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The Verbal Behavior Approach to Early and Intensive Behavioral Intervention for Autism:A Call for Additional Empirical Support
Abstract
Early and intensive behavioral intervention (EIBI) has been firmly established and disseminated as one of the most effective treatments for early childhood autism. Recently, a number of practitioners have employed a variant of this approach in which the language curriculum is organized and taught according to Skinner’s (1957) analysis of verbal behavior. In this commentary, we briefly describe the verbal-behavior approach to EIBI and summarize the existing data that support its use. Although the approach is conceptually sound and is supported by a modest literature on the acquisition of verbal operants, no outcome research currently exists to directly support the long-term application of the verbal-behavior approach to children with autism. Thus, we outline three steps that clinicians and researchers can take to collect and publish outcome data on the verbal-behavior approach so that correspondence between dissemination and empirical evidence can be better coordinated.
... storočia propagovali Thorndike (1905), Pavlov (1927), Watson (1930 a Skinner (1953) (Simpson 2005 Intervenciu je možné chápať ako intenzívnu formu edukácie detí zameranú na zlepšenie zručností v oblastiach ako je komunikácia, hra, sociálne zručnosti a iné (Perry, Condillac 2003;Granpeesheh et al. 2009a;Klintwall, Eikeseth 2014;Maštenová 2016). Maurice (1996) Každý z týchto modelov alebo prístupov bol publikovaný v mnohých štúdiách, ktoré potvrdzujú ich efektivitu pri práci s deťmi s poruchami autistického spektra (Lovaas 1987;McEachin et al. 1993;Carr, Firth 2005;Corsello 2005;Healy at al. 2008;Vismara, Rogers 2008;Boyd et al. 2010;Dawson et al. 2010;Eikeseth et al. 2012;Rogers et al. 2012;Larsson 2013;DeSouza et al. 2017 a iné). EIBI model vyvinutý Lovaasom (1981, 2003 bol pravdepodobne najvýznamnejším vstupom do metodológie behaviorálnych intervencií, ktorú už niekoľko rokov používajú odborníci v oblasti behaviorálnej analýzy (Carr, Firth 2005;Corsello 2005 (Lovaas 1987;McEachin et al. 1993;Corsello 2005;Larsoon, Wright 2011;Smith, Eikeseth 2011 (Barbera, Rasmussen 2007). ...
... Maurice (1996) Každý z týchto modelov alebo prístupov bol publikovaný v mnohých štúdiách, ktoré potvrdzujú ich efektivitu pri práci s deťmi s poruchami autistického spektra (Lovaas 1987;McEachin et al. 1993;Carr, Firth 2005;Corsello 2005;Healy at al. 2008;Vismara, Rogers 2008;Boyd et al. 2010;Dawson et al. 2010;Eikeseth et al. 2012;Rogers et al. 2012;Larsson 2013;DeSouza et al. 2017 a iné). EIBI model vyvinutý Lovaasom (1981, 2003 bol pravdepodobne najvýznamnejším vstupom do metodológie behaviorálnych intervencií, ktorú už niekoľko rokov používajú odborníci v oblasti behaviorálnej analýzy (Carr, Firth 2005;Corsello 2005 (Lovaas 1987;McEachin et al. 1993;Corsello 2005;Larsoon, Wright 2011;Smith, Eikeseth 2011 (Barbera, Rasmussen 2007). Dôraz na učenie sa v prirodzenom prostredí a generalizáciu naučených zručností s inými ľuďmi, materiálmi a v inom prostredí robí z neho dobrý prístup na doplnenie vzdelávacích a intervenčných programov pre osoby s PAS (Perry, Condillac 2003 (Sundberg, Partington 1998In Carr, Firth 2005). ...
... EIBI model vyvinutý Lovaasom (1981, 2003 bol pravdepodobne najvýznamnejším vstupom do metodológie behaviorálnych intervencií, ktorú už niekoľko rokov používajú odborníci v oblasti behaviorálnej analýzy (Carr, Firth 2005;Corsello 2005 (Lovaas 1987;McEachin et al. 1993;Corsello 2005;Larsoon, Wright 2011;Smith, Eikeseth 2011 (Barbera, Rasmussen 2007). Dôraz na učenie sa v prirodzenom prostredí a generalizáciu naučených zručností s inými ľuďmi, materiálmi a v inom prostredí robí z neho dobrý prístup na doplnenie vzdelávacích a intervenčných programov pre osoby s PAS (Perry, Condillac 2003 (Sundberg, Partington 1998In Carr, Firth 2005). ...
Vedecká monografia sa sústreďuje na aplikovanie princípov
a metód aplikovanej behaviorálnej analýzy pri vzdelávaní detí s poruchami
autistického spektra. Naším cieľom je overiť efektívnosť behaviorálnych
procedúr v rámci behaviorálno-intervenčného prístupu – verbálne správanie
v procese rozvíjania komunikačnej kompetencie detí s poruchami autistického
spektra v predškolskom veku, čo následne môže podporiť aj rozvoj ich
sociálnych zručností a eliminovať prejavy problémového správania. Výskumný
súbor budú tvoriť deti rôzneho veku od 2 do 7 rokov s diagnózou alebo
potvrdeným podozrením na poruchu autistického spektra, ktorým budú
behaviorálne intervencie poskytované v rôznej intenzite od 3 do 12 hodín
týždenne. Realizovaný výskum bude mať kvantitatívny charakter a bude
prebiehať formou jednoprípadových experimentálnych štúdií.
... Para Carr e Firth (2005), dois marcos foram responsáveis pela divulgação em larga escala dos princípios da análise do comportamento junto às pessoas com TEA: as publicações do artigo de Lovaas (1987) sobre intervenção comportamental intensiva e precoce (Early and Intensive Behavioral Intervention -EIBI) e do livro de Catherine Maurice (1993), que descreveu o tratamento de seus dois filhos autistas por meio da AAC. ...
... O modelo desenvolvido por Lovaas é apontado como a influência mais significativa sobre a metodologia de ensino utilizada por praticantes da análise do comportamento nos últimos anos (Carr & Firth, 2005). Inclui, em linhas gerais, tratamento intensivo de 30 a 40 horas semanais, elaboração de programas para desenvolver habilidades em diferentes áreas (e.g., comunicação, habilidades sociais, autocuidado e brincar), criação de muitas oportunidades para a criança praticar aquilo que está faltando em seu repertório, ensino de habilidades em pequenos passos que são apresentados da forma mais simples para a mais complexa (chamado de ensino por tentativas discretas) e uso abundante de reforço positivo para que o ambiente de ensino se torne afetivo e motivador. ...
... A abordagem de Lovaas parece ser mais padronizada entre praticantes e clínicas do que o modelo VB. Para Carr e Firth (2005), isso pode estar relacionado ao fato de que, enquanto a abordagem Lovaas foi desenvolvida em um ambiente universitário, a abordagem VB nasceu da prática clínica e da interpretação do trabalho de Skinner sobre comportamento verbal. ...
O presente estudo faz uma breve apresentação sobre o transtorno do espectro autista (TEA), bem como sobre as categorias gerais de trabalho referentes ao ensino de linguagem para alunos da educação especial na análise aplicada do comportamento. O objetivo foi realizar uma revisão dos artigos publicados no Journal of Applied Behavior Analysis (JABA) entre 2008 e 2012. A revisão foi realizada por meio da base de dados PubMed e o critério de seleção dos artigos incluiu as palavras comportamento verbal e autismo no corpo do texto. Vinte e sete artigos foram selecionados e analisados por (a) ano da publicação, (b) filiação dos autores, (c) número de participantes de cada estudo, (d) tema, (e) procedimentos utilizados e (f) tipo de artigo. As revisões foram excluídas. Os resultados mostraram que o ensino de mando foi o tema mais estudado e que controle de estímulos e reforçamento positivo foram os procedimentos mais frequentes. Além disso, universidades e centros prestadores de serviço têm publicado juntos, o que mostra que o desenvolvimento das estratégias de ensino tem se dado de forma integrada com profissionais que atuam na área e lidam com questões práticas referentes às dificuldades dessa população.
... 4. How interventions' efficacy is reported? The originality of the research is threefold: firstly, provide an update the state of literature since Carr and Firth (Carr and Firth, 2005), Sautter and LeBlanc (Sautter and LeBlanc, 2006), Presti and Moderato (Presti and Moderato, 2016) and DeSouza et al. (DeSouza, Akers and Fisher, 2017); secondly, focus on school-aged children with ASDs (7-18 years old) ; thirdly, analyse the articles according to characteristics of publications, characteristics of interventions and reporting method regarding the effects of interventions. ...
... Despite the absence of gold standard articles (RCTs), the absence of quality assessment of the selected articles this review allows to document the effects of VB in children with ASDs from single-case studies at school age with 84 children with ASDs. Thirdly, it highlighted the strengths and weaknesses of current research in this field even if this model recognized for its high degree of internal consistence and its strong conceptual and logical foundation (Carr and Firth, 2005). ...
Although the Skinner verbal behavior model was published several years ago, its implementation among children with autism spectrum disorders (ASDs) is rare in Europe. A systematic literature review analysed 37 studies published from 2010 to 2019 which included outcomes of 84 ASDs students aged 7 to 18 years. This study documents the characteristics of the publications, of the interventions in link with this model. Four main findings emerged from the results. 1. The lack of implementation of this model in Europe. 2. An improvement in ASDs students' language skills on each verbal operant taught. 3. The possibility to implement this method in a classroom. 4. The great heterogeneity in data reporting between studies. Recommendations for future research are suggested.
... Well-known examples for comprehensive ABA-based interventions are Early Intensive Behavioral Interventions (EIBI) [4], which make up the majority of the studies considered in the present study. However, since some comprehensive, intensive ABA-based methods are not called EIBI, for instance the Verbal Behavior approach (ABA-VB, for a detailed description see [9]), we will use the term comprehensive ABA-based interventions rather than EIBI in our study. While treatment goals in behavioral interventions are most often in line with typical sequences of development (e.g., the promotion of more adaptive behavior), another group of interventions is explicitly designed on applying behavioral methods (e.g., methods based on ABA) and developmentally-based strategies in naturalistic settings, deriving individual learning objectives from developmental sequences [10]. ...
Background
Many studies display promising results for interventions that are based on Applied Behavior Analysis (ABA) in the treatment of autism spectrum disorder (ASD). Methods: This meta-analysis assessed the effects of such treatments on developmental outcomes in children with ASD and on parental stress based on 11 studies with 632 participants. Results: Compared to treatment as usual, minimal or no treatment, comprehensive ABA-based interventions showed medium effects for intellectual functioning (standardized mean difference SMD = 0.51, 95% CI [0.09; 0.92]) and adaptive behavior (SMD = 0.37, 95% CI [0.03; 0.70]). Language abilities, symptom severity or parental stress did not improve beyond the improvement in control groups. Moderator analyses indicate that language abilities at intake could influence the effect sizes and the influence of treatment intensity might decrease with older age. Conclusions: Practical implications and limitations are discussed.
... Although this work was theoretical and not specifically focused on disabilities or interventions for language disorders, it is clear that research spurred by Skinner's Taxonomy of Verbal Behavior has led to the development of interventions for individuals on the autism spectrum and with other disabilities. Although research immediately following Skinner's publication was sparse, several calls for research (Carr & Firth, 2005;Sautter & Leblanc, 2006;Sundberg, 1991) and the demand for effective clinical interventions has culminated in a significant increase in published studies in recent years (DeSouza et al., 2017;Petursdottir, 2018). In this special issue of Behavioral Interventions, we sought papers that would call to light some understudied areas in need of additional investigation as well as studies that would be immediately useful to practitioners. ...
... However, communication interventions for preschool children with ASD are imperative because children with ASD have difficulty learning and using language and these difficulties begin early in development (APA, 2013). Research in the field of VB primarily focuses on the training of a single verbal operant or the combination of two verbal operants (Carr and Firth 2005;Goldsmith et al. 2007). The results of this systematic review revealed that when professionals target a single verbal operant, the mand, preschool children with ASD increase their ability to verbally communicate. ...
When educating young children with autism, it is imperative to use a teaching practice that is supported by evidence-based research. This review examined and synthesized the results of studies targeting the acquisition of verbal requests (mands) by young children with autism. Results indicated that verbal mand interventions are effective at increasing communication for young children with autism. These interventions were primarily implemented in clinical or private school settings by highly trained professionals. There are also several methodological limitations in the articles reviewed. Given the limitations, the researchers discuss implications for practice and future research.
... The application of the verbal behavior approach to improving language has surged over the last 30 years (see Dymond, O'Hora, Whelan, & O'Donovan, 2006;Reed, DiGennaro Reed, Jenkins, & Hirst, 2014) due, in no small part, to the booming success of this approach in children with autism spectrum disorder (ASD) (Sundberg & Michael, 2001). Carr and Firth (2005) have also provided a comprehensive historical account of verbal behavior's rise in autism service delivery. This verbal behavior approach to early intervention for autism became more widespread after publication of Sundberg and Partington's Teaching Language to Children with Autism or Other Developmental Disabilities (1998) . ...
... Various conceptual and treatment models have been utilized within the autism literature, including the Lovaas model (Carr & Firth, 2005;Smith & Iadarola, 2015), and models based on Skinner's conceptual analysis of language, coined Verbal Behavior (VB) or Applied Verbal Behavior (AVB; for further review see Kates-McElrath & Axelrod, 2006). Generally speaking, a verbal behavior curriculum would focus on the functional independence of verbal operants, rather than receptive versus expressive language categories found in the Lovaas approach (Gamba, Goyos, & Petursdottir, 2015). ...
Practitioners in the field of autism treatment have historically been challenged by training complex language repertoires in individuals with an autism spectrum disorder, specifically when traditional training techniques have demonstrated a failure to promote a generalized repertoire. The inclusion of research from the field of Relational Frame Theory (RFT) may assist the practitioner in developing treatment targets that demonstrate measurable progress in language and cognitive skills. Since the call for a potential synthesis between Skinner's Verbal Behavior and RFT, there has been an increasing trend in publications on derived verbal behavior, with the majority of research articles focused on the intraverbal, often utilizing conditional discrimination training, and a near even split between using participants with a diagnosis of autism and those without any diagnoses. A summary of the research within the field of derived relational responding on each of Skinner's verbal operants is provided, followed by recommendations for practitioners.
... According to Carr and Firth (2005), "Applied behavior analysis has been successfully applied to behavioral excesses and deficits in the area for autism since the 1960s" (p. 18). ...
The field of Applied Behavior Analysis is a relatively new field that started in the 1960s in the Western society, and even newer in Saudi Arabia and United Arab Emirates. The purpose of this study was to explore the perceptions of non-native Applied Behavior Analysis therapists working in Saudi Arabia and the United Arab Emirates regarding barriers and supports of effective practices in Applied Behavioral Analysis with clients who have Autism Spectrum Disorder. This study compared the responses elicited from surveys as well as face-to-face interviews with non-native Arabic speaking ABA practitioners and non-Arabic speakers who are Applied Behavior Therapists working in these two countries.
Data regarding the perceptions of Applied Behavior Therapists about barriers and supports for effective practice was collected through both surveys and interviews. Eligible participants were certified from the Behavior Analyst Certification Board (BACB) as Registered Behavior Technicians “RBT’s,” Board Certified Assistance Behavior Analysts (must be supervised by a BCBA and practicing ABA), Board Certified Behavior Analysts “BCBA’s” and Board Certified Behavior Analysts-Doctoral “BCBA-D’s” working in Saudi Arabia or United Arab Emirates. Several themes emerged from the data that addressed specific barriers to effective practice; efforts to overcome barriers, concerns about barriers, and the impact of language barriers on implementation of strategies with and by families with the family member with ASD. In addition, a variety of targeted support strategies including assessment tools used for work, interventions used with clients, learning opportunities in the Applied Behavior Approach were identified. Limitations to this study include, but were not limited to, small sample size, data collection method and recruitment method.
Applied verbal behavior (AVB) is an intervention approach grounded in Skinner's (1957) analysis of verbal behavior. Common components of the AVB approach have been established as evidence-based, indicating the approach should be progressed into the manualization and implementation phase of research. In the present study, we used an intervention package consisting of computer-based training, performance and competency-based training, and in vivo training to promote the use of AVB procedures in 26 classrooms in a nonpublic school serving students with autism. We evaluated the effects of this intervention package on the performance of teacher level staff via a controlled consecutive case series design, nonconcurrent multiple probe design, and aggregate data analysis using inferential statistics. Results showed that staff members demonstrated high levels of fidelity with AVB procedures when working directly with students. Measures of student behavior showed significantly increased engagement with staff members, reduced interfering behavior, and increased rates of manding. These findings have implications for the dissemination of AVB in educational settings.
Parent-managed behavioral interventions for young children with autism are under-researched. We analyzed data from 66 children served by 25 different early intervention consultants. After a mean of 31.6 months of intervention IQ scores had not changed (N = 22). Vineland adaptive behavior scores had increased significantly by 8.9 points (N = 21). No children aged > 72 months attained normal functioning, i.e., IQ > 85 and unassisted mainstream school placement (N = 42). Progress for 60 children across 12 months was found for mental age (5.4 months), adaptive behavior (9.7 months), and language (5.1 months). The interventions did not reproduce results from clinic-based professionally directed programs. The effectiveness of the parent-managed intervention model as it has developed and the adequacy of professional services in that model are discussed.
Discrete trial training (DTT) is a method for individualizing and simplifying instruction to enhance children's learning. For children with autism, DTT is especially useful for teaching new forms of behavior (e.g., speech sounds or motor movements that the child previously could not make) and new discriminations (e.g., responding correctly to different requests). DTT can also be used to teach more advanced skills and manage disruptive behavior. However, several cautions about DTT are noteworthy: First, the method must be combined with other interventions to enable children to initiate the use of their skills and display these skills across settings. Second, early in treatment, children with autism may require many hours of DTT per week, although controversy exists over precisely how much is appropriate. Third, to implement DTT effectively, teachers must have specialized training. Despite these limitations, DTT is one of the most important instructional methods for children with autism.
The Early Intervention Project (EIP) is a discrete-trial treatment program for young, high-functioning children with autism that claims to provide recovery of normal functioning in almost one half of the cases and lead to substantial improvements in an additional 42% of cases. Many school districts across the country are being asked and sued by parents to provide the EIP for a period of 2 to 3 years. We evaluate the EIP according to threats to experimental validity - namely, internal, external, and construct validities. The EIP also is evaluated with respect to treatment integrity issues, which pose threats to all types of experimental validity. Sufficient threats to the experimental validity of the EIP prevent unqualified endorsement of it as a validated treatment for children with autism. The most relevant and serious threats to validity for school districts are those of external validity. Given the background, training, resources/supports, and supervision provided in the original EIP investigation, it probably cannot be exported to school districts with fidelity and is unlikely to produce results similar to those claimed by the EIP authors (Lovaas, 1987, 1993; McEachin, Smith, & Lovaas, 1993; Smith, McEachin, & Lovaas, 1993). School districts are advised to consider the experimental nature of the EIP program before agreeing to its adoption for any children with autism and to examine other intervention alternatives.
Developed a home-based alternative to preschool for educational programs of young autistic children. The model includes (a) systematic use of behavioral teaching techniques and treatment procedures; (b) intensive training conducted in each child's natural home; and (c) extensive parent training. Most of the 14 18–64 mo old children who participated demonstrated significant gains in language, self-care, and social and academic development, as evidenced by the results of standardized assessments and individual treatment data. Results also indicate a change in parents' ability to teach their handicapped children. Results are compared with previous findings reported in the literature. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this book is to describe and explain methodology and research design in clinical psychology. The book elaborates the methods of conducting research and the broad range of practices, procedures, and designs for developing a sound knowledge base. It also focuses on the underpinnings, rationale, and purposes of these practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)