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JOURNAL OF APPLIED BEHAVIOR ANALYSIS AN EVALUATION OF TWO METHODS FOR INCREASING SELF-INITIATED VERBALIZATIONS IN AUTISTIC CHILDREN JOHNNY L. MATSON, JAY A. SEVIN, MARGARET L. Box, AND KELLEY L. FRANas LOUISIANA STATE UNIVERSITY AND BART M. SEVIN AUBURN UNIVERSITY Three children with autism and mental retardation were treated for deficits in self-initiated speech. A novel treatment package employing visual cue fading was compared with a graduated time-delay procedure previously shown to be effective for increasing self-initiated language. Both treatments induded training multiple self-initiated verbalizations using multiple therapists and settings. Both treatments were effective, with no differences in measures of acquisition of target phrases, main- tenance of behavioral gains, acquisition with additional therapists and settings, and social validity. DESCRIPTORS: autism, language, time delay Communication training has been an important focus in treating children with autism for many years (Matson, 1989). However, one important aspect of language, spontaneous or self-initiated speech, has received little emphasis in the literature. Charlop, Schreibman, and Thibodeau (1985) de- fined self-initiated verbalizations as verbal responses to nonverbal discriminative stimuli in the absence of verbal discriminative stimuli. (In contrast to the definition of verbal stimuli given by Skinner, 1957, this study does not include printed words as verbal stimuli.) Given that much of normal daily com- munication is not verbally prompted, teaching chil- dren to initiate language is an important goal. There have been a limited number of studies on increasing self-initiated speech in autistic children (e.g., Charlop et al., 1985; Charlop & Walsh, 1986; Ingenmey & Van Houten, 1991; Matson, Sevin, Fridley, & Love, 1990). These studies used a treatment package consisting of modeling, pos- itive reinforcement, and graduated time delay. Graduated time delay is a stimulus-shaping pro- Address correspondence and reprint requests to Johnny L. Matson, 236 Audubon Hall, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803- 5501. cedure in which a verbal model is first paired with and later faded from a nonverbal discriminative stimulus, while also fading reliance on verbal prompts. In previous studies using time delay, self- initiated target phrases increased in all participants. Generalization to additional stimuli, settings, and persons occurred. Also, two studies demonstrated maintenance of acquired gains several months later (Ingenmey & Van Houten, 1991; Matson et al., 1990). Given the importance of self-initiated speech, the development of additional strategies for treating this aspect of language may be useful. Studying alternative procedures may increase our understand- ing of the variables associated with the acquisition of self-initiated speech. Therefore, we examined a treatment package consisting of modeling, multiple exemplars and reinforcers, and a visual-cue/stim- ulus-fading procedure for increasing self-initiated verbalizations. In addition, we compared this al- ternative strategy to time delay, the only successful treatment to date. We compared the effects of the two procedures on acquisition of target responses. We also induded maintenance, generalization to other therapists and settings, and treatment ac- ceptability (social validity). 389 1993,269,389-398 NUMBER 3 (FALL 1993)

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Page 1: An evaluation of two methods for increasing self initiated verbalizations in autistic children-matson

JOURNAL OF APPLIED BEHAVIOR ANALYSIS

AN EVALUATION OF TWO METHODS FOR INCREASINGSELF-INITIATED VERBALIZATIONS IN

AUTISTIC CHILDREN

JOHNNY L. MATSON, JAY A. SEVIN,MARGARET L. Box, AND KELLEY L. FRANas

LOUISIANA STATE UNIVERSITY

AND

BART M. SEVINAUBURN UNIVERSITY

Three children with autism and mental retardation were treated for deficits in self-initiated speech.A novel treatment package employing visual cue fading was compared with a graduated time-delayprocedure previously shown to be effective for increasing self-initiated language. Both treatmentsinduded training multiple self-initiated verbalizations using multiple therapists and settings. Bothtreatments were effective, with no differences in measures of acquisition of target phrases, main-tenance of behavioral gains, acquisition with additional therapists and settings, and social validity.DESCRIPTORS: autism, language, time delay

Communication training has been an importantfocus in treating children with autism for manyyears (Matson, 1989). However, one importantaspect of language, spontaneous or self-initiatedspeech, has received little emphasis in the literature.Charlop, Schreibman, and Thibodeau (1985) de-fined self-initiated verbalizations as verbal responsesto nonverbal discriminative stimuli in the absenceof verbal discriminative stimuli. (In contrast to thedefinition of verbal stimuli given by Skinner, 1957,this study does not include printed words as verbalstimuli.) Given that much of normal daily com-munication is not verbally prompted, teaching chil-dren to initiate language is an important goal.

There have been a limited number of studies onincreasing self-initiated speech in autistic children(e.g., Charlop et al., 1985; Charlop & Walsh,1986; Ingenmey & Van Houten, 1991; Matson,Sevin, Fridley, & Love, 1990). These studies useda treatment package consisting of modeling, pos-itive reinforcement, and graduated time delay.Graduated time delay is a stimulus-shaping pro-

Address correspondence and reprint requests to Johnny L.Matson, 236 Audubon Hall, Department of Psychology,Louisiana State University, Baton Rouge, Louisiana 70803-5501.

cedure in which a verbal model is first paired withand later faded from a nonverbal discriminativestimulus, while also fading reliance on verbalprompts. In previous studies using time delay, self-initiated target phrases increased in all participants.Generalization to additional stimuli, settings, andpersons occurred. Also, two studies demonstratedmaintenance of acquired gains several months later(Ingenmey & Van Houten, 1991; Matson et al.,1990).

Given the importance of self-initiated speech,the development of additional strategies for treatingthis aspect of language may be useful. Studyingalternative procedures may increase our understand-ing of the variables associated with the acquisitionof self-initiated speech. Therefore, we examined atreatment package consisting of modeling, multipleexemplars and reinforcers, and a visual-cue/stim-ulus-fading procedure for increasing self-initiatedverbalizations. In addition, we compared this al-ternative strategy to time delay, the only successfultreatment to date. We compared the effects of thetwo procedures on acquisition of target responses.We also induded maintenance, generalization toother therapists and settings, and treatment ac-ceptability (social validity).

389

1993,269,389-398 NUMBER 3 (FALL 1993)

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JOHNNY L. MATSON et al.

METHOD

SubjectsResearch participants were 3 boys with autism.

Each participant met DSM-III-R criteria for autismand was severely autistic as rated by the ChildhoodAutism Rating Scale (Schopler, Reichler, & Renner,1988). Randy was 5 years old. He had an IQ of62 (Stanford Binet). His expressive language was

equivalent to 2 years 4 months (Vineland AdaptiveBehavior Scale). Chris was 4 years old. He had an

IQ of 71 (Stanford Binet). His expressive languagewas equivalent to 2 years 4 months (VinelandAdaptive Behavior Scale). Darryl was 4 years old.He had an IQ of 47 (Stanford Binet). His ex-

pressive language was equivalent to 1 year 1 month(Vineland Adaptive Behavior Scale).

These participants were selected for participationbecause of their severely limited use of self-initiatedlanguage. Specifically, language for Randy consist-ed entirely of immediate and delayed echolalia andsimple noun labeling in response to the question,"What is this?" Chris named objects and familymembers when asked, and occasionally asked fordesired foods. Darryl's speech was severely delayedand consisted almost entirely of contextually in-appropriate, delayed echoing of a few phrases (e.g.,"comb your hair, comb your hair"). Thus, verbalbehavior of all 3 participants consisted almost en-

tirely of echoing modeled phrases and limited re-

sponding to verbal prompting.

Setting and MaterialsTreatment occurred in a university clinic, with

a therapist and a behavioral rater present. Sessionswere approximately 20 min long and occurred fourtimes per week. Setting generalization probes oc-

curred in the homes of Randy and Chris and in a

classroom for Darryl.Stimulus materials present during sessions in-

cluded toys, edible items, children's books, and cue

cards. The toys (cars, tops, liquid bubbles, stuffedanimals), edible items (dry cereal and M&Ms®),and children's books were selected because theyappeared to be preferred by the participants duringtwo unstructured sessions prior to baseline, corrob-

orating reports by their parents. Toys and edibleitems served both as stimulus cues for verbalizationsand as reinforcers for correct verbalizations. Duringthe visual-prompt procedure, cue cards (4 in. by6 in. index cards with target words written in dif-ferent colored markers) were used.

Target Behaviors andSelection Procedures

Parents of participants compiled a list of self-initiated (nonverbally prompted) words or phrasesconsidered important for treatment. Target vocal-izations were selected from these lists to ensure thatthe verbalizations would be socially meaningful.Four targets were selected for each participant. ForRandy and Chris the verbalizations were "hello,""excuse me," "thank you," and "play with me."For Darryl, the verbalizations were the same, except"help me" was substituted for "play with me."The participants had not previously used thesephrases (as reported by parents and confirmed dur-ing direct observations of participants in multiplesettings and during baseline sessions). During theexperiment, parents did not indude these targetphrases in any home-based training.A correct response occurred when the participant

said the target phrase within 10 s after presentationof a nonverbal stimulus cue and prior to the pre-sentation of a verbal model. Nonverbal stimuluscues differed for each target word: For "hello," thestimulus consisted ofthe therapist entering the room.Slight variations were introduced by having thetherapist enter the room waving, not waving, orentering after knocking. These variations were usedto promote generalization of the verbalizations be-ing trained. For "help me," stimulus cues involvedplacing a desired toy or edible item out of theparticipant's reach, in a dosed container that theparticipant could not open, or in another inacces-sible part of the room. For "play with me," theparticipant was shown games or toys requiring 2players (e.g., ball to be tossed back and forth). For"excuse me," stimulus cues induded placing a de-sired toy or edible item on a table or chair andthen blocking the participant's path to it. For "thank

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INCREASING LANGUAGE

you," stimuli involved handing the participant anyof a number of desired toys or edible items.

Thus, stimulus cues included object presentation,manipulation of objects, and specific social scenar-ios. Each target used multiple stimulus cues. Inorder to enhance generalization to other similarsituations not induded in training (training suffi-cient exemplars, Stokes & Baer, 1977), these var-ious cues and scenarios were rotated across trials.

DesignA multiple baseline design across behaviors was

used. For each participant, two target phrases weretrained with time delay, and two were trained usingthe visual-cue procedure. No 2 participants receivedthe same treatment for an identical pair of targetphrases; treatments for target phrases were coun-terbalanced across participants.

For each participant, treatment began simulta-neously on two target behaviors, one treated usingtime delay and one treated using visual cues. Whenacquisition criteria for both of the initial verbali-zations were met, treatment began on the remainingpair of target phrases.

Each participant's design included baseline,treatment, and follow-up phases. Generalizationprobes occurred in the baseline phase to assess gen-eralized acquisition to additional therapists and oneadditional setting. In addition, generalization probesoccurred during the treatment phase.

Experimental Conditions:Time Delay

Baseline. Each session induded five consecutivetrials for each of four target phrases (a total of 20stimulus prompts). The order of behaviors trainedwas rotated across sessions. During baseline trials,the therapist presented only nonverbal stimulus cues(e.g., the therapist knocked and entered the room).Correct self-initiated target responses were rein-forced with rewards intrinsic to the situation. Re-sponses other than the target behaviors were notreinforced.

Treatment. Treatment began simultaneously forthe first pair ofbehaviors. The time-delay procedurewas identical to that used by Matson et al. (1990).

The delay interval between stimulus presentationand verbal model (by the therapist) was initially 2s and was increased to 4 s after two consecutivesessions in which self-initiated phrases or correctimitations of a target occurred for at least 80% ofthe trials (four of five). The interval was graduallyincreased by 2-s durations in this manner. Self-initiated verbalizations and correct imitations of themodel were reinforced, but only self-initiated ver-balizations (before the model) were considered cor-rect.

Reinforcers were rotated within and across ses-sions and induded praise (for all targets), edibleitems if used as a stimulus cue (for "excuse me,"help me," and "thank you"), access to toys whentoys were used as stimuli, and 30-s contingent playwith the therapist (for "play with me").

Acquisition of a target response was defined asthree consecutive sessions in which self-initiated ver-balizations occurred during at least 80% of the trialsfor the target.

Generalization probes and sequential modi-fication. Generalization probes occurred duringbaseline for two additional therapists and one ad-ditional setting. Before successful acquisition (de-fined above) of target phrases with the first ther-apist, generalization probes identical to baselinesessions occurred (i.e., no models). Once successfulacquisition with this therapist was attained, trainingbegan with the second therapist. After acquisitioncriteria were reached with this therapist, trainingbegan with the third therapist in different settings.Thus, generalization consisted of a sequential mod-ification procedure (Stokes & Baer, 1977).

Follow-up. Maintenance was assessed at 10months for Randy and Chris and at 2 months forDarryl. During follow-up sessions, stimulus pre-sentation was identical to treatment sessions. Self-initiated verbalizations were reinforced, but mod-eling and graduated time delay were not used.

Experimental Conditions:Visual Cues

Baseline. Stimulus cues were identical to thosedescribed for time delay (e.g., the therapist enteredthe room) with one addition: During stimulus pre-

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JOHNNY L. MATSON et al.

Treatment

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Figure 1. Percentage of correct self-initiated verbalizations during baseline, treatment, and follow-up sessions for Randy.Duration of the delay interval (e.g., 4 s, 6 s) and the phase of visual cue fading (e.g., Step 3, Step 4) employed in eachsession are noted by an arrow at each progression.

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INCREASING LANGUAGE

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Figure 2. Percentage of correct self-initiated verbalizations during baseline, treatment, and follow-up sessions for Chris.Duration of the delay interval (e.g., 4 s, 6 s) and the phase of visual cue fading (e.g., Step 3, Step 4) employed in eachsession are noted by an arrow at each progression.

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JOHNNY L. MATSON et al.

sentation, the therapist held a flash card (4 in. by6 in.) with the target word (e.g., "hello") printedon it. Correct self-initiated verbalizations were re-inforced. (Reinforcement procedures were identicalin both procedures.)

Treatment. Each trial included stimulus-cuepresentation followed by a 10-s interval for self-initiated responding. As in the time-delay proce-dure, if the target phrase was not self-initiated, thetherapist modeled the target phrase; the model wasalways followed by a 10-s delay to assess correctimitations. A five-step stimulus-fading procedurewas used over the course of treatment. In Step 1,the stimulus included the cue card only (i.e., thetherapist showed the participant a card with theword "hello" printed on it). In Step 2, the cuecard paired with a nonverbal stimulus was used(i.e., the therapist entered the room holding thecard). Step 3 was identical to Step 2 except thesize of the card was reduced by one half; in Step4, the size of the card was again reduced by onehalf. In Step 5, the card was completely eliminated;only the nonverbal stimulus (e.g., entering the room)was presented. Modeling was used at each step ifthe participant did not respond spontaneously dur-ing the initial 10-s interval. The criterion for mov-ing from step to step was three consecutive sessionswith correct self-initiated verbalizations (not imi-tations) occurring at rates of 80% or greater. Self-initiated phrases and correct imitations were rein-forced.

Generalization probes and sequential modi-fication. Generalization procedures were identicalto those used in the time-delay procedure. Probesoccurred prior to acquisition of target responses.Programming (sequential modification) occurredduring treatment phases. The second therapist be-gan generalization programming after the partici-pant had successfully reached Step 4 of visual cuefading with the primary therapist. At the conclusionof treatment for the first 2 participants, we ques-tioned whether the gradual fading of the card wasa necessary component of treatment. Thus, we con-ducted fading and generalization procedures forDarryl more rapidly. The intermediate steps of fad-ing the visual cue (Steps 3 and 4) were eliminated.

The third therapist began generalization program-ming immediately after the second, and these ther-apists did not use cue cards during generalizationprogramming.

Follow-up. Self-initiated verbalizations were re-inforced, and modeling and visual cues were notused.

Social ValiditySocial validity was assessed in two ways. First,

a group of 15 persons made up of special educationteachers, doctoral students in psychology, and par-ticipants' parents considered vignettes describingboth treatments. These persons individually ratedeach procedure using the Treatment Evaluation In-ventory-Short Form, a measure of treatment ac-ceptability (Kelley, Heffer, Gresham, & Elliot,1989; Miller& Kelley, in press). The order in whichthey rated the two procedures was balanced acrossthe 15 raters. Differences in acceptability of the twoprocedures were analyzed using paired difference ttests. Respondents rated both procedures favorably.No significant differences were found.

The second procedure was conducted to assesswhether improvements in speech would be notice-able to average observers unfamiliar with autism.Twenty undergraduate psychology students, blindto experimental conditions, rated baseline andposttherapy videotapes of the participants. T testswere used to examine rated differences in targetbehaviors and three untreated behaviors before andafter treatment. (See Matson et al., 1990, for moredetails on this procedure.) Per comparison alphalevel was adjusted using the Bonferroni correctionprocedure. Raters noted significant improvementsin all four target behaviors for all 3 participants,with the exception of "play with me" for Chris,which was significant only at the .05 level. Nosignificant differences in the three untreated behav-iors were noted.

Interobserver AgreementInterobserver agreement for target responses was

calculated for 37% of all sessions. Agreement oc-curred when both raters scored a trial identically(i.e., no response, correct imitation, incorrect self-

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INCREASING LANGUAGE

initiated response, or correct self-initiated response).Reliability was calculated by dividing the totalnumber of agreements by the number of agree-ments plus disagreements and multiplying by 100%.Interobserver agreement was 99% to 100% for alltargets and participants.

RESULTS

Figure 1 displays data for Randy. Both timedelay and visual cues were effective in increasingself-initiated responding. Using time delay, Randyreached acquisition criterion for "play with me"within 14 treatment sessions. Using visual cues,acquisition of "hello" at Step 1 occurred withinnine treatment sessions. The card was completelyeliminated by the 21st treatment session. Acqui-sition criteria for the remaining two target phraseswere met within 10 treatment sessions. Trainingby additional therapists and in a second setting onall target phrases produced almost immediate andaccurate use of target phrases. Gains were main-tained at the 10-month follow-up. Few differencesin the effectiveness of the two procedures occurredfor Randy.

Chris showed similar gains (Figure 2). Althoughearly sessions showed variable responding, initialacquisition criteria were met for both verbalizationsby the 16th treatment session. Acquisition of thesecond set of verbalizations occurred before the10th treatment session. Gains with additional ther-apists and setting occurred rapidly across all phases.With the exception of the target phrase "play withme" at the first follow-up session, gains were main-tained after 10 months. Both procedures were alsoeffective for Darryl (Figure 3). All four behaviorswere relatively stable at high levels of respondingby the end of treatment.

DISCUSSION

A treatment package consisting of verbal mod-eling, visual cues and fading, and training withmultiple exemplars and reinforcers was effective inincreasing self-initiated verbalizations in 3 childrenwith autism. The visual-cue procedure was as ef-

fective as time delay, the only treatment previouslyfound to be effective. No differences with regardto acquisition, maintenance, or treatment accept-ability were noted.

In attempting to train self-initiated language,several difficulties are encountered. Self-initiatedlanguage often occurs in response to internal (i.e.,physiological) or complex social cues. The natureofthese stimuli may in part account for the difficultyin training self-initiated speech. First, of practicalsignificance, these stimuli are often difficult to ma-nipulate in natural settings. Second, stimulus ov-erselectivity and lack of social awareness, commonin autistic children, may interfere with identificationof and attention to events that serve as discrimi-native stimuli for self-initiated language. The vi-sual-cue procedure was therefore intended to trainverbalizations to occur in response to salient stimuli(e.g., large brightly colored cards). We hoped thatpairing cue cards with more complex social cueswould increase the salience of the social cue. Stim-ulus control is at the heart of this cueing procedure.Cards were successfully established as discrimina-tive stimuli for target phrases (Step 1) prior tointroducing nonverbal cues (Step 2). Thus, stim-ulus control progressed from verbal models to cardsand from cards to nonverbal stimuli.

This extrastimulus prompting procedure repre-sents one method of coping with the social andattentional problems associated with autism. Thereis, of course, no special relevance to using coloredcards. Any neutral stimulus with salient featuresmight have sufficed. Cards have the advantage ofbeing small, easy to move into the participant'svisual field, and easy to carry to new settings. Also,given the reading deficits of our participants, usingcue cards with words might have the benefit ofteaching children to read a few phrases.Some preliminary comparisons between the vi-

sual-cue and graduated time-delay procedures wereattempted. Both treatment packages used verbalmodeling, positive reinforcement, rotation of re-inforcers, multiple stimulus cues, and stimulus-shaping procedures. The chief differences in theprocedures induded (a) the use of verbal modelsversus verbal models with extrastimulus visual

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JOHNNY L. MATSON et al.

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INCREASING LANGUAGE 397

prompts and (b) the use of 2-s graduated versus10-s constant time delay. The present study cannotbe considered a pure comparison between gradu-ated and constant delay procedures, given the ad-ditional difference between the two treatment pack-ages. Also, there was perhaps a procedural bias infavor of the visual-cue procedure because partici-pants had less time to respond (only 2 s) in initialtime-delay sessions. Nevertheless, the effectivenessof the visual-cue procedure suggests that, at leastunder some circumstances, graduated delay inter-vals are not essential components for training self-initiated speech. Perhaps other methods of stimulusshaping might be substituted. Similarly, as notedwith Darryl, some stimulus fading steps may notalways be necessary. Future research should focuson creating a technology for determining the leveland speed at which stimuli need to be faded tomaximize generalization while minimizing thenumber of sessions.

Some autistic children selectively respond to vi-sual stimuli (Rincover & Koegel, 1975). Given thephenomenon of stimulus overselectivity, there ap-pears to be a sound theoretical rationale for in-cluding visual components in language training forsome children. Although a need for alternativetreatments has not been shown by demonstratedweaknesses in the time-delay procedure, visualcueing might be a back-up technique in cases inwhich verbal prompting is not feasible (e.g., hear-ing-impaired clients). The procedures used in thisstudy could easily be adapted for use with signingand total communication. More important, devel-oping new techniques for increasing self-initiatedlanguage may lead to greater understanding of theprocesses that underlie current techniques. Com-parisons of different treatment techniques may leadto the identification of components that are bothcommon across effective treatments and essentialfor positive outcomes.Our results should be interpreted in light of

several limitations. One consists of our use of se-quential modification to program generalization.Treatment was implemented by additional thera-pists and in an additional setting. Self-initiated gen-eralization was not evaluated. Because visual cueing

had been untested, our goal was not primarily tostudy generalization but to evaluate the rapiditywith which acquisition could be achieved whentreatment was implemented by new persons and innew settings. Several steps were taken to ensurethat naturalistic elements were included in training.Despite the clinical setting, scenarios were con-structed to occur as they would in a natural setting,variations in the scenarios were introduced, andreinforcers intrinsic to the language tasks were in-duded. In addition, in the final phases of treatment,target responding in natural settings was demon-strated. A second potential limitation is that theremay have been cross-treatment interference, giventhat the treatments were introduced simultaneous-ly. However, because the integrity of the multiplebaseline was maintained (i.e., the second pair oftarget behaviors did not improve until treatmentbegan), we consider cross-treatment interference tobe unlikely.No studies have focused on training autistic chil-

dren to initiate language in response to internal cues(e.g., physiological events). Target behaviors mightinclude "I'm hungry," "I'm tired," and "I feelsick." It may be possible to manipulate some in-ternal states and then teach children to label them(e.g., to label "I'm tired" after exercise or "I'mfull" after eating a meal). A second approach mightinvolve teaching children to verbalize internal statesthat are difficult to manipulate but that are frequentnaturally occurring events (e.g., hunger, anger). Inlight of the usefulness of behavioral approaches forthese verbalizations, more research is warranted.

REFERENCES

Charlop, M. H., Schreibman, L., & Thibodeau, M. G.(1985). Increasing spontaneous verbal responding inautistic children using a time delay procedure. Journalof Applied Behavior Analysis, 18, 155-166.

Charlop, M. H., & Walsh, M. E. (1986). Increasing autisticchildren's spontaneous verbalizations of affection: An as-sessment of time delay and peer modeling procedures.Journal of Applied Behavior Analysis, 19, 307-314.

Ingenmey, R., & Van Houten, R. (1991). Using timedelay to promote spontaneous speech in an autistic child.Journal of Applied Behavior Analysis, 24, 591-596.

Kelley, M. L., Heffer, R. W., Gresham, F. M., & Elliot, S.N. (1989). Development of a modified treatment eval-

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398 JOHNNY L. MATSON et al.

uation inventory. Journal of Psychopathology and Be-havioral Assessment, 11, 235-247.

Matson, J. L. (Ed.). (1989). Chronic schizophrenia andadult autism: Issues in diagnosis, assessment and treat-ment. New York: Springer.

Matson,J. L., Sevin,J. A., Fridley, D., & Love, S. R. (1990).Increasing spontaneous language in three autistic chil-dren. Journal of Applied Behavior Analysis, 23, 227-234.

Miller, D. L., & Kelley, M. L. (in press). Treatment ac-ceptability: The effect of parent gender, marital adjust-ment, and child behavior. Journal of Child and FamilyBehavior Therapy.

Rincover, A., & Koegel, R. L. (1975). Setting generalityand stimulus control in autistic children. Journal ofAp-plied Behavior Analysis, 8, 23 5-246.

Schopler, E., Reichier, R. J., & Renner, B. R. (1988). Thechildhood autism rating scale. Los Angeles: WesternPsychological Services.

Skinner, B. F. (1957). Verbal behavior. Englewood Cliffs,NJ: Prentice-Hall.

Stokes, T. F., & Baer, D. M. (1977). An implicit tech-nology of generalization. Journal of Applied BehaviorAnalysis, 10, 349-367.

Received October 13, 1991Initial editorial decision January 24, 1992Revisions received April 10, 1992; July 27, 1992;

November 3, 1992; March 18, 1993Final acceptance March 18, 1993Action Editor, Susan Fowler