JOURNAL OF APPLIED BEHAVIOR ANALYSIS
2017, 50, 805–818
NUMBER
4 (FALL)
PARENT-IMPLEMENTED BEHAVIORAL SKILLS TRAINING OF SOCIAL
SKILLS
REBECCA K. DOGAN
OT&P MEDICAL PRACTICE
MELISSA L. KING
SOUTHEAST MISSOURI STATE UNIVERSITY, AUTISM CENTER FOR DIAGNOSIS AND TREATMENT
ANTHONY T. FISCHETTI
BASIX BEHAVIORAL HEALTH
CANDICE M. LAKE
WEDGWOOD CHRISTIAN SERVICES
THERESE L. MATHEWS
MUNROE-MEYER INSTITUTE, UNIVERSITY OF NEBRASKA MEDICAL CENTER
AND
WILLIAM J. WARZAK
MUNROE-MEYER INSTITUTE, UNIVERSITY OF NEBRASKA MEDICAL CENTER
Impairment in social skills is a primary feature of Autism Spectrum Disorders (ASDs). Research
indicates that social skills are intimately tied to social development and negative social consequences can persist if specific social behaviors are not acquired. The present study evaluated the
effects of behavioral skills training (BST) on teaching four parents of children with ASDs to be
social skills trainers. A nonconcurrent multiple baseline design across parent–child dyads was
employed and direct observation was used to assess parent and child behaviors Results demonstrated substantial improvement in social skills teaching for all participants for trained and
untrained skills. Ancillary measures of child performance indicated improvement in skills as well.
High levels of correct teaching responses were maintained at a 1 month follow-up. This study
extends current literature on BST while also providing a helpful, low-effort strategy to modify
how parents can work with their children to improve their social skills.
Key words: autism spectrum disorders, parent training, behavioral skills training, social skills
This study is based on a dissertation submitted by the
first author in partial fulfillment of the Ph.D. degree at
the University of Nebraska Medical Center – MunroeMeyer Institute.
The authors would like to thank and acknowledge the
support of the dissertation committee including Drs.
Keith Allan and Blake Lancaster.
Request for materials or reprints should be sent to
Rebecca K. Dogan at rebecca.dogan112@gmail.com
doi: 10.1002/jaba.411
Acquisition of social skills is frequently a difficult and prolonged process for children with
autism spectrum disorder (ASD), which
extends far beyond formal social skills programming. Similar to other forms of behavior
change, maintenance of social skills requires
regular practice in a variety of settings, under
varying circumstances, and with multiple people (Stokes & Baer, 1977). If training of novel
skills is limited to one setting or individual
© 2017 Society for the Experimental Analysis of Behavior
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(e.g., in a university environment with an
experimenter), newly learned skills may not
contact naturally maintaining reinforcers, which
could adversely affect maintenance and generalization. Identifying a treatment package in
which parents serve as the primary trainers is
likely to increase the probability that treatment
gains would generalize and maintain because
parents have more opportunities to facilitate
acquisition, and frequently accompany their
children to novel settings (Matson, Mahan, &
Matson, 2009). In addition, teaching parents
to serve as primary trainers may benefit children, parents, and practitioners by saving time
and resources.
Extensive research has demonstrated the
effectiveness of behavioral skills training (BST;
i.e., instructions, modeling, role-play, feedback;
Crane, 1995) to teach parents a range of skills
(e.g., Crane, 1995; Crockett & Hird, 2009;
Forehand et al., 1979; Gross, Miltenberger,
Knudson, Bosch, & Brower Breitwieser, 2007;
Hsieh, Wilder, & Abellon, 2011; Lafasakis &
Sturmey, 2007; Magen & Rose, 1994; Miles &
Wilder, 2009; Stewart, Carr, & LeBlanc,
2007). BST has been used to teach novel skills
in very brief periods of time (e.g., Himle, Miltenberger, Flessner, & Gatheridge, 2004;
Nigro-Bruzzi & Sturmey, 2010; Toelken &
Miltenberger, 2012) and is viewed as an integral part of a number of well-researched and
empirically supported parent training programs
(e.g., McMahon & Forehand, 2003; McNeil &
Hembree-Kigin, 2010). Stewart, Carr, &
LeBlanc (2007) were the first researchers to
gather parent and child data to examine the
effects of caregiver-implemented BST on social
skill acquisition of a child with ASD. Targeted
social skills included increasing eye contact,
soliciting input from a conversational partner,
and decreasing perseverative topics. All components of BST were incorporated into both
training procedures (i.e., instructors training
caregivers and caregivers training their child)
and required thirteen 1-hr sessions to complete.
Systematic replications and extensions of this
research are necessary to support the use of
parent-implemented BST to teach social skills
to children with ASD. In doing so, limitations
of Stewart et al. (2007) can be addressed. For
instance, Stewart et al. used an A-B design,
which does not control for threats to internal
validity. The study also included a single child
participant. Replication across additional individuals is needed to identify potential individual
differences that could affect BST implementation. Furthermore, direct observation data were
not provided on individual caregiver skills
(i.e., parent and sibling data were combined;
rehearsal and feedback skills were combined).
The present study sought to replicate and
extend Stewart et al. (2007). Experimental control was strengthened and replication was made
feasible by using a multiple baseline design and
precisely defining specific skills and responses
for parent and child participants. The primary
purpose of the present study was to evaluate
the effects of BST as a teaching tool to train
four parents of children with ASD to be social
skills trainers. We evaluated both parents’ use
of BST to teach social skills to their children.
Finally, we examined whether training produced parent performance that maintained and
generalized to contexts in which parents taught
untrained and novel skills to their children.
METHOD
Participants
Four parent–child dyads participated. All
children had an IQ of 70 or greater and diagnosis of autistic disorder, Asperger’s disorder, or
pervasive developmental disorder–not otherwise
specified. In addition, the children participated
in at least one general education class and
received a score of 70% or above on a pretreatment compliance check. As part of the compliance check, children were provided 10 simple,
one-step instructions (e.g., “Hand me a tissue
please”) and rates of compliance were
PARENT-IMPLEMENTED BST
measured. The pretreatment assessment
included interviews, direct observation, and formal assessments to determine if the child met
criteria to participate. Some children had participated in applied behavior analysis (ABA) therapy, but none of their parents had formal
hands-on training with ABA, social skills training, or implementation of BST. All parents
were the biological mothers of their child and
were between the ages of 37 to 47. Three parents reported their relationship status as
“married,” and one reported being “separated.”
All parents reported having other children living in the home. Parents were asked to complete two rating scales: the Achenbach Child
Behavior Checklist–Parent Report Form
(CBCL–PRF; Achenbach; 1991) and the Social
Skills Improvement System (SSIS; Gresham &
Elliot, 2008). The CBCL–PRF was selected
because it is applicable for children aged 6 to
18 years and includes questions that assess
common childhood behavior problems, as well
as subscales associated with ASD symptoms.
The SSIS assesses social skill impairments in
children aged 8 to 18 years. The assessed skills
are in the areas of communication, cooperation,
assertion, responsibility, empathy, engagement,
and self-control. Problem behaviors (externalizing, bullying, hyperactivity/inattention, and
internalizing) are also assessed. Both the
CBCL–PRF and SSIS have favorable validity
and reliability scores (Crosby, 2011; Nakamura, Ebesutani, Bernstein, & Chorpita, 2009).
Dyad 1 (Hana and Carter). Hana and her
son Carter (age 9) were African American.
Hana reported having a master’s degree, an
occupation as a nurse, and a family income of
$50,000-$75,000 per year. She also noted a
previous history of depression, but indicated
she had received treatment. Based on the
CBCL–PRF and SSIS parent-completed form,
Carter scored in the above-average range on
several of the problem behavior subscales and
in the below-average range on the Social Skills
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Standard Score subscales (see Supporting Information for all subscale and standard scores).
Carter was verified and received services by
school staff under the category of autism. The
Autism Diagnostic Observation Schedule
(ADOS; Lord, Rutter, DiLavore, & Risi, 2000)
was administered by the experimenter, a doctoral intern certified in administering and interpreting the ADOS, to verify that Carter met
the qualifications for participation in the study.
Carter was administered Module 3, which is
designed for children and adolescents with fluent speech. Data suggested that Carter met the
criteria for an autism spectrum disorder, with
his total score falling above the cut-off for that
category.
Dyad 2 (Shari and James). Shari and her son
James (age 10) were Caucasian. Shari reported
having a master’s degree, working for a nonprofit company, and having a family income of
$50,000-$75,000 per year. Based on the
CBCL–PRF and SSIS parent-completed form,
James scored in the above-average range on
multiple problem behavior subscales and in the
below-average range on the Social Skills Standard Score.
James also had a comorbid diagnosis of
attention-deficit/hyperactivity disorder and was
verified and received for services by a school
psychologist under the classification of autism.
Assessments provided by school staff included
the ADOS, direct observation, the Vineland
Adaptive Behavior Scales, the Gilliam Autism
Rating Scale, and the Behavior Assessment
Scale for Children–II. Results from the autism
assessment suggested that James met the criteria
for an autism spectrum disorder.
Dyad 3 (Abby and Eric). Abby and her son
Eric (age 9) were Caucasian. Abby reported
having a bachelor’s degree, an occupation as a
web designer, and a family income of $50,000$75,000 per year. Based on the CBCL–PRF
and SSIS parent-completed form, Eric scored
in the above-average range on several of the
problem behavior subscales and in the
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below-average range on the Social Skills Standard Score.
Eric was verified and received for services by
school staff under the category of autism. The
ADOS Module 3 was administered by the
experimenter. Data suggested that Eric met the
criteria for an autism spectrum disorder, with
his total score falling above the cut-off for that
category.
Dyad 4 (Kathy and Sam). Kathy and her son
Sam (age 12) were Caucasian. Kathy reported
having a doctoral degree, an occupation as a
professor at a local university, and a family
income of $75,000-$100,000 per year. She also
noted a previous history of anorexia but indicated she had received treatment. Based on the
CBCL–PRF and SSIS parent-completed form,
Sam scored in the above-average range on several problem behaviors. The Social Skills Standard Score could not be determined due to
incomplete items.
Sam received a diagnosis of PDD–NOS
from a developmental pediatrician at the age of
5 years and was also verified and received for
services by his school under the category of
autism. The ADOS Module 3 was administered by the experimenter to verify whether
Sam met the inclusion criteria for participation
in the study. The assessment results suggested
that Sam met the criteria for an autism spectrum disorder. Kathy also reported that Sam
was prescribed psychotropic medications; however, these medications remained unchanged
throughout the duration of the study (see Supporting Information for full parent/child data).
Setting and Materials
All training took place at the residences of
each parent–child dyad in a room that included
a table and chairs for all participants and training staff. A SlideHD Flip video camera with tripod was used to record each session. The BST
handout (see Supplemental Information) was
provided to each parent during all phases
following baseline. The BST handout was
adapted from the steps listed in Working with
Parents of Noncompliant Children (Shriver &
Allen, 2008) and modified based on ratings
provided by behavior analysts working in the
field. Several professionals with experience conducting research using BST rated the steps
associated with the BST method using a fivepoint Likert-type scale. Based on their ratings,
the steps rated as most important were added
to the BST handout. A puppet was also used in
some sessions as a pretend conversational
partner.
Dependent Measures and Data Collection
Primary dependent measure. The primary
dependent measure was percentage of BST
steps correct. During each trial, the parent had
the opportunity to emit 15 correct teaching
steps. We required correct performance for 5 of
15 steps: a) provide appropriate rationale and
b) state all steps during the instruction component, c) provide an opportunity for skill demonstration by the trainer during the modeling
component, d) provide an opportunity for skill
demonstration by child during the role-play
component, and e) provide immediate feedback. These steps were selected based on ratings provided by several professionals in the
field with experience conducting research using
BST. Professionals were asked to rate the steps
associated with the BST method using a fivepoint Likert-type scale (i.e., 1 = most important; 5 = least important). The steps rated as
most important by professionals with extensive
experience in BST research were identified as
required steps. Observers scored correct and
incorrect steps using a direct observation data
form. We calculated percentage of BST steps
correct overall by dividing the number of steps
correct by the total number of possible steps
(15) and multiplying by 100. We calculated
percentage of required BST steps correct by
dividing the number of required steps correct
PARENT-IMPLEMENTED BST
by the total number of required steps (5) and
multiplying by 100.
Secondary dependent measures
1. Child percentage of correct steps. Observers
scored the number of correct social skills
steps that the children performed during
each trial. Social skills included joining in
a conversation and asking for help (see
Supporting Information for the steps
required for each social skill). Percentage
of correct steps was calculated by dividing
the number of correct steps performed by
the total number of possible steps comprising the skill and multiplying by 100.
2. Modified version of the Treatment Evaluation Inventory-Short Form. The Treatment
Evaluation Inventory–Short Form (TEI–
SF; Kelley, Heffer, Gresham, & Elliot,
1989) is considered a psychometrically
sound, abridged version of the Treatment
Evaluation Form (TEF), which was developed by Kazdin (1980) to measure the
acceptability of behavioral interventions for
children. Parent participants rated treatment acceptability on a variety of dimensions (e.g., acceptability, effectiveness,
meaningfulness, willingness to continue
use of treatment) on a five-point Likerttype scale (i.e., 1 = strongly disagree;
5 = strongly agree). The original form was
modified in that the word “treatment” was
replaced with “Behavioral Skills Training”
and the questions were simplified to make
them shorter.
Interobserver Agreement (IOA) and Procedural
Integrity
Interobserver agreement (IOA) was assessed
by having a second observer independently
score at least 33% trials, across all conditions
(i.e., baseline, training/supplemental training,
posttraining, follow-up, and generalization
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probe phases). Observations were randomly
selected for each parent–child dyad for all conditions. IOA was calculated using the point-bypoint formula (i.e., number of agreements
divided by the total number of agreements and
disagreements, converted to a percentage). For
the parents, the mean overall agreement scores
were 100% for Hana, 98% for Shari (range,
95%–100%), 100% for Abby, and 98% for
Kathy (range, 90%–100%). For the child participants, mean IOA values were 100% for
Carter, 81% for James (range, 75% –100%),
100% for Eric, and 90% for Sam (range, 75%
to 100%).
Procedural integrity data for parentimplemented BST were collected during all
training sessions for each parent. The following
categories were evaluated: (a) presentation of
the BST Parent Handout, (b) inclusion of correct components of BST during training, and
(c) delivery of feedback following role-play.
Procedural integrity was calculated by dividing
the number of steps correctly presented by the
total number of steps, multiplied by 100. Procedural integrity values were 100% for all
parents.
Experimental Design
A nonconcurrent multiple baseline design
(Watson & Workman, 1981) across parent–
child dyads was used to evaluate the effects of
BST to teach parents to implement social skills
instruction with their children with autism.
Procedure
Session durations ranged from approximately
20–120 min. The maintenance probe, subsequent training, and follow-up sessions lasted
20–45 min, whereas the initial training session,
consisting of three trials, required a total session
duration of 120 min. Multiple trials were conducted in each session, but the exact number of
trials varied depending on the phase and on the
rate of parent skill acquisition (i.e., with a
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minimum of two and a maximum of seven
trials per session). A trial consisted of an opportunity in which a parent was asked to teach the
graduate student playing the role of the child
(in baseline) or their actual child a specific
social skill. All trials lasted up to 10 min. The
number of trials per participant varied during
baseline due to the multiple baseline design,
and the number of parent–child training and
posttraining trials varied if the self-monitoring
procedure (described below) was required.
Throughout all phases of the study, vignettes
were presented to provide contrived practice
opportunities. The written vignettes included a
brief description of a typical social interaction,
the rationale for the skill, and the name of the
skill being targeted. Vignettes were selected
from The SCORE Skills: Social Skills for Cooperative Groups manual (Vernon, Schumaker, &
Deshler, 1996) and adapted to fit the skills
assessed in the current study (i.e., Joining in a
Conversation; Asking for Help). Examples of the
vignettes adapted for the joining in a conversation and asking for help skills are provided
below:
It is break time and you see your friends
trying to come up with an idea of what to
play. You are interested in playing ______
(activity) but need more people to play
with you. Use the Joining in a Conversation Skill.
You’re working on a class art project and
are having trouble understanding the directions. You see your friend is way ahead of
you and his/her project looks pretty good.
Use the Asking for Help Skill.
The target skills (see Supporting Information) were selected from Teaching Social Skills
to Youth (Dowd & Tierney, 2005). Two social
skills, with four steps each, were targeted: joining in a conversation and asking for help.
Twenty-five vignettes were written targeting
joining in a conversation, which was targeted in
training sessions, and five vignettes were
written to focus on asking for help, which was
included in generalization probes. Vignettes
were randomly selected and presented throughout all phases of the study; however, one
vignette was used repeatedly as part of the
training phase. At the beginning of the study,
the order of the vignettes was determined using
a random sequence generator (available at
www.random.org). Graduate students played
the role of the conversational partner described
in the vignettes to guarantee there were sufficient individuals to perform the skill. When
the child performed the desired skill (i.e., by
joining in a conversation or asking for help),
the graduate student, principle investigator
(PI), or parent (depending on the phase) would
allow for natural consequences to occur, such
as continuing the conversation, asking a follow
up question, or providing assistance in answering a question.
Baseline (BL). During baseline, as well as all
subsequent phases, parents were asked to demonstrate, to the best of their ability, how they
would teach their child each social skill. Each
parent was informed that in addition to their
child, they could also interact with the principal investigator (PI) and research assistants to
aid in role-play. Parents were also provided a
vignette as well as the social skill sheet, a document that stated the name of the skill to be
taught and listed its steps.
If a parent failed to provide an opportunity
for her child to demonstrate the social skill as
part of a role-play component (i.e., failed to
perform step 11), the PI used previously developed scripts to provide an occasion for skill
demonstration. If a parent simply read the skill
name and corresponding steps (i.e., “Join in a
conversation by looking at the people who are
talking, waiting for a point when no one else is
talking, making a short, relevant comment that
relates to the topic discussed, and giving other
people a chance to participate”), it did not
count as providing an opportunity for skill
demonstration, because there was no contrived
PARENT-IMPLEMENTED BST
conversation to join in. Therefore, to determine
if the child already had the skill in his repertoire, the experimenter used preselected scripts
that included a contrived yet seemingly ordinary opportunity for the child to display each
of the skills. For instance, the child was asked
to sit at the table while the PI and parent discussed upcoming holiday plans, providing an
opportunity for the child to join in the
conversation.
Training. During the training phase, each
parent was taught how to use BST to teach a
specific social skill to her child. The child was
not present. The PI started by explaining the
roles of the individuals present and the
sequence of the training. For instance, the PI
would say: “First, I will show you how to teach
social skills with you playing the role of the
child and myself playing the role of the instructor. Later, we will switch and you will play the
role of the instructor.” Training took place during one session at the parent’s home. One
training vignette was used (i.e., “Your grandma
is talking with ____________ about going to
the grocery store and picking out something for
dinner. You want to go too because you think
_______ would be a great idea for dinner. Use
the joining in a conversation skill”).
Instructions. The BST handout (see Supplemental Information) was introduced as part of
the training phase and made available to each
parent during all remaining phases of the study.
The PI reviewed the BST handout and then
instructed the parent on how to correctly use
the BST steps to teach a specific social skill.
Parents were also encouraged, but not required,
to provide attention (e.g., praise, touch) and
small rewards (e.g., snacks, breaks, access to
toys) contingent on compliant behaviors.
Modeling. Following the instruction component, each parent observed the PI and two
graduate students as they modeled the correct
use of the BST steps using the training
vignette. One graduate student used a puppet
to ensure that there were sufficient
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conversational partners to demonstrate the target skill (i.e., joining in a conversation). Next,
the PI modeled the entire BST method, one
step at a time, while the parent played the role
of the child. This included providing the parent
(playing the role of the child) with appropriate
feedback in the form of descriptive praise for
skills demonstrated correctly and corrective
feedback on steps not demonstrated correctly
or missed.
Role-play. After the PI reviewed the BST
steps, the parent and PI switched roles (i.e., PI
played the role of the child and the parent
played the role of the instructor), and the parent used BST to teach the PI the targeted skill.
At this time, novel vignettes were provided to
the parent and data were collected on correct
teaching steps.
Feedback. Following the role-play, the PI
provided the parent (playing the role of the
instructor) with the same form of feedback that
was delivered as part of the modeling component. The parent moved on to the next phase
(parent–child posttraining) after the following
mastery criteria were met: (a) parent met or
exceeded an 80% level of proficiency of correct
teaching steps across three consecutive trials
using three novel vignettes; (b) parent demonstrated the use of all required steps; and (c) for
those parents who were administered the maintenance probe, parents continued to demonstrate an 80% level of proficiency of correct
teaching steps. If parents did not meet the criteria during the training session, they were
required to complete a training booster session.
Training booster sessions (T-B). The training
booster (T-B) phase consisted of a supplementary training phase that involved two additional
opportunities for the parent to rehearse the
BST steps with the training vignette while playing the role of the instructor (with the PI playing the role of the child). The PI provided
feedback in the same way as during initial
training. The instruction and modeling components were not included.
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REBECCA K. DOGAN et al.
Maintenance probe (M). The maintenance
probe was mandatory if more than one day had
elapsed between the training or T-B session
and the parent–child posttraining phase (PostT). In these cases, two maintenance probes
were conducted at the beginning of the session
to assess if the skills had maintained. During
the maintenance probes, the parent was given
novel vignettes and asked to teach the skill to
the PI who played the role of the child. If previously acquired skills were maintained, the
parent moved on to the parent–child posttraining phase. Two parents (Hana and Kathy)
required the maintenance probes, and both met
criteria to move on.
Self-monitoring procedure (SM). A selfmonitoring procedure was implemented if parents failed to meet training criteria following
training and the T-B session. This modified
procedure required parents to physically check
off each step as completed, on the BST Handout. If a parent failed to mark a step, the PI
stated, “Please place a checkmark in the box
when you have correctly completed the step.”
No other feedback was provided.
Parent–child posttraining (Post-T). After she
had met training mastery criteria, the parent
began using the treatment package consisting
of a BST handout, the social skill sheet with
steps, and a vignette, to teach her child the target social skill. Mastery criteria for parent–child
posttraining were the same as in other phases
for the parent. In addition, we required that
the child achieved at least 80% of steps correct
across three trials. If the parent failed to meet
criterion, the self-monitoring procedure (PostSM) was implemented, and at least three additional trials took place. If the child’s responding
did not meet criteria, two additional trials took
place.
Generalization. The parent was provided
with the materials (BST handout, social skill
sheet with steps, and a vignette) and given an
opportunity to teach her child the untrained
skill (i.e., asking for help). Probe data were
collected to determine if parents would correctly use the BST steps to teach their child a
novel social skill. The following skills were
selected by Hana, Shari, Abby, and Kathy,
respectively: (1) introducing yourself (five
steps), (2) correcting another person (six steps),
(3) waiting your turn (five steps), and (4) interrupting appropriately (five steps).
Follow-up. Follow-up was implemented
1 month after the completion of the parent–
child posttraining phase. The parent was provided the opportunity to teach the trained and
untrained skills. In addition, the parents were
given the opportunity to teach a social skill of
their own selection. The parents had previously
(following the final parent–child posttraining
session) been asked to select a skill to teach
from Teaching Social Skills to Youth (Dowd &
Tierney, 2005). The skill had to include four
to six steps and be directly from the book.
They had the opportunity to practice, on their
own and without feedback, between the final
Post-T session and the follow-up session.
RESULTS
Figure 1 shows both the percentage of BST
steps correct overall as well as the percentage of
required steps correct, for all parents. During
the baseline phase, all parents displayed very
few correct teaching steps (range, 0%–13%).
The BST intervention package (i.e., training
session) increased correct teaching of target
social skills for all parents. During the first
training phase, the percentage of correct BST
steps increased for all parents (range, 77%–
97%). Kathy met mastery criteria during the
first training phase, and Hana met mastery criteria during the initial T-B session. Shari and
Abby required the self-monitoring procedure
(SM) before meeting criteria. Furthermore, parents displayed high integrity when performing
the required steps, which were rated as critical
components of BST by professionals. Total
trials of training (excluding the generalization
PARENT-IMPLEMENTED BST
Parent Percentage of BST Steps with Correct Teaching
BL
T-B
Training
M Post-Training Follow up
100
90
80 Required
Parent 70 BST Step
Selected Skill
Probe
60
Trained
50
Skill
40
30
Generalization
20
Skill Probe
10
0
Hana
-10
PostT-B SM
Post-SM
Training
100
90
80
70
60
50
40
30
20
10
0
Shari
-10
T-B
SM
Post-Training
100
90
80
70
60
50
40
30
20
10
0
-10
Abby
M
100
90
80
70
60
50
40
30
20
10
0
Post-Training
Kathy
2
4
6
8
10 12 14 16 18 20 22 24 26
Trials
Figure 1. Percentages of parent correct teaching and
required steps across phases.
probes) were six for Hana, nine for Shari, nine
for Abby, and three for Kathy. Each phase was
completed in one session, with the exception of
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the additional self-monitoring protocol used
with Shari (during training and parent–child
posttraining) and Abby (during training).
During the parent–child posttraining sessions, Hana, Abby, and Kathy met the mastery
criteria within the first three trials, with mean
correct teaching steps of 100% (Hana), 95%
(Abby), and 84% (Kathy). One parent (Shari)
required the additional self-monitoring procedure (Post-SM). This resulted in an increase in
her performance of correct teaching steps to an
average of 95%. Overall, the correct teaching
steps for Hana, Shari, Abby, and Kathy
increased by 96%, 86%, 88%, and 82%,
respectively, when comparing scores in baseline
and posttraining phases. See Supporting Information for a fine-grained analysis of results for
individual BST steps.
Figure 2 displays percentages of steps correct
for the child participants. During baseline,
none of the parents provided an opportunity
for their child to practice the target skill
(i.e., joining in a conversation). Therefore, the
experimenters used preselected scenarios to create consistent opportunities for skill demonstration. When the children were provided the
opportunity to demonstrate the joining-in-aconversation skill, most emitted few correct
steps, with the average percentage of correct
steps for Carter, James, Eric, and Sam being
12%, 50%, 35%, and 33%, respectively. During the Post-T sessions, when the parents
taught their children, only Carter met the mastery criterion (i.e., 100% or higher on posttraining trials, meaning children had to display
all correct steps). Nevertheless, parentimplemented BST increased child percentage of
correct steps by approximately 88% (Carter),
25% (James), 55% (Eric), and 12% (Sam).
Carter’s data were relatively stable in baseline
and Post-T phases, with a clear level change
from one phase to another. James’ data indicated a potentially decreasing trend in baseline,
but overall higher levels during the parent–
child posttraining phase. Eric’s data showed an
REBECCA K. DOGAN et al.
814
BL
Child Percentage of Steps Correct
100
90
80
70
60
50
40
30
20
10
0
-10
Post-Training
Follow up
Parent Selected Skill
Probe
Trained
Skill
Generalization Skill
Probe
Carter
100
90
80
70
60
50
40
30
20
10
0
-10
100
90
80
70
60
50
40
30
20
10
0
-10 0
100
90
80
70
60
50
40
30
20
10
0
-10 0
James
Eric
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16
Sam
2
4
6
8
10
Trials
12
14
16
18
Figure 2. Percentages of child correct performance of
skills across phases.
increasing trend during baseline, rendering level
change from baseline to Post-T difficult to
interpret. Lastly, Sam’s data showed a prominent decreasing trend in baseline, and an
increasing trend and clear level change in the
parent–child posttraining phase.
Generalization and Follow-up Data
Baseline generalization probes yielded few correct target behaviors for parents and children.
The percentage of BST steps correct ranged from
0% - 13% across parents (Figure 1). The percentage of target skill steps correct was 0% for all
children (Figure 2). When the generalization
probe was administered in the Post-T phase, correct responding increased for both parents and
children. For the parents, the percentage of steps
correct ranged from 86% to 100%, and for the
children, the percentage of steps correct ranged
from 75% to 100% during Post-T.
The BST skills maintained for all four parents during the follow-up session, with a range
of 80% - 100% across participants for the
trained skill, and 60% - 93% for the untrained
skill targeted in the generalization probes
(Figure 1). For the child participants, the
trained skill maintained for Carter, James, and
Sam, whose percent correct ranged from 75%
to 100%. Eric, who had an average score of
90% during the training phase, displayed a
slight decrease at follow-up (75%). Maintenance of the untrained skill was slightly lower
for all four child participants, with a range of
50% - 75% across participants. We could not
collect data for James during the generalization
probe in the follow-up phase, because his
mother did not provide an opportunity for
role-play during the rehearsal phase.
Direct observation of parent and child
behavior with a parent-selected skill was
included in the follow-up assessment. Correct
teaching steps for the parent-selected skill for
Hana, Shari, Abby, and Kathy were 86%,
93%, 93%, and 60%, respectively. Kathy failed
to provide Sam with an opportunity for skill
demonstration, which contributed to her low
score. For that reason, data for the parentselected skill are not presented for Sam in
Figure 2. Carter, James, and Eric performed
the parent-selected skill with an accuracy of
80%, 66%, and 100%, respectively.
PARENT-IMPLEMENTED BST
Social Validation of Training
The modified version of the TEF–SF with a
five-point Likert scale ranging from 1 (Strongly
Disagree) to 5 (Strongly Agree) was completed
by all parents at posttreatment and follow-up.
Average parent ratings of BST scores (posttreatment; follow-up) were: acceptability of BST (5;
5), willingness to use BST (5; 5), likeability of
procedure (5; 4.75), belief that child did not
experience discomfort (4.25; 4.25), found BST
resulted in meaningful change (4; 4.50), and
positive reaction to BST (4.75; 4.75).
DISCUSSION
We evaluated the use of instructions, modeling, role-play, and feedback to teach parents to
use Behavioral Skills Training (BST) to implement social-skill instruction with their children
with autism. The intervention was effective in
increasing the parents’ correct use of BST for
social skills instruction, and performance gains
generalized to a social skill that had not been
included in training. Furthermore, the parents
were able to use BST to implement instruction
with a novel, parent-selected social skill, with
moderate to high accuracy.
Although most children did not meet the
criterion level for mastery, they displayed an
increase in the number of correctly performed
steps with both the trained and untrained skills.
Parents and children also continued to display
these skills at follow-up, 1 month later. Furthermore, parents reported high satisfaction ratings when evaluating the BST intervention.
Similar to Stewart et al. (2007), the present
study indicated that family members can learn
BST skills in a short period of time, and use
BST to teach their children social skills. Parents
responded to BST differently; some individuals
required more training than others. However,
even Shari, who required the longest training
and Post-T phase duration, still met mastery
criteria in a relatively short period of time
(i.e., three 2-hr sessions). The current study
815
supports previous research demonstrating that
improvements in children’s social skills can
occur as a function of caregiver-implemented
BST; however, longer posttreatment phases are
needed to fully evaluate acquisition and maintenance (Stewart et al., 2007).
Consistent with previous literature, the current study suggests that BST can be used to
teach novel skills in a brief period of time
(Himle et al., 2004; Nigro-Bruzzi & Sturmey,
2010; Toelken & Miltenberger, 2012). Each
parent was able to increase their child’s correct
number of steps for the targeted social skill
(joining in a conversation) in a relatively short
period of time (i.e., 20 - 40 min). It is likely
that with more practice, all children would
have achieved mastery. Future studies should
include a more thorough evaluation of child
performance by increasing the duration of the
parent-implemented social skills instruction to
assess what variations or modifications to the
protocol are required to increase skill
acquisition.
Limitations of the current study warrant
consideration. First, the four basic components
of BST were extended to 15 precisely defined
steps for data collection purposes. However,
some of the steps may be unnecessary
(e.g., brief quiz, behavior-specific praise), and
future research may consider a component
analysis to determine the compulsory steps (see
Table 1). Second, because strict operational
definitions were used to define the skill steps
and stringent criteria were set for parent and
child behavior, flexibility and creativity of parent behavior was limited. Third, for child participants, the mastery criterion for correct steps
was 100%; however, given such a brief training
period a less stringent criterion would have
been more appropriate.
The increasing trend in Eric’s baseline and
decreasing trend in Sam’s baseline make it
more challenging to interpret their data. It is
possible that fluctuations in motivating operations accounted for some of this variability. In
816
REBECCA K. DOGAN et al.
Table 1
BST Steps and Definitions
Dependent Measures
Instruction
1) Rationale
2) State all steps
3) Chance to ask questions
4) Brief quiz
Modeling Phase
1) Introduction to modeling phase
2) Read vignette
3) Skill demonstration
4) Review modeled steps
5) Chance to ask questions
Rehearsal Phase
1. Introduction to rehearsal phase
2. Opportunity for rehearsal
Feedback Phase
1. Immediate feedback
2. Behavior-specific >1
3. More praise then correctives
4. If a step was missed, repeat
rehearsal component
Operational Definition
Parent states the name of the skill and gives at least one reason why the skill is important
Parent states all steps (in order) included in skill
Parent asks the child if he/she has any questions
Parent asks the child to recite the steps associated with skill
Parent states they will demonstrate the skill while child watches
Parent reads vignette or describes scenario similar to vignette
Parent demonstrates steps (models correct and/or correct/incorrect behaviors)
Parent explains what steps were demonstrated correctly (or incorrectly and how they should
have been displayed)
Parent asks the child if he/she has any questions
Parent states that the child is to practice the skill
Parent reads vignette or describes scenario, have at least 1 conversational exchange and allow
≥1 sec pause for child to comment
Parent must provide feedback within 10s
Parent states 2 positive behaviors the child displayed (about steps or nonverbal behavior)
Total praise statements must be > than corrective
Parent provides corrective feedback on missed step and repeats rehearsal component
* Required steps are italicized.
other words, parent choice of potential reinforcers or lack of clear contingencies for participation may have influenced the children’s
motivation to respond with their best effort.
The majority of previous social skills training
research has focused on positive nonverbal
behaviors (e.g., eye contact) and vocal verbal
behaviors, such as initiation of speech (Matson,
Matson, & Rivet, 2007). Therefore, similar
social skills were selected as target behaviors in
the current study. These behaviors are significant to this population, because impairments in
these areas are critical for diagnosis and influence the development and sustainability of
social relations (Owens, Granader, Humphrey, & Baron-Cohen, 2008; White, Keonig, & Scahill, 2007). Further studies should
evaluate the effects of parent-implemented BST
on more intermediate or advanced level skills
(e.g., interrupting appropriately; accepting
defeat or loss). Finally, future studies should
collect follow-up data to evaluate greater maintenance of acquired skills.
In conclusion, training parents to be social
skills trainers through the use of a BST model
may empower parents to work independently
and effectively with their own children, and
allow them to substitute or add new skills of
varying difficulty as their children age and
mature. The simplicity, practicality, and
straightforwardness of the BST handout (see
Supplemental Information) may allow for its
use by not only parents but also other caregivers (e.g., grandparents, teachers, babysitters)
who spend time with children.
Services for children with autism remain difficult for many families to access or afford. The
simple nature of the BST method increases the
likelihood that social skills training could be
implemented in the home, group clinical settings, and school settings. It also has proven to
be an efficient approach to teaching skills
within a short period of time. Moreover, the
simple and straightforward language used in the
BST handout should allow for it to be easily
understood by nonexperts and translated into a
PARENT-IMPLEMENTED BST
wide range of languages to reach larger
populations.
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Received May 18, 2014
Final acceptance September 26, 2015
Action Editor, Einar Ingvarsson
SUPPORTING INFORMATION
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publisher’s website.