1. Effects of Video Modeling, Prompting, and Reinforcement Strategies on Increasing A Generalized Repertoire of Prosocial Behavior in Children with Autism Sharon A. Reeve, Ph.D., BCBA Oct. 14, 2003 Presentation at Queens College

2. Importance of a Definition Researchers have been inconsistent in defining prosocial behavior We need to identify antecedent and consequential stimuli to effectively define prosocial behavior We can then treat it as a type of operant behavior and subsequently teach it (Novak, 1996)

3. Broad Definition of Prosocial Behavior Any act intending to benefit another such as responses associated with helping, cooperating, sharing, care giving, taking turns, friendliness, affection, empathy, and/or sympathy – Distinction among categories is ambiguous Observed in children of typical development as early as 1 ½ to 3 years of age – Children have been observed offering to help another person who is injured by offering a toy or trying to comfort. (Eisenberg & Fabes, 1998)

4. Prosocial Behavior is Learned Prosocial behavior is primarily learned by imitation of children of typical development – In contrast children with autism are unlikely to imitate one engaging in prosocial behavior Children of typical development are more likely to initiate prosocial behavior than children with autism. – Equally to children with disabilities and children of typical development Children with autism were still unlikely to imitate the prosocial behavior. (Honig & McCarron, 1988)

5. Importance of Prosocial Behavior in Children Increased perception of social competence (Eisenberg, Fabes, Karbon, Mur­phy, Wosinski, Polazzi, Carlo, & Juhnke, 1996; Peterson, Ridley- Johnson, & Carter, 1984). Increased frequency in engagement in positive social interactions with peers (Farver & Branstetter, 1994; Howes & Farver, 1987). Increased likelihood of having many close friends and a best friend (Farver & Branstetter, 1994; Coie, Dodge, & Kupersmidt, 1990).

6. Negative Outcomes of Prosocial Behavior Deficit in Children with Autism Can be a source of frustration and distress to those who interact with a person with autism (Harris, Handleman, & Alessandri, 1990). Parents, peers, and teachers may be discouraged from attempting to interact with the children (Lovaas, Koegel, Simmons, & Long 1973). Further reduces the opportunities for learning (Lovaas, Koegel, Simmons, & Long, 1973).

7. Negative Outcomes of Prosocial Behavior Deficit in Children with Autism Unlikely to have friends or sustained interactions with peers (Sigman, 1998) Perceived as less socially competent, whether valid or based on biased expectations (Center & Wascom, 1986)

8. Theories for Deficits in Prosocial Behavior Lack “theory-of-mind” (Baron-Cohen et al., 1985) Early deficit in imitation (Rogers & Pennington, 1991) Result of an interaction between deficient innate structures that play a role in processing of emotional input and a lack of social experience (Bemporad et al., 1987)

9. Theories for Deficits in Prosocial Behavior Various cognitive deficits (Gillberg, 1992) Failure to discriminate and respond to social cues in environment (Morrison & Bellack, 1981)

10. Increasing Prosocial Behavior in Children with Autism Under Specific Training Conditions (No Generalization Measures) Kohler, Strain, Hoyson, Davis, Donina, & Rapp (1995) – a comprehensive intervention increased prosocial behavior between children with autism and their peers

11. Increasing Prosocial Behavior in Children with Autism Under Specific Training Conditions (No Generalization Measures) Kamps, Leonard, Vernon, Dugan, Delquadri, Gershon, Wade, & Folk (1992) – social skills training for students with autism conducted concurrently with non-handicapped peers was an effective procedure for increasing: frequency of social interactions amount of time engaged in prosocial behavior duration of each social interaction in children with autism

12. Increasing Prosocial Behavior in Children with Autism Under Specific Training Conditions (With Generalization Measures) Strain, Kerr, & Ragland (1979) – indicated that both intervention techniques increased each child with autism’s prosocial behavior – Neither technique, however, produced increase in prosocial behavior during generalization sessions Charlop & Walsh (1986) – time-delay procedure was effective in teaching children with autism to respond with “I love (like) you” in response to a hug – target behavior generalized across settings for all children, but across persons and settings for only one child

13. Increasing Prosocial Behavior in Children with Autism Under Specific Training Conditions (With Generalization Measures) Harris, Handleman, & Alessandri (1990) – Taught to offer assistance to a person who expressed an inability to complete a task – adolescents given instructions as to how to help – all three adolescents showed an increase in their offers of assistance as training progressed – generalization occurred across settings, people, and situations during only a limited number of trials

14. Strategies that Increase Generalization Teaching multiple exemplars of target behavior using common stimuli (Balsam, 1988; Stokes & Baer, 1977) Teaching generalized imitative repertoire (Harris et al., 1990; Poulson & Kymissis, 1988). Use of video modeling (Charlop, Schreibman, & Tyron, 1983; Haring, Kennedy, Adams, & Pitts- Conway, 1987)

15. Purpose of Present Study To determine extent to which children with autism can learn to engage in both verbal and motor prosocial responses commonly labeled as helping “Helping” was selected as prosocial response because it results in longer interactions than other prosocial responses To determine extent to which helping responses generalized from training to novel situations in which there was an opportunity to engage in helping behavior

16. Method Participants Four children with autism (Irene, Tom, Eddie, and Nathan) who attended classes at Institute for Educational Achievement (IEA) They ranged in age from 5-6 years

17. Method Setting Most experimental sessions took place in small classroom at IEA Approximately once every two weeks, sessions were conducted in staff room at IEA To assess occurrence of helping responses in a new setting, pre- and post-intervention measures were taken in children’s regular school classrooms at IEA

18. Definition of “Helping” Helping: a child with autism engaging in a problem-solving activity with an adult. For each problem-solving activity, three different stimulus components were used to signal to the child that a specific helping response should be emitted: – non-verbal – verbal – affective discriminative stimuli

19. Eight Possible Experimenter- Defined Categories of Helping Cleaning Replacing Broken Materials Picking up Objects Sorting materials Locating Objects Carrying Objects Putting Items Away Setting Up an Activity

20. Category Structure Response Category General Description Nonverbal S D Verbal & Affective S D Verbal Response (dependent measure) Motor Response (dependent measure) Cleaning adult wipes messy surfaces 1. Wiping a black board 2. Wiping a wipe-off board 3. Wiping a desk 4. Wiping a chair 5. Wiping a table (trained- category probe) 1. “Oh, time to clean the black board.”while shaking head 2. “Boy, how did this get messy?” wrinkling brow 3. “Oops, I have to clean this desk.” while rolling eyes 4. “Uh oh, what a dirty chair.” while signing 5. “Wow, this table is messy.” while eyes wide “May I help?” 1. Wiping a black board 2. Wiping a wipe off board 3. Wiping a desk 4. Wiping a chair 5. Wiping a table

21. Criterion that Defined a Mastery Level of Performance Correct combined verbal and motor helping response on at least 94% (15/16) of the total number of training trials for four consecutive sessions.

22. Categories for Each Child Irene Tom EddieNathan Trained Categories Locating Carrying Putting Away Setting Up Cleaning Replacing Picking Up Sorting Putting Away Setting Up Cleaning Replacing Picking Up Sorting Locating Carrying Non- trained Categories (Probes) Cleaning Replacing Locating Carrying Picking Up Sorting Putting Away Setting Up

23. Assignment of Trials (for Tom) CategoryNon-Verbal Stimuli for Training Trials Within Category Probe Trials CleaningWiping: 1. backboard 2. wipe-off 3. Desk 4. Chair Wiping: 1. Table Replacing Broken Materials Replacing broken or torn 5. Paintbrushes 6. Forks 7. Pencils 8. Crayons Replacing: 2. Paper Picking up Objects Picking up: 9. Paper clips 10. Money 11. LM 12. Pict cards Picking up 3 Comp Disks Sorting MaterialsSorting: 13. Scissors/glue 14. markers 15. sticks 16. Utensils Sorting 4. paper/brush Across-Category Probe Trials Locate ObjectsLocating 5. Puzzle piece Carry ObjectsCarrying 6. See & says

24. Baseline & Treatment Trials Baseline –Both training and probe trials presented –Neither trial type associated with treatment or reinforcement –Token reinforcement and verbal praise provided only for on-task behavior Treatment – Both training and probe trials presented – Training trials associated with treatment – Probe trials not associated with treatment

25. Teaching Procedure Presentation of Live Discriminative Stimuli (non-verbal & verbal)  Incorrect Verbal and/or Motor Response by child  Presentation of Video Model  Re-presentation of Live Discriminative Stimuli  Incorrect Verbal and/or Motor Response by child  Presentation of Motor and/or Verbal Prompts  Re-presentation of Live Discriminative Stimuli  Correct Verbal and Motor Responses by child  Reinforcement (token + praise)

26. Non-Helping Verbal and Non- Verbal Discriminative Stimuli Non-VerbalVerbal Holding a Mr. Potato HeadOh, what a cool potato head! Holding up a markerBoy, isn’t this a great marker? Holding up a toy trainWow, don’t you love this train? Holding up scissorsWow, these are neat scissors? Holding up potato chipsOh, I love potato chips! Holding up a bookHey, this is a great book! Holding up an etch-a sketchBoy, this is a tine etch-a-sketch! Holding up an oreoHey, don’t you love oreos? Holding up a puzzleOh, this is a cool puzzle! Holding up a toy carWow, check out this cool toy!

27. Additional Strategies Used to Promote Generalization Treatment sessions were conducted once every eight sessions in the staff room (not the typical experimental session room) Treatment sessions were conducted once every 10 sessions by a secondary experimenter (not the primary experimenter)

28. Pre- and Post-Intervention Measures For each child, three pre-intervention sessions were conducted before treatment was introduced. Three post-intervention sessions were conducted after all participants had achieved mastery criterion

29. Counterbalanced Assignment of Additional Categories TomNathanIreneEddie Trained Categories Cleaning Replacing Picking Sorting Picking Sorting Locating Carrying Locating Carrying Putting away Setting up Putting away Setting up Cleaning Replacing Non- Trained Categories (Probes) Locating Carrying Putting away Setting up Cleaning Replacing Picking Sorting Novel Categories (Pre/Post Tests) Putting away Setting up Cleaning Replacing Picking Sorting Locating Carrying

30. Pre- and Post-Intervention Measures Measures 1-3 – Combination of novel trials, probe trials, and training trial types – Conducted in the child’s regular school classroom with their regular school instructor. Measures 4-6 – Combination of novel trials, probe trials, and training trial types – Conducted in the child’s regular school classroom by the primary experimenter Measure 7 – Used trials from the two novel categories – Conducted in the experimental setting by the primary experimenter

31. Social Validity Measures Measure 1 – Used to assess increase in each child’s prosocial behavior from baseline to treatment. – Undergraduate raters were asked: “In which of the two video-taped episodes (the first or the second) did the child appear to engage in more prosocial behavior?” Measure 2 – Used to assess whether the prosocial behavior emitted by the children in this study was similar to the behavior emitted by their age-matched peers. – Undergraduate raters were asked: “Was appropriate prosocial behavior used by this child?”

32. Interobserver Agreement Obtained for the percentage of trials that contained a correct or incorrect helping response for each child. Obtained for the frequency of occasions in which each child emitted a helping response during non- helping episodes. Obtained for the accuracy of presentation of the nonverbal, verbal, and affective discriminative stimuli for all trial types across all experimental conditions and children.

34. Percentage of Trials in Which Video Presentation Occasioned a Correct Helping Response on Subsequent Presentation of the Discriminative Stimuli Treatment Session 12345678910 Irene4650-100 -- Tom678033750- 50-100 Eddie401000 - --- Nathan67758310050----100 Note: dashes indicate a child emitted no errors during that session

35. Total Number of Occasions in Which Each Child Engaged in a Non-Contextual Helping Response Baseline Sessions 1-5 Treatment Sessions 1-5 Treatment Sessions 6-10 Irene080 Tom091 Eddie090 Nathan0122

36. Mean Percentage of Correct Helping Responses Collapsed Across All Seven Post- Intervention Measures 123 Irene100.0 Tom94.797.494.7 Eddie97.4 Nathan97.494.7

37. Number of Sessions Required to Achieve a Mastery Level of Performance During Untrained-category Probe Trials and Trained-Category Probe Trials ChildTrained- category Probes Untrained- category Probe Irene74 Tom69 Eddie95 Nathan94 Mean7.75.5

38. Results of Social Validity Measures Measure 1 – indicated that the children with autism’s responses in treatment episodes were more helpful than those in baseline episodes Measure 2 – indicated no difference between prosocial behavior of the children with autism and age- matched peers of typical development

39. Conclusions Results of present study suggest that social programs for children with autism should include training in prosocial behavior Systematic application of video modeling, prompting, and reinforcement taught children to use both motor and verbal helping responses in training and novel situations

40. Conclusions Children demonstrated a generalized repertoire of helping behavior as evidenced by emitting appropriate helping behavior in presence of novel verbal and nonverbal discriminative stimuli drawn from novel categories of helping

41. Benefits When a Child with Autism Engages in Prosocial Behavior Children who engage in prosocial behavior tend to be viewed by adults as more socially competent (Eisenberg et al., 1996; Peterson, Ridley-Johnson, & Carter, 1984). An adult may be more likely to interact with the child with autism who engages in prosocial behavior (Charlop & Walsh, 1986; Harris et al., 1990).

42. Benefits When a Child with Autism Engages in Prosocial Behavior Increased social interactions provided for child with autism may result in additional access to social reinforcement (Lovaas et al., 1973; Lovaas, 1981) Engagement in prosocial behavior may lessen deficits in social behavior prevalent in diagnosis of autism (Wing, 1988)

43. Future Areas of Research Define most efficient way to teach a generalized repertoire of helping behavior Use more natural teaching paradigms, such as incidental teaching (Hart & Risley, 1975), to further facilitate generalization of prosocial behavior from training to novel situations Identify minimum levels of prerequisite skills that children with autism need to emit before they are able to consistently engage in prosocial behavior

44. Future Areas of Research Determine whether early intervention efforts for children with autism that include prosocial behavior training with peers would produce a generalized imitative repertoire of prosocial behavior Should include follow-up training and maintenance of newly acquired prosocial behavior emitted by children with autism

45. Social Skills: ProSocial Behavior Examples of skill acquisition programs – Helping – Perspective taking

46. “Helping” Skill Domain: Social & Peer Interaction Skills Category: ProSocial Behavior Operational Definition: – Within 5 seconds of the discriminative stimuli (S D ) Johnny says “Can I help”AND engages in a problem- solving activity with another person. Examples of problem-solving activities are further defined as teaching sets. – Data are collected minimally weekly and are summarized as percentage of opportunities in which Johnny effectively engaged in a helping response – During data collection, no prompts are used.

47. “Helping” Teaching Sets with Specific response definitions – Cleaning The child places a cloth in contact with a surface and engages in either back-and-forth or circular arm movements until the adult stops making that same motion. – Replacing Broken Materials – Picking up Objects – Sorting materials – Locating Objects – Carrying Objects – Putting Items Away – Setting Up an Activity

48. “Helping” Discriminative Stimulus: – Non-verbal: various motor movements depending on the set – Verbal: exclamation – Affective: facial expression Criterion for Advancement: – Engaging in helping on at least 90% of the opportunities for two consecutive sessions.

49. “Helping” Response Category General Description Nonverbal S D Verbal & Affective S D Verbal Response (dependent measure) MotorResponse Cleaning adult wipes messy surfaces 1. Wiping a black board 2. Wiping a wipe-off board 3. Wiping a desk 4. Wiping a chair 5. Wiping a table (trained- category probe) 1. “Oh, time to clean the black board.”while shaking head 2. “Boy, how did this get messy?” wrinkling brow 2. “Boy, how did this get messy?” wrinkling brow 3. “Oops, I have to clean this desk.” while rolling eyes 4. “Uh oh, what a dirty chair.” while signing 4. “Uh oh, what a dirty chair.” while signing 5. “Wow, this table is messy.” while eyes wide 5. “Wow, this table is messy.” while eyes wide “Can I help?” “Want some help?” “How about some help?” “How about some help?” 1. Wiping a black board 2. Wiping a wipe off board 3. Wiping a desk 4. Wiping a chair 5. Wiping a table

50. “Helping”: Teaching Procedure Presentation of Live Discriminative Stimuli (non-verbal, verbal affective)  Incorrect Verbal and/or Motor Response by child  Presentation of Video Model  Re-presentation of Live Discriminative Stimuli  Incorrect Verbal and/or Motor Response by child  Presentation of Motor and/or Verbal Prompts  Re-presentation of Live Discriminative Stimuli  Correct Verbal and Motor Responses by child  Reinforcement (token + praise)

51. “Helping” Generalization: – Generalization of helping across stimuli is programmed by teaching multiple exemplars of helping scenarios within a category (e.g., cleaning multiple surfaces) and across category (e.g., cleaning, picking up, carrying). – Generalization across stimuli is assessed by probing Johnny’s helping skills in the presence of within and across category exemplars not associated with teaching. – Generalization across instructors and settings is programmed by conducting teaching across multiple instructors and settings and is assessed in novel settings and with novel instructors.

52. “Helping” Maintenance: – Johnny’s helping responses will be maintained throughout his day as various opportunities to help occur in the natural environment. Inter-Observer Agreement: – Inter-observer agreement data are collected monthly and calculated by using the formula: Number of Agreements X 100 = IOA Number of Agreements + Disagreements

53. “Perspective Taking” Skill Domain: Social & Peer Interaction Skills Category: ProSocial Behavior Operational Definition: – Observing the behavior of another person and responding according to the private thoughts the person might experience in that situation (e.g., saying “that’s too bad” upon seeing a person break a toy) – Within 5 seconds of the discriminative stimuli (S D ) Johnny says a contextually relevant statement AND emits an appropriate motor response. Examples of statements are further defined as teaching sets. – Data are collected minimally weekly and are summarized as percentage of opportunities in which Johnny effectively engaged in perspective taking – During data collection, no prompts are used.

54. “Perspective Taking” Teaching Sets with Specific response definitions 1. excitement 2. pain 3. frustration

55. “Perspective Taking” Discriminative Stimulus: – Non-verbal: various motor movements depending on the set – Verbal: exclamation Criterion for Advancement: – Engaging in helping on at least 90% of the opportunities for two consecutive sessions.

56. “Perspective Taking Response Category Nonverbal SD Verbal SD Verbal Response Motor Response Excitement Showing cool toy Completing model Holding up mateirals “look at this” “I did it” “I found it” “can I see?” “Let me see” “Show me” Hand on chest Pain Bumping arm on chair Sitting down Waving hand “ouch” “I don’t feel good” “oh, ah” “Are you ok?” “Are you alright” “It’s ok” Pat arm Frustration Holding up broken lego model Trying to put shape in sorter Trying to remove lid from box “I broke it” “I can’t do it” “It’s stuck” “I can help” “let me try” “Want some help” Hold out hand

57. “Perspective Taking”: Teaching Procedure Presentation of Discriminative Stimuli (non-verbal & verbal )  Incorrect Verbal and/or Motor Response by child  Presentation of Audio and Manual Prompts  Re-presentation of Live Discriminative Stimuli  Correct Verbal and Motor Responses by child  Reinforcement (token + praise)

58. “Perspective Taking Generalization: – Generalization of perspective taking across stimuli is programmed by teaching multiple exemplars of perspective taking scenarios within a category (e.g., different ways to show excitement) and across category (e.g., excitement, sadness) – Generalization across stimuli is assessed by probing Johnny’s perspective taking skills in the presence of within and across category exemplars not associated with teaching. – Generalization across instructors and settings is programmed by conducting teaching across multiple instructors and settings and is assessed in novel settings and with novel instructors.

59. “Perspective Taking” Maintenance: – Johnny’s perspective taking will be maintained throughout his day as various opportunities occur in the natural environment. Inter-Observer Agreement: – Inter-observer agreement data are collected monthly and calculated by using the formula: Number of Agreements X 100 = IOA Number of Agreements + Disagreements