The Effects of Video Modeling on the Adult Implementation of PECS Phase 1A

Home , Video modeling

THESIS

Presented in Partial Fulfillment of the Requirements for the Degree of Master of Arts in

the Graduate School of The Ohio State University

Shaun Barrett

Graduate Program in Educational Studies

The Ohio State University

2017

Master’s Examination Committee:

Sheila Morgan, Advisor

Helen Malone

Copyrighted by

Shaun Barrett

2017

Abstract

This study examined the effects of a video modeling training video on early childhood education staff members' implementation of the Picture Exchange Communication

System (PECS) Phase 1A. Quality of the implementation was determined by participants following a task analysis of 10 steps wherein a confederate acting as the student exchanges a PECS picture of an item to receive access to that item. After baseline data collection, participants were instructed to watch the researcher's training video of PECS

Phase 1A being modeled. The video was uploaded to YouTube so participants had access to the training video and was viewable on their own time. After viewing the video, participants were assessed on their performance again using the 10 step task analysis. A multiple-baseline across participants design was used to evaluate the effectiveness of the intervention. Findings indicated the number of steps completed correctly improved as a result of the training intervention.

Vita

2006-2011………………………………… B.S. Early Childhood Special Education The Ohio State University Columbus, Ohio

2011- 2016………………………………... Lead Teacher/Early Intervention Specialist The Nisonger Center Early Childhood Ed. Columbus, Ohio

2016- present……………………………… Developmental Specialist The Nisonger Center Early Childhood Ed. Columbus, Ohio

FIELDS FOR STUDY

Major Field: Educational Studies Area of Emphasis: Special Education, Early Childhood, Applied Behavior Analysis

iii

Table of Contents

Abstract…………………………………………………………………………………………….ii

Vita………………………………………………………………………………………………..iii

List of Figures...……………………………………………………………………………………v

Chapter 1: Introduction…………………………………………………………………………….1

Chapter 2: Method..………………………………………………………………………………21

Chapter 3: Results………………………………………………………………………………...27

Chapter 4: Discussion…………………………………………………………………………….32

References………………………………………………………………………………………..40

Appendix A: Social Validity Questionnaire...……………………………………………………50

Appendix B: PECS Data Collection Sheet……………………………………………………….52

Appendix C: Scenario Questionnaire…………………………………………………………….54

List of Figures

Figure 1. Steps completed for each dyad………………………………………………………31

CHAPTER 1

LITERATURE REVIEW

Prevalence of Children with Developmental Disabilities

Developmental disabilities are a group of conditions classified by an individual's impairment in the areas of learning, language, or behavior manifested at birth or in early childhood (Currie, Gershkoff, & Cifu, 1993). These conditions impact everyday functioning and typically affect the individual throughout his or her lifetime. In the

United States, about 15% of children ages 3 through 17 years have one or multiple developmental disabilities (Boyle et al., 2011). According to the Center for Disease

Control (CDC), from 1998 to 2008, the prevalence of children with disabilities rose from

12.84% to 15.04%. That is an increase of 2.2% within a 10 year period (Boyle et al.,

2011). Though the prevalence of children with disabilities may seem low, it is vitally important that we consistently track how many children have developmental disabilities, how services are being carried out, and what evidence based approaches are showing effective treatment to improve their quality of life.

Under Part C of the Individuals with Disabilities Education Act (IDEA), children with developmental delays or disabilities ages birth through three have legislation ensuring they have access to Free Appropriate Public Education (FAPE) in the Least

Restrictive Environment (LRE) along with an Individualized Family Service Plan (IFSP)

detailing specific child and family goals. According to government publications as recent as 2016, there are a total of 350,581 children (ages birth to three-years-old) in the United

States identified with developmental delays or disabilities (U.S. Department of

Education, 2016). According to that data from 2014, the number of children with developmental disabilities birth through age 3 years equates to 2.95% of the US population.

Part C of IDEA mandates that early intervention services be provided, to the best extent possible, in the child's natural learning environment (IDEA, §303.26). That is, a child with developmental disabilities should receive his or her services where his typically developing peers would be. The only exception to the rule is if early intervention services cannot be satisfactorily attained in the natural environment. In that case, an appropriate alternative setting is allowed (e.g., hospital, residential facility, clinic, and early intervention center/class for children with disabilities). Due to this mandate, and reflected in the U. S. Department of Education report, 88.1% of children qualifying for early intervention receive services in the home setting and 7.6% receive their services in a community based setting like child care centers, preschool programs, early childhood centers, libraries, or parks. Only about 4.4% receive their services in other settings such as hospitals, clinics, or classrooms for children with special needs

(U.S. Department of Education, 2016). Specifically for Ohio, 95.01% of children receive services in the home setting, 3.13% in the community, and 1.86% in other settings (Ohio

Department of Developmental Disabilities, 2017). These data suggest a strong need for the caregivers of children with developmental disabilities and childcare staff to be equipped and empowered to be competent interventionists for their children.

With the prevalence of speech delays in young children with special needs, it is especially important that caregivers have evidence-based interventions that help their children develop language. In 2014, speech or language impairments accounted for

43.7% of children ages three through five receiving Part B services, followed by developmental delays at 37%, and by autism at 8.9% (U.S. Department of Education,

2016). Taking into account that the latter two can coincide with communication problems, it is clear that making progress in language development is imperative to this population of young children in early intervention.

Characteristics: Children with Language Delays

While language delay is an overarching term, there are many kinds of communication difficulties that involve both receptive and expressive skills. The

American Speech-Hearing Association (ASHA) lists speech and language disorders such as childhood apraxia of speech, dysarthria, articulation and phonological problems, and other medical conditions. According to Wankoff (2011), some indicators of a potential speech and language disorder for a young child include:

 Below 8 months of age: feeding problems, medical conditions, motor or sensory

impairments, little to no "affective engagement", minimal sensory exploration

using senses like vision, hearing, and touch.

 Between 8-12 months: little to no communicative acts (e.g., joint attention or

gestures), rare use of facial expressions and gestures, limited acts of requesting or

protesting.

 Between 12-18 months: low instances of vocal, verbal, or gestural turn taking,

difficulty comprehending simple words.

 Between 18-24 months: Using under 50 words by age 24 months, slow

vocabulary growth after 24 months, rarely initiates communication/speech and

tends to echo language heard.

 Between 24-36 months: lack of mini conversational speech, hard to understand by

family and strangers alike, lack of grammatical complexity.

One of the most basic human rights is the right to communicate. Young children progress through many changes as they learn and grow, especially in the early stages of life. While all developmental domains are connected in some way or another, communication skills are necessary to express oneself, make wants and needs known, and to contribute in discussion. In a recent study, of 144 children ages 2 to 7 with a specific language impairment, 54% also had behavioral problems (Maggio et al., 2014). This shows a strong need for effective language intervention to help aid in reducing challenging behaviors.

After many years of neuroscientific and behavioral research, Harvard

University's Center on the Developing Child in conjunction with the National Scientific

Council on the Developing Child (National Scientific Council, 2007) concludes that young children's experiences from birth through age 5 years have a tremendous impact on the future development of their brains. Many neural connections are being made in the brain during the early years of life and childhood experiences help shape the quality of those connections. For example, whether or not an adult engages in interaction, mutuality, and reciprocity with a child contributes in the later development of complex skills (or lack thereof) like language and communication (National Scientific Council,

2007). In light of these findings, it only strengthens the urgency for quality evidence-

based strategies in the early years of life. Furthermore, the use of evidence-based practice is mandated by law (IDEA, 2004, Section 635(a)(2)). Sometimes, with the combination of parent desperation and non-validated "miracle treatments", educators are faced with un-scientific interventions that are harmful to those it proposes to help. Interventions such as Facilitated Communication purported to be a means for children and adults to communicate using a keyboard and a "facilitator" to help guide the individual’s hand to type messages the user wishes to express. Facilitated Communication has been thoroughly debunked, but still has proponents and exists in slightly altered forms

(Mostert, 2012). This proselytizing of fad treatments is extremely problematic for two reasons. First, they may replace scientifically validated treatments with ineffective ones.

Second, pushing inadequate treatments despite science that contradicts it can lead to mistrust and loss of credibility for professionals and in the field as a whole (Mostert,

2012). Frankly, we don't have time for children's language development to be wasted on pseudo-science, fad treatments, and unsubstantiated interventions.

Alternatives: Other Means to Communicate

Due in part to the large portion of children with developmental delays needing communication intervention, research has been conducted to find alternative ways for individuals to communicate. The common term for other approaches in communication is

Augmentative and Alternative Communication (AAC). AAC is defined as "all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas." (American Speech-Language-Hearing Association, n.d.). There are two types of AAC systems. Some are considered unaided communication systems (i.e., dependent on the individual's body alone) such as gestures or American Sign Language. Conversely,

aided communication systems are those that require equipment or tools in addition to the individual's body.

Some of the more well-known aided communication systems are communication devices that have voice output capabilities. AAC can be as simple as a BIGMack switch that produces a single pre-recorded message or complex as an AAC program like

Proloquo2Go on a tablet device. As seems to be customary with technological devices, and the added weight of being marketed for children with special needs, these AAC methods can be quite expensive. A single push-button BIGMack retails on the company's website for $135. The cost of an Ipad starts at $329 (Apple Ipad, n.d.) and downloading the Proloquo2Go app costs $249 (Proloquo2Go, n.d.). Dedicated AAC devices such as

Dynavox's Indi™ with software costs about $1,000 (Indi with Snap, n.d.)

Another category of AAC is the Picture Exchange Communication System

(PECS; Bondy & Frost, 2001). At its inception, PECS was created as an AAC intervention for individuals with autism spectrum disorder and other similar developmental disabilities. PECS focuses on the initiation component of communication so that children are not prompt dependent to start communicating. It was designed to be a simple and inexpensive means for children with special needs to communicate with their families, educators, and other caregivers in a wide range of environments. PECS is rooted in behavior analytic principles such as prompting (non-verbal), reinforcement, and fading. Individuals exchange picture symbols that represent objects, actions, or other words to the person with whom they are interacting. In total, there are six phases in which learners progress to develop more sophisticated means of communication. The phases are

1) the basic exchange, 2) distance and persistence, 3) picture discrimination, 4) sentence

building, 5) responding to questions, and 6) commenting (Frost & Bondy, 1994). While it can be a standalone communication system, some individuals use it to help develop spoken language or transition to a speech generating device (SGD).

Picture Exchange Communication System: The Evidence

The Picture Exchange Communication System has been tested and researched since its inception, mostly in Phases 1 through 3. The National Professional Development

Center (NPDC) on Autism Spectrum Disorder has determined PECS to be an evidence based practice. In order to qualify as an evidence based practice, the NPDC requires at least two high quality experimental/quasi-experimental group designs studies, or three different investigators with at least five single subject design studies, or a combination of the previous criteria. NPDC further defines high quality design on their website (National

Professional Development Center, n.d.). At its foundation, PECS is grounded in applied behavior analysis. This is exemplified in a study by Bondy, Tincani, and Frost (2004) describing PECS within the framework of B.F. Skinner’s work on verbal behavior (1957) and how language acquisition occurs. That is, Skinner uses functional analysis of verbal behavior rather than focusing on the modality of the communication. Being cognizant of issues regarding stimulus control and reinforcement helps in developing effective training protocols (Bondy et al., 2004). For example, researchers may approach a communication method such as PECS within the framework of environmental stimuli (e.g., presence of preferred toy/reinforcer) evoking target behaviors (e.g., handing a PECS picture to the communication partner) and the future likelihood of those behaviors occurring again based on subsequent consequences (e.g., access to the preferred reinforcer). Using this

methodology for examining communication programs can better inform training steps and procedures (Bondy et al., 2004).

In the early research years of PECS, Frost and Bondy (1994) go into detail on all of the methodology of teaching each phase of PECS and then transition into their findings. Several investigations were taken into account when discussing the effectiveness of PECS. One of the studies discussed is a longitudinal study of the effects of PECS training on 66 children under five years old who identified with autism spectrum disorder (ASD) and had practically no system of communication (children even with some functional communication were excluded from the study). While they do not go into exact environmental conditions or how many trials it took for children to acquire the skills necessary for PECS, it was reported that 76% of all children who participated in learning PECS (and continued to use it for more than 1 year) used speech as their sole communication system or in combination with a picture based system (Frost & Bondy,

1994).

To expand upon previous research, Charlop-Christy, Carpenter, Le, LeBlanc, and

Kellet (2002) examined the effects of PECS on the emergence of speech, social- communicative behaviors, and problem behaviors. Procedures included teaching all phases of PECS to criterion and collecting data on student behavioral responses to five spontaneous speech opportunities and five verbal imitation opportunities during play and academic settings. Participants were ages 12, 5, and 3 but all had the same language skills equivalent to around a 1-year-old. Prior to PECS training, a preference assessment was conducted to find each child's top five stimuli preferences. Once preferences were established, children came to 15-minute training sessions at a behavioral treatment

program two times per week. Core dependent measures were a frequency count of number of trials each child took to meet criterion for each phase as well as the total number of minutes it took until criterion was met. They also collected data on auxiliary measures related to other behaviors. Results showed that all three children reached criterion (80% correct) for all phases of PECS with an average of 170 minutes per phase and 246 trials per phase. Also, the experimenters documented a significant expansion in verbal speech and increases in desired behaviors and reduction of problem behaviors.

Ganz and Simpson (2004) extended the findings of Charlop-Christy et al. (2004) for rapid PECS skill acquisition with young children with characteristics of ASD by following a similar procedure as Charlop-Christy et al. (2004), collecting data on PECS

Phases 1 through 4 while also collecting data on language variables. Specifically, Ganz and Simpson (2004) examined the effects of PECS training on number of words spoken, increasing the complexity and length of phrases, and decreasing unintelligible vocalizations for three children with ASD or developmental delays (DD). Similar to previous studies, the children were taught PECS up to phase four with mastery criteria being 80% over three consecutive sessions of 15 trials. Sessions occurred between two and five times per week in the children's natural environment (classroom). Dependent variables were proficiency relative to each PECS phase (i.e., steps completed independently or if prompts were needed) and number of intelligible words versus non- word vocalizations made. By the conclusion of the study, all participants made progress in using PECS as their communication system as well as increasing the average number of words spoken per trial.

Other researchers expanded on the original programming PECS offered such as the improvisation of mands. Marckel, Neef, and Farrari (2006) taught children with autism to use a combination of color, shape, and function cards to make requests. For example, if a child wanted a cookie, he would request it with the "round", "brown", and

"eat" cards. Chaabane, Alber-Morgan, and DeBar (2009) extended this research by teaching parents to train their children improvisation of mands. Park, Alber-Morgan, and

Cannella-Malone (2011) also taught parents to implement PECS with their children.

PECS has also been used in conjunction with other behavioral principles such as differential reinforcement of alternative behaviors (DRA) and prompting to increase peer- directed mands (Paden, Kodak, Fisher, Gawley-Bullington, & Bouxsein, 2012) as well as response effort, chaining, and fixed ratios of reinforcement (e.g., FR3) (Buckley &

Newchok, 2005). Studies have continued to be produced further adding to the already extensive support that PECS is a very effective, evidence-based approach improving communication skills. To date, Pyramid Educational Consultants (the company responsible for PECS) list 150 published articles related to the implementation of PECS

(Pyramid Educational Consultants, n.d.). Equally important to the system itself is effective training to reach high levels of user fidelity.

Effective Training: Core Principles

Behavior analysts have an ethical code of conduct to teach any type of behavioral intervention in the most effective evidence based ways. "Disseminating information about effective practices among caregivers in this regard has become a professionally expected responsibility of behavior analysts" (Parsons, Rollyson, & Reid, 2012, p. 2).

Therefore, in order for special education professionals to fulfill their responsibility, they

need to consult the research to see what the most effective behavioral strategies are.

Effective training such as behavior skills training (BST) involves instruction, modeling, rehearsal, and feedback (Miltenberger, 2004). New learners of a particular skill need to first be instructed on what the skill is they will be learning. Then, the new skill must be modeled for them. This is followed by implementation practice of the learner. Finally, the new learner should receive positive praise for correct responding and corrective feedback on areas where they responded incorrectly. This is to further increase proficiency with which the learner performs the new skill.

In conjunction to this framework, it is vital that behavior skills training involve prompting as well as generalizing target skills across settings. The National Professional

Development Center on Autism Spectrum Disorders (n.d.), in collaboration with a report by Wong et al. (2014), reports prompting procedures to be an evidence based practice for children with autism. They do so by citing a variety of peer-reviewed articles (e.g.,

Akmanoglu & Batu, 2004; Ingvarsson & Hollobaugh, 2011; Taylor & Hoch, 2008).

Additionally, Neitzel and Wolery (2009) provide an overview of research on prompting procedures to teach pointing to objects, identifying numbers/objects, and exhibiting "on task" behavior. Prompting procedures include but are not limited to most-to-least, least- to-most, and graduated guidance. Specific types of prompts include verbal, gestural, physical, and visual. Having a firm grasp of prompts and prompting procedures can aid in the effectiveness of teaching new skills to both children and adults.

These prompting procedures have been shown to be successful and can lead to great gains for individuals in a multitude of areas. Sometimes skills are taught to a child in a clinical setting but may prove difficult for the child to apply in real life settings or

across environments. The problematic consequences of teaching a child in one specific setting can be exemplified by a study conducted about the prevalence of schools calling themselves "ABA schools" but only using Discrete Trail Teaching (DTT) to teach skills.

The authors emphasize, "Although DTT has many advantages to recommend its use, it is not well suited to teach the full range of cognitive, social, academic, leisure, and functional living skills children with autism and related disorders need to develop and generalize to varied natural environment" (Steege, Mace, Perry, & Longnecker, 2007, p.

1). So too, it naturally follows that when teaching adults an intervention program or method, special educators should make sure to equip them to respond correctly in a variety of settings. For example, special educators want caregivers to be competent in carrying out a Differential Reinforcement of Other Behaviors (DRO) behavior plan in the classroom, home, outdoor play time, or in the gym.

Staff/Parent Training: Justification

While expert behavior analysts have years of training to implement a variety of behavioral interventions, research has shown it is possible to successfully train caregivers, staff members, or other individuals without a behavioral background to carry out a particular procedure with high fidelity (Lerman, Tetreault, Hovanetz, Strobel, &

Garro, 2008; Mueller et al., 2004; Petscher & Bailey, 2006). Meadan, Ostrosky, Santos, and Snodgrass (2013) explain difficulties young children with disabilities face involving the identification of cues and responding appropriately to them. Meadan et al. (2013) further explain adults skilled in providing assistance and using prompts can influence how well a child learns a new skill and therefore teaching behavioral procedures to adults like educators, parents, or other staff members is plausible and evidence based. One such

study taught teachers how to use the system of least-to-most prompts, contingent imitation, and praise to build pretend play skills in children with disabilities (Barton &

Wolery, 2010). Another study demonstrated that mand training can also be taught to staff with high fidelity and result in positive outcomes for children with disabilities (Nigro-

Bruzzi & Sturmey, 2011).

Researchers and educators know that staff training can be effective and produce positive results for the staff involved and by extension the children in their care. Most of the studies were conducted with children older than age 3. However, considering the

IDEA mandate regarding the priority of natural learning environments for children ages birth through three, educators should focus on family and caregiver training for children with developmental delays and/or disabilities. Noting the statistic again, about 95% of early intervention services are delivered in the child's home or child care facility (U.S.

Department of Education, 2016). Ohio Early Intervention's IFSP Guidelines document states the family, service coordinator, and early intervention team members decide on the amount of visits and number of minutes service providers should carry out services for a child's goals (Ohio Early Intervention, 2016).

There is one troubling issue with the IFSP guidelines, however. Other than zero, there is no minimum requirement of services explicitly written. That is, an IFSP could be written in a way that the family only receives one visit in six months for 30 minutes and it is entirely legal. That is not the case in most IFSP documents, but at the very least it is problematic. Khun and Marvin (2016) counter this "bare minimum" legal statute and give a detailed flow chart on how to decide the amount of visits and minutes of services that should be provided based on meaningful variables like level of need, opportunities

available, and cultural considerations. All of these factors culminate in showcasing the need for quality parent and staff training.

Counter-intuitive in nature, Ohio Early Intervention states that intervention actually occurs when the specialist is not present (DeDino, 2017). That is, the specialist provides training and coaching for the parent and/or staff during scheduled visits thereby equipping those caregivers to carry out intervention activities throughout the child's daily routines without the specialist present. The amount of opportunities in a short one hour visit is limited in nature. The specialist may be able to take part in one routine a child has but that is the extent of the visit. If a parent or staff member is trained in an effective strategy, though, the amount of opportunities for a child to practice a particular skill increases exponentially.

Video Modeling: A Sampling of Applications

Video modeling is a mode of teaching that uses recorded video of an individual or group of individuals modeling a particular skill or intervention. The new learner, then, watches these videos of the skill being modeled and in turn attempts to carry out the skill independently. Video modeling has been utilized in a variety of ways and research continues to build supporting its practicality. Extensions of the core method of video modeling include video self-modeling (VSM), other individuals modeling the skill, and point-of-view modeling (i.e., having the video record at the angle in which the learner would have vision) (Bellini & Akullian, 2007). As discussed by Ganz, Earles-Vollrath, and Cook (2011), researchers demonstrated video modeling is effective for increasing appropriate social interactions (Apple, Billingsley, & Schwartz, 2005; Gena, Couloura, &

Kymissis, 2005; Maione & Mirenda, 2006; Nikopoulos & Keenan, 2003), improve

conversation skills (Charlop & Milstein, 1989; Charlop- Christy, Le, & Freeman, 2000;

Sherer et al., 2001), improve daily living skills (Haring, Kennedy, Adam, & Pitts-

Conway, 1987; Keen, Brannigan, & Cuskelly, 2007), improve play skills (Charlop-

Christy et al., 2000; Dauphin, Kinney, & Stromer, 2004; MacDonald, Clark, Garrigan, &

Vangala, 2005; Maione & Mirenda, 2006; Nikopoulos & Keenan, 2003, 2007), and reduce problem behaviors (Luscre & Center, 1996).

A similar review of video modeling studies was conducted but focused strictly on children with autism. After a review of 19 studies, Delano (2007) describes implications for practitioners working with children with autism. For example, Delano (2007) concludes video modeling treatments may support children with autism in their central deficits, help facilitate skill acquisition, and promote generalization across a variety of settings.

Behavior Skills Training: A Common Framework in a Series of Contexts

As Iwata et al. (2000) expresses concern in that staff training is typically overlooked as a research topic in behavior disorder assessments and treatments due to the level of competence needed as a prerequisite. "In other words, implementation errors in clinical research are typically minimized as unwanted sources of risk to both clients and staff as well as potential sources of experimental confounding and, as a result, have not been examined systematically as dependent variables” (Iwata et al., 2000, p. 182). The goal for this study was to determine if a behavior skills training package was effective and time-efficient in teaching undergraduate students how to conduct a functional analysis (FA). The training consisted of two phases. The first phase was conducted in a group format where undergraduate students were given written descriptions of the

components of a FA and subsequently quizzed on those integral pieces until they got at least 90%. In the second phase, students watched video models of how to correctly implement an FA given three different functional conditions. After reviewing the video, the undergraduate students then attempted to carry out an FA to fidelity and received immediate corrective feedback. Results showed that all participants reached at least 95% accuracy of correct responses during a simulated FA session. As for time efficiency, the training lasted around two hours. This demonstrates that effective, systematic, and time- sensitive training is plausible for inexperienced individuals to demonstrate complex skills like implementing FAs. Using Iwata et al.’s framework, additional studies were conducted to show other skills can be taught in the same manner.

A study was conducted using behavior skills training to teach staff how to conduct a paired-stimulus preference assessment with positive results (Lavie & Sturmey,

2002). Following the basic principles of a brief instruction, video model, and rehearsal with verbal feedback, researchers successfully trained three staff members in this specific preference assessment with near 100% fidelity across the board. Verbal feedback included behaviors that were carried out correctly, as well as behaviors the staff member needed to practice. A notable difference in this case, however, was practicing with children with special needs (as opposed to a confederate). Similar to the previous Iwata et al. research, though, the authors of this study also discuss the short time frame of about

80 minutes to train these individuals.

Shortly after the publication of the Lavie and Sturmey (2002) article, another study used BST techniques to train staff members discrete-trial teaching (DTT) with significant gains of correct responses compared to baseline (Sarokoff & Sturmey, 2004)

The participants in this case were three special education teachers with master’s degrees in special education or were close to completing the master’s program. One three-year- old child with autism was involved in practicing DTT with the teachers. All of the teachers were using DTT previously, but their combined average fidelity rate was 45%.

As the authors point out, “Instructions, feedback, rehearsal, and modeling were responsible for a large increase in all 3 teachers’ performance of discrete-trial teaching.

Moreover, the procedure was taught quickly and effectively” (Sarokoff & Sturmey, 2004, p. 537).

Yet another experiment built upon previous research used behavior skills training as a mode to teach staff members how to carry out behavior intervention plans (Hogan,

Knez, & Kahng, 2015). Researchers used the same outline of verbal instructions, modeling, rehearsal, feedback to train participants. For this particular study, the authors decided to conceptualize the framework into two phases. Phase one was verbal instructions and modeling, and the second phase was rehearsal and feedback. Participants would go through phase 1 until they met criterion and then move to phase 2. If they had difficulty in phase 2, they would be reverted back to phase 1 until they met a mastery and then moved back to phase 2. Results showed improvement in all staff participants as a result of the training received.

The above examples are just a sampling of the extensive research that has been conducted providing support for behavior skills training. BST has also been demonstrated to be effective in teaching parents how to conduct descriptive analyses and select treatments based on the functional assessment (Shayne & Miltenberger, 2014), guided compliance (Miles & Wilder, 2009), and the picture exchange communication system

(Homlitas, Rosales, Rocio, & Candel, 2014). In summation, there are a few characteristics for evidence-based BST training: integral principles of brief instruction, modeling, rehearsal, and feedback, low time commitment, and participant satisfaction.

Two Exemplars: Putting the Pieces Together

There are published studies that combine the evidence-based practices of the

Picture Exchange Communication System (PECS), adult training, video modeling, and behavior skills training. The first study to be discussed involved three adults with no prior knowledge of how to use PECS. After baseline performances were recorded, participants went through behavior skill training that used video modeling as the primary teaching modality. The confederate, acting as the child, had a list of possible responses she could exhibit. Participants had multiple sessions of modeling, rehearsal, and feedback until they correctly performed 80% of all the steps over two consecutive trial blocks. Results showed significant improvement in all three phases that were taught using this skills training package (Rosales, Stone, & Rehfeldt, 2009).

In a follow up study, researchers built upon this previous experiment to learn more about the effectiveness of the PECS behavior skills training package developed so far (Homlitas, Rosales, Rocio, & Candel, 2014). Whereas the previous study had undergraduate students learning PECS, this one was implemented in the natural environment with three teachers working in a therapeutic center for children with autism.

Using video modeling and the same format of BST, the teachers were taught PECS

Phases 1 through 3A. They again used a confederate equipped with a menu of behaviors to exhibit, making sure the teachers responded correctly to a variety of behavioral responses. Results showed the participants met or exceeded criterion levels of the

implementation of PECS. Additionally, these skills carried over to working with their actual students.

Purpose: Next Steps in Research

While each evidence-based practice has been shown to be heavily researched and produces significant positive results, there is still room to grow in this area. Seemingly inevitable, there are always limitations in research studies, but equally so are there directions for future research. Next steps considered for the present study involve the following:

 Investigate strategies to teach implementation of PECS without a behavior

specialist’s continued presence (Homlitas, C., Rosales, R. & Candel, L., 2014).

 Research examining the amount of training necessary for high rates of fidelity in

PECS implementation (Ganz & Simpson, 2004).

 Video modeling studies considering the amount of information presented (such as

the length of the video) while maintaining acceptable performance (Catania,

Almeida, Liu-Constant, & DiGennaro-Reed, 2009).

Considering the number of children entering in early intervention services along with the focus of natural learning environments and coaching staff and parents to carry out evidence-based strategies, it is reasonable to explore effective training methods. As noted before, the primary window for language acquisition is birth through five years of age. For children who have delays in language, it is imperative that we support them in their communication skills whether it is through verbal means or through AAC technologies like PECS. It is desirable to have a methodology that can potentially reach beyond the bounds of needing a behavioral therapist present for the entire training and

learning process. Therefore, it is the aim of this present study to examine variables of behavior skills training, PECS training, adult implementation, and video modeling to help formulate a more cohesive, time efficient, and cost-effective training program that extends previous findings. The following research questions were posed.

1. What are the effects of a PECS Phase 1A training package using video modeling

on the number of steps implemented accurately by early childhood staff?

2. What are the participants’ opinions of being trained in PECS Phase 1A using this

behavior skills training model?

CHAPTER 2

METHOD

This chapter presents the methods that were used in this study. The participants and setting are explained as well as the observer and experimenter identified. In addition, this chapter presents the materials used, definition of dependent variables, IOA, procedural fidelity, social validity, and experimental design procedures.

Participants and Setting

The participants in this study were six female staff members in an early childhood education/childcare facility. Three participants were paraprofessionals with early childhood education experience ranging from 2 to 5 years. One participant was a lead teacher with 20 years of experience in early childhood education, another participant was a program assistant with 10 years of experience working with children, and the final participant was an occupational therapist with 25 years of experience mostly in the 1 to 5- year-old range. All participants worked in a fully inclusive classroom(s). The ratios of peers to children with developmental delays is 8:2 for infants through one-year-old, 10:4 for toddlers, and 12:6 for 3 to 5-year-olds (with Individualized Education Plans).

Participants reported little to no experience on how to implement Picture Exchange

Communication System (PECS).

Baseline and intervention sessions were conducted seated at a small table in an office located at the early childhood center where the staff members worked. Video modeling training sessions were conducted and viewed on the participants’ own time without the experimenter present. Recording performance of PECS implementation steps occurred during staffs’ regular working hours. Staff members working hours ranged from mornings only to typical 9 hour days with varying beginning and ending times.

Participants were randomly assigned to one another to form 3 groups of 2. The participants did not typically work together in the same classroom(s).

Experimenter

The experimenter was a graduate student at The Ohio State University pursuing a master's degree in applied behavior analysis and pursuing Board Certified Behavior

Analyst (BCBA) certification. The experimenter received a Bachelor of Science in

Special Education: Early Childhood from The Ohio State University. The experimenter also has a 5 year professional special education teaching license for Pre-k through 3rd grade from the Ohio Department of Education. Additionally, the experimenter is certified as a developmental specialist for children ages birth through 3 years old. He has been a lead teacher in a toddler (18 months-36 months old) special education classroom within an early childhood education center for 6 years in conjunction with providing early intervention services in in-home and childcare center settings for 5 of those years.

Observers

Observers included two employees of the center where the research was conducted. One observer was a developmental specialist who was seeking her master's degree in applied behavior analysis, provided IOA and participated as a model in the

training video. The other observer was a speech language pathologist who provided guidance using PECS and also participated as a model in the training video.

Materials

Materials for this study consisted of a PECS binder, PECS pictures of toys used in the training, the modeling training video, and a camera to record performance sessions.

The PECS 3 ring binder was 9 ¼ inches x 10 inches with Velcro strips affixed to the face of the binder as well as on the plastic page dividers inside. PECS pictures were 2 inches x

2 inches and depicted a Boardmaker icon of a toy train and other pictures such as a ball or book. A toy train was used as the preferred item of the confederate. The training video was created using free-to-download video editing software named Lightworks version 14.

The total length of the training video was 2 minutes and 11 seconds. The modeling training video showed each step of the PECS Phase 1A process and labeled with text each step within the video as it was being performed. The training video was uploaded to

YouTube for participants to view. A camera was used to record both the training video and performance sessions.

Dependent Variable

The dependent measure in this study was the number of steps in the task analysis completed out of 10. The steps are as follows:

1. Arrange the training environment by providing one picture of a preferred item

on a Velcro strip in front of the student.

2. Position the communication partner in front of the student.

3. Display the item in view of the student, providing no verbal prompts.

4. The communication partner interacts with the item (e.g., playing with the toy).

5. As student reaches toward the item, helper places her hand on the student's

hand and redirects the student's hand to be placed on the picture (with no

verbal prompts).

6. Helper's hand is used overtop students hand to pick up the picture

7. As student picks up the picture, communication partner opens one hand in

front of the student.

8. The helper assists the student in placing it in the open hand of the

communication partner.

9. The communication partner takes the picture and says the item name out loud

(within 2 seconds).

10. The communication partner immediately gives the item to the student (within

2 seconds).

A step will be counted as correct if the participant follows the step as written. A step will counted as incorrect if the participant skips the step or completes the step incorrectly (e.g., provides a verbal prompt).

Inter-observer Agreement (IOA)

A second trained observer independently observed videotapes and scored the number of steps completed accurately for 33% of baseline, intervention, and maintenance sessions. The observer’s scores were compared to the experimenter’s scores to determine

IOA. IOA for correct steps was calculated using number of agreement over agreement plus disagreement multiplied by 100 (i.e., Agree / (Agree+Disagree) x 100 = IOA).

Experimental Design

A multiple baseline across participants design was used to evaluate the effects of

PECS training using video modeling on the adult implementation of PECS Phase 1A. The experimental conditions were baseline and intervention. Prior to collecting intervention data, participants were able to watch the training video on their own time. Groups had at maximum 1 week to watch the training video before performance sessions occurred, or sooner if they were ready to perform the steps.

Procedures

Baseline: During baseline sessions, each group was told they would be implementing PECS Phase 1A. The experimenter explained that there were two people for Phase 1A because there is a communication partner and a helper to help the student/confederate learn to use PECS. Each session of one trial would begin with the communication partner having the toy and it would end when the student/confederate gaining access to the toy. The two participants could choose to stay in the same role or switch if they would like. The experimenter recorded the number of steps completed correctly and incorrectly for each dyad. No feedback was provided during the session.

Intervention: After completing baseline conditions, participants were given access to the PECS training video via a URL link that was unique for each participant.

Within the video, the experimenter modeled and provided a description of each step that was written in conjunction with the step being performed. After watching the video

(within a week), performance sessions were recorded again in the same conditions as baseline. After the first performance session, participants were given feedback immediately after of which steps were completed correctly and which steps they did not complete correctly. Once told the steps they needed to correct, participants were

instructed to watch the video again, paying close attention to the steps they may have missed. After one week or when the group was ready, the performance session process was repeated. This continued until each group reached mastery of all 10 steps in 2 consecutive sessions across at least 5 intervention sessions.

Maintenance: After completing intervention conditions and successfully performing all 10 steps for at least 2 consecutive sessions, participants moved into the maintenance phase. The maintenance phase was between a few days to a week from the last session dyads performed PECS Phase 1A. Two data points were collected during the maintenance phase.

Social Validity

Following the completion of the study, participants were asked to complete a questionnaire to rate the extent to which they felt the intervention was effective in training them to complete all steps of PECS Phase 1A. This questionnaire utilized a

Likert-type scale. The questionnaire can be found in appendix A.

CHAPTER 3

RESULTS

This chapter presents IOA as well as a summary of results as displayed in Figure

IOA

IOA was calculated for the dependent variable during baseline, intervention, and maintenance conditions by a second trained observer for at least 33% of all phases. IOA was calculated using total agreement for total number of steps completed correctly divided by the total number of steps. IOA across all dyads and all phases of the experiment was 93.3%.

Summary of Results

Figure 1 shows number of completed steps for dyad 1, 2, and 3. In this section, specific results are explained by group.

Group 1

Dyad 3 was composed of group members Jackie and Molly. Dyad 3 had stable baseline data with 4 steps completed correctly across 5 sessions. Dyad 3 was given access to the training video after session 5 concluded. In session 6, dyad 3 completed 9 out of 10 steps correctly. The communication partner prompted "train" before the confederate picked up the picture. Dyad 3 was given feedback on which step was completed

incorrectly and given the opportunity to watch the video again. Unplanned, the helper told her communication partner what she did wrong (i.e., used verbal prompts). Though the team was given time to watch the video again, they both felt they did not need to watch the video because they self-identified the problem. In the following sessions, they performed all 10 steps correctly. Jackie watched the training video 1 time, while Molly watched the video 3 times total. Over two maintenance sessions, Dyad 3 continued performed 9 steps correctly out of 10 in the first session and 10 out of 10 in the 2nd session.

Group 2

Dyad 2 was composed of group members Emily and Nancy. Dyad 2 had stable baseline data with 4 steps completed correctly across 8 sessions. Dyad 2 was given access to the training video after session 8 concluded. In sessions 9 through 14, dyad 2 completed 10 out of 10 steps correctly. Due to the fact they completed all steps correctly in the first session during intervention, they did not need to watch the video again.

Emily watched the training video 2 times and Nancy watched the video 1 time. Over two maintenance sessions, Dyad 2 continued to perform all 10 steps correctly.

Group 3

Dyad 1 was composed of group members Julie and Tammy. Dyad 1 remained in baseline the longest and had stable baseline data with an average of about 4 steps completed correctly across 11 sessions. Dyad 1 was given access to the training video after session 11 concluded. In session 12, dyad 3 completed 9 out of 10 steps correctly.

The communication partner delayed saying the name of the toy out loud more than 2 seconds after the picture was handed to her. Dyad 1 was given feedback on which step

was completed incorrectly and given the opportunity to watch the video again. Similar to what happened in Dyad 3, the helper told the communication partner what she did wrong and what she should have done (i.e., say the name of the item immediately after receiving the picture). Though they had the opportunity to watch the video again, they expressed they knew what they did wrong and how to correct it. The following session, this dyad improved to 10 out of 10 steps completed. In further sessions, they performed all 10 steps correctly. Julie watched the training video 4 times altogether and Tammy watched the video 3 times total.

Social Validity

Following completion of the study, participants were asked to complete a questionnaire to rate the extent to which they felt the intervention was effective in training them to carry out PECS Phase 1A, as well as their thoughts on the feasibility of this training. Results showed overall positive remarks on this training procedure. The questions and average scores for each question are as follows:

1. I feel using video modeling training for PECS Phase 1A is an effective

way to learn this intervention. (Average: 4.83)

2. I feel using video modeling training for PECS Phase 1A was a convenient

way for me to learn this intervention. (Average: 5)

3. After completing the training, I feel confident I could implement the first

phase of this intervention with a child that has communication needs.

(Average: 4.83)

4. I would recommend this video modeling training of PECS Phase 1A to

others who work with or have children with communication needs.

(Average: 5)

5. Learning through this video modeling training was time consuming.

(Average: 1)

Figure 1: Steps completed for each dyad

Baseline Intervention Maintenance

Dyad 3

Dyad 2

Dyad 1

CHAPTER 4

DISCUSSION

This chapter presents answers to research questions posed, limitations of the present study, implications for practitioners, and overall conclusions.

Research Question 1: Effect of PECS Video Modeling Training

With respect to the first research question, the results indicate that video modeling

PECS Phase 1A was effective in increasing the number of steps completed correctly.

Dyads 3 increased from an average of 4 steps completed correctly in baseline to 10 steps correct during intervention. Dyad 2, likewise, increased from an average of 4 steps completed correctly to 10 steps correct during intervention. Dyad 1 had a small dip in baseline but stabilized at 4 correct steps per session. Maintenance phases for all dyads showed that they maintained the skills by completing 10 out of 10 steps correctly. Further

Analysis of YouTube's video analytics showed how many times each participant watched the video. The range of times the video was viewed was between 1 and 4 times. The results of this study support the research of following the basic principles of a brief instruction, video model, and rehearsal with verbal feedback (Miltenberger, 2004). The present study follows previous research of behavior skills training using video modeling as applied to FAs (Iwata et al, 2000) as well as to PECS training (Rosales, Stone, &

Rehfeldt, 2009). Results show continued support of BST as an effective and time

efficient method to teach non-experienced individuals a complex skill involving multiple steps.

The present study also extends previous research in behavior skills training. In particular, it investigated strategies to teach the implementation of PECS without a behavior specialist's continued presence by allowing participants to view the training video on their own time without the researcher physically watching. In addition, previous researchers suggested examining the amount of training necessary for high rates of fidelity in PECS implementation (Ganz & Simpson, 2004). The data suggest all steps in

Phase 1A of PECS can be taught through video modeling and a short amount of time while still retaining high fidelity. Lastly, researchers suggested further research of video modeling to consider the amount of information presented (such as the length of the video) while maintaining acceptable performance (Catania, Almeida, Liu-Constant, &

DiGennaro-Reed, 2009). The training video in this study has a duration of 2 minutes 11 seconds. The first part of the video shows Phase 1A being performed completely without any editing. The second part is a replication of the same performance but edited and enhanced with additional features including freeze frames of steps being performed and text explaining how the step is performed in that moment. Utilizing the video analytics of

YouTube provided additional data as well (e.g., number of times video was watched).

Research Question 2: Participants Opinions

Participants’ opinions of the training methodology were documented in a 5 question survey. Participants were asked to rate how much they agreed with a variety of statements on a scale of 1 (strongly disagree) to 5 (strongly agree). Overall, participants had positive remarks about this training procedure. The results of all the social validity

questionnaires that were returned are displayed in Figure 2. Additional comments spoke of the factor of convenience, clarity of the video, and how quickly they were able to learn the steps.

Limitations and Future Research

Despite successful outcomes of the present study, there were some limitations to consider. First, the study is lacking data to see if skills performed on the confederate would generalize to practicing with an actual student. To counteract this point, a short questionnaire was developed to probe how participants would respond given a certain scenario of student behavior. Future research should allow time for generalization conditions to be examined and data to be collected on participant performance with actual children who have communication delays.

Another limitation to the study was stopping at PECS Phase 1A. Eventually,

PECS Phase 1 is complete when no physical prompting (e.g., hand over hand, graduated guidance, etc.) is needed for the child to request an object or activity. The current study assumed the student (i.e., confederate) only had reaching for the object in his repertoire.

This was so participants would be equipped for future children who may need errorless learning at first before fading prompts. Future research may utilize a menu of responses for the confederate similar to the study conducted by Rosales, Stone, and Rehfeldt

(2009). However, this study shows that teaching the initial steps of PECS Phase 1A was effective using video modeling, and therefore warrants future video modeling trainings to be produced for fading prompts in Phase 1 as well as continue through other phases in

PECS.

An additional limitation was the lack of procedural reliability for the experimenter. While the video was the same for participants, a secondary observer was not watching to make sure the experimenter was giving the same kind of feedback and other procedures equally for all participants. Future research should be sure to include a procedural checklist for the secondary observer to follow during the experiment.

A limitation of the maintenance condition also exists. The time between the intervention phase and maintenance phase was relatively short. This makes it difficult to know if participants would maintain PECS Phase 1A training over time. Future research should investigate the results of a larger gap of time between intervention and maintenance phases. This will help increase the accuracy of how well participants maintain their training.

A limitation was also found concerning participant roles. The two participants did not switch roles during the intervention. This limits how many steps each participant actually performs and does not allow for the participants to show if they can perform the steps from the other role. Future research should create procedures that allow participants to change roles and ensure they can perform all 10 steps of PECS Phase 1A.

One final limitation to note concerns the accuracy of social validity. There may be a bias of the social validity measure due to participants working in the same center as the researcher. Participants may have engaged in more positive verbal responses to please the experimenter. Future research should attempt to objectively measure social validity by using this training procedure at a center wherein the researcher has no previous social connection or relationships. This would help improve the objectivity of center staff's verbal responses during social validity.

Implications for Practitioners

Early childhood staffs are likely to have children with special needs in their classrooms. It is important that we develop effective and time efficient ways to teach teachers, assistants, and other staff. As this study shows, behavior skills training using video modeling for PECS Phase 1A fills this need and does so in a short amount of time.

Often times it is difficult for early childhood education programs or childcare centers to set aside enough professional development time for its staff. Having videos uploaded onto a familiar format (i.e., YouTube) that can be accessed at any time on various devices

(desktop computer, smart phone, etc.) can help curb this lack of time on a professional development day.

Developmental specialists and therapists may be able to use this method of training staff in childcare settings or early childhood education programs in addition to their direct services they already provide. As described previously, asking staff members, especially two staff members in the same room, to be pulled aside to practice learning

PECS is usually too strenuous to keep teacher to student ratios within compliance. Staff members can watch the training video on their break and practice with a confederate when they are not required in the classroom. This may make the transference of implementing PECS with a child much easier.

Additionally, utilizing a platform that keeps track of how many times the training video was watched, the duration of how long those videos were watched, and when they were viewed can provide valuable information to a director or program manager. This aids in providing accountability to staff members who may need a particular behavior skills training, such as learning PECS Phase 1A. If staff members are having difficulty

completing steps during rehearsal, administration can provide feedback on what steps were missed and staff members can go back and watch the video again.

An additional implication for practitioners is getting adult schedules to align during working hours. This proved to be difficult for session recordings. It is important to keep in mind childcare centers and other institutions that have young children must maintain certain teacher to student ratios to keep in compliance with governing institutions. Therefore, it may be difficult to pull a teacher or assistant out of the classroom without disrupting these ratios, especially if there is low staffing that day.

However, with the video being uploaded to YouTube, all participants could watch the training video when they had free time. The performance sessions were the only aspect affected by time constraints amongst participants. Future practitioners should work in close collaboration with the director or program manager of the center to determine optimal times staff members could be pulled out and not interrupt daily activities of the center.

A final point to keep in mind was the difficulty in uploading "private" videos for all participants. Originally, the experimenter made the training video private for each participant but individuals voiced difficulty opening the video as they needed to create another specific account to access it. To remedy this situation, the experimenter uploaded the training video as "unlisted" instead of private. This means that the training video was uploaded 6 total times, but each video had its own unique URL address. Each participant got their own URL link so data could be collected on how many times each participant watched the video, when they watched the video, duration of watching the video, etc..

Using the "unlisted" option meant a random individual would not be able to find it on

YouTube simply by typing in the name of the video into the search bar. They would need to have the unique URL link in order to watch it. This does leave the possibility of participants sharing their link with one another. In anticipation of this problem, participants were told not to share their link. There would not be a motivation to share it since they all had their own link. It is also possible they could watch the video together, thus interfering with the accuracy of YouTube's analytics. However, participants were also asked not to watch the video together to help prevent this scenario from occurring.

Future practitioners should aim to improve video privacy by creating a Gmail account for each participant ahead of time to sign in and view the video as well as implement further measures to ensure accuracy of the YouTube analytics feature.

Conclusion

In summation, there are many children that come to early intervention services that have delays in speech. One evidence based communication method to aid in developing language is the Picture Exchange Communication System. This study shows

PECS Phase 1A can be taught to early childhood education staff members using video modeling and performing on a confederate acting as a student. Utilizing YouTube as the platform to make videos available was effective and it also gave additional analytical data to track participant activity. The participants in this study improved greatly in steps completed within a short amount of time. This teaching procedure may be applicable for directors, program managers, or therapists to help teach staff members PECS Phase 1A without a large time commitment or disrupting classroom ratios. Instead of limiting intervention time to just when a therapist is available, training caregivers how to use

PECS throughout a child's daily routines will provide more intervention time and increased opportunities for the child to communicate.

Reference List

American Speech-Language-Hearing Association (n.d.). What is AAC? Retrieved from

http://www.asha.org/public/speech/disorders/AAC/

American Speech-Language-Hearing Association (n.d.). Child speech and language:

preschool language disorders. Retrieved from

http://www.asha.org/public/speech/disorders/childsandl.htm.

Apple Ipad. (n.d.). Retrieved from https://www.apple.com/ipad/

Akmanoglu, N., & Batu, S. (2004). Teaching pointing to numerals to individuals with

autism using simultaneous prompting. Education and Training in Developmental

Disabilities, 39 (4), 326-336.

Apple, A. L., Billingsley, F., Schwartz, I. S., & Carr, E. G. (2005). Effects of video

modeling alone and with self-management on compliment-giving behaviors of

children with high-functioning ASD. Journal of Positive Behavior

Interventions, 7, 33-46.

Barton, E. E., & Wolery, M. (2010). Training teachers to promote pretend play in young

children with disabilities. Exceptional Children, 77 (1), 85-106.

Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-

modeling interventions for children and adolescents with autism spectrum

disorders. Exceptional Children, 73, 264-287.

Bondy, A., & Frost, L. (2001). The picture exchange communication system. Behavior

Modification, 25,725-744.

Bondy, A., & Peterson, S. (1990, May). The point is not to point: Picture-exchange

communication system with young students with autism. Paper presented at the

annual meeting of the Association for Behavior Analysis, Nashville, TN.

Bondy A, Tincani M, & Frost, L. (2004). Multiply controlled verbal operants: An

analysis and extension to the picture exchange communication system. The

Behavior Analyst, 27, 247-261.

Boyle, C. A., Boulet, S., Schieve, L. A., Cohen, R. A., Blumberg, S. J., Yeargin-Allsopp,

M., Visser, S., ... Kogan, M. D. (2011). Trends in the prevalence of

developmental disabilities in US children, 1997-2008. Pediatrics, 127, 6, 1034-

42.

Buckley, S. D., & Newchok, D. K. (2005). Differential impact of response effort within a

response chain on use of mands in a student with autism. Research in

Developmental Disabilities, 26, 1, 77-85.

Catania, C. N., Almeida, D., Liu-Constant, B., & DiGennaro-Reed, F. D. (2009). Video

modeling to train staff to implement discrete-trial instruction. Journal of Applied

Behavior Analysis, 42, 387–392.

Chaabane, D. B. B., Alber-Morgan, S. R., & DeBar, R. M. (2009). The effects of parent-

implement PECS training on improvisation of mands by children with autism.

Journal of Applied Behavior Analysis, 42(3), 671–677.

Charlop, M. H., & Milstein, J. P. (1989). Teaching autistic children conversational speech

using video modeling. Journal of Applied Behavior Analysis, 22, 3, 275-285.

Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002).

Using the picture exchange communication system (PECS) with children with

autism: assessment of PECS acquisition, speech, social-communicative behavior,

and problem behavior. Journal of Applied Behavior Analysis, 35(3), 213–231.

Charlop-Christy, M. H., Le, L., & Freeman, K. A. (2000). A comparison of video

modeling with in vivo modeling for teaching children with autism. Journal of

Autism and Developmental Disorders, 30, 6, 537-552.

Dauphin, M., Kinney, E. M., Stromer, R., & Koegel, R. L. (2004). Using video-enhanced

activity schedules and matrix training to teach sociodramatic play to a child with

autism. Journal of Positive Behavior Interventions, 6, 238-250.

DeDino, N. (2017). Early Intervention Program Updates, #1715. Retrieved from

http://ohioearlyintervention.org/up_doc/EI-Program-Updates-1715.pdf

Delano, M. E. (2007). Video modeling interventions for individuals with

autism. Remedial and Special Education, 28 (1), 33-42.

DiGennaro-Reed, F. D., Codding, R., Catania, C. N., & Maguire, H. (2010). Effects of

video modeling on treatment integrity of behavioral interventions. Journal of

Applied Behavior Analysis, 43, 291-295.

Fetherston, A. M., & Sturmey, P. (2014). The effects of behavioral skills training on

instructor and learner behavior across responses and skill sets. Research in

Developmental Disabilities, 35, 541-562.

Frost, L. A., & Bondy, A. S., (1994). The picture exchange communication system

training manual. Cherry Hill, NJ.: PECS, Inc.

Ganz, J. B., & Simpson, R. L. (2004). Effects on communicative requesting and speech

development of the picture exchange communication system in children with

characteristics of autism. Journal of Autism and Developmental Disorders, 34,

395-409.

Ganz, J. B., Earles-Vollrath, T. L., & Cook, K. E. (2011). Video modeling. Teaching

Exceptional Children, 43, 8-19.

Gena, A., Couloura, S., & Kymissis, E. (2005). Modifying the affective behavior of

preschoolers with autism using in-vivo or video modeling and reinforcement

Contingencies. Journal of Autism and Developmental Disorders, 35, 545-556.

Haring, T. G., Kennedy, C. H., Adams, M. J., & Pitts-Conway, V. (1987). Teaching

generalization of purchasing skills across community settings to autistic youth

using videotape modeling. Journal of Applied Behavior Analysis, 20, 89-96.

Hogan, A., Knez, N., & Kahng, S. (2015). Evaluating the use of behavioral skills training

to improve school staffs’ implementation of behavior intervention plans. Journal

of Behavioral Education, 24, 242-254.

Homlitas, C., Rosales, R. & Candel, L. (2014). A further evaluation of behavioral skills

training for implementation of the Picture Exchange Communication System.

Journal of Applied Behavior Analysis, 47, 198-203.

Indi with Snap + Core First. (n.d.). Retrieved from https://www.tobiidynavox.com/en-

US/devices/Multi-Access-Devices/indi/

Ingvarsson, E. T., & Hollobaugh, T. (2011). A comparison of prompting tactics to

establish intraverbals in children with autism. Journal of Applied Behavior

Analysis, 44(3), 659-664.

Iwata, B. A., Wallace, M. D., Kahng, S. W., Lindberg, J. S., Roscoe, E. M., Conners, J.,

… Worsdell, A. S. (2000). Skill acquisition in the implementation of functional

analysis methodology. Journal of Applied Behavior Analysis, 33(2), 181–194.

Keen, D., Brannigan, K. L., & Cuskelly, M. (2007). Toilet training for children with

autism: The effects of video modeling. Journal of Developmental and Physical

Disabilities, 19, 291-303.

Kuhn, M., & Marvin, C. A. (January 01, 2016). ``Dosage'' decisions for early

intervention services. Young Exceptional Children, 19, 20-34.

Lavie, T., & Sturmey, P. (2002). Training staff to conduct a paired-stimulus preference

assessment. Journal of Applied Behavior Analysis, 35(2), 209–211.

Lerman, D. C., Tetreault, A., Hovanetz, A., Strobel, M., & Garro, J. (2008). Further

evaluation of a brief, intensive teacher-training model. Journal of Applied

Behavior Analysis, 41, 243-248.

Libby, M. E., Weiss, J. S., Bancroft, S., & Ahearn, W. H. (2008). A comparison of most-

to-least and least-to-most prompting on the acquisition of solitary play skills.

Behavioral Analysis in Practice, 1, 37-43.

Luscre, D. M., & Center, D. B. (1996). Procedures for reducing dental fear in

children with autism. Journal of Autism and Developmental Disorders, 26,

547-556.

MacDonald, R., Clark, M., Garrigan, E., & Vangala, M. (2005). Using video modeling to

teach pretend play to children with autism. Behavioral Interventions, 20, 4, 225-

238.

Maggio, V., ra ana, N. E., Richaudeau, A., Torres, S., Giannotti, A., & Suburo, A. M.

(2014). Behavior problems in children with specific language impairment.

Journal of Child Neurology, 29, 2, 194-202.

Maione, L., & Mirenda, P. (2006). Effects of video modeling and video feedback on

peer-directed social language skills of a child with autism. Journal of Positive

Behavior Interventions, 8, 106-118.

Marckel, J. M., Neef, N. A., & Ferreri, S. J. (2006). A preliminary analysis of teaching

improvisation with the Picture Exchange Communication System to children

with autism. Journal of Applied Behavior Analysis, 39(1), 109–115.

Meadan, H., Ostrosky, M. M., Santos, R. M., & Snodgrass, M. R. (2013). How can I

help? Prompting procedures to support children's learning. Young Exceptional

Children, 16, 31-39.

Miles, N. I., & Wilder, D. A. (2009). The effects of behavioral skills training on caregiver

implementation of guided compliance. Journal of Applied Behavior Analysis, 42,

405-410.

Miltenberger, R. (2004). Behaviour modification: Principles and procedures (3rd ed.)

Belmont, CA. Wadsworth Publishing.

Moore, J. W., & Fisher, W. W. (2007). The effects of videotape modeling on staff

acquisition of functional analysis methodology. Journal of Applied Behavior

Analysis, 40, 197–202.

Mostert, M. P. (August 01, 2012). Facilitated communication: The empirical imperative

to prevent further professional malpractice. Evidence-based Communication

Assessment and Intervention, 6, 18-27.

Mueller, M. M., Piazza, C. C., Moore, J. W., Kelley, M. E., Bethke, S. A., Pruett, A. E.,

Oberdorff, A. J., ... Layer, S. A. (2004). Training parents to implement pediatric

feeding protocols. Journal of Applied Behavior Analysis, 36, 545-562.

National Professional Development Center (n.d.). What criteria determine if an

intervention was effective? Retrieved from http://autismpdc.fpg.unc.edu/what-

criteria-determined-if-intervention-was-effective

National Scientific Council on the Developing Child (2007). The science of early

childhood development. Retrieved from: http://developingchild.harvard.edu/wp-

content/uploads/2015/05/Science_Early_Childhood_Development.pdf

Neitzel, J., & Wolery, M. (2009). Overview of prompting. Chapel Hill, NC: The National

Professional Development Center on Autism Spectrum Disorders, Frank Porter

Graham Child Development Institute, The University of North Carolina.

Nigro-Bruzzi, D., & Sturmey, P. (2011). The effects of behavioral skills training on mand

training by staff and unprompted vocal mands by children. Journal of Applied

Behavior Analysis, 43, 757-761.

Nikopoulos, C. K., & Keenan, M. (2003). Promoting social initiation in children with

autism using video modeling. Behavioral Interventions, 18, 87-108.

Nikopoulos, C., & Keenan, M. (January 01, 2007). Using video modeling to teach

complex social sequences to children with autism. Journal of Autism and

Developmental Disorders, 37, 4, 678-693

Ohio Department of Developmental Disabilities (2017). Ohio 2017 Child Count and

Settings Data. Retrieved from http://ohioearlyintervention.org/up_doc/2017-

Child-Count-and-Settings-Data.pdf

Ohio Early Intervention (2016). Ohio Early Intervention Individualized Family Service

Plan Guidance. Retrieved from http://ohioearlyintervention.org/up_doc/OH-EI-

IFSP-Guidance-Document-050616.pdf

Paden, A. R., Kodak, T., Fisher, W. W., Gawley-Bullington, E. M., & Bouxsein, K. J.

(2012). Teaching children with autism to engage in peer-directed mands using a

picture exchange communication system. Journal of Applied Behavior Analysis,

45(2), 425–429.

Park, J. H., Alber-Morgan, S. R., & Cannella-Malone, H. (May 01, 2011). Effects of

mother-implemented picture exchange communication system (PECS) training

on independent communicative behaviors of young children with autism

spectrum disorders. Topics in Early Childhood Special Education, 31, 1, 37-47.

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2012). Evidence-based staff training: A

guide for practitioners. Behavior Analysis in Practice, 5(2), 2–11.

PECS Research (n.d.). Retrieved from http://www.pecsusa.com/research.php

Petscher, E. S., & Bailey, J. S. (September 06, 2006). Effects of training, prompting, and

self-monitoring on staff behavior in a classroom for students with disabilities.

Journal of Applied Behavior Analysis, 39, 2, 215-226.

Proloquo2Go. (n.d.). Retrieved from http://www.assistiveware.com/product/proloquo2go

Rosales, R., Stone, K., & Rehfeldt, R. A. (2009). The effects of behavioral skills training

on implementation of the picture exchange communication system.. Journal of

Applied Behavior Analysis, 42(3), 541–549.

Sarokoff, R. A., & Sturmey, P. (2004). The effects of behavioral skills training on staff

implementation of discrete-trial teaching. Journal of Applied Behavior Analysis,

37(4), 535–538. http://doi.org.proxy.lib.ohio-state.edu/10.1901/jaba.2004.37-535

Sherer, M., Pierce, K. L., Paredes, S., Kisacky, K. L., Ingersoll, B., & Schreibman, L.

(January 01, 2001). Enhancing conversation skills in children with autism via

video technology. Which is better, "self" or "other" as a model? Behavior

Modification, 25, 1, 140-58.

Simms MD, Schum RL. (2011) Language development and communication disorders. In:

Kliegman RM, Stanton BF, St. Geme JW, III, et al, eds. Nelson Textbook of

Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; chap 32.

Skinner, B.F., (1957). Verbal Behavior. East Norwalk, CT. Appleton-Century-Crofts

Steege, M. W., Mace, F. C., Perry, L., & Longenecker, H. (2007). Applied behavior

analysis: Beyond discrete trial teaching. Psychology In The Schools, 44(1), 91-99.

Steward, K.K., Carr, J.E., & LeBlanc, L.A. (2007). Evaluation of family-implemented

behavioural skills training for teaching social skills to a child with asperger’s

disorder. Clinical Case Studies, 6, 252-262.

Taylor, B. A., & Hoch, H. (2008). Teaching children with autism to respond to and

initiate bids for joint attention. Journal of Applied Behavior Analysis, 41(3), 377-

391.

U.S. Department of Education (2016). 38th Annual Report To Congress on the

Implementation of the Individuals with Disabilities Education Act. Retrieved from

https://www2.ed.gov/about/reports/annual/osep/2016/parts-b-c/38th-arc-for-

idea.pdf

Vladescu, J. C., Carroll, R., Paden, A., & Kodak, T. M. (January 01, 2012). The effects of

video modeling with voiceover instruction on accurate implementation of

discrete-trial instruction. Journal of Applied Behavior Analysis, 45, 2, 419-23.

Wankoff, L. S. (2011). Warning signs in the development of speech, language, and

communication: When to refer to a speech language pathologist. Journal of

Child and Adolescent Psychiatric Nursing, 24(3), 175-184.

Wong, C., Odom, S. L., Hume, K. Cox, A. W., Fettig, A., Kucharczyk, S., ... Schultz, T.

R. (2014). Evidence-based practices for children, youth, and young adults with

autism spectrum disorder. Chapel Hill: The University of North Carolina, Frank

Porter Graham Child Development Institute, Autism Evidence-Based Practice

Review Group.

Appendix A: Social Validity Questionnaire

Research Questionnaire

Date:______

Thank you for participating in this research. If you would like, please answer the following questions regarding the PECS Phase 1A training with video modeling. For the following statements, please use the rating scale provided. You may skip any questions you do not wish to answer. In this scale, 1 is strongly disagree, 3 is neutral, and 5 is strongly agree.

1. I feel using video modeling training for PECS Phase 1A is an effective way to learn this intervention.

1 2 3 4 5

2. I feel using video modeling training for PECS Phase 1A was a convenient way for me to learn this intervention.

1 2 3 4 5

3. After completing the training, I feel confident I could implement the first phase of this intervention with a child that has communication needs.

1 2 3 4 5

4. I would recommend this video modeling training of PECS Phase 1A to others who work with or have children with communication needs.

1 2 3 4 5

5. Learning through this video modeling training was time consuming.

1 2 3 4 5

Feel free to add any additional comments you may have below and/or on the back of this page:

Appendix B: Data Collection Sheet

Dyad: ______Session:______Date:______

Picture Exchange Communication System Phase 1 Checklist

Implementation Step Step Completed?

1. Arrange the training environment by providing one picture of a preferred item on a Velcro strip in front of the student.

2. Position the communication partner in front of the student.

3. Display the preferred item in view of the student, providing no verbal prompts.

4. The communication partner interacts with the item (e.g., eating food, playing with toy).

5. As student reaches toward the item, helper places her hand on the students hand and re-directs the student’s hand to be placed on the picture. (no verbal prompts)

6. Helper’s hand is used overtop students hand to pick up the picture.

7. As student picks up the picture, communication partner opens one hand in front of the student.

8. The Helper assists the student in placing it in the open hand of the communication partner.

9. The communication partner takes the picture and says the item name out loud. (within 2 seconds)

10. The communication partner immediately gives the item to the student. (within 2 seconds)

+ = Independent --- = not completed/incorrect Communication Partner: Para-professional sitting in front of student Helper: Para-professional sitting behind the student

Appendix C: Scenario Questionnaire

Scenarios for Children in PECS Phase 1A

Dyad #:______

In this experiment, we assumed that the child with whom you were working (the actor) only responded by reaching for the desired item. This questionnaire is a short probe to see how you and your partner would respond given different behaviors. Briefly describe what the team working with the child should do given each scenario.

1. The child reaches for the picture and just lays his or her hand on it.

2. The child picks up the picture but just plays with it.

3. The child does not reach for the item you have presented.