus least-to-most prompt fad-
intrusive prompt) if the participant responded ing procedure. The most efficient combination
with unprompted (during sessions with no was the model prompt plus least-to-most
prompt provided) or prompted incorrect prompt fading procedure for both Alex and
responses for 50% or more of trials. Zelda.
Progressive prompt delay. The prompt deter- Training with least efficient arrangement. The
mined to be most efficient in the prompt experimenters arranged an instructional condi-
assessment was implemented and faded using a tion consisting of the prompt type and prompt
progressive prompt delay (0 s, 2 s; Seaver & fading procedure associated with the least effi-
Bourret, 2014). The progressive prompt delay cient instruction for each participant. The least
used during the prompt fading assessment was efficient combination for Ethan was the model
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1120 LAUREN K. SCHNELL et al.

prompt plus the most-to-least prompt fading Alex demonstrated mastery in the model
procedure, the full physical prompt and pro- prompt and partial physical-prompt conditions
gressive prompt delay for Alex, and the partial in 11 and 12 training sessions, respectively.
physical prompt and progressive prompt delay Similarly, he demonstrated mastery in the
for Zelda. model prompt and partial-physical prompt con-
ditions in four and five training sessions,
respectively, during his prompt-type assessment
replication. Alex failed to demonstrate mastery
RESULTS in the full-physical prompt condition during
Figures 1–3 illustrate the percentage of trials both comparisons.
with problem behavior and unprompted correct Zelda demonstrated mastery in the model
responses for all comparisons during the prompt and full-physical prompt conditions in
prompt type assessment, prompt-fading assess- six and seven training sessions, respectively.
ment, and most versus least efficient compari- Similarly, he demonstrated mastery in the
sons. The comparative analysis of efficiency model prompt and the full-physical prompt
measures— training sessions to mastery, total conditions in five and seven training sessions,
training time, and total incorrect responses— respectively, during his prompt-type assessment
for all initial and replication assessments is replication. Zelda failed to demonstrate mastery
provided in Table 1. Across all comparisons, in the partial-physical prompt condition during
participants emitted unprompted correct both comparisons.
responses during a low to moderate percentage We used the results of the prompt-type assess-
of trials during baseline sessions across condi- ment to inform the prompt type to be included
tions. Increases in unprompted correct in each participant’s prompt-fading assessment.
responses were observed only after the intro- That is, we arranged the full-physical prompt to
duction of intervention. be in place for Ethan and the model prompt to
The results of the prompt-type assessment be in place for Alex and Zelda. The results of
indicate that the prompt type associated with the prompt-fading assessment indicate that the
the most efficient training differed across par- least-to-most prompt-fading procedure was most
ticipants. That is, the full-physical prompt was effective for all three participants.
most effective for Ethan and the model prompt During his initial prompt-fading assessment
was most effective for Alex and Zelda. Addi- comparison, Ethan demonstrated mastery in
tionally, all participants failed to demonstrate the least-to-most, progressive-prompt delay,
mastery with one of the prompt types and and most-to-least prompt-fading conditions in
Zelda engaged in problem behavior across all 4, 5, and 10 training sessions, respectively.
conditions. More specifically, Ethan demon- Similarly, he demonstrated mastery in the least-
strated mastery in the full-physical prompt and to-most, progressive-prompt delay, and most-
partial-physical prompt conditions in 9 and to-least in 3, 8, and 10 training sessions,
10 training sessions, respectively. Similarly, he respectively during the replication comparison.
demonstrated mastery in the full-physical Alex demonstrated mastery in the least-to-
prompt and partial-physical prompt conditions most and most-to-least prompt-fading condi-
in four and seven training sessions, respec- tions in seven and eight training sessions,
tively, during his prompt-type assessment repli- respectively. Similarly, he demonstrated mastery
cation. Ethan failed to demonstrate mastery in in the least-to-most and most-to-least prompt-
the model-prompt condition during both fading conditions in 6 and 11 training sessions,
comparisons. respectively during the replication comparison.
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1121

Baseline Training Baseline Training

100 100
The Percentage of Trials with Problem Behavior and Unprompted Correct Responding

80 80

60 60

40 40

20 20
Ethan
0 0
0 20 40 60 80 100 0 10 20 30 40 50 60

Baseline Training Baseline Training

100
100

80
80

60
60

40
40

20
20 Alex

0
0
0 10 20 30 40 50 60 70 80 90
0 10 20 30 40 50 60

Baseline Training Baseline Training

100 100 Model
Partial Physical
80 80 Full Physical
Control
60 60 Problem Behavior

40 40

20 20
Zelda
0 0
0 10 20 30 40 50 60 0 10 20 30 40 50 60
Sessions Sessions

Figure 1. Percentage of trials with problem behavior and unprompted correct responses for all participants during
the prompt-type assessment.

Alex failed to demonstrate mastery in the Similarly, he demonstrated mastery in the least-
progressive-prompt delay condition during to-most, most-to-least, and progressive-prompt
both comparisons. delay prompt-fading conditions in four, eight,
Zelda demonstrated mastery in the least-to- and five training sessions, respectively, during
most, most-to-least, and progressive-prompt the replication comparison.
delay prompt fading conditions in five, eight, Overall, the results of the most versus least
and seven training sessions, respectively. efficient comparison indicate that the most
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1122 LAUREN K. SCHNELL et al.

Baseline Training Baseline Training

100
100

80
80
The Percentage of Trials with Problem Behavior and Unprompted Correct Responding

60
60

40
40

20
20
Ethan
0
0
0 10 20 30 40
0 10 20 30 40

Baseline Training Baseline Training

100 100

80 80

60 60

40 40

20 20
Alex
0 0
0 10 20 30 40 50 0 10 20 30 40 50

Baseline Training Baseline Training

100 100

Control
80 80
PPD
LTM
60 60
MTL
Problem Behavior
40 40

20 20
Zelda
0 0
0 10 20 30 40 0 10 20 30 40
Sessions Sessions

Figure 2. Percentage of trials with problem behavior and unprompted correct responses for all participants during
the Progressive prompt delay (PPD), Least-to-most.(LTM), Most-to-least (MTL) conditions of the prompt-fading
assessment.

efficient training condition was associated with conditions in 8 and 13 training sessions,
best outcomes for all participants. During his respectively, during his replication.
initial comparison, Ethan demonstrated mas- During his initial most versus least efficient
tery in the most efficient and least efficient con- comparison, Alex demonstrated mastery in the
ditions in 3 and 11 training sessions, most efficient condition in six training sessions.
respectively. Similarly, he demonstrated mastery Similarly, he demonstrated mastery in the most
in the most efficient and least efficient efficient condition in six training sessions
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1123

100 Baseline Training 100 Baseline Training

80 80
The Percentage of Trials with Problem Behavior and Unprompted Correct Responding

60 60

40 40

20 20 Ethan

0 0
0 5 10 15 20 25 30 35 0 5 10 15 20 25 30 35 40 45

100 Baseline Training 100 Baseline Training

80 80

60 60

40 40

20 20 Alex

0 0
0 5 10 15 20 25 30 0 5 10 15 20 25 30

100 Baseline Training 100 Baseline Training

80 80 ME
LE
60 60 Control
Problem Behavior
40 40

20 20 Zelda

0 0
0 5 10 15 20 25 30 35 0 5 10 15 20 25 30
Sessions Sessions

Figure 3. Percentage of trials with problem behavior and unprompted correct responses for all participants during
the most efficient (ME) versus least efficient (LE) comparison.

during his replication. Alex failed to demon- most versus least efficient comparison replica-
strate mastery in the least efficient condition tion. Zelda failed to demonstrate mastery in
during both comparisons. Zelda demonstrated the least efficient combination during both
mastery in his initial most versus least efficient comparisons.
comparison in six training sessions. Similarly, Ethan and Alex did not engage in problem
he demonstrated mastery in the most efficient behavior during the prompt-type assessment,
condition in four training sessions, during his prompt-fading assessment, or most versus least
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1124 LAUREN K. SCHNELL et al.

Table 1
Training Sessions to Mastery, Training Time, and Incorrect Responses for all Participants Across Assessments

Training sessions to mastery Total training time Incorrect responses

Condition Phase Ethan Alex Zelda Ethan Alex Zelda Ethan Alex Zelda
Prompt Type Model * 11 6 * 12 16 14 10 2
PP 10 12 * 24 12 * 6 10 27
FP 9 * 7 22 * 19 6 28 2
Model * 4 5 * 8 10 9 0 2
PP 7 5 8 23 10 * 0 2 12
FP 4 * 7 16 * 17 0 15 1
Prompt Fading PPD 5 * 7 10 * 17 0 19 0
MTL 10 8 8 17 9 13 0 0 0
LTM 4 7 5 8 9 9 1 0 5
PPD 8 * 5 11 * 8 0 22 1
MTL 10 11 8 17 23 10 0 0 0
LTM 3 6 4 5 10 5 1 0 0
Comparison LE 11 * * 16 * * 6 12 11
ME 3 6 6 5 8 7 2 2 1
LE 13 * * 22 * * 3 16 12
ME 8 6 4 12 7 6 3 0 0

Note. The specific phases of each assessment have been abbreviated into the following, Model, Partial physical (PP), Full
physical (FP), Progressive prompt delay (PPD), Most-to-least (MTL), Least-to-most (LTM), Least efficient (LE), and
Most efficient (ME). Total training time is rounded to the nearest whole number.
* Signifies the mastery criterion was not met

efficient comparisons. During the prompt-type 0% and 63% of most efficient and least effi-
assessment, Zelda engaged in problem behavior cient sessions respectively, during the replica-
during 91%, 15%, and 100% of the model tion comparison.
prompt, full-physical prompt, and partial-
physical prompt sessions, respectively, during
the initial comparison. He engaged in problem
behavior for 55%, 60%, and 78% of the model DISCUSSION
prompt, full physical prompt, and partial physi- The identification of individualized instruc-
cal prompt sessions, respectively, during the tional procedures for individuals with ASD is
replication comparison. an important endeavor as understanding the
During the prompt-fading assessment, Zelda optional instructional components that precede
engaged in problem behavior for 48% and and follow student responding may result in
30% of the most-to-least and least-to-most more efficient acquisition of academic responses
prompt fading sessions during the initial com- over time (Cengher et al., 2015; Seaver &
parison. Zelda engaged in problem behavior for Bourret, 2014). As students with ASD may not
35% of least-to-most sessions during the repli- demonstrate adequate learning using traditional
cation comparison but did not engage in prob- instructional approaches (e.g., Howard,
lem behavior during most-to-least or Stanislaw, Green, Sparkman & Cohen, 2014),
progressive prompt delay conditions. it is necessary to maximize individual instruc-
Zelda engaged in problem behavior for 80% tional opportunities. One potential way to do
and 90% of most efficient and least efficient this is by providing clinicians a technology to
sessions respectively, during the initial compari- assist in the selection of efficient, learner-
son. Zelda engaged in problem behavior for specific instructional procedures.
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
INSTRUCTIONAL ASSESSMENT 1125

One way to identify the most efficient the outcomes on domestic vocational tasks.
instructional procedures is by conducting indi- Johnson et al. compared four reinforcement
vidualized instructional assessments (Cengher arrangements during training of arbitrary
et al., 2015; Johnson et al., 2017; McGhan & AVCDs and tested for generality across func-
Lerman, 2013; Seaver & Bourret, 2014). Along tional AVCDs, tacts, and intraverbals. Across
this line, Seaver and Bourret (2014) evaluated participants, generality of assessment results
an instructional assessment to identify the most was observed during subsequent AVCD train-
efficient response prompt and prompt-fading ing, but not for the other task types (tacts,
procedure when teaching block building to intraverbals). Future researchers would be wise
individuals with ASD. In a replication, Cen- to conduct replications to establish the general-
gher et al. (2015) evaluated a similar assessment ity of outcomes to other tasks that require
to determine the most efficient prompts and motor responses (e.g., visual–visual conditional
prompt-fading procedures when teaching discriminations, vocational tasks, play skills).
responses to one-step directions. Although Although our findings that outcomes are pri-
Seaver and Bourret demonstrated learner- marily learner-specific are not surprising, they
specific results, in that the most efficient pro- do beg the question, why might the efficiency
mpts and prompt-fading procedures varied of certain instructional components be learner-
across participants, Cengher et al. found that specific? One explanation may be related to the
all three of their participants learned most specific learner characteristics of each partici-
efficiently with full-physical prompts and most- pant. Perhaps there may be skills or barriers in
to-least prompt fading. Our prompt-type the participants’ repertoires that influence their
assessment results are somewhat similar to responding under certain instructional compo-
Seaver and Bourret as the outcomes indicated nents. For example, in Zelda’s case, the experi-
the model prompt was most efficient for two menters observed higher levels of problem
participants and the full-physical prompt was behavior during the partial-physical prompt
most efficient for one. However, similar to condition, which may be related to potentially
Cengher et al., we found that the same aversive properties of the physical prompt in
prompt-fading procedure (least-to-most) was this condition (see problem behavior data
most efficient for all three participants. depicted in Figure 3). These occurrences of
Similar to Seaver and Bourret (2014) and problem behavior led to an overall increase in
Cenghar et al. (2015) we replicated the out- the session times during both the partial-
comes of each initial assessment across an addi- physical and full-physical prompt conditions
tional set of targets for all participants and then and ultimately prevented Zelda from meeting
validated these outcomes by comparing a com- the mastery criterion in the partial-physical
bination of the most versus least efficient prompt condition. We suspect that Zelda likely
prompt type and prompt-fading procedures. met mastery criterion in the full-physical
Across participants, results replicated during prompt condition because instances of his
both assessments and the most versus least problem behavior were placed on extinction in
comparisons. Unlike Seaver and Bourret and this condition. During the full-physical prompt
Johnson et al. (2017), our evaluation did not condition, regardless of problem behavior
test for generality across skill types. For exam- occurrence, hand-over-hand prompting was
ple, Seaver and Bourret conducted an assess- implemented to ensure Zelda selected the cor-
ment to determine the efficiency of different rect comparison stimulus. Ultimately, this may
prompt types and prompt-fading procedures on have led to an overall decrease in problem
block building, then assessed the generality of behavior and the eventual mastery in the full-
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1126 LAUREN K. SCHNELL et al.

physical prompt condition. However, this was (e.g., an additional hand over hand step in the
not the case for the partial-physical prompt hierarchy) and partial physical prompt, future
condition. During this condition, hand-over- evaluations could modify the conditions to
hand prompting was implemented but only allow participants to meet the mastery criteria
until Zelda’s hand was 15.24 cm over the cor- within a similar number of steps across all
rect comparison stimulus. Therefore, Zelda prompt types.
could continue to engage in problem behavior One variable which has not been consistently
and not engage in a prompted correct response. reported in the literature on instructional
Ethan, on the other hand did not meet the assessment is the duration of time it took
mastery criterion in the model prompt condi- researchers to complete the assessments. The
tion during the prompt-type assessment. This exceptions to this are Seaver and Bourret
could perhaps be due to his imitation reper- (2014) and Johnson et al. (2017) who reported
toire, as he was the only participant to score mean assessment durations of 8 hr and 3 hr
into Level 1 on the imitation domain of the 45 min, respectively. Our assessment proce-
VB-MAPP, suggesting he may not be able to dures, including the initial and replication
spontaneously imitate the novel behavior of prompt type and prompt-fading comparisons
others. This suggests future research is needed without and with the most versus least efficient
to identify what learner characteristics are corre- comparisons took an average of 3 hr 12 min
lated with improved performance under the (range, 2 hr 50 min to 3 hr 40 min) and 3 hr
context of specific instructional components or 45 min (range, 3 hr 34 min to 4 hr 30 min)
what role assessments can play in assessing per participant, respectively. This duration
these learner-specific skills. includes the cumulative duration of training
Another possible explanation is learning his- sessions across the conditions of all compari-
tory. The participants’ teachers reported mixed sons but did not include the time required to
histories with the prompt types and prompt- complete other procedural components
fading procedures used in the current evalua- (e.g., the color and stimulus preference assess-
tion. This history may be relevant as previous ments). The duration of the assessment could
research (e.g., Coon & Miguel, 2012; Kay be considered a mitigating factor as it may
et al., 2019; Roncati, Souza, & Miguel, 2019) make it unlikely that practitioners would utilize
has demonstrated the role that proximal history such procedures in their clinical work. Future
plays on subsequent responding. Future research is needed to identify ways to reduce
research could examine the degree to which a assessment duration. In this vein, Carroll et al.
history with a prompt type and prompt-fading (2018) evaluated the validity of an abbreviated
procedure influences the relative efficiency of assessment to identify the most efficient error-
such instructional components when teaching correction procedure for participants with ASD
AVCDs. and developmental delays. During the initial
It should be noted that the full physical hier- assessment, the experimenters identified an
archy in the prompt-type assessment included error-correction procedure following 60 training
an additional step relative to the model and trials, then evaluated the degree to which this
partial physical hierarchies. This may have outcome was valid across two validation com-
served as a potential confound as this additional parisons. The results indicated high correspon-
step may have resulted in a longer duration to dence between the abbreviated and validation
mastery. Although the experimenters arranged assessments for a subset of participants, and
these hierarchies in this manner to distinguish partial correspondence for the remaining partic-
the differences between the full physical ipants. Additional research is needed to evaluate
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INSTRUCTIONAL ASSESSMENT 1127

the usefulness of abbreviated assessments for based on the principles of applied behavior
identifying learner-specific instructional analysis. Given the costly (Jacobson, Mulick, &
components. Green, 1998) and comprehensive (Lovaas,
To make decisions regarding the relative effi- 1987) nature of intensive behavioral interven-
ciency of prompt types and prompt-fading pro- tion, it seems important to maximize
cedures we examined training sessions to instructional time.
mastery and total training time to mastery. Dif- The findings from the current study raise
ferent measurement scales may result in varying questions regarding how clinicians should
interpretations of efficiency and lead to the arrange instructional components for individ-
inadvertent promotion of one instructional pro- uals with ASD during teaching. Future research
cedure over another (e.g., Black et al., 2016). should continue to develop and modify instruc-
This issue seems directly relevant as previous tional assessments to examine additional com-
studies have drawn conclusions regarding ponents of teaching (e.g., error-correction
instructional efficiency by comparing training procedures) and to focus on combining results
trials (e.g., McGhan & Lerman, 2013; Seaver & from assessment procedures to identify the
Bourret, 2014), training sessions (e.g., Cengher most efficient interventions for clinical practice.
et al., 2015), or training time (e.g., Johnson In this vein, McGhan and Lerman (2013)
et al., 2017). This is problematic because it is evaluated the use of an assessment to identify
possible that the conclusions drawn from using the least intrusive and most efficient error-
one measurement scale (training trials or ses- correction procedures when teaching AVCDs
sions) may be different when compared to to individuals with ASD. Similar to the current
another (training time). These changes in mea- study the authors found that results were idio-
surement scale may result in varying interpreta- syncratic across learners. A combination of the
tions of efficiency and lead to the inadvertent most efficient prompt type, prompt-fading pro-
promotion of one instructional procedure varia- cedure, and error correction procedures should
tion as efficient when results would vary if a be compared with a combination of the least
different measurement scale were used efficient component variations to evaluate the
(Skinner, 2010). As such, future studies should potential usefulness of this assessment method-
evaluate different measurement scales and the ology in maximizing skill acquisition.
effect that they have on determining both effec- Lastly, in the current study we did not con-
tiveness and efficiency of instruction. duct all conditions to mastery. That is, once
For all participants, the differences in train- mastery was achieved in a condition, training
ing sessions to mastery (between one to three was only continued in all other conditions for a
sessions) and training times (between 1 to limited number of sessions (equal to 25% of
12 min) between the most and least efficient the number of sessions required in the condi-
conditions across comparisons were small. In tion that produced mastery) as long as there
fact, the results of both Ethan and Alex’s was no increasing trend in performance. Train-
prompt-type assessments may appear to have ing termination was necessary for all three par-
produced equivalent outcomes, as the differ- ticipants. We implemented this criterion to
ences across the most and least efficient prompt prevent possible establishment of the presenta-
types varied by only one session. These differ- tion of stimuli as aversive (McGhan & Lerman,
ences may seem insignificant at first, however, 2013) and to ensure that we maximized the
it is easy to imagine how such differences can time that participants spent receiving effective
compound over the long periods of time that intervention. Because of this termination we
consumers with ASD may receive intervention are unaware of how much additional training
 19383703, 2020, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jaba.623 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [16/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1128 LAUREN K. SCHNELL et al.

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Cubicciotti, J. E., Vladescu, J. C., Reeve, K. F.,
There has been very little research on assess- Carroll, R. A., & Schnell, L. K. (2018). Effects of
ment of the components of discrete trial train- stimulus presentation order during auditory–visual
ing to identify which would be most effective. conditional discrimination training for children with
autism spectrum disorder. Journal of Applied Behavior
The results of these assessments have potential Analysis. Advance online publication. https://doi.org/
utility in informing future teaching and instruc- 10.1002/jaba.530
tional components arranged across individual Dunn, L. M., & Dunn, D. M. (2007). Peabody picture
vocabulary test (4th ed.). San Antonio, TX: Pearson.
students to increase teaching efficiency. Similar
Fisher, W., Piazza, C. C., Bowman, L. G.,
to Seaver and Bourret (2014), our results dem- Hagopian, L. P., Owens, J. C., & Slevin, I. (1992).
onstrate the usefulness of applying assessments A comparison of two approaches for identifying rein-
to identify instructional components prior to forcers for persons with severe and profound disabil-
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teaching. Outcomes of these studies may help 491–498. https://doi.org/10.1901/jaba.1992.25-491
in guiding clinicians to arrange instructional Heal, N. A., Hanley, G. P., & Layer, S. A. (2009). An
components that lead to the most efficient out- evaluation of the relative efficacy of and children’s
preferences for teaching strategies that differ in
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research-article2017
BMOXXX10.1177/0145445517699929Behavior ModificationEdwards et al.

Special Issue Article

Behavior Modification
2018, Vol. 42(1) 9­–33
Increasing Functional © The Author(s) 2017
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DOI: 10.1177/0145445517699929
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Children With Autism journals.sagepub.com/home/bmo

Using Backward Chaining

Chelsea K. Edwards1, Robin K. Landa1,2,

Sarah E. Frampton1, and M. Alice Shillingsburg1,3

Abstract
Research with individuals with disabilities has demonstrated the utility of
intervention approaches to address toy play, also referred to as functional
leisure engagement (FLE). Examples include prompting FLE, blocking
stereotypy, and differentially reinforcing appropriate FLE with social or
automatic (i.e., access to stereotypy) reinforcers. Backward chaining has
yet to be evaluated, but may be useful for establishing more complex
FLE. The current study employed a treatment package consisting of these
components with three school-aged children with autism in a therapeutic
classroom. Effects were evaluated during pretest and posttest sessions,
which consisted of free access to toys in a novel setting. The percentage
of session with FLE was evaluated using a multiple probe design across
participants. Results showed all participants demonstrated an increase in FLE
and two participants showed decreased stereotypy. Feasibility for classroom
implementation is discussed.

Keywords
autism spectrum disorder, backward chaining, functional engagement,
functional play, toy play

1MarcusAutism Center, Atlanta, GA, USA

2WesternNew England University, Springfield, MA, USA
3Emory University, Atlanta, GA, USA

Corresponding Author:
M. Alice Shillingsburg, Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA 30329, USA.
Email: [email protected]
10 Behavior Modification 42(1)

The development of play skills is crucial for children diagnosed with autism
spectrum disorder (ASD), as it functions as a platform for the development of
social interaction and social communication skills (Bloom, 1993; Piaget,
1952). Although exploratory engagement with items is seen in infancy, func-
tional toy play typically begins to emerge later in the first year of life. This
higher level form of play has been delineated from its earliest precursors by
being characterized as playing with toys “according to their intended func-
tion” (Baron-Cohen, 1987, p. 142). Demonstrations of functional play skills
earlier in life have been correlated with the later development of language
with typically developing children (Bates, Benigni, Bretherton, Camaioni, &
Volterra, 1979; Ungerer & Sigman, 1984) and children with ASD (Sigman &
Ruskin, 1999; Toth, Munson, Meltzoff, & Dawson, 2006). However, children
with ASD engage in fewer spontaneous appropriate play acts than their typi-
cally developing peers (Lewis & Boucher, 1988; Wing, Gould, Yeates, &
Brierley, 1977). Sigafoos, Roberts-Pennell, and Graves (1999) found that
play skills for preschoolers with ASD showed little growth over a 3-year
period in comparison with the development of their other adaptive skills. This
deficit in play is of significant concern, as these failures to play may then
exacerbate failures to develop social communication skills. Thus, interven-
tions that support the development of play skills are of critical importance for
learners with ASD (Jarrold, Boucher, & Smith, 1996).
Although a wide variety of interventions have been proposed to teach toy
play to children with ASD (see Lang et al., 2009; Luckett, Bundy, & Roberts,
2007; Stahmer, Ingersoll, & Carter, 2003), many, especially highly struc-
tured, behavior-analytic procedures, have been described as failing to pro-
duce genuine play, in part due to the reliance on external rather than “internal”
rewards and limited spontaneity, flexibility, and generalization of targeted
play behaviors (Luckett et al., 2007). This criticism highlights several key
features of play that researchers and clinicians have emphasized including
that play is a behavior that is “freely chosen, personally directed, and intrinsi-
cally motivated” (Hughes, 2012). Thus, instead of being highly structured
and adult directed, activities should be selected and initiated by the child.
Only interventions that evaluate play in an unstructured context, in which the
individual is free to engage with the toys or in other behaviors, would meet
this criteria (e.g., Eason, White, & Newsom, 1982; Nuzzolo-Gomez, Leonard,
Ortiz, Rivera, & Greer, 2002). Furthermore, play should not be motivated
exclusively by contingent reinforcers such as adult attention or other tangible
reinforcers. Thus, the intervention, including any contingent reinforcers,
must be fully withdrawn for this criteria to be met (e.g., Eason et al., 1982;
Kasari, Gulsrud, Wong, Kwon, & Locke, 2010; Nuzzolo-Gomez et al., 2002).
These characteristics of an intervention not only increase the acceptability of
Edwards et al. 11

outcomes, but also make it more sustainable in applied settings. For example,
a teacher serving 6 to 10 children with ASD will find it difficult to deliver
carefully scheduled tangible reinforcers during common free play contexts,
in the midst of other responsibilities.
Another key feature of play to consider is the importance of generaliza-
tion. Play outcomes should also have generality across toys and settings.
Without these measures, there is little to suggest that the play intervention
will have effects beyond the intervention setting itself. This is crucial when
services are delivered outside of the child’s home (i.e., in a treatment clinic or
school), because play is an ongoing, daily activity for children. Last, in addi-
tion to the quantity of play behaviors, the quality of play should be empha-
sized. Several studies have included dependent measures such as simple
object manipulation (Hanley, Iwata, Thompson, & Lindberg, 2000) and
touching toys (Nuzzolo-Gomez et al., 2002), which may have been appropri-
ate for the participants in those studies but limits extensions to more complex
play behavior requiring a series of steps.
In addition to these key elements of what constitutes play, another factor
to consider when designing a toy play intervention in an applied setting is
whether the intervention will address sources of competing reinforcers.
Engagement in other behaviors that produce competing reinforcers have been
cited as a potential reason that children with ASD fail to develop appropriate
play skills, most notably when the competing behavior is stereotypy (e.g.,
Honey, Leekam, Turner, & McConachie, 2006; Wing & Gould, 1979). Thus,
many studies evaluating treatment packages for addressing toy play include
measures to specifically target the reduction of stereotypy. Some components
of these treatment packages include contingent access to tangible and social
reinforcement for appropriate play (e.g., Eason et al., 1982; Horner, 1980;
Nuzzolo-Gomez et al., 2002; Singh & Millichamp, 1987), blocking stereo-
typy (e.g., Hanley et al., 2000), and contingent access to stereotypy for appro-
priate play (e.g., Hanley et al., 2000; Potter, Hanley, Augustine, Clay, &
Phelps, 2013). Thus, not only will an effective treatment package need to
address the common criticisms of behavioral play interventions noted above,
it must also effectively address stereotypy.
Lang et al. (2014) provided an efficacious treatment package that met
these criteria with three young children with ASD who demonstrated low
levels of play and frequent stereotypy. To address concerns related to general-
ity, the baseline and posttest measures were conducted in a different setting
from intervention. Furthermore, generalization to untrained toy sets was also
measured. To address concerns related to extrinsic reinforcers, the baseline
and posttest evaluations took place during unstructured play situations in the
absence of the teacher who conducted the treatment. Treatment consisted of
12 Behavior Modification 42(1)

redirecting stereotypy, prompting toy play, and contingent tangible reinforce-

ment on a gradually faded schedule. All participants showed increased occur-
rences of appropriate play in the untrained setting, in the absence of the
teacher and extrinsic reinforcement. For one participant, play behaviors gen-
eralized to an untrained play set and stereotypy remained at low levels. The
other two participants still showed a moderate degree of stereotypy, though
below baseline levels, and generalization across toy sets was not observed.
For these participants, a lag schedule of reinforcement was added which
resulted in sustained, low levels of stereotypy and generalization to the
untrained play set. Overall, this study serves as a strong example of a treat-
ment package to address play skills in an applied, school-like setting.
However, the children in this study were 3 years old and had emerging vocal
language so their responsiveness to this intervention may not represent find-
ings for older, school-aged students with greater barriers to learning.
Furthermore, participants selected for the Lang study engaged in pretreat-
ment repetitive toy play and were able to select toys within a paired stimulus
assessment, suggesting they already had some degree of interest in engaging
with toys. Two other studies also showed both a reduction in stereotypy and
increased play with generality across toys, one using video modeling
(Paterson & Arco, 2007) and the other, self-management (Stahmer &
Schriebman, 1992). While the participants in these studies were school-aged
(6-13 years), they were also able to communicate using complete sentences
and were reported to have generalized imitation repertoires (Paterson &
Arco). So, although these interventions addressed stereotypy and generaliza-
tion of play behaviors, these approaches may not be effective for minimally
verbal, school-aged children with ASD.
Although several effective approaches to increasing toy play while also
reducing stereotypy have been established in the literature, no study has
shown how to teach more complex play sequences to minimally verbal,
school-aged children. This may be accomplished through the application of
backward chaining, a procedure often referenced in curricular manuals (e.g.,
Leaf & McEachin, 1999; Maurice, Green, & Luce, 1996) but yet to be widely
applied in the literature. In their review of the literature, Stahmer et al. (2003)
outlined general recommendations for teaching simple toy play to individuals
with disabilities using chaining procedures. The authors highlighted the
importance of breaking down a toy play sequence into steps, teaching the
individual steps, and then applying forward or backward chaining procedures
to ensure the sequence of steps is established so that the toy play is func-
tional. Given the complexity of play skills and the likelihood that functional
play will require multistep sequences, backward chaining may be a valuable
procedure to include in treatment packages aimed at increasing play.
Edwards et al. 13

The purpose of the current study was to build upon prior research on
establishing functional play skills by evaluating the direct and indirect effects
of an intervention package consisting of (a) backward chaining, (b) blocking
stereotypy, and (c) differential reinforcement in the form of tangible items
and access to stereotypy. Furthermore, the current study addressed limita-
tions of prior studies by including measures of play during free play, assess-
ment of generalization across settings, and generalization to novel toys.
These components were included to most closely mimic those present in
most classroom settings. Importantly, the intervention was conducted with
three school-aged children with ASD with minimal verbal skills to evaluate
the effectiveness of the intervention within a population with more pro-
nounced deficits than has been included in prior studies (e.g., Lang et al.,
2014; Nuzzolo-Gomez et al., 2002; Paterson & Arco, 2007; Stahmer &
Schriebman, 1992).

Method
Participants and Setting
All participants received one-on-one services within a therapeutic classroom
at a center-based intervention program, 5 days a week for 2 hr each day. The
Verbal Behavior-Milestones Assessment and Placement Program (VB-MAPP;
Sundberg, 2008) was administered to each participant upon their admission
into the clinic and was used for ongoing clinical programming. The clinical
case manager, a board certified behavior analyst (BCBA), in consultation
with the participant’s parents determined that an intervention to support the
development of functional play was appropriate. Scores from the VB-MAPP
were used to confirm deficits with play, but no other inclusion or exclusion
criteria were required for participation in the study.
Ethan, a 4-year-old male, was diagnosed with ASD at the age of 3 by a
licensed psychologist. He was administered the Mullen Scales of Early
Learning (Mullen, 1995), which indicated his skills were in the 18- to
21-month range for receptive language, visual reception, and fine motor
skills while scores related to oral production were comparable to 14 months.
The Adaptive Behavior Assessment System (ABAS; Harrison & Oakland,
2003) indicated Ethan’s overall functioning was below the 1st percentile.
Ethan had a VB-MAPP Milestone score of 46, a play domain score of 7.5
(18- to 30-month range), and an imitation domain score of 7 (18- to 30-month
range). Specifically, in the area of play, Ethan was observed to engage func-
tionally with only a few items when specifically directed, but was unable to
assemble toys with multiple parts. Although Ethan engaged in cooperative
14 Behavior Modification 42(1)

play with others, he did not engage in sustained independent play. His parents
noted his limited independent play as a particular concern at home, as they
reported that he engaged in either impassivity or repetitive bids for attention
when asked to play by himself (e.g., such as when parental attention was
diverted toward cooking dinner). In regard to imitation skills, ongoing clini-
cal data collection suggested that by the time Ethan began his participation in
the study, he could imitate any novel action presented by a therapist. Last,
Ethan had a score of 0 on the VB-MAPP Barriers Assessment for self-stimu-
lation, indicating that he did not engage in stereotypy.
Lance, a 4-year-old male, was diagnosed with a neurodevelopmental
disorder, which encompasses ASD, at age 2, by a neurodevelopmental
pediatrician. At that time, the Capute Scales (Accardo & Capute, 2005)
were administered, including both the Cognitive Adaptive Test (CAT) and
Clinical Linguistic Auditory Milestone Scale (CLAMS). Scores from the
CAT revealed overall functioning in the 16- to 18-month range. Scores
from the CLAMS revealed receptive language functioning in the 7- to
12-month range and expressive language functioning in the 8- to 14-month
range. Lance had a VB-MAPP Milestone score of 42, a play domain score
of 7 (18- to 30-month range), and an imitation domain score of 1.5 (0- to
18-month range). Specifically, in the area of play, Lance could engage
functionally with several items when specifically directed, but could not
assemble toys with multiple parts. In regard to imitation skills, Lance mas-
tered his first gross imitation target after 3 months of teaching. Lance had
a score of 2 on the VB-MAPP Barriers Assessment for self-stimulation,
indicating that he engaged in stereotypy on a relatively frequent basis and
that it interfered with his completion of other activities. Lance’s parents
completed the Behavior Problems Inventory (BPI) and reported a variety
of stereotypic behaviors of varying intensity and frequency including pac-
ing, head hitting, spinning, repetitive body movements, scratching, and
waving his arms.
Trey, a 7-year-old male, had been reportedly diagnosed with ASD, but no
additional testing or diagnostic information was available. Trey had a
VB-MAPP Milestone domain score of 20.5, a play domain score of 4 (0- to
18-month range), and an imitation domain score of 4 (0- to 18-month range).
Specifically, in the area of play Trey was observed to engage functionally
with several items when specifically directed and could assemble some toys
with multiple parts, such as puzzles and matching tasks, but did not do so in
the absence of adult direction. Trey did not receive a score on the VB-MAPP
Barriers Assessment for self-stimulation because he engaged in high rates of
other forms of problematic behavior during the initial assessment. However,
his therapists reported instances of self-biting, pacing, twirling, and bursts of
Edwards et al. 15

running which interfered with group play periods. Caregiver information

from the BPI was not available for Trey.
Baseline and treatment sessions took place in the clinic setting. Each par-
ticipant had his own teaching area in a large classroom which consisted of a
table, chairs, preferred toys and foods, and other teaching materials. Pretests
and posttests were conducted in a separate room within the clinic, to serve as
a generalization environment. The room consisted of a table, three treatment
toys, three novel toys, and probe materials.

Toy Selection
For all participants, a total of six toys were selected. Three toys were selected
for treatment: single inset puzzles, toy train and tracks, and toy piano. The
remaining three toys were assigned to generalization: car track, drum toy, and
pop-up toy. The toys were specifically selected to promote developmentally
appropriate, functional play. Conventional use of these toys produced a spe-
cific outcome (e.g., a song on the piano, a train pushed around the tracks),
making functional engagement more readily differentiated from stereotypy.
For example, when participants engaged in correct steps for playing the
piano, the toy lit up and replayed the designated song. Likewise, engaging in
the designated steps for the train set involved constructing the train track,
thereby enabling participants to push the train around the track. Finally, the
toys selected were deemed to be developmentally appropriate given the par-
ticipant’s developmental level (Lifter, Ellis, Cannon, & Anderson, 2005). The
VB-MAPP Milestones Assessment suggests that playing with toys with mul-
tiple parts and playing with toys according to design emerges within 18 to 30
months in development, which aligns with the scores observed for all partici-
pants. For these participants, preference for specific toys was not used
because none of these participants freely engaged or selected toys to engage
with either at home or on any occasion in the clinical setting.

Response Measurement
Functional leisure engagement (FLE) was the primary dependent variable
evaluated during the pretest and posttest. FLE was defined as any instance in
which the participant was engaged in functional play responses specifically
identified for each activity. A list of appropriate actions was created for each
toy which would resemble appropriate FLE in a typically developing child
(e.g., toy train tracks—connecting the track, putting the train on the track,
moving the train along the track). FLE was not scored if the participant was
not engaging with a toy, engaging with a toy in an inappropriate way (i.e.,
16 Behavior Modification 42(1)

mouthing, disruption, etc.), or engaging with the toy for less than 5 s at a
time. Further, FLE did not require play responses to occur in a specific order
or for completion of a sequence of actions. The duration of FLE was tracked
with a 5-s onset/offset. The number of seconds spent in FLE was then divided
by 360 (the total number of seconds in the 5-min session), resulting in the
percentage of session spent engaged in FLE.
Step completion served as the dependent variable during step completion
baseline and treatment probe sessions. Step completion was defined as the
independent completion of a step in the designated order. A task analysis was
created for each activity consisting of eight steps. Step completion was
defined separately for each toy and was scored each time the participant com-
pleted a step in the designated order, without prompts. Step completion was
not recorded if the participant did not engage with the toy or complete the
step in order, or required prompts to complete the step. For example, for the
train set containing six tracks and one train, 100% correct step completion
was recorded if the participant completed the following steps in order: Step
1–connect track, Step 2–connect track, Step 3–connect track, Step 4–connect
track, Step 5–connect track, Step 6–connect track, Step 7–put train on top of
track, Step 8–move train along the track. Observers recorded the total number
of steps completed, which was divided by the total number of steps and con-
verted to a percentage. As backward chaining was used, the chain was com-
pleted by the therapist and only the targeted steps were probed.
Stereotypy was measured during pre- and posttests for Trey and Lance and
included a variety of behaviors. For Trey, stereotypy was defined as any
instance of mouthing, spinning, posturing, and bursts of running. Mouthing
was defined as any instance in which an object or Trey’s fingers crossed the
plane of Trey’s lips with a 5-s onset/offset. Spinning was defined as any
instance in which Trey rotated his body 360 degrees with a 5-s onset/offset.
Posturing was defined as any instance in which Trey’s knees were on the
floor with a 5-s onset/offset. Bursts of running were defined as any instance
in which Trey moved at a pace faster than walking around the room with a 5-s
onset/offset. For Lance, stereotypy was defined as any instance of head hit-
ting, pacing, repetitive body movements, scratching, and spinning. Head hit-
ting was defined as any instance or attempt in which an object Lance was
holding contacted his head from a distance of 3 in. (7.6 cm) or greater. Pacing
was defined as any instance in which Lance walked more than 3 ft. (.91 m)
from one point in the room to another, at least two times with a 5-s onset/
offset. A repetitive body movement was defined as any instance in which
Lance engaged in behavior at least five consecutive times with no functional
relation to the toys in the room with a 5-s onset/offset. Scratching was defined
as any instance in which Lance’s nails came into contact with his skin and left
Edwards et al. 17

red marks with a 5-s onset/offset. Spinning was defined as any instance in
which Lance rotated his body 360 degrees with a 5-s onset/offset. A total
duration measure was taken for all behaviors and converted into a percentage
of session.

Interobserver Agreement (IOA)

IOA data were collected by trained independent observers using pen and
paper and were collected for FLE during an average of 79.8% (range =
66.8%-100%) of sessions across all participants. IOA data were collected for
stereotypy an average of 34.8% (range = 33.3%-36.4%) of sessions across
two participants (Lance and Trey). The percentage of IOA data was calcu-
lated by taking the smallest duration measure recorded and dividing by the
largest duration measure, then multiplying by 100. The percentage of IOA
averaged 96.7% (range = 90%-100%) for FLE. The percentage of IOA aver-
aged 87.1% (range = 72.8%-100%) for stereotypy. For step completion data,
data were collected for an average of 44.5% (range = 41%-50%) of sessions
across all participants. For these data, trial-by-trial IOA was calculated for
each participant by taking the number of trials with agreements and dividing
by the total number of trials with agreements and disagreements then multi-
plying by 100. The percentage of agreements averaged 98.9% (ranging =
96.7%-100%).

Fidelity of Implementation
Treatment integrity data were also collected by a trained independent
observer. Step-by-step procedures were outlined in a checklist, and the inde-
pendent observer recorded whether the therapist followed the procedures
exactly as detailed (scored as a “+”) or with any deviation (scored as a “−”).
Scores were calculated by dividing the number of correctly implemented
steps by the total number of steps then multiplying by 100. The average per-
centage of sessions in which treatment integrity was scored across all partici-
pants was 61% (range = 44.5%-79.8%). The percentage of correct
implementation averaged 100%.

Experimental Design and Visual Display of Data

A multiple probe design across participants was used to evaluate FLE prior to
and following step completion treatment (i.e., pretest and posttest). The pre-
test and posttest sessions followed the procedures of a free operant preference
assessment (Roane, Vollmer, Ringdahl, & Marcus, 1998). Step completion
18 Behavior Modification 42(1)

was evaluated in a manner similar to a changing criterion design during base-

line and treatment probe sessions. However, as backward chaining was incor-
porated into the treatment probe sessions, the participants were not free to
complete all of the possible steps. Thus, the number of steps that could be
completed in a treatment probe was limited to the target step and previously
mastered steps.

Procedures
Reinforcer selection. Therapists identified preferred items for all phases of this
study using a variety of formats. Because the participants in this study were
also being served in a clinic providing comprehensive intervention, careful
assessment of highly preferred items and activities using questionnaires
(Fisher, Piazza, Bowman, & Amari, 1996) and structured preference assess-
ments (e.g., DeLeon & Iwata, 1996) were periodically conducted. The identi-
fied items and activities were then incorporated into sessions and moment to
moment verbal requests of those identified items were used to identify cur-
rent preference. Therefore, a variety of preferred items identified via parental
interview, structured preference assessment, and requests were present on the
table and additional items were stored in bookshelves nearby. The therapist
either waited for participants to engage in a request or issued a vocal prompt
to occasion a request (e.g., “What would you like to work for?”) before start-
ing each session. Lance typically requested the iPad, cookies, and pretzels.
For Trey, an iPad was the only item requested as he did not exhibit sustained
interest in any other play activities or foods. Ethan typically requested potato
chips, candy, or the iPad. Ethan’s clinical programming also included the use
of a token board. Once all tokens were earned, he would often clap his hands
and remove the tokens to start over, rather than exchange them for a backup
reinforcer. Thus, the token board was incorporated throughout all phases of
the study for Ethan. Tokens (Ethan) and other items (Lance and Trey) were
delivered at the end of each session. During these reinforcer intervals, thera-
pists reinforced requests (including bids for attention) and allowed unre-
stricted access to stereotypy.

Pretest and posttest. Pretest and posttest sessions were used to evaluate the
percentage of session in which the participant demonstrated FLE and stereo-
typy. Sessions were 5 min and were conducted in a separate room inside the
clinic. Procedures followed those used in free operant preference assessments
(Roane et al., 1998). Toys were placed on a table in the room and were equi-
distant from each other and the participant. Using hand over hand prompts
provided by the therapist, the participant was exposed to all toys individually
Edwards et al. 19

for 10 s prior to every session. The therapist began the session by stating,
“Play with whatever you want.” During the session, no prompts or other
forms of interaction with the participant were provided. If dangerous behav-
ior occurred, such as elopement, this behavior was blocked, and minimal
attention was provided. The therapist tracked the total duration of FLE and
stereotypy on separate timers and a count of the number of toys the partici-
pant demonstrated FLE with during the session. After 5 min, the therapist
provided noncontingent access to tokens (for Ethan) or the previously identi-
fied preferred item (Lance and Trey) for a period of 1 min. Noncontingent
access was provided so that results of pre- and posttest sessions could be
evaluated in the absence of programmed contingencies. Furthermore, it was
hypothesized that these conditions would mimic those of a school routine.
For example, after the independent play time, all students rotate to recess or
snack (presumed highly preferred activities) regardless of performance dur-
ing play time. Additionally, the participants were not blocked from engaging
in stereotypy during these periods. Pretest sessions were conducted until
stability.

Step completion baseline. Baseline sessions were conducted with each of the
six toys. Therapists presented one toy per session, in random order, for 2 min,
during which data collectors scored the number of steps completed. During
the session, no prompts or other forms of interaction with the participant were
provided. Dangerous behavior, such as elopement, was blocked, but the ther-
apist avoided redirecting the participant to engage in any other behavior. At
the end of the session, therapists delivered tokens (Ethan, which he then
exchanged for his iPad) or noncontingent access to the previously selected
preferred items for 2 min. As noted above, during these periods of noncontin-
gent access, stereotypy was not blocked. After the period of noncontingent
access, the therapist presented the next session. A minimum of three baseline
sessions per toy were conducted until data were deemed stable.

Step completion treatment probe. Percentage of steps completed for each of

the three toys assigned to treatment was evaluated during each step comple-
tion treatment probe session. The therapist randomized the toys and placed
them one at a time in front of the participant. Using backward chaining, the
therapist completed all nontargeted steps then provided the instruction, “Play
with your toys” and provided an independent response opportunity to com-
plete the next step. The therapist then recorded the steps completed indepen-
dently by the participant. If the participant errored or did not initiate step
completion within 10 s, the therapist used least-to-most prompting to com-
plete that step and then moved on to the next step to be probed. Least-to-most
20 Behavior Modification 42(1)

prompting progressed through the following as needed: a verbal instruction

followed by a gestural prompt, followed by light physical guidance to move
the child’s hands to the toy, followed by hand-over-hand guidance to com-
plete the step. Upon independent completion of the behavior chain, the thera-
pist provided 30-s to 60-s access to reinforcers depending on the number of
steps completed. Step completion treatment probe sessions were then fol-
lowed by treatment sessions (described below). Mastery criteria ranged from
three to six consecutive probes with 100% independence on the targeted step.
Following mastery of a step, treatment began for the next step in the chain.
Mastery of the entire chain for each toy was 100% independent step comple-
tion of a predetermined number of consecutive probes; however, probes of all
steps continued following mastery to assess maintenance.

Step completion treatment. Following step completion treatment probes, step

completion treatment sessions were conducted with each toy. Procedures
were similar to step completion treatment probes; however, the therapist used
most-to-least prompting to help the participant to complete the target steps
and provided the preselected preferred items (e.g., tokens, tangible items)
contingent upon completion of the final step of the chain. If stereotypy
occurred during the treatment sessions, the therapist immediately blocked
and redirected by prompting the appropriate step in the chain. Each step com-
pletion treatment sessions typically lasted less than 2 min. Following three
step completion treatment sessions, a step completion treatment probe ses-
sion was conducted. Of note, a treatment probe was not conducted until at
least 20 min had elapsed since the last step completion treatment session.

Results
Results of pretests and posttest for all participants are shown in Figure 1 and
the results of step completion baseline and treatment probes are shown for
individual participants in Figures 2 to 4. The average percentage of sessions
(pretest and posttest) with occurrences of stereotypy for Lance and Trey is
shown in Figure 5. As shown in Figure 1, Ethan demonstrated no FLE during
pretest sessions (M = 0%). In Figure 2, the step completion baseline data
show he completed an average of 16.7% steps correctly for piano (range =
0%-25%), an average of 29.2% steps correctly for puzzles (range =
0%-87.5%), and no steps correctly for the trains. During step completion
treatment, Ethan reached mastery criteria, independently completing 100%
of steps correctly for at least three consecutive sessions, in 36, 34, and 46
sessions for piano, puzzles, and trains, respectively. During the posttests
(Figure 1), Ethan engaged in FLE for an average of 66.7% of the sessions
Edwards et al. 21

Figure 1. Results from pretest and posttest sessions are displayed for all
participants.
Note. The percentage of sessions in which the participants engaged in FLE with target toys
are shown with black bars. The percentage of sessions in which participants engaged in FLE
with generalization toys are shown with gray bars. The asterisks indicate that a session was
conducted, but 0% FLE was exhibited. The solid phase line indicates when SC treatment
occurred with toys assigned to treatment. SC = step completion; FLE = functional leisure
engagement.
22 Behavior Modification 42(1)

Figure 2. Results of BL and step completion treatment probes across the piano,
puzzles, and trains for Ethan.
Note. The dashed line indicates the designated percentage of steps requiring independent
completion. BL = baseline.

(range = 0%-100%). During all posttest sessions, Ethan only engaged with
the generalization toys (e.g., pop-up toys, car track, and drum). No stereotypy
data were collected for Ethan.
Edwards et al. 23

Figure 3. Results of BL and step completion treatment probes across the piano,
puzzles, and trains for Lance.
Note. The dashed line indicates the designated percentage of steps requiring independent
completion. BL = baseline.

As shown in Figure 1, Lance displayed FLE during the pretests for an

average of 9.1% of the sessions (range = 0%-15%). The percentage of ses-
sions in which FLE included generalization toys averaged 5.4% (range =
0%-12.33%) and for treatment toys averaged 4% (range = 0%-11%). As
shown in Figure 5, during pretests Lance engaged in stereotypy for an
24 Behavior Modification 42(1)

Figure 4. Results of BL step completion treatment probes across the piano,

puzzles, and trains for Trey.
Note. The dashed line indicates the designated percentage of steps requiring independent
completion. BL = baseline.

average duration of 35.5% of the sessions (range = 20%-46%). In Figure 3,

the step completion baseline data show he completed 0% of steps correctly
for piano, puzzles, and trains. During step completion treatment, Lance
reached mastery criteria in 41, 34, and 45 sessions for piano, puzzles, and
Edwards et al. 25

Figure 5. Results from pretest and posttest sessions are displayed for Lance and
Trey.
Note. The percentage of sessions in which the participants engaged in stereotypy are shown
with white bars. The asterisks indicate that a session was conducted, but 0% stereotypy was
exhibited. The solid phase line indicates when SC treatment occurred. SC = step completion.

trains, respectively. During the posttests (Figure 1), Lance engaged in FLE
for an average of 75.2% of the sessions (range = 72%-79.3%). The percent-
age of session engaged in FLE with generalization toys averaged 23.1%
(range = 11.7%-32.7%) and for treatment toys averaged 52.1% (range =
39.3%-67.7%). As shown in Figure 5, during posttests Lance engaged in ste-
reotypy for an average duration of 2.2% of the sessions (range = 0%-6.6%).
As shown in Figure 1, Trey displayed FLE during the pretests for an aver-
age of 5.9% of the sessions (range = 0%-29.3%). Trey engaged only with the
treatment toys during the pretest. As shown in Figure 5, during pretests Trey
engaged in stereotypy for an average duration of 40.7% of sessions (range =
3.6%-65%). As shown in Figure 4, the step completion baseline data show he
completed an average of 0% steps correctly for piano, an average of 16.67%
26 Behavior Modification 42(1)

of steps correctly for puzzles (range = 12.5%-25%), and an average of 33.3%

of steps correctly for trains (range = 0%-62.5%). During step completion
treatment, Trey reached mastery criteria in 94, 36, and 71 sessions for piano,
puzzles, and trains, respectively. During the posttests (Figure 1), Trey engaged
in FLE for an average of 52.11% of the sessions (range = 0%-69.7%). The
percentage of session engaged in FLE with generalization toys averaged
14.7% (range = 0%-23%) and for treatment toys averaged 37.4% (range =
0%-55.4%). As shown in Figure 5, during posttests Trey engaged in stereo-
typy for an average duration of 17.6% of the sessions (range = 0%-38.4%).

Discussion
All three participants in the current study demonstrated an increase in func-
tional play in treatment settings (i.e., step completion treatment), which
resulted in an increase in FLE in a free play setting (i.e., posttest). Two of the
three participants engaged with both targeted and generalization toys in the
posttests. The results of this study extend upon prior research on teaching
functional toy play to children with autism by demonstrating the efficacy of
backward chaining in teaching more complex play behaviors involving mul-
tiple steps in a sequence. These results also add to the body of research that
demonstrates the generality of behavior-analytic interventions for teaching
toy play and address some of the limitations regarding behavioral approaches
to teaching play. By assessing toy play in an unstructured setting in which the
intervention was fully withdrawn, we were able to evaluate whether activities
were selected and initiated by the child, who was free to either play with
items or engage in other behaviors (e.g., stereotypy, impassivity, or attempts
to gain access to other reinforcers). The inclusion of generalization toys
enabled us to assess treatment generality to novel items and allowed us to
identify the occurrence of novel play behaviors. Our results indicated that,
following treatment, participants continued to engage in play in the absence
of programmed contingencies, thereby meeting the definition of play set
forth by Hughes (2012) and addressing the concern proposed by Luckett
et al. (2007) that highly structured approaches result in reliance on external
rewards. The increase in untargeted play actions with novel toys is also nota-
ble given Luckett et al.’s concerns regarding limited spontaneity, flexibility,
and generalization associated with highly structured behavior-analytic inter-
ventions. Although similar effects have been previously demonstrated (Lang
et al., 2014), our results provide further support to the generality of behav-
ioral interventions for play by including children who exhibited limited inter-
est in toys prior to intervention (i.e., children who either did not approach
toys or did not engage in sustained interaction with toys) and with more
Edwards et al. 27

pronounced intellectual and verbal deficits than in other studies (Paterson &
Arco, 2007; Stahmer & Schriebman, 1992).
The generality of play behaviors to untargeted toys and the persistence of
play even when external reinforcers were removed suggests that something
about the learned play behaviors themselves were reinforcing. This is an ideal
outcome. The use of a backward chaining procedure to teach multistep func-
tional play potentially lead to the child experiencing for the first time, the rein-
forcing experience of playing with toys. In contrast, previous studies that
targeted simple object manipulation or merely touching toys may not have
taught behaviors that ultimately were automatically reinforcing. In the current
study, it is possible that teaching the participants what to do with the toys
required reinforcement for the behaviors to be learned, but did not require
external reinforcement for the behaviors to be maintained. Further, the general-
ization toys may have had similar features to the trained toys that made engag-
ing in a sequence of responding possible with those toys even though they were
novel. For example, the car and car track have similar features to the train and
train track in that the car and train both have wheels and are vehicles and the car
track and train track are both flat tracks with grooves (though different shapes
and colors). Thus, in the presence of the novel car track, similar responses such
as pushing the car along the car track may have been evoked. Teachers and
parents hoping to teach generalized toy play skills may want to consider
whether the toy play behaviors will be automatically reinforcing once taught
and may consider having other toys with similar features available.
The treatment package we employed involved several components of pre-
viously established interventions for increasing functional engagement such
as prompting and differential reinforcement of appropriate play behaviors
with social reinforcers (e.g., Nuzzolo-Gomez et al., 2002), restricted access
to stereotypy during “play time” (e.g., Hanley et al., 2000; Potter et al., 2013),
and access to nonsocial reinforcers contingent on appropriate play (i.e., con-
tingent access to stereotypy or other behaviors; e.g., Potter et al., 2013),
which were embedded within a backward chaining approach. Although this
intervention sounds quite intensive, one backward chaining session with one
targeted toy typically took fewer than 2 min to conduct. Therefore, while
other interventions, such as self-management or in-vivo or video modeling,
might seem relatively more feasible to implement in settings such as the
classroom, the current intervention package is fairly simple to implement and
could be interspersed with other teaching activities throughout a school day.
The intervention employed in our study was efficacious for three partici-
pants who exhibited limited to no play in unstructured settings, with limited
imitation skills, and who engaged in stereotypic behaviors (Lance and Trey),
suggesting that this package may be particularly suited for children with
28 Behavior Modification 42(1)

more pronounced deficits and without the prerequisites (i.e., imitation skills)
to benefit from other empirically supported interventions such as video mod-
eling or self-management. In addition, the finding that it resulted in general-
ization of play to contexts with minimal to no oversight suggests that, once
the toy play skills are taught, parents or teachers may see increases in play
during periods in which attention is not continuously available, without hav-
ing to intervene in or otherwise restructure the typical play context. This may
be ideal for caregivers whose attention must be diverted during the times in
which the child is expected to play independently. In a classroom, for exam-
ple, free play contexts are often associated with lower instructor to child
ratios as the teacher is preparing for the next instructional block.
As noted, two of the participants in our study demonstrated reductions in
stereotypy in free play contexts following intervention. Given the likelihood
that stereotypy competes with appropriate functional play, this result is encour-
aging. However, it is important to note that these participants engaged in ste-
reotypy at low to moderate levels in baseline. Whether the treatment package
employed in our study would also be successful for individuals who engage in
high-rate or continuous stereotypy is unclear and other procedural components
may be necessary to facilitate practical maintenance of low rate stereotypy for
these individuals (see Slaton & Hanley, 2016, for an example and further dis-
cussion). Thus, replication across participants is necessary to evaluate this
across a wide variety of children with ASD. Future researchers should also
consider conducting component analyses to determine the critical components
of the intervention package. Last, additional research is also needed to evaluate
whether similar results would be achieved when the intervention package is
implemented by teachers or parents and whether caregivers deem the proce-
dures and outcomes associated with this intervention as socially acceptable.
A few limitations and other procedural aspects of our study indicate sev-
eral other areas for future research. First, we assessed generalization across
only one setting and did not evaluate maintenance in the free play, posttest
context. Therefore, in addition to researching the generality of this interven-
tion across participants, researchers should examine the extent to which this
intervention facilitates both generalization and maintenance across a wider
variety of situations. Second, we included a component (i.e., backward
chaining) that has not been previously evaluated in the literature on toy play.
Though effective in the current study, it is not clear if other procedures
would be more effective and efficient. Therefore, future researchers might
investigate the relative efficacy of backward chaining compared with other
teaching procedures, such as forward chaining or differential reinforcement
with schedule thinning, in promoting generalization and maintenance of toy
play among children who demonstrate limited interest in toys. Furthermore,
Edwards et al. 29

it may be the case that the relative efficacy of backward chaining is depen-
dent on the type of play skills being taught and, therefore, researchers should
also consider assessing the relative efficacy of backward chaining using a
wide variety of play items, including those that are commonly associated
with a specific sequence of actions (e.g., a puzzle set) and those that are not
(e.g., dolls). Third, we did not formally assess preference for the toys prior
to selecting them for inclusion in the study. Given that the participants did
not engage in any play prior to this study, selecting toys based on preference
was not feasible. However, if a child shows interest in toys or engages in
some approximations of play with toys, conducting a preference assessment
and including higher preferred toys is warranted. Finally, we did not collect
data on whether participants would have engaged in steps above and beyond
that which we specifically reinforced during the backward chaining inter-
vention. In other words, participants were given the opportunity to complete
only a certain number of steps at the time of the treatment probe—whether
they would have exceeded the target requirement is unclear, but is possible,
given the similarity of some steps (e.g., putting one vs. another piece in a
puzzle). Therefore, during treatment, future researchers and practitioners
may also consider interspersing terminal probes that enable students to
engage in multiple play actions, to determine whether play is conforming to
the contingencies in place.
In summary, the current treatment package was effective in teaching func-
tional toy play for three participants diagnosed with autism and may be useful
for parents and teachers who are interested in promoting play. When consid-
ering this strategy for use in a school setting, it may be useful to select toys
that promote developmentally appropriate, functional play and that result in
a specific outcome when used correctly. Therefore, it is important that the
selection of toys matches the developmental level of the child and, when
feasible, takes into consideration the child’s preferences for the types of toys
and activities used. It is also important to understand that external reinforce-
ment may be needed to teach play behaviors and that once the natural rein-
forcement of the new play behaviors is experienced, those external reinforcers
can be removed. Last, teachers may appreciate the current strategy in that
each teaching session only required a few minutes making this procedure
something that might easily fit in with other activities that occur during the
school day. Though not explicitly evaluated, it may be easier to teach step
completion in a few brief 1:1 sessions throughout the day.

Acknowledgments
The authors would like to thank Mandi Kaur and Heidi Morgan for their assistance
with data collection.
30 Behavior Modification 42(1)

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

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Author Biographies
Chelsea K. Edwards received her BA in psychology at Agnes Scott College in
Decatur, GA, and her MA in applied behavior analysis at Ball State University in
Muncie, IN. She currently resides in Duluth, GA and is a practicing BCBA.
Robin K. Landa, MS, BCBA, is a doctoral student at Western New England
University. Her current research interests include assessment and treatment of prob-
lem behavior and procedures for promoting generalization and maintenance of adap-
tive skills.
Edwards et al. 33

Sarah E. Frampton, MA, BCBA, is a behavioral clinical practitioner at the Marcus

Autism Center. Her current research interests include procedures for promoting emer-
gence of untrained skills and developing social communication skills for children
with autism spectrum disorder.
M. Alice Shillingsburg is the director of the Language and Learning Clinic at the
Marcus Autism Center. She is an assistant professor in the Department of Pediatrics
at Emory University School of Medicine. She is a licensed psychologist and board
certified behavior analyst.