Training High School Students to Provide Behavioral Instruction to Children with Autism

Background:  

Studies have shown that children with autism who receive intensive behavioral therapy can make significant progress in the acquisition of language, social, motor, and academic skills.  However, many of the children who make the most progress receive intensive programs that are large in scope, requiring 20-40 hours of therapy weekly over the course of many years.  Many families have difficulty finding the financial resources to meet this number of hours, as well as finding personnel with adequate training to administer the intensive therapy.

Objectives:  

The focus of this present study is to evaluate the effectiveness of training high school students to provide intensive behavioral therapy to children with autism.  Our hypothesis is two-fold: first, the use of high school students would reduce the financial burden of therapy on the parents of children with autism; second, the techniques used to train high school students would enable them to perform Applied Behavior Analysis (ABA) teaching methods to criteria previously established by research (i.e., ability to perform ABA discrete trials independently, with a minimum of 92% accuracy, during the final two sessions of the study). 

Methods:  

Study participants included eight high school students (mean age = 15.82 years, SD = 0.87) and eight children with ASD (mean age = 4.69 years, SD = 1.02).  Children with ASD were recruited for study participation after completion of diagnostic assessment at a hospital-based Autism Clinic.  Five children with ASD and seven students completed the study, one child with ASD was excluded and three subjects dropped out (two children with ASD, one student).  Study duration was 10 weeks; the first two weeks included baseline sessions and didactic training, with the following eight weeks consisting of twice weekly individual training sessions with an ABA therapist.  A single-subject design was used to measure the effects of the training intervention on the discrete-trial performance of the high school students.  To measure intervention accuracy, researchers used a feedback evaluation form to score the first fifteen discrete trials of each session.  The feedback evaluation form included eleven different components of the ABA discrete trial.  Interrater reliability between two coders was established; reliability was calculated by dividing the total number of congruent items by the total of congruent plus non-congruent items, then multiplying the result by 100 to obtain a percentage.

Results:  

By the end of the study, the majority of the high school students performed discrete trials independently, with 90% minimum accuracy (mean = 89%, SD = 1.48).  The intertrial interval (i.e, time span between trials) had the greatest impact on the percentage of accuracy.  Parent and student satisfaction was reported to be high, based on social validation surveys completed at the end of the study.

Conclusions:  

Results of the present study suggest that training high school students may be an effective and cost saving method of providing intensive behavioral therapy to children with autism.  Further research is needed to determine the long-term cost-benefits, continued treatment integrity, and analysis of teaching the intertrial interval component of discrete trials.