A growing body of literature suggests manipulating some graphing conventions can affect visual analysis and adherence to graphing conventions varies widely in single case design publications. Yet use of graphing conventions by the wider population of behavior analysts is largely unexplored. The current study examined relations among types of graphing conventions (established versus unestablished functions), demographic variables (e.g., education level, primary job setting), and likelihood of revision ratings reported by 631 board certified behavior analysts (BCBAs, BCaBAs, and BCBA-Ds). Statistically significant differences in ratings were detected across types of conventions and demographic categories. Master’s level BCBAs in clinical roles were more likely to revise conventions that affect visual analysis than conventions whose functions are unknown, whereas there were no differences between types of conventions for doctoral level BCBAs in academic roles. We discuss these findings in the context of audience control of graphing conventions.

Graphing is a complex and critical skill for behavior analysts. We evaluated the effects of conceptual training modules and feedback checklists on verbal behavior about graphing conventions and adherence to graphing conventions with graduate students in behavior analysis. In Experiment 1, conceptual training increased the accuracy of verbal behavior, though both participants achieved criterion in the absence of instruction for some verbal behavior. When graphing adherence did not meet criterion, feedback checklists were implemented that resulted in criterion performance. In Experiment 2, checklists were provided as the primary intervention. Two out of four participants reached criterion for graphing adherence and verbal behavior with this intervention alone, while the remaining two participants reached criterion after a combination of checklists and conceptual training. This evaluation highlights the utility of a sequential approach to training the component skills of a complex repertoire while assessing conceptual behavior and extension of skill acquisition of the individual learner.

Background: While training in Applied Behavior Analysis (ABA) increases parents' skills in reducing problem behaviors of their children with Autism Spectrum Disorder (ASD; autistic) and reduces their own parental stress, these programs have not been tailored nor accessible to Spanish-speaking parents, and their acceptability within this population remains unclear.Method: A 10-week ABA parent training program was delivered to monolingual Spanish-speaking parents (n=11) of children with ASD aged 6-10 years old.The program included an initial assessment, six group and four individual evening meetings delivered exclusively in Spanish, with food, transportation, and childcare.Individual interventions were designed with each family to address a parent nominated target behavior.Child behaviors were monitored weekly using Antecedent-Behavior-Consequence (ABC) recording and the Aberrant Behavior Checklist and Parent Stress Index was administered before and after the intervention.Results: There was high attendance (84.6%) across sessions overall.A wide range of behavioral challenges was reported; approximately 78% of parents found the intervention to be acceptable and saw reduced problem behavior.Parental stress was also significantly reduced post-intervention.Conclusions: Adaptations to existing ABA parent training interventions are needed to better support Spanish-speaking families of children with ASD, and acceptability of these interventions should be an ongoing part of an iterative intervention delivery process.

This paper examines the reliability and validity of parent target problems (PTPs) in a multi-site randomized controlled trial of parent training (PT) versus psychoeducation (PEP) in children (150 boys, 19 girls; mean age 4.7 ± 1.2 years) with autism spectrum disorder (ASD) and disruptive behavior. At baseline, treatment blind, independent evaluators asked parents to nominate the child’s top two problems. Each problem was documented in a brief narrative. Narratives were reviewed and revised at follow-up visits during the six-month trial. When the trial was completed, five judges, blind to treatment condition, independently rated change from baseline on a 9-point scale (1 = normal; 2 = markedly improved; 3 = definitely improved; 4 = equivocally improved; 5 = no change; 6 = possibly worse; 7 = definitely worse; 8 = markedly worse; 9 = disastrously worse) at Weeks 8, 12, 16, and 24 (inter-rater intraclass correlation = 0.78). PTP scores for the two target problems were averaged across the five raters, yielding a mean score for each child at each time point. Mean PTP scores showed improvement in both treatment groups over the 24-week study. Compared to PEP, PTP ratings showed a steeper decline in PT based on significant interaction of group and time (t(df) = 2.14(155.9), p = 0.034; Week 24 effect size = 0.75). In categorical analysis, we compared cutoffs mean PTP scores of 3.0 (definitely improved), 3.25, and 3.5 with the positive response rate on the Clinical Global Impressions-Improvement scale from the original study. Sensitivities ranged from 52–78%. PTP narratives offer a systematic, reliable, and valid way to track child-specific outcomes in clinical trials and clinical practice.

The Behavior Analyst Certification Board (BACB) annually publishes data on the pass rates of institutions with verified course sequences (VCS). The current study analyzed BACB-published data from the years 2015-2019 and explored relations among program mode, number of first-time candidates, and examination pass rates. In a correlation analysis of number of first-time candidates and pass rates, there was a weak negative correlation, indicating that larger numbers of first-time candidates are associated with lower pass rates. Further, statistically significant differences were found among the mean number of first-time candidates, mean pass rates, and mean number of passing first-time candidates across program modes. Campus and hybrid programs had higher mean pass rates than distance programs, whereas distance programs had higher numbers of passing first-time candidates than campus programs. External validity and implications for indicators of program quality are discussed.

A scoping review of the literature was conducted to identify published studies in which parents of children with Autism spectrum disorder (ASD) were trained to implement interventions designed to improve their child's feeding and mealtime behaviors. Twenty-six studies were included in the review. Of these, 23 used single subject designs, and 3 used group designs. All reported improvements in target behaviors (usually acceptance of novel foods or reduction in disruptive mealtime behavior). However, only 3 described a procedure for incorporating parent input into the intervention plan; 7 directly measured parents' fidelity in implementing intervention procedures; and 7 assessed social validity or parent satisfaction. Thus, there is a need for more systematic involvement of parents in treatment for feeding in children with ASD and more comprehensive outcome assessment.

Objective: Anxiety disorders are one of the most commonly co-occurring psychiatric diagnoses in youth with autism spectrum disorder (ASD), with a frequency ranging from 22% to 84%. Methods: We conducted a chart review of 29 children and adolescents with ASD who had been treated with selective serotonin reuptake inhibitor (SSRI) monotherapy for an anxiety disorder for at least 2 months. Subsequent chart reviews were conducted for the first follow-up visit within 2-6 months (M = 4.2 months) and the visit closest to 9 months posttreatment (ranging from 7 to 12 months; M = 10.5 months). The presence of adverse events (AEs) was examined, and a consensus Clinical Global Impressions Improvement (CGI-I) score was determined. Results: Fifty-five percent of patients were given a CGI-I of "improved" or "very much improved" at the 9-month follow-up. Four patients discontinued treatment owing to AEs. Other reported AEs not leading to discontinuation included vivid dreaming, increased emotional lability, and irritability. Responders included a number of patients who had failed previous SSRI trials. Conclusions: This study suggests that SSRI treatment should be considered for individuals with ASD and anxiety disorders, even if prior SSRI trials have been unsuccessful.

OBJECTIVE:This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior. METHODS:This was a 24-week, 6-site, randomized trial of parent training versus parent education in 180 children with ASD (aged 3-7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented. RESULTS:At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p = .004; effect size = 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p = .11; effect size = 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gains in Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment. CONCLUSION:These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time. Clinical trial registration information-Randomized Trial of Parent Training for Young Children With Autism (RUBI); http://clinicaltrials.gov/; NCT01233414.

IMPORTANCEDisruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials.OBJECTIVETo evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior.DESIGN, SETTING, AND PARTICIPANTSThis 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.INTERVENTIONSParent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies.MAIN OUTCOMES AND MEASURESParents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3.RESULTSAt week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001).CONCLUSIONS AND RELEVANCEFor children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT01233414.

Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials.To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior.This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies.Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3.At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001).For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.clinicaltrials.gov Identifier: NCT01233414.

Many children with autism spectrum disorders (ASD) have co-occurring feeding problems. However, there is limited knowledge about how these feeding habits are related to other behavioral characteristics ubiqitious in ASD. In a relatively large sample of 256 children with ASD, ages 2–11, we examined the relationships between feeding and mealtime behaviors and social, communication, and cognitive levels as well repetitive and ritualistic behaviors, sensory behaviors, and externalizing and internalizing behaviors. Finally, we examined whether feeding habits were predictive of nutritional adequacy. In this sample, we found strong associations between parent reported feeding habits and (1) repetitive and ritualistic behaviors, (2) sensory features, and (3) externalizing and internalizing behavior. There was a lack of association between feeding behaviors and the social and communication deficits of ASD and cognitive levels. Increases in the degree of problematic feeding behaviors predicted decrements in nutritional adequacy.

OBJECTIVES:A large percentage of children with autism spectrum disorders (ASD) have bedtime and sleep disturbances. However, the treatment of these disturbances has been understudied. The purpose of our study was to develop a manualized behavioral parent training (BPT) program for parents of young children with ASD and sleep disturbances and to test the feasibility, fidelity, and initial efficacy of the treatment in a small randomized controlled trial (RCT). PARTICIPANTS AND METHODS:Parents of a sample of 40 young children diagnosed with ASD with an average age of 3.5years were enrolled in our study. Participants were randomized to either the BPT program group or a comparison group who were given nonsleep-related parent education. Each participant was individually administered a 5-session program delivered over the 8-week study. Outcome measures of feasibility, fidelity, and efficacy were collected at weeks 4 and 8 after the baseline time point. Children's sleep was assessed by parent report and objectively by actigraphy. RESULTS:Of the 20 participants in each group, data were available for 15 participants randomized to BPT and 18 participants randomized to the comparison condition. Results supported the feasibility of the manualized parent training program and the comparison program. Treatment fidelity was high for both groups. The BPT program group significantly improved more than the comparison group based on the primary sleep outcome of parent report. There were no objective changes in sleep detected by actigraphy. CONCLUSIONS:Our study is one of few RCTs of a BPT program to specifically target sleep disturbances in a well-characterized sample of young children with ASD and to demonstrate the feasibility of the approach. Initial efficacy favored the BPT program over the comparison group and suggested that this manualized parent training approach is worthy of further examination of the efficacy within a larger RCT.

Sleep problems are a common occurrence among children with autism spectrum disorders (ASD). In addition to the adverse effects that sleep problems present for children's neurodevelopment, learning, and daytime behaviors, these sleep problems also present significant challenges for the entire family. This article outlines the results of a comprehensive review of behavioral intervention literature to address sleep problems in young children with ASD using the National Autism Center (NAC) criteria. Results indicate that a variety of antecedent- and consequence-based interventions have been evaluated with young children with ASD to address sleep disturbances. The empirical strength of the literature reviewed reveals an emerging evidence base. These findings suggest the need for more research evaluating behavioral interventions with young children with ASD to contribute to best practices for early childhood special educators and practitioners working with these children.

Background and purpose: The purpose of this study was to compare two parent completed questionnaires, the Modified Simonds & Parraga Sleep Questionnaire (MSPSQ) and the Children's Sleep Habits Questionnaire (CSHQ), used to characterize sleep disturbances in young children with autism spectrum disorders (ASD). Both questionnaires have been used in previous work in the assessment and treatment of children with ASD and sleep disturbance.Participants and methods: Parents/caregivers of a sample of 124 children diagnosed with ASD with an average age of six years completed both sleep questionnaires regarding children's sleep behaviors. Internal consistency of the items for both measures was evaluated as well as the correlation between the two sleep measures. A Receiver Operating Characteristics (ROC) curve analysis was also conducted to examine the predictive power of the MSPSQ.Results: More than three quarters of the sample (78%) were identified as poor sleepers on the CSHQ. Cronbach's alpha for the items on the CSHQ was 0.68 and Cronbach's alpha for items on the MSPSQ was 0.67. The total scores for MSPSQ and CSHQ were significantly correlated (r = .70, p < .01). After first identifying the poor sleepers based on the CSHQ, an area under the curve was 0.89 for the MSPSQ. Using a cut off score of 56 on the MSPSQ, sensitivity was .86 and specificity was .70.Conclusions: In this sample of children with ASD, sleep disturbances were common across all cognitive levels. Preliminary findings suggest that, similar to the CSHQ, the MSPSQ has adequate internal consistency. The two measures were also highly correlated. A preliminary cut off of 56 on the MSPSQ offers high sensitivity and specificity commensurate with the widely used CSHQ. (C) 2012 Elsevier B.V. All rights reserved.

With reports of the growing incidence of autism spectrum disorder ASD in the United States, a large number of families of affected children is seeking alternative or complementary forms of treatment. One of the more popular interventions has been use of elimination regimes, such as the gluten and casein free (GFCF) diet. This pilot study involved a three-month, prospective, open label, randomized, parallel groups design of a GFCF diet compared to a healthy, low sugar diet (attention control) for young children with ASD. Both treatment groups evidenced some gains across a range of variables, including measures of behavior, language, and ratings of the core features of ASD. No statistically significant differences were noted between treatment groups. While our results do not support use of a GFCF diet in ASD, it is possible that a greater period of time is required for treatment before gains can be observed. Moreover, no significant nutritional differences or side effects were observed on the GFCF diet compared to the control diet. However, adherence to the GFCF diet proved difficult based on our adherence data.