exploring behavioural skills training to teach self-monitoring...

Running Heading: BEHAVIOURAL SKILLS TRAINING AND ANXIETY 1

Exploring Behavioural Skills Training to Teach Self-Monitoring Skills for Anxiety in Children

with Autism.

Valerie Varasteh

University of British Columbia

BEHAVIOURAL SKILLS TRAINING AND ANXIETY 2

Exploring Behavioural Skills Training to Teach Self-Monitoring Skills for Anxiety in Children

with Autism.

Anxiety is a common feeling that is experienced by individuals with typical development

and individuals with atypical development, where the intensity can vary from person to person.

For individuals with autism, anxiety may be frequently experienced by some persons and may

also range in the level of severity. Anxiety is not considered a characteristic of autism in the

DSM-IV-TR (MacNeil, Lopes & Minnes, 2009; Reaven, 2009a; White, Oswald, Ollendick, &

Scahill, 2009). Many children and adolescents with autism engage in behaviours that are

correlated with symptoms of anxiety and interfere with the child’s daily functioning (Chaflant,

Rapee, Carroll, 2007; MacNeil et al., 2009; Reaven, Blakeley-Smith, Culhane-Shelburn,

Hepburn, 2012; Reaven et al., 2009b; Steensel, Bogels, & Perrin, 2011; Sze & Wood, 2008;

Wood, Drahota, Sze, Har, Chiu, & Langer, 2009). Core characteristics of autism correlate to

anxiety symptoms and some researchers have suggested anxiety may be an underlying symptom

that may account for and heighten the core deficits (MacNeil et al., 2009; White et al., 2007).

These behaviours include repetitive and stereotypic behaviours, forms of aggressions,

perseverative thoughts, and withdrawal from social situations (Ozsivadjian & Knott, 2011;

Reaven, 2009a; Sofronoff, Attwood, & Hinton, 2005; Spiker, Lin, Dyke, Wood, 2012).

Ozsivadjian and Knott (2011) reported cases where children and adolescents with autism

displayed depression and sensory arousal as well.

Social skills impairments have been found to relate to anxiety. The belief that individuals

with autism have a preference for being alone and purposefully stay away from social situations

may actually be due to the underlying challenge of anxiety that develops in the individual with

autism, when the person is placed in a social situation (Chaflant et al., 2007; Gillott, Furniss, &


Walter, 2001; MacNeil et al., 2009; Ozsivadjian, & Knott, 2011; Sofronoff et al., 2005; White

et al., 2009). This is especially considerable for children and adolescents who are on the higher

end of the spectrum; individuals at the higher end of the spectrum are more aware of his/her

challenges in social situations and may experience more anxiety during a social interaction

(Chaflant et al., 2007; Gillott et al., 2001; MacNeil et al., 2009; Reaven, 2009a; Sofronoff et al.,

2005; White et al., 2009).

Most researchers have found the number of anxiety cases reported are higher in children

and adolescents with autism than in children and adolescents with typical development (Bellini,

2004; Chaflant et al., 2007; Gillott et al., 2001; MacNeil et al., 2009). In addition, the samples of

children and adolescents with autism, who display anxiety, are equivalent in rate to children and

adolescents with anxiety disorders (MacNeil et al. 2009). In the literature review by White et al.

(2009), the researchers reported anxiety disorders maybe found in children with autism range

between 11 to 84%. Within the core deficits in autism, the cognitive and communication

impairments may possibly complicate the ability to assess and diagnose children and adolescents

with autism with a possible anxiety disorder (Wood et al., 2009; Reaven, 2009a).

Identifying a comorbid anxiety disorder is difficult for children and adolescents with

autism because the core deficits in autism are seen to overshadow the anxiety symptoms that

contribute to the impairments. In consequence, it is believed to be challenging to separate if an

anxiety disorder truly exists because the anxiety related to the functional impairment has to be

distinct from the core deficits in autism (MacNeil et al. 2009; Steensel et al., 2011). Furthermore,

to be diagnosed with certain anxiety disorders, the DSM-IV-TR lists autism as an exclusionary

criterion because the features of autism are similar to, or overlap, with symptoms of specific

anxiety disorders (Ozsivadjian & Knott, 2011; Wood et al. 2009).


Relaxation responses are identified to counteract the outcome of stress within the body,

which produces an increase in heart rate, increase in blood pressure, slowed digestive

functioning, decrease in the blood flow to the extremities, and an increase in the fight or flight

hormones, cortisol and adrenalin (Paclawskyj, 2011). Formal relaxation training is a logical

technique to reduce anxiety and provide an individual with strategies to overcome stress-related

situations. The relaxation skills may be self-directed, which can be utilized by children with

autism at anytime, and perhaps without the need of assistance from a caregiver (Paclawskyj).

A form of relaxation training introduced by Schilling and Poppen (1983) is Behavioural

Relaxation Training (BRT). BRT is an exercise, which includes training in a number of

behaviours in the response class, and works on relaxation as a whole compared to focusing on

one aspect of the response class and presuming it will generalize (Paclawskyj; Schilling &

Poppen). The researchers, Schilling and Poppen, observed in previous clients who acquired skills

in Progressive Muscle Relaxation, certain observable behaviours resulted when clients reported

relaxation increased in self-reports and with physiological measures (Paclawskyj; Schilling &

Raymer). The behaviours included slowed breathing, jaw dropped, feet were kept apart, throat

and extremities are still with no movement, and eyes are closed (Schilling & Poppen). In total,

BRT consists of ten postures and behaviours and include: (1) breathing; (2) remaining quiet; (3)

body is still; (4) head; (5) eyes; (6) jaw; (7) throat; (8) shoulders; (9) hands; and (10) feet

(Donney & Poppen, 1989; Raymer & Poppen, 1985; Schilling & Poppen). Tension in the

muscles is relieved in the limbs and extremities and no restless movement is observable while

the learner concentrates on practicing deep breathing.

Schilling and Poppen recognized that relaxation is a complex response class, which

comprises of overt behaviours, and individualized and subjective physiological and cognitive


behavioural responses. For most individuals with autism, the subjective and internal states are

difficult to express; in BRT, the emphasis is in the overt behaviours and no verbal reports or

teaching of altering internal physiological behaviours are described (Paclawskyj). BRT is

considered to be a promising form of relaxation training in Applied Behavioural Analysis

(Paclawskyj).

In the study by Schilling and Poppen (1985), direct teaching of the behaviours in BRT

was an efficient technique to teach relaxation to individuals with typical development. The

participants in the study were found to have acquired the skills in two sessions and maintained

the behaviours in follow-up 4 to 6 weeks after training. Schilling and Poppen proposed BRT

might be an effective method to teach relaxation to individuals with developmental disabilities

because the focus on objective postures can be taught, rather than the subjective states most often

associated with relaxation.

Raymer and Poppen (1985) examined the effects of BRT for children with diagnosed

hyperactivity. Children with hyperactivity were prescribed medication to reduce the level of

hyperactivity, however the medication had little efficacy. Raymer and Poppen sought to identify

alternative treatment methods and examined if intensive BRT could teach children to relax and if

BRT generalized to the home setting, and were maintained. The results from the study showed

BRT was an effective method to teach relaxation to children with hyperactivity, and the steps

required in BRT, modeling, prompting, and feedback, contributed to the child’s success. Raymer

and Poppen informed BRT is acquired easily because of the observable behaviours presented to

learner, in comparison to the subjective discriminations required with progressive muscle

relaxation. Donney and Poppen (1989) further extended this study by training parents to teach


BRT to children with hyperactivity. Donney and Poppen found parents were able to conduct

teaching and by the third session, parents required minimal assistance from the experimenters.

In total, 15 studies on BRT have been conducted in the area of children with

hyperactivity, Parkinson’s for the tremors, student anxiety, tension headaches, stress

management, traumatic brain injuries, and for individual’s with Huntington’s disease

(Paclawskyj). In addition, participants in the study of BRT were predominantly examined in

adults. Research in the area of children with autism and other developmental disabilities, and the

practice of BRT is low.

Behavioural skills training (BST) are a teaching intervention used to teach a number of

skills to children with autism and other developmental disabilities. BST assists children with

autism to understand and differentiate appropriate behaviours in various situations. The goal in

BST is to teach the learner a behaviour that does not exist in the individual’s behaviour

repertoire, or may enhance and strengthen certain behaviours (Miltenberger, 2008). The four

components of BST comprise of: modeling, instruction, rehearsal, and feedback. Modeling

comprises of demonstrating the target behaviour, which is developmentally appropriate for the

learner, in a situation that is relative to the situation in which the behaviour is expected to occur

in actuality (Miltenberger). The model for BST is an individual familiar to the learner, and an

individual the learner shows preference toward, such as a teacher, parent, familiar adult, sibling,

or peer (Miltenberger). The model may be the interventionist/instructor of BST, and have dual

responsibility to teach and model the target behaviour to the learner. Modeling is performed in

vivo or artificially through video.

Video modeling in BST is known as symbolic modeling where the video includes the

instruction of the correct behaviour and the model engaging in the correct behaviour(s). The


setting of the video may be the same real-life situations, in which the behaviour is expected to

occur in, or in a similar context. Symbolic modeling may be viewed as effective for displaying

the correct behaviour modeled in a variety of situations to promote generalization

(Miltenberger). Moreover, modeling of correct behaviour is required to be repeated as often as

needed for the learner to acquire the behaviour correctly. Implementers of BST may consider

symbolic modeling as an efficient technique in BST since the video facilitates the repeated

exposure of the model to the learner with a minimal amount of effort from the model and/or

instructor providing the intervention. Following the first step in BST, modeling, the learner is

expected to rehearse the behaviour and be reinforced immediately.

Instruction in BST explains the behaviour to the learner at a level that is understandable

by the learner and yields the expectations of the behaviour to be performed (Miltenberger).

Miltenberger suggested the learner repeat the instruction to the instructor to confirm the learner

correctly perceives the behaviour, and supports self-prompting for correct imitation. However, if

the learner is unable to communicate verbally, the learner may be able to repeat the steps in an

alternative method. For instance, visual materials may be ordered in the correct chain for chained

behaviours, or monitoring the behaviours in the model for a second time with a checklist for the

learner to complete allows for the learner to indicate if the behaviours were performed correctly.

The context in which the rehearsal is completed correlates to the same observed situation

as the symbolic model. Rehearsal is an effective phase in BST where the learner may recite the

target behaviour(s) prior to engaging in the behaviour in a real-life situation (Miltenberger).

Feedback from the instructor arises in conjunction to rehearsal, and entails praise and

reinforcement, in addition to the correction of error though further instruction, if needed. Positive


feedback and corrective feedback is a significant factor in motivating and sustaining the learner’s

participation in BST.

Researchers have implemented BST to teach children with autism safety skills in the

home, and in relation to abduction prevention skills (Gunby, Carr, & Leblanc, 2012; Summers et

al., 2011), and social skills such as conversational skills (Stewart, Carr, & LeBlanc, 2007). In the

study by Gunby et al., the children with autism were taught to respond to generic lures from

strangers through in vivo BST and were supplemented with video to support generalization of

the skill. Gunby et al.’s study did not yield results of generalization, with the exception of one

participant. In the study by Summers et al., a BST package was created to train children with

autism to respond to the hazards of a ringing doorbell and the presence of chemicals. For both

safety hazards, the participants were able to effectively respond to a ringing doorbell by

acquiring a parent’s attention, and identifying chemicals cleaners and informing parents. The

results of the Summers et al. study noted the efficacy of training, between 9 to 26 trials, and

participants displayed consistent and an increase in safe behaviours.

BST has been applied in training parents’ for food selectivity and teaching social skills to

children with autism, care workers, medical service providers, and teachers and support staff in

schools working with students with autism (Bruzzi-Nigro & Sturmey, 2010; Gianoumis,

Seiverling, & Sturmey, 2012; Graudins, Rehfeldt, DeMatteu, Baker, & Scaglia. 2012; Seiverling,

Williams, Sturmey, & Hart, 2012; Toelken & Miltenberger, 2012). In research by Toelken and

Miltenberger (2012), school staff members were trained with BST to implement prompting in a

system known as SWAT, to increase the level of independence for students with autism in an

inclusive classroom setting. The acronym SWAT stands for: (1) say; (2) wait and watch; (5) act

out; and (5) touch to guide. The SWAT technique was implemented by staff members to fade


their support levels and allowed for the students with autism to engage in behaviours, which

allowed the students complete tasks independently (Toelken & Miltenberger). Toelken and

Miltenberger reported the staff members were keen to continue BST training for the second and

third target behaviours; this was perhaps ascribed to the quick and efficient training procedures,

which did not take time out from the responsibilities of the job.

In the study by Seiverling et al. (2012), mother participants were trained in BST to assist

in feeding their children with autism; as a result of training the mothers’ food refusal and

challenging behaviour during mealtimes decreased and the parents reported increases in the

number of food items consumed by their child (Seiverling et al). Seiverling et al. collected social

validity data and the mothers rated the BST package as excellent and found the modeling

component as an effective and helpful phase in training.

The purpose of this research is to examine the effects of teaching relaxation skills to

children with autism, though BST, to help reduce the level of anxiety. The present proposal sets

out to examine and extend the research on BRT to include children with autism who display

significant forms of anxiety, and determine if BRT is applicable this population. In order to

support the identification of anxiety in children with autism, becoming aware of the physical

symptoms will be taught to the children since the body’s reaction to the anxiety is more easily

identifiable than emotional states for children with autism (MacNeil et al., 2009; Rotherman-

Fuller, & MacMullen, 2011). It is hypothesized that if children with autism are taught to detect

physiological symptoms of anxiety, identify anxiety provoking situations, and acquire relaxation

strategies via BST, the children with autism will be better able to implement the strategies during

natural settings after recognizing and understanding the physiological symptoms related to the

onset of anxiety.


Method

Research Question

The study aims to address two research question: (1) Is there a functional relationship

between the implementation of behavioural skills training and teaching self-monitoring skills for

the identification of physical symptoms related to anxiety? And (2) is there a functional

relationship between the implementation of behavioural skills training and developing relaxation

strategies to reduce the level of anxiety? If there is a reduction in anxiety for children with

autism, the study results may have implications for professionals who work with children with

autism and strengthen the support of behvioural skills training as an effective mode of

intervention.

Participants

Description of the participants. The researcher will recruit 3 participants who have a

diagnosis of autism and display behaviours related to anxiety. To confirm the diagnosis with

autism, the parents of the participants’ are asked to provide the appropriate documentation for

the diagnosis from a clinical psychologist, psychiatrist, and/or pediatrician. The research seeks to

enlist participants in the rage range of 7 to 12 years of age. As part of the recruitment

prerequisite, the children with autism should posses a good and sufficient conception and

understanding of emotions; it is suspected by the researcher that older children with autism

whose educational history show early intervention may have obtained programming for emotion

identification. The researcher will include participants who are both male and female and no

restrictions are placed on race and ethnic background. Proficiency in English is part of the

inclusion criteria.


To gain information on the participant’s communication levels, the researcher is going to

review a report of The Autism Diagnostic Observation Schedule-Generic (ADOS-G; Lord et al.,

2000). The ADOS-G is a diagnostic assessment for autism that was administered by the child’s

clinical psychologist, psychiatrist, and/or pediatrician, and is divided into four modules. The

ADOS-G will provide the researcher with an overall understanding and description of the

participants. A request to parents to yield a copy of the ADOS-G and other documents will be

outlined in a letter to the family upon initial contact via email. Specific detail for the inclusion

and exclusion criteria is listed below.

Information on the child’s education is collected in the preliminary phase. To obtain a

clear conception of the participants’ educational background, the researcher will give the parents

a questionnaire to complete. The document requests information on the history of services and

the current education the child with autism receives. Investigation in early intervention services

will yield knowledge of the intensity and duration of intervention. Inclusion criteria requirements

will be documented on a checklist given to the family, and required documents need to be

prepared and mailed to the researcher within a timeframe of one week, seven business days, after

initial contact.

Criteria. The inclusion and exclusion criteria will assist with enlisting participants for the

study. Inclusion criteria for participants will be as follows: (a) resides in the Lower Mainland; (b)

access to a television and DVD player, or a computer; (c) chronological age between 7-12 years;

(d) diagnosis of the autism; (e) well developed language repertoire and English proficiency; (f)

imitation skills; (g) display an understanding of, and ability to identify different emotions; and

(h) meets criteria for anxiety symptoms from the Screen for Child Anxiety Related Emotional

Disorders and Spence Child Anxiety Scale–Parent.


As part of the inclusion criteria, pre-requisite skills are mandatory for participation.

Similar to the Reaven et al. (2009) and Reaven et al. (2012) studies, the participants are required

to be able to communicate using full sentences with a well-developed language repertoire. To

identify language, the ADOS-G report provides information on the child with autism’s verbal

skills. Imitation is a second pre-requisite skill for participants and The Imitation Battery

measures and assesses for imitation. The Imitation Battery was developed to examine the nature

and the prevalence of imitation deficits in children with autism (Rogers, Hepburn, Stackhouse, &

Wehner, 2003). For the purpose of this investigation, the assessment is administered to confirm

the participant has developed a repertoire of imitation skills required for inclusion. A final pre-

requisite skill that is part of the inclusion criteria is knowledge of, and the ability to identify basic

emotions such as happy, angry, and sad. In the article by Lickel, MacLean, Blakeley-Smith, and

Hepburn (2012), prerequisite skills for CBT were assessed. Lickel et al. (2012) implemented the

Pictures of Facial Affect system and The Thought/Feeling/Behaviour (TFB) Discrimination

Task. The present proposal will utilize the Pictures of Facial Affect and the TFB Discrimination

Task to assess the participants’ knowledge of emotions and the ability to differentiate between

thoughts and feelings, and behaviour statements and words related to different emotions (Lickel

et al.).

The participants’ anxiety levels consist of a primary direct measure and additional

supplemental self-report measures to support the researchers initial perception of the

participants’ anxiety. The self-report measures include the Screen for Child Anxiety Related

Emotional Disorders (SCARED) by Birmaher, Brent, Chiapetta, Bridge, Monga, and Baugher

(1999), and the Spence Child Anxiety Scale – Parent (SCAS – P; Nauta, Scholing, Rapee,


Abbott, & Spence, 2004). If prospective participants do not contain all of the inclusion standards,

the child with autism fulfills the exclusion criteria.

Inclusion criteria measures.

Imitation Battery. The Imitation Battery was developed by Rogers et al. (2003) to

identify imitation skills in children with autism and other developmental disabilities. Rogers et

al. incorporated manual actions (e.g. tap head with hand, marching by alternating legs in one

spot), actions with objects tasks, and oral-facial actions. The original assessment consists of 16

tasks. For the purpose of this study, the three types of imitation tasks are presented in a random

order consisting of three instructions per task, which totals to nine tasks. During the assessment

procedure, the researcher gives the instruction, “Try this”, or “(Name) do this” and repeats the

action with three movements before the participant engages in the imitation (Rogers et al.). A

time delay of 3-5 seconds is given to respond. Correct responses are reinforced with verbal praise

and a choice for a tangible item. If the participant does not respond to the instruction, the

researcher will begin the next instruction. No feedback is given. Once the nine tasks are

complete, the error tasks are reintroduced. If the participant responds correctly, the participant is

reinforced. If an error occurs, the researcher will pause for 3 s, reintroduce the task and provide

the necessary prompts for manual and action with object tasks. If an error occurs in oral-facial

tasks, corrective feedback is utilized. For example “Nice try! That’s a hard one! Let’s try it on

the other side of the cheek.” Following the corrective feedback for the oral-facial task, the

researcher suggests repeating the action once more and includes a verbal instruction of how to

imitate.

The scoring is a pass or fail system for each imitation task (Rogers et al.). A score of 0

will be given if the participant does not imitate, no response to the model, or imitates incorrectly.


Incorrect imitations for manual tasks include performing the action partially, or performing with

the incorrect body part. Partial actions are also considered to be incorrect. A score of 1 will be

given if a correct imitation of the instruction is modeled (Rogers et al.). In total, the participants

can score between 0 and 9. A score of 8 or 9 is satisfactory.

Pictures of Facial Affect. Lickel et al. (2012) used the Pictures of Facial Affect system to

examine if children with autism could recognize and identify six emotions: happy, sad, scared,

angry, surprised, and disgusted. The children examined 36 images of males and females with

different facial expressions; images were divided onto six cards with six images each. The

experimenter placed the card onto the table and then read out the different emotions and asked

the child to receptively label each image to the correct emotion. If the participant labels the

emotion correctly, the participant receives immediate praise. The researcher delivers a choice of

tangible reinforcers at the completion of each trial, identifying all six emotions. If the participant

yields an incorrect response, the researcher will: (a) removes the materials; (b) provide a pause of

3 s; (c) reintroduce the emotion card; (d) reads the incorrect emotion; (e) presents a 3 s time

delay before prompting the correct response; and (f) delivers praise. The time delay allows for

the participant to answer correctly independently. The prompt following the time delay is a

gesture to the correct image related to the emotion. Data for an error is recorded and counted

toward the total score. For the purpose of this investigation, the participants will identify happy,

sad, angry, scared, and worried. Thirty-six images of males and females displaying the six

emotions will be presented to the participants and the same procedural system is used as the one

implemented by Lickel et al. In total, the participants can score between 0 and 36. An acceptable

score for the Pictures of Facial Affect is 33 or higher.


The Thought/Feeling/Behaviour (TFB) Discrimination Task. The TFB Discrimination

Task was adapted by Lickel et al. (2012) from the original version developed by Oathamshaw

and Haddock (2006). The TFB Discrimination Task assesses the participants’ ability to

differentiate between a thought, feeling, and behaviour, by indicating which category a statement

or word belongs to (Lickel et al.; Oathamshaw & Haddock). To begin the task, the researcher

will instruct the participant to listen to a comment or word and point to the corresponding card

identifying if it is a thought, behaviour, or feeling. If the participant yields a correct response, the

participant is praised and given a choice for a tangible reinforcer. If the participant yields an

incorrect answer, the researcher uses corrective feedback; for example, “That was a good try, it’s

a hard one!” The researcher will return to the incorrect statement or word at the end of the task

and reintroduce the statement or word for a second trial. If the participant gives the correct

response, the participant receives praise and a tangible reinforcer. A time delay of 3 s is offered

before the researcher will assist the participant with a gestural prompt to the correct response.

Data for an error response is recorded and counted toward the total. Oathamshaw and Haddock

had a total of 24 statements or words. For the purpose of this research study, the number of

statements or words is reduced to 21 to have an equal number of thought, feeling, and behaviour

statements or words.

Screen for Child Anxiety Related Emotional Disorders (SCARED). The SCARED by

Birmaher et al. (1999) is a measurement tool to assess and screen for childhood anxiety

disorders, and is administered to both the child and parent. The SCARED was specifically

designed to measure anxiety in the clinical population (Nuata, et al., 2004). The SCARED is a

41-item questionnaire and answers are provided on a three point-scale. The scale ranges from 0

to 2, 0 meaning not true and/or not often, and 2 meaning true and/or often true. The maximum


score on the SCARED is 82 and a score of 25 or greater is significant. A score of 30 or more

may represent a specific anxiety disorder. For the purpose of this research proposal, the parent

will complete the SCARED pre- and post-intervention. The 5-item scale is administered to the

parent during the recruitment period.

Spence Child Anxiety Scale – Parent (SCAS – P). The SCAPS-P is a parent version of a

questionnaire to assess anxiety symptoms in children in the typical development population, and

correlates closely to the DSM-IV criteria for anxiety disorders (Nauta et al., 2004). The scale has

a total of 38-items and is scored on a four-point scale between 0 and 3, 0 meaning never and 3

meaning always. A score of 114 is the maximum score obtainable. The score is devised on a sub-

scale and correlates with the different anxiety disorders (Nuata et al.). The SCAS-P is

implemented pre- and post-intervention.

Preference Assessment. To assist with identifying potential reinforcers for the

independent variable, a preference assessment will gain knowledge of preferred stimuli for the

participants. The procedure utilized for this study is the multiple-stimulus without replacement

system (MSWO). Research by DeLeon and Iwata (1996) suggested MSWO results in the high

number of identified reinforcers and is the more efficient system (Tullis, Cannella-Malone, &

Fleming, 2012). The preference assessment is a component of the recruitment procedures. A

comprehensive assessment procedure to identify effective reinforcers will take place before the

researcher begins assessment for inclusion criteria with each participant. The stimuli materials

for the assessment will include tangible items such as toys and food. The toys items will vary in

range from sensory items (e.g. squishy balls, light sticks,etc.) to current popular items (e.g.

Angry Birds). If parents report specific food restrictions, the choice of edible items will meet the

needs of the participants. In the MSWO procedure, the researcher adheres to the procedure by


DeLeon and Iwata. The researcher will present a choice of seven items equally spaced on a tray.

Before the assessment begins, each participant evaluates the items on a tray for a short duration

of time, approximately 10 s.

Following DeLeon and Iwata’s method for the MSWO the assessment, the researcher

uses the instruction “pick one” and waits for a response from the participant. After the participant

picks an item, the materials are removed from the table and the researcher records which item

was chosen first. The participant accesses the toy item for 20 s and if it is an edible, the

researcher allows for the participant for consume the food item prior to introducing the next trial.

In the next presentation of the tangible items, the order of the presentation is altered and there is

no replacement of the previously obtained item by the participant. If the participant attempts to

obtain two items at once, the researcher blocks the participant, removes the tray, and ends the

trial. The items on the tray are reordered; moving the items from the far left to the far right on the

tray, and re-presents the instruction. If the participant does not respond to the instruction within a

30 s timeframe, the trial is marked as “no response”. Trials continue until the participant selects

the last item. The outcome of the assessment produces a hierarchy of items from the array.

Calculating the percentage for the different items is by dividing the number of times the item was

chosen by the number of times in which it was presented to the participant (Carr, Nicolson, &

Higbee, 2000; DeLeon & Iawata; Tullis et al., 2012). The researcher ranks the percentage from

one to seven, one being the highest and most preferable reinforcer.

For the purpose of this study, the initial comprehensive assessment follows the guidelines

by DeLeon and Iwata and includes five assessment sessions to identify available reinforcers for

task engagement during the Imitation Battery, Pictures of Facial Affect, and the TFB

Discrimination Task. A second and shorter MSWO assessment precedes the intervention. Similar


to the studies by Carr et al. (2000) and Tullis et al. (2012), three sessions are conducted versus

five. Tullis et al. reported the duration of the five-session assessment is approximately 22

minutes, and the three-session assessment reduces the duration for assessment and contributes to

the feasibility of implementing MSWO system in applied settings. The researchers in the Carr et

al. and Tullis et al. reported three preference assessment sessions were conducive to revealing an

abundant number of reinforcing items. The series of steps to implement the MSWO is consistent

with the system developed by DeLeon and Iwata. Preference assessment is a continuous

procedure employed throughout the study to ensure the reinforcement materials are continually

novel and prevent the possibility of satiation. Preference assessments will take place every week

of intervention with the researcher.

Description of the recruitment procedure. To recruit participants for the study, the

researcher will contact agency representatives that support children with autism. An email with

a brief summary of the study discloses the purpose to the representatives. Upon consent to recruit

participants at the agency, a flyer with information about the research and initial contact

information is distributed to families at the agency. In addition, a letter to the British Columbia

Autism Community Training (ACT) will inform the members of the research and inquire if

consent for recruitment through ACT is available. If permission is received from ACT, postings

regarding the research study is provided on the ACT website. Recruitment of participants

consists of individuals who reside in the Lower Mainland.

Settings and materials

The location for a large portion of the experimental procedures will take place in natural

settings. The administration of preliminary measurement tools, for behaviours such as the

imitation and identification of emotions, and the preference assessment will take place in a lab


setting at the University of British Columbia. The lab setting is at a location that is familiar to

prospective participants and is suitable for the purpose of time and convenience for the

researcher. If participants are unable to commute to the lab setting, the researcher contacts the

family to make an appointment for an assessment session. Training for the parent or caregiver

interventionist takes place in a group at the lab setting. The lab setting is a feasible meeting

location where parents and caregivers are trained with one another and are able to practice

implementing prompting procedures, data collection, and attain general feedback from the

researcher.

The intervention will take place in the participant’s home. The location for intervention is

a room in the house where the participant is free of distraction and has access to a television,

with a DVD player, or a computer. The room in the house should accommodate up to three

individuals in the room at once. Data collection will occur in the home, and video recordings of

sessions are evaluated at the University of British Columbia.

Measurement

Dependent variables. The main dependent variables in this research proposal are anxiety

in children with autism and the use of relaxation/calming strategies. Anxiety measures are

observed through the heart rate of the participants. Heart rate, also known as pulse, is the number

of heartbeats, which are measured by a unit of time, and is based on the number of contractions

of the ventricular muscles (Spodick, Raju, Bishop, & Rifkin, 1992). The heart rate is an

observable variable that is measured by physical touch on the inside of the wrist or on the neck,

close to the carotid artery, or by using a monitor. The rate of heartbeat varies depending on the

individuals’ physical and mental states where an increase and decrease in heart rate is

measurable. The target heart rate is the resting rate for each participant. The resting rate is


recorded at the beginning of each baseline session to obtain stability in rate. Heart rate measures

during baseline include: (a) before the presentation of the video, (b) at the start and end of each

video clip; and (c) at the end of the session. Heart rate measures in intervention are intermittent

and include: (a) before the presentation of the video, (b) at the start, middle and end of each

video clip; (c) start of rehearsal; (d) end of rehearsal; and (e) at the end of the session. The

measure of heart rate is beats per minute and recorded with a monitor, which is discussed in the

measurement procedures. The parent or caregiver interventionist collects data on an interval

recording system. For every minute the heart rate is recorded, the occurrence of a resting heart

rate is scored. Dividing the number of intervals of resting heart rate by the total number of

intervals and multiplying by 100 calculate the percentage of intervals of the resting heart rate.

Behavioural Relaxation Training is the relaxation strategy under investigation as a

dependent variable. BRT consists of ten postural positions and behaviours (Donney & Poppen,

1989; Raymer & Poppen, 1985). Raymer and Poppen (1985) included a detailed description of

BRT. The description of BRT is the same for this study with one alteration in the position of the

hands. Raymer and Poppen measured the following: (a) breathing–rate is lower than at baseline;

(b) quiet–the participant does not initiate verbal communication or engage in vocalizations; (c)

body–trunk is still and no movement is observable; (d) head–is in the midline of the body; (e)

eyes–are closed and eyelids are smooth; (f) mouth–lips are parted slightly to allow for exhale; (g)

throat–no movement; (h) shoulders–no movement and sloped down; (i) hands–placed on the

thigh, palms up, with fingers curled in to touch the palm; and (j) feet–flat on the ground pointed

away from each other.

Similar to Raymer and Poppen, breathing rate is recorded as number of breaths per 30 s

by observing the movement of the stomach and chest. The number of breaths during intervention


is lower than baseline for the reason that the technique of breathing changes to deep breathing.

Raymer and Poppen included 15 s to observe quiet, body, head, eyes, mouth, throat, shoulders,

hands, and feet tasks; and 15 s to record data. The dependent measure for BRT is total duration

of the behaviour chain paired with breathing rate. Data are expressed as number of minutes

engaged in the behaviour per session.

The parent or caregiver interventionist records BRT data with the trial recording system.

The trail recording system is a suitable choice for BRT since the behaviour is a set of ten chained

tasks performed by the participant with a clear beginning and end. The ten steps include: (a)

breathing; (b) quiet; (c) body; (d) head; (e) eyes; (f) mouth; (g) throat; (h) shoulders; (i) hands;

and (j) feet. During the session, the parent will record the level of prompting necessary for each

step and in addition to correctly performing deep breathing, breathing rate is recorded. Dividing

the number of steps successfully completed by the total numbers of steps in the routine and

multiplying by 100 calculates the percentage for BRT.

Measurement procedures

General data collection procedures. All data collection will take place in the home

during intervention sessions. Having the parent or caregiver as the main interventionist, the

position requires data taking in a timely manner that is accurate with the participants behaviours.

Data will be taken in pencil and paper format on a template devised by the researcher. Data

collection will include: (a) the participants ability to attend to the video clips; (b) recording of

heart rate; (c) required prompting levels in role-play; and (d) the participant performs BRT

independently.

To collect data on the participants’ attention to the video, a partial interval recording

system is used. The parent will be given a stopwatch to collect data in 30 s intervals for the


occurrence or nonoccurrence of attending. When the parent emits a verbal reminder, a “V” for

verbal prompt is recorded in the interval, following a score of non-occurrence. The percentage of

intervals of attending will be calculated by dividing the number of intervals of attending by the

total number of intervals and multiplying by 100.

The primary measure of heart rate is collected with the Polar Move, a strapless heart rate

monitor designed for children and adolescents. The Polar Move displays the heart rate in beats

per minute (bpm), or in percent. For the purpose of this research, the parent will record the bpm

on an interval basis.

To collect data on the participants’ performance on BRT, the tasks in the behaviour chain

are measured. The topography for each task is: (a) breathing–inhaling through the nose, with

partial projection of the trunk forward and primary movement is seen in the abdominal region,

and with lips parted an exhale through the mouth; (b) quiet–the participant does not initiate

verbal communication or engage in vocalizations; (c) body–trunk is still and no movement is

observable; (d) head–is in the midline of the body; (e) eyes–are closed and eyelids are smooth;

(f) mouth–lips are parted slightly to allow for exhale; (g) throat–no movement; (h) shoulders–no

movement and sloped down; (i) hands–placed on the thigh, palms up, with fingers curled in to

touch the palm; and (j) feet–flat on the ground pointed away from each other. The prompting

procedures include: (a) fully physical prompt; (b) partial physical prompt; (c) model; (d) gesture;

(e) verbal cue; and (f) independent. When behaviour is maintained for three 60 s trials with 90%

accuracy, BRT reaches mastery criterion.

Inter-observer Agreement Procedure. To obtain independent observers to collect inter-

observer agreement (IOA), two graduate students from the University of British Columbia are

recruited for this position. The independent observers will be trained by the researcher and given


a manual to review the procedures and gain a proficient understanding of the dependent

measures and the coding system. A protocol is also set up for the etiquette of observing sessions

to collect IOA. Etiquette of observation includes: (a) the duration of the observation period; (b)

seating arrangements; (c) interaction with others; and (d) problem solving strategies. Once the

independent observer gains a criterion of 90% agreement across two consecutive preliminary

observations with the researcher, formal data collection will begin. If low IOA is found during

the preliminary stages of data collection, the operational definitions will be reexamined and

refined.

Collection of IOA is collected in the home for 35% of sessions and the video recordings

will be assessed at the University of British Columbia for further IOA assessments. An

agreement of 90% is accepted for the observation of each dependent variable. Each IOA session

will include two independent observers recording data on a datasheet. The observers will be

unaware the data is collected for reliability measures. The observers will be separated in the

home by having the observers sitting at opposite sides of the intervention setting. At the

University of British Columbia setting, the independent observers will be watching the video

recordings in the same setting and positioned five feet away from each other to limit bias in data

collection. IOA collection in the home should occur 10% of the time and 25% will be collected

via video.

To minimize the chance of threats to internal validity, such as observer drift and observer

bias, the independent observers are continually trained during the study by the researcher and

reminded of the threats related to biases. Furthermore, if participant reactivity generates from the

presence of independent observers, alterations to the home setting include moving the

intervention to a larger room where the obtrusiveness of the observers is minimized.


IOA for intervals of attending. The two observers will collect data with the interval-by-

interval procedure for IOA. The two observers record the occurrence and non-occurrence of

parent or caregiver interventionists recording the data for attending in 30-second intervals. An

agreement score is given when the two observers both score either occurrence or non-occurrence

of data recording in the same interval, and a disagreement score is given when the two observers

data contradict one another for the same interval. To obtain a percentage for agreement, the

number of agreements divided by the total of agreements plus disagreements multiplied by 100 is

calculated.

IOA for percentage of intervals of heart rate. The two observers will collect data with

the interval-by-interval procedure for IOA. The two observers will examine an observation

session and collect data in 60-second intervals. The observers will record the occurrence of data

collection in each interval, and will record non-occurrence. Agreement scores are given when the

two observers record occurrence and non-occurrence in the same interval, and a disagreement

score is given when the data from the two observers oppose one another. To obtain a percentage

for agreement, the number of agreements divided by the total of agreements plus disagreements

multiplied by 100 is calculated.

IOA for total duration of BRT. The two observers will collect data with the interval-by-

interval procedure for IOA. The two observers examine a video-recorded session and data is

collected on the number of steps completed correctly in BRT. Occurrence of each chain task is

scored, and a non-occurrence score is given for each chain task not completed. An agreement

score is given when the two observers score either an occurrence, or non-occurrence in each

interval. A disagreement score is given when the two observers occurrence and non-occurrence

scores contradict one another in each interval. To obtain a percentage for agreement, the number


of agreements divided by the total of agreements plus disagreements multiplied by 100 is

calculated. A cue to record data is provided with a personal audio device for each observer. The

audio cue allows for accuracy in the data and a signal is given simultaneously to activate the

audio device.

Procedural Fidelity. Three graduate students from the University of British Columbia,

who are recruited from the Faculty of Education, will receive training to collect data on

procedural fidelity. Procedural fidelity data is recorded for baseline procedures and the execution

of intervention. Each graduate student will be randomly assigned to a participant. The graduate

students’ responsibility is to observe the video recordings of the intervention sessions and

compare the interventionists’ ability to follow the procedural plan, and calculate the percentage

of agreement. The student collects baseline data for three consecutive sessions and collects

intervention data for 35% of sessions for the duration of the intervention phase. The formula to

obtain a percentage for procedural fidelity is: the number of observed behaviours divided by the

number of planned behaviours multiplied by 100. This formula will apply to each of the

following intervention procedural steps: (a) use of an attention cue; (b) recording the heart rate at

correct intervals; (c) implementation of prompting procedures; and (d) delivering the appropriate

consequence for response.

Research Design

A multiple probe baseline across participants’ is the experimental design proposed to

evaluate the effects of Behavioural Skills Training (BST). The multiple probe baseline design is

an appropriate design seeing that anxiety hinders the child’s ability to manage the day-to-day

routines and interactions and removal of intervention may be considered harmful to the child’s

wellbeing. In addition, behaviours learned may not be reversible. The potential participants for


this research study display similarities in the behaviours related to anxiety, and employ the

behaviours in comparable settings and situations in which anxiety occur. A multiple baseline

probe design (days) for the study is a relevant design since data collection before intervention is

intermittent. Data in the baseline phase is unable to be collected on a continuous schedule since

the participant may have time constraints, such as school. In addition, incorporating parents as

intervention agents further increases the time restraints. Data is required to be recorded across

four consecutive days or sessions, and probe trials will take place daily. Previous research in

BST implemented multiple baseline designs to teach different skills such as oral care, natural

language paradigm, parent training for children with food selectivity, and social skills (Bruzzi-

Nigro & Sturmey, 2010; Gianoumis et al., 2012; Graudins et al., 2012; Seiverling et al., 2012;

Stewart et al., 2007).

Research Procedures

The procedures are discussed as follows: (a) preliminary start-up procedures; (b) baseline; (c)

intervention; and (d) follow-up.

Preliminary start-up procedures. Once consent is attained from the parents, the

preliminary procedures for this research proposal involve meeting with the children and parents

to determine if the child meets components of the inclusion criteria. Imitation skills,

identification of emotions, and anxiety measures are modules for the inclusion criteria requiring

assessment. The MSWO preference assessment precedes the evaluation of the inclusion criteria,

which will take place in the first meeting. In the initial meeting, an appointment is arranged for

the inclusion criteria assessment. The child with autism will receive the Imitation Battery,

Pictures of Facial Affect system, and The TFB Discrimination Task assessments at the

University of British Columbia. Following the evaluation of the Imitation Battery, Pictures of


Facial Affect system, and The TFB Discrimination Task, the parent receives the SCARED and

SCAS-P. A period of one week, seven business days, will be provided to the family to finish the

SCARED and SCAS-P. Upon the completion of the Imitation Battery, Pictures of Facial Affect

system, and The TFB Discrimination Task, and the evaluation of the SCARED AND SCAS-P,

the researcher contacts the family to inform the parent and child if the meets standards for

participation. If the child is accepted into the study, a meeting is scheduled to inform the parents

of the components of the study.

The researcher asks the parents to review an information packet about BST and BRT. A

comprehensive BST and BRT manual outlines the phases and explains the roles and

responsibilities of the parent or caregiver. The researcher will give answers to questions about

BST if the parents are unclear of the factors related to each teaching method. A discussion of the

production of video materials will take place between the parents and researcher. Video materials

will involve the participation of parents, or caregivers, of the child with autism and the

researcher. The parent or caregiver who is not involved with implementing intervention is the

model for the video clips. If a parent or caregiver does not give consent to participate in the

video model, the parents or caregivers are asked to find an individual, who is familiar with the

child and is highly preferred, willing to partake in the video model. Each child participant is

provided with an individualized video. Each video clip is based on a situation that generates

anxiety in the child with autism. The adult model act-outs and verbally identifies the physical

features that emerge as anxiety and models BRT. Each anxiety-provoking scenario is created in

the true location where anxiety is developed for the child with autism. The adult model is

thinking aloud and identifying what factors generate anxiety in the situation, cue to relax, and

begin BRT to help self-regulate behaviours. The research proposal entails two dependent


variables; following the criteria for video modeling, each dependent variable will have 3

different video modeling clips (Charlop-Christy & Freeman, 2000; Ganz, Earles-Vollrath, &

Cook, 2011; McCoy & Hermansen, 2007). In total, six scenarios are created for each participant.

Editing of videos will take place at the University of British Columbia lab and completed by the

researcher. The duration of the video, for all six clips, is edited to approximately 5 to 8 minutes

long (Ganz et al.). For baseline, three out of the six clips are created to display the anxiety-

provoking situation and no cue is presented for engaging in BRT. The chain of behaviours

affiliated with BRT is performed without verbal instruction. The instructional cue for engaging

in the coping skills is present in the intervention videos.

A training session is provided for the adult model in BRT. The model is given a script of

the main components necessary that require a label to identify the behaviour. The ten

components will have a description that is clear and succinct. Models will have an opportunity to

practice, and is given feedback to ensure the behaviours are done correctly. A description of

breathing includes inhaling through the nose, with the breath filling the stomach, and with lips

parted, exhales through the mouth. An explanation of quiet will entail the model commenting on

staying silent and without making noises or sounds. An illustration of the body will comprise of

the trunk, shoulders, and head. The trunk of the body is still and not engaging in movement while

the head remains in a straight position with no movement toward the sides. The shoulders are

described to be loose, with the sensation of being heavy and sloped down. The head remains still

in the central midline of the body, with no movement or tilt positioning to the side. The eyes,

mouth, and throat are illustrated together. The eyes will be closed with smooth eyelids, which

denotes the eyes are not squinting while closed, and the mouth is relaxed remaining open and

lips split slightly. To describe the throat, no swallowing will occur. The hands and feet


description will remain the same as the operational definition for BRT (hands are placed on the

thigh, palms up, with fingers curled in to touch the palm; and feet are flat on the ground pointed

away from each other).

The training for the parent or caregiver who is the main implementer of the intervention

will take place in the same timeframe as the creation of the video clips. Parent and caregiver

training include, monitoring the participant’s heart rate, data taking, and providing the necessary

prompting procedures to teach the participant relaxation strategies. The group-based training

allows the researcher to train all parents at once versus individualized training time slots, which

allocates more time to training and for video editing. The parents are given the heart rate

monitor at the time of training to acquire the skills in using the monitor appropriately. The

researcher will study and analyze the heart rate monitor instructions to adapt and simplify the

instructions for the group. The parent or caregiver interventionists will practice using the

monitors on other group members until the participant and caregiver is comfortable with

applying the monitor to the participant. A packet of data sheets is distributed to the parent or

caregiver interventionists. One data sheet is a checklist to observe the participants ability to

attend to the video, and a second data sheet requires the parent or caregiver interventionist to

record what prompting procedures, or assistance, is required for the participant to rehearse and

implement BRT prompting procedures. The prompting procedures reviewed in the group training

involve most-to-least prompting. Parents are trained to lend assistance in steps where the

participant does not respond in the rehearsal phase of an intervention session. Furthermore,

parents are trained to present a time delay of 3 to 5 seconds before assisting the participant.

Depending on the BRT behaviour, e.g. closed hands, the parent can yield hand-over-hand

assistance. Hand-over-hand assistance is faded to a gestural prompt after two rehearsals of the


behaviour, and a gesture continues for another three or four rehearsals. The level of fading will

depend on the participant’s abilities and is individualized to suit his/her needs. If the BRT

behaviour is too difficult to prompt, i.e. no movement in the throat, closed eyes with smooth

eyelids, the parent will provide an in vivo model of the correct behaviour. For most prompting,

verbal to gestural cues should suffice. Furthermore, reinforcement and feedback training is

reviewed.

Before the intervention commences, the researcher will visit the families to go over the

baseline and intervention procedures. At this time, the research will conduct a brief MSWO

preference assessment. The items identified as reinforcers are made available to the participant

during the intervention phase. In addition to the items from the first MSWO assessment, the

second MSWO yields a higher number of items for the parent interventionist to present to the

participant.

Baseline. During the baseline phase, the researcher will probe and observe if coping

strategies are acquired from watching the baseline video clips. Before in the introduction of the

video, the participants are allocated time to watch leisure shows on the television to identify and

record the resting heart rate. The participants will watch a segment of the video with the adult

model engaging in anxiety provoking situations. The video clip is short in duration and the

observation will identify if the participant is able to engage in coping strategies without the

instructional cue in the intervention video. The participants’ heart rate is recorded to obtain if an

elevated heart rate generates from watching the scenario. An initial four observation periods are

allocated to gain a stable baseline. All sessions are recorded to check for procedural fidelity and

IOA data.


Intervention. The intervention will begin at the completion of the baseline procedure.

The main procedure for this intervention involves BST. The video clips incorporate modeling

and instruction phases of BST simultaneously. For the modeling phase, the adult model in the

video demonstrates the behaviours that lead to the use of correct behaviours, BRT, and is

immediately reinforced. To assist with the participants attending skills, the parent or caregiver

interventionist is highlighting the important features in the video clip. Each video clip

incorporates a break for the participant to engage in rehearsal before attending to the next

segment of the video.

The instruction in the video describes the behaviours and clearly states the actions of the

behaviour the learner is expected to engage in. Anxiety is a chain of actions leading to the coping

strategy. In the video, when anxiety begins to develop in the adult model, the model will verbally

express the physical signs of anxiety and emphasize the heart is beginning to beat fast. The

description for an increase in heart rate includes the heart beating backwards and forwards in the

chest at a quickened pace, the “thump” or beating begin to get stronger, and the sensation of the

heart moving up into the throat of the person. The indication of the models heart beating fast will

then lead to identification of a feeling (“I’m anxious/ worried/ stressed, nervous”) and a reminder

to engage in BRT. To begin BRT, the model utters a comment with a verbal cue that must

include “quiet and still” (Lindsay et al., 1996). Subsequently, the model will perform the BRT

steps and verbally describe each step. Pairing the instruction and modeling components may

enhance the acquisition of identifying the anxiety and implementing appropriate coping

strategies (Milltenberger). When the adult model in the clip completes BRT and makes a

statement that indicates he/she is all right, the parent or caregiver interventionist will pause the

video and either cover the screen or turn the monitor or television off, following reinforcement.


Reinforcement is given to the participant, in the form of praise, for attending to the clip. The

heart rate monitor checks occur every minute. Attending to the video is important to supports the

participants’ rehearsal in the next phase of BST (Miltenberger, 2008).

The parent or caregiver interventionist records heart rate data before engaging in

rehearsal. Rehearsal begins when the participant is given the instruction, “Now its your turn to

try,” from the adult interventionist in the room. The participant will role-play the behaviours

observed in the video clip. The participant imitates the verbal component of the clip during the

identification of anxiety, and participates in the verbal cues and physical actions of BRT. The

parent or caregiver interventionist will provide the necessary prompts for correct imitation. Heart

rate is monitored every minute to identify if resting heart rate is attainable. If prompting occurs,

the parent or caregiver interventionist will immediately take data following the prompt.

Reinforcement of the correct behaviours in rehearsal immediately succeeds the imitation of the

behaviour. Reinforcers in the form of praise and a tangible are provided; the tangible item is

offered in the form of choice. Rehearsal of behaviours continues until the participant is correctly

demonstrating the behaviour independently for three to four consecutive days.

Feedback during the rehearsal stage of BST is continuous. If participants engage in errors

during the rehearsal, immediate correction and in vivo instruction is provided to the participant.

However, the praise for participation precedes the discussion and correction of errors. Praise

entails the description of verbal and nonverbal actions exhibited by the participant. For example,

the parent may comment, “You did a great job describing how your body feels when you get

anxious and sitting still to practice breathing”. If an error is identified, the feedback from the

parent or caregiver will not entail negative statements. Corrective feedback comments include

wording such as, “How about trying…” or, “You can also try it…” etc. For example, the parent


may comment, “Awesome job keeping your eyes closed and relaxed, and breathing through your

nose and out through your mouth! I could really see you breathing into your stomach. With your

hands, how about trying to place them on your thighs with palms up and curling your fingers into

your palms. I think it is more comfortable than having your arms hang down your sides. Let’s

give it a try.” The feedback states the error without emphasizing the participant as incorrect;

instead, the behaviour of hanging the arms down the side is ineffective, and the parent

recommends a more effective, and correct, behaviour. The parent or caregiver describes steps

the adult model utilizes in the video, or gives alterative models that are similar, for the

participant to imitate. The parent or caregiver interventionist expects correct imitation following

the error correction and instructional cue, and offers differential reinforcement for correcting the

aspects of the behaviour. If multiple errors are observed, the parent or caregiver interventionist

will discuss and correct the error one at a time and focus on one aspect until correct performance

is acquired. All sessions are recorded for procedural fidelity and IOA.

Symbolic modeling, rehearsal, and feedback are mandatory for all six video clips, where

the participant will observe and role-play in each intervention session. If the participant is

observed to have difficulties with skill acquisition via video, the data does not show progress,

BST will continue in in vivo format. In this case, parent or caregiver interventionist will be the

model and data on attending is collected by the research assistant in video format. The parent or

caregiver interventionist continues to take data in the rehearsal phase. Parent or caregiver

training will take place in the home before intervention is altered.

Intervention sessions occur daily, most likely after school, and are scheduled to take

place at the same time everyday. The duration of the session is approximately 20 to 30 minutes

and varies depending on the participant’s attention and acquisition levels. The participant is lead


into the session room by the parent or caregiver interventionist and the parent or caregiver will

prepare the television, or computer for the video clips. After preparation, the parent will sit

behind the participant and begin to take data. Each day, the parent or caregiver participating in

the intervention presents the six video clips in alternating orders. The multiple exemplars and

alternation of the orders assists in the generalization of the relaxation strategies (Miltenberger,

2008). A document with the alternating video order will assist with the randomization order for

the parent. A video camera is set up to record sessions. The video camera is set up in a position

that can observe the participant and the interventionist. The parent will begin the recording

before the participant enters the room and identifies the date and time of the intervention.

Follow-up. To follow-up on the participants’ ability to generalize and maintain the

behaviours, the researcher will schedule a consultation with the parents two weeks after the

completion of the intervention. The follow-up procedures consist of the parent, caregiver, or

adult model not involved in the intervention procedure to complete the SCARED after the

completion of the intervention procedure. The evaluation of the SCARED informs the researcher

of the changes in the participant and whether improvements are observed. Furthermore, the

information will reveal the social validity of the effects for significant others of the participants.

To identify the social validity of the procedure, a questionnaire regarding the complexity of

implementing the intervention procedures will be given to parent or caregiver interventionist to

yield information on the feasibility of this intervention. To gain “consumer satisfaction data”

(Gast, 2010 p.102), parents of the participant will distribute a questionnaire to teachers and adult

individuals who interact with the participant on a regular basis, and is not aware of the

intervention. The feedback from the questionnaire will contribute additional information

regarding generalization and the effectiveness of the intervention.


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7610.2008.01948.x


Figure Caption

Figure 1

Graph with anticipated results for percentage of intervals of resting heart rate.

Figure 2

Graph with anticipated results for the percentage of relaxation training behaviours.


Figure 1. The above is a graphic display of anticipated results for the percentage of intervals of resting heart rate.


Figure 2. The above is a visual graphic display of the anticipated results for the percentage of relaxation training behaviours.


Timeline

Week 1 to 4 • Complete research on the topic of study and begin to formulate succinct literature review. • Identify and determine the measurement procedures and experimental design. • Prepare a research proposal draft. • Present the research topic to supervisor and research committee; await approval on the topic

for research. • Upon receiving approval, complete thesis proposal to include: (1) literature review on topic;

(2) research question; (3) information on potential participants; (4) setting of research; (5) measurement procedures; (6) research design; (7) research procedures; and (8) references.

• Submit application to the ethical review board at the University of British Columbia. Wait for approval.

Week 5 to 8 • Begin to recruit graduate students’ for positions as an observer for IOA and procedural

fidelity. • Begin to compose a thorough literature review on the topic of research. • Meet with supervisor to discuss and review comments and feedback received from the ethical

review board. • Revise and edit the research proposal for resubmission of application to the ethical review

board. Week 9 to 13 • Train observers for IOA. • Assess interobserver agreement. • Develop a social validity questionnaire regarding the implementation of the intervention

procedures. • Prepare materials and datasheets for inclusion criteria measures: (1) Imitation Battery; (2)

Pictures of Facial Affect; and (3) The Thought/Feeling/Behaviour Discrimination Task. • Approach and contact agency representatives to gain permission to recruit participants from

the agencies. Contact ACT to inquire if recruitment of participants is feasible and permitted through ACT.

• Recruit participants for study. • Purchase the Polar Move heart rate monitors. • Set up the lab setting for meeting with potential participants and the area for implementing

the inclusion criteria measures. • Collect and purchase items for preference assessment. • Set up initial meeting with potential participants individually. • Prepare a document to provide the parents with a brief outline of the research study. Week 14 to 17 • Recruit graduate students from the University of British Columbia to observe and evaluate

procedural fidelity. • Obtain consent for participation.


• Phone parents of the participants to set-up meetings for the preference assessment and the inclusion criteria measures.

• Provide the parents with a document, which outlines the mandatory documentation of the participant.

• Conduct MSWO preference assessment with potential participants. • Assess potential participants to determine inclusion criteria: (1) Imitation Battery; (2)

Pictures of Facial Affect; and (3) The Thought/Feeling/Behaviour Discrimination Task. • Provide parents with the Screen for Child Anxiety Related Emotional Disorders and Spence

Child Anxiety Scale – Parent. • Evaluate the results of the (1) Imitation Battery; (2) Pictures of Facial Affect; and (3) The

Thought/Feeling/Behaviour Discrimination Task; (4) Screen for Child Anxiety Related Emotional Disorders; (5) and Spence Child Anxiety Scale – Parent.

• Determine which children with autism meet the criteria for inclusion to participate. Notify the family to set-up further meetings.

• Determine which children with autism do not meet the criteria for inclusion and inform the parents. Prepare a document for the parents that summarize and outline the results from the assessments.

• Train the observers for procedural fidelity. • Test IOA observers; minimum score of 90%. Week 18 to 22 • Assign participants, at random, to baseline lengths. • Parents are provided a comprehensive information packet with details about BST and BRT,

and information about parent involvement in the study. • A phone or in-person meeting is arranged to discuss creating video materials for the study. • The adult model in the video is given training in BRT at the University of British Columbia. • The researcher and parents will create video materials for the participants. • Video edits will take place at the University of British Columbia. • Parent training for implementation of intervention will take place at the University of British

Columbia. • Review procedural fidelity procedures with observers • Conduct a brief MSWO preference assessment. • Meet with the parents to discuss and prepare for baseline with the first participant. • Retest IOA observers. Week 22 • Implement the first baseline. • Obtain data for baseline of first participant • Meet with supervisor to discuss the implementation of the intervention progress. • Conduct IOA for the first participant. • Obtain video for procedural fidelity. Assess for procedural fidelity. Week 23 to 24 • Implement the first intervention phase.


• Coordinate a phone meeting to discuss intervention with parent interventionist, for first participant.

• Meet with the first participant’s family to discuss progress. Collect data. • Meet with parents to discuss and prepare for baseline with the second participant. • Conduct a brief MSWO preference assessment. • Arrange in-person or phone meeting with IOA observers to go over training. • Procedural fidelity is measured for the first participant. • Conduct IOA and evaluate for first participant. Week 25 • Implement the second baseline • Obtain data for baseline of second participant • Meet with supervisor to discuss progress in intervention procedures. • Meet with the first participant’s family to discuss progress. Collect data. • Procedural fidelity is measured for the first participant. • Conduct IOA and evaluate for the first and conduct IOA second participant. • Obtain video for procedural fidelity for the second participant at baseline; assess for

procedural fidelity. Week 26 to 27 • Implement the second intervention phase • Coordinate a phone meeting to discuss intervention with parent interventionist, for second

participant. • Meet with the second participant’s family to discuss progress. Collect data. • Conduct a brief MSWO preference assessment with second participant. • Meet with parents to discuss and prepare for baseline with the third participant. • Arrange in-person or phone meeting with IOA observers to go over training. • Procedural fidelity is measured for the second participant. • Conduct IOA and evaluate for the second participant. Week 28 • Implement the third baseline • Obtain data for baseline of third participant. • Meet with supervisor to discuss progress in intervention procedures. • Meet with the second participant’s family to discuss progress. Collect data. • Administer the SCARED and SCAS – P, and intervention questionnaire to the first

participant’s parents. • Procedural fidelity is measured for the second participant. • Obtain video for procedural fidelity for the third participant at baseline; assess for procedural

fidelity. • Conduct IOA and evaluate for second and conduct IOA for third participant Week 29 to 30 • Implement the third intervention phase


• Coordinate a phone meeting to discuss intervention with parent interventionist, for third participant.

• Meet with the third participant’s family to discuss progress. Collect data. • Conduct a brief MWSO preference assessment with the third participant. • Conduct follow-up, after three weeks, with the first participant. • Begin to write the results. • Arrange in-person or phone meeting with IOA observers to go over training. • Procedural fidelity is measured for the third participant. • Conduct and evaluate IOA for second and third participant Week 31 • Meet with the third participant’s family to discuss progress. Collect data. • Administer the SCARED and SCAS – P, and intervention questionnaire to the second

participant’s parents. • Meet with supervisor to discuss progress in intervention procedures. • Procedural fidelity is measured for the third participant. • Conduct and evaluate IOA for third participant Week 32 to 33 • Conduct follow-up, after three weeks, with the second participant. • Arrange in-person or phone meeting with IOA observers to go over training. Week 34 • Administer the SCARED and SCAS – P, and intervention questionnaire to the third

participant’s parents. • Meet with supervisor to discuss progress in intervention procedures. Week 35 • Conduct follow-up, after three weeks, with the third participant. Week 36 to 40 • Discuss the results with the supervisor • Write and prepare the results and discussion sections. Week 41 to 42 • Present the draft manuscript to supervisor and family. Week 43-44 • Discuss feedback from the supervisor and modify and edit the manuscript to include

revisions. Week 45 • Complete manuscript.

exploring behavioural skills training to teach self-monitoring...

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