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Intentions to Implement: Predicting the Use of Pivotal Response Training (PRT) in
Public School Autistic Support Classrooms

A Dissertation

Submitted to the Faculty

of

Drexel University

by

Michelle Marie Nutini

in partial fulfillment of the

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requirements for the degree
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Doctor of Education
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2019
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ProQuest Number: 13903162




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© Copyright 2019
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This Ed.D. Dissertation Committee from The School of Education at Drexel University
certifies that this is the approved version of the following dissertation:

Intentions to Implement: Predicting the Use of Pivotal Response Training (PRT) in

Public School Autistic Support Classrooms

Michelle Marie Nutini

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IE Committee:

____________________________________
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Constance Fox Lyttle, Ph.D., J.D.

____________________________________
Bridget Sweeney Blakely, Ph.D.
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____________________________________
David S. Mandell, Sc.D.

0D\
____________________________________
Date
 Dedication

This dissertation is dedicated to my family, friends, and community, without

whom this journey would have never been possible.

To my mother, Karen Hall: Thank you for being such an incredible mommy and

such an exemplar role model as a teacher, mother, and friend. Thank you for instilling in

me a lifelong love of learning and for supporting me along the way. Your patience,

kindness, and support is unmatchable, as is your ability to remember, recognize, and

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celebrate each accomplishment, no matter how small. Thank you for being such an

awesome Gammy to Desi and a big thank you to Gramps for being so accommodating
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and supportive.

To Alexis, my husband and partner in life and love: you saw this coming before I
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did (!) and I so appreciate your encouragement and support throughout this process. This

wouldn’t have been possible without your partnership, respect, understanding, and
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willingness to take on the lion’s share of parenting and household management over these

past few years. Your daily dedication and diligence to your passions is unstoppable and I

continue to be inspired by your creativity: www.alexisnutini.com @dos_tres_press

To Desi: I never cease to be amazed by your interest, energy, and love for life.

Seeing the world through your eyes has been an endless source of inspiration, and you

manage to teach me something new each day. I can’t wait to make more “Desi and

Mommy lists of things to do” and spend time with you.

To (Dr.) Stacy and Jonathan Donlon: you both taught me so much growing up,

and watching you both grow and become so accomplished in your work and professional
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lives has been an inspiration and source of motivation. Even though we are separated by

geographical distance, I am so appreciative of the time we continue to be able to spend

together with you and your families.

To Jeannie: your attention and delight in capturing and telling stories that may

have gone unsaid helped inform my decision to embrace qualitative interviewing. Thank

you for your continued kindness, love, support, and patience.

To my family and friends: thank you for all of your love and inspiration. I am so

lucky to be part of such a wonderful family and community of educators, artists, and

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helpers who work daily to challenge the status quo. I so enjoy the time I get to spend

with you and learn from you. It really does take a village and I am grateful to everyone
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that has lent a hand, inspiration, and support along the way. To my family members that

I have lost along the way: thank you for your role in getting me where I am today. I
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know that you would be so proud. To my Babchi: your commitment to education was

unwavering and I am still inspired by your stories and experiences of leadership and
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management when you were an emergency room nurse Crozer Chester Hospital. To my

father-in-law, Dr. Hugo G. Nutini: it is a true honor to share your title – you have left

such big shoes to fill in your legacy and life’s work. To Jean Pierre: thank you for your

ability to interject laughter into any occasion. To Dr. Doren L. Slade: I am so grateful for

your insight, perseverance, drive, and love.

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 Acknowledgments

I would not be at this point in my journey without the vision of Dr. Constance

Lyttle and Dr. Michel L. Miller O'Neal, as well as the support of Owen Schugsta

throughout the USELT (Urban Special Education Leaders for Tomorrow) project. Dr.

Lyttle, your strength, dedication, and commitment towards advocating for students with

disabilities and growing educators is inspiring. I am so thankful for you being such a

strong, unwavering system of support, encouragement, and wisdom throughout this

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experience and process. To the late Dr. Miller, I am so grateful to have met you and

learn so much from you and from your work. Owen, thank you for your work behind the
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scenes – your help with registering for classes and coordinating travel allowed me to

focus on my coursework and research.

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Dr. Kristen Betts, your enthusiasm, innovative spirit, and editorial fierceness were

a motivating force behind the completion of this work – thank you.

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Dr. Bridget Sweeney Blakely, thank you for pushing me to do a mixed methods

study as well as ensuring that my writing was clear and focused. I am so appreciative of

the insight and guidance you provided.

Dr. David S. Mandell, the opportunities to participate in your research projects

over the last decade have thoroughly shaped and left an indelible mark on my practice

and work and I am forever grateful to you and your team. Thank you for your

mentorship, insight, guidance, and direction in helping to articulate and bring this study

to fruition as well as the opportunity to work with you in this capacity and look forward

to continued collaboration.
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 To my USELT family—Dr. Charlotte Brickhouse, Dr. Danielle Heeney, Dr.

Justin Lien, Dr. Carlene Reid, Dr. Angel Royal, Dr. Joe Rubens, Dr. Mauria Uhlik, Dr.

LaTwyne Wise, and the future Dr. Guy Desjardins—I have learned something from each

and every one of you and cherish the rich friendships and sisterhoods this cohort has

yielded.

Mr. Kelly (Edward J. Kelly) and Ms. G (Ethel Gamble) – you are experts in

seamlessly embedding and embodying best practices while making learning fun. To you

and all of the exceptional educators and mentors I have had the privilege to meet and

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work alongside: thank you!

To our students on the spectrum—and the parents, families, and educators who
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support them—your hard work and dedication are inspiring. May we continue to learn

from one another and work together to build connections and improve outcomes.
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 Table of Contents

LIST OF TABLES ............................................................................................................. xi

LIST OF FIGURES ..........................................................................................................xiii

1. INTRODUCTION TO THE RESEARCH .................................................................... 1

Introduction to the Problem .......................................................................................... 1

Statement of the Problem Researched ........................................................................... 2

Purpose and Significance of the Problem ...................................................................... 3

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Research Questions Focused on Solution Finding ........................................................ 5
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Conceptual Framework ................................................................................................. 5

Definition of Terms ..................................................................................................... 10

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Assumptions and Limitations ...................................................................................... 13

Summary...................................................................................................................... 13

2. THE LITERATURE REVIEW ................................................................................... 15

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Introduction to Chapter 2............................................................................................. 15

Literature Review ........................................................................................................ 25

Summary...................................................................................................................... 49

3. RESEARCH METHODOLOGY ................................................................................ 51

Introduction ................................................................................................................. 51

Research Design and Rationale ................................................................................... 52

Site and Population ...................................................................................................... 54

Research Methods ....................................................................................................... 55

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 Ethical Considerations ................................................................................................. 69

4. FINDINGS, RESULTS, AND INTERPRETATIONS ............................................... 72

Findings ....................................................................................................................... 73

Results and Interpretations ........................................................................................ 131

Summary.................................................................................................................... 138

5. CONCLUSIONS AND RECOMMENDATIONS .................................................... 141

Introduction ............................................................................................................... 141

Conclusions ............................................................................................................... 141

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Recommendations ..................................................................................................... 149

Summary.................................................................................................................... 154
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LIST OF REFERENCES ................................................................................................ 156

APPENDIX A: INITIAL REASONED ACTION APPROACH/INTENTIONS

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SURVEY ................................................................................................................... 167

APPENDIX B: RECRUITMENT EMAIL ..................................................................... 176

APPENDIX C: CONSENT FORM ................................................................................. 178

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APPENDIX D: THANK YOU EMAIL .......................................................................... 181

APPENDIX E: FOLLOW-UP SURVEY ........................................................................ 182

APPENDIX F: FOLLOW-UP SURVEY EMAIL .......................................................... 183

APPENDIX G: SEMI-STRUCTURED INTERVIEW PROTOCOL ............................. 184

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 List of Tables

1. Severity Levels for Autism Spectrum Disorder .......................................................... 22

2. Data Collection Timeline ............................................................................................ 69

3. Participant Characteristics ........................................................................................... 75

4. Participants’ Experience with Pivotal Response Training (PRT) ............................... 77

5. Classroom Factors ....................................................................................................... 78

6. Means, Standard Deviations, and Correlation of Attitude Items to

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Intentions (N = 26) ...................................................................................................... 81

7. Means, Standard Deviations, and Correlation of Social Norms Items to

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Intentions (N = 26) ...................................................................................................... 83

8. Means, Standard Deviations, and Correlation of Behavioral Control Items to

Intentions (N = 26) ...................................................................................................... 86
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9. Descriptive Statistics: Determinants of Intentions and Intentions (n = 26)................. 88

10. Frequency Statistics: Determinants of Intentions and Intentions (n = 26) .................. 89

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11. Means, Standard Deviations, Correlations of Determinants of Intentions and

Intentions (n = 26) ....................................................................................................... 92

12. Means, Standard Deviations, and Correlation of Intentions and Use.......................... 93

13. Interview Participant Selection: Determinants of Intentions, Intentions, &

Use Scores (Averaged) ................................................................................................ 97

14. Initial Codes................................................................................................................. 98

15. Creating Headings to Categorize Participants’ Intentions and Use Status ................ 104

16. Organizing Categories, General and Participant Category-Specific Themes............ 106

17. Individual Teacher Characteristics ............................................................................ 107

18. Classroom Variables .................................................................................................. 111

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19. Experience with Pivotal Response Training.............................................................. 122

20. Frequency Distribution Chart of Participants’ Responses with Descriptive

Statistics ..................................................................................................................... 134

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 List of Figures

1. Model of research streams ........................................................................................... 10

2. Reasoned Action Approach ......................................................................................... 46

3. Distribution of participants’ intentions to run one-on-one pivotal

response training .......................................................................................................... 87

4. Frequency distribution of participants’ averaged responses of determinants of

intentions and intentions (n = 26) ................................................................................ 89

5. Frequency distribution of participants’ intentions to use and use of PRT .................. 91

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6. Chi square: Frequency of counts of intentions and use ............................................... 94
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 Abstract

Intentions to Implement: Predicting the Use of Pivotal Response Training (PRT) in

Public School Autistic Support Classrooms

Michelle Marie Nutini, Ed.D.

Drexel University, 2019

Chairperson: Constance Fox Lyttle, Ph.D., J.D.

Within the last two decades, increased attention has been placed on the identification and

implementation of evidence-based practices for students with autism in school settings

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consistent with federal legislation, regulatory guidance, case law, and the impetus to

improve outcomes for such individuals. However, even with an increasing wealth of
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studies investigating the extensive research-to-practice gap as related to community and

public school settings, there remains an additional gap in understanding what elements
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inspire teachers to implement interventions in their classrooms. The purpose of this

mixed method phenomenological research study was to explore autism support teachers’
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intentions to use and their use of pivotal response training (PRT), a naturalistic evidence-

based practice rooted in the principles of applied behavioral analysis. Applying Fishbein

and Ajzen’s (2010) reasoned action approach (RAA) as a guiding theoretical framework,

this research examined how the determinants of intentions (attitudes, social norms, and

behavioral control) predicted autism support teachers’ intentions and use of this practice

with students in their K-5 autistic support classrooms. Employing a QUANTITATIVE-

phenomenology (QUAN  phen) sequential explanatory approach, this three-phase

research study first collected quantitative data to develop and test the associations

between constructs, later expanding upon these findings through follow-up

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phenomenological interviews with a subset of participants to surface factors impacting

teachers’ ability to act on their intentions and add an additional layer of depth and

explanation to the results. The RAA was successful in predicting autism support

teachers’ intentions to run one-on-one PRT, finding that behavioral control had the

statistically strongest relationship with intentions and was a significant predictor of them.

The relationship between intentions and use was not found to be statistically significant,

suggesting additional factors impacted autism support teachers’ use of PRT. Qualitative

findings revealed the themes were related and distinctive to autism support teachers’

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strength of intentions and use of PRT. The findings from this mixed methods study

suggest that improving autism support teachers’ behavioral control over PRT would
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increase the strength of their intentions and use of PRT and includes recommendations

for practice and future research.

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 1

Chapter 1: Introduction to the Research

Introduction to the Problem

Federal legislation requires that students with autism who are eligible for special

education services be educated in their least restrictive environment and instructed using

methods based on scientific research (Individuals with Disabilities Education

Improvement Act of 2004 [IDEA], 2004). As a result of this mandate, school districts

must ensure that its educators are both trained in evidence-based practices and are able to

implement them with fidelity (Bellini, Henry, & Pratt, 2011; Suhrheinrich, Stahmer, &

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Schreibman, 2007; Williams, Fan, & Goodman, 2011). Considering that much of the

research supporting these evidence-based practices originated from clinical settings, there
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are notable challenges involved in translating this research into practice, particularly in
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urban public school settings (Dingfelder & Mandell, 2011; Locke et al., 2015).

In recent years, researchers have explored teachers’ awareness of and perceived

ability to deliver evidence-based practices (Brock, Huber, Carter, Juarez, & Warren,
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2014). Additionally, there is growing research on how to effectively and efficiently train

educators in evidence-based practices (Alexander, Ayres, & Smith, 2015) as well as

studies identifying specific barriers to implementation (Locke et al., 2015; Mandell et al.,

2013) and exploring individual and organizational-level factors (Locke et al., 2016).

However, having educators adopt and implement evidence-based practices within public

school settings continues to be a slow, challenging, and multi-layered process.

In an article advocating for the alignment of research and policy, the roles of

effective interventions and personnel preparation were outlined as two of the leading
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concerns impacting the education of students diagnosed with autism, highlighting the

need to build capacity over a decade ago (Simpson, 2003). Since that time, the National

Autism Center (2009a) and the National Professional Development Center on Autism

Spectrum Disorders (2012) have identified a number of evidence-based practices for

students with autism and have generally found that practices based on the principles of

applied behavioral analysis have greater evidence supporting their use; however, they

also tend to require a great deal of training and resources in order to implement them with

fidelity (Rispoli, Neely, Lang, & Ganz, 2011; Stahmer et al., 2015; Suhrheinrich et al.,

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2013). Recent studies have explored what elements of evidence-based practices are

particularly effective for students with autism as a means to better support educators’
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ability to implement them in public school settings and have found that the evidence-

based practice of pivotal response training (PRT) in particular, could be considered a key
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active ingredient in classroom practice (Pellecchia et al., 2015).

Statement of the Problem Researched

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Federal regulations and professional guidance outline the use of evidence-based

practices in educational programming. While using evidence-based practices for students

with autism is emblematic of professional ethical and education standards (Council for

Exceptional Children [CEC], 2009), the designation of a practice as evidence-based is not

an automatic guarantee that educators will use these practices. A growing body of

literature identifies numerous individual and organizational factors that present barriers

and challenges to implementation of these practices within school settings. Although

many factors contribute to an educator’s decision to use a practice, teachers ultimately

play the central role in facilitating or hindering the implementation of evidence-based

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practices in their classroom instructional practices. Some educators choose not to adopt

these practices while others experience difficulties implementing them with fidelity

(Locke et al., 2015; Mandell et al., 2013). Prior to addressing the challenges and barriers

to the implementation of evidence-based practices within public school settings, there is a

need to examine whether teachers intend to implement the practices in the first place.

Purpose and Significance of the Problem

Purpose

The purpose of this mixed methods study was to explore autism support teachers’

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intentions to use and their use of the evidence-based practice of PRT and examine how

the determinants of these intentions (attitudes, perceived norms, and behavioral control)
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predicted their intentions and use of the practice with students in their K-5 autistic

support classrooms. Using Fishbein and Ajzen’s (2010) RAA, this research study tests
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the associations between each of the determinants of intention for the practice of PRT on

the teachers’ intentions and use of PRT. This research was conducted to investigate
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whether autism support teachers have intentions to implement PRT and what the

strongest influences are on those intentions and to gain insight into how their lived

experiences affect their intentions and use of the practice. This research is anticipated to

inform future efforts to implement the evidence-based practice of PRT into urban public

school settings.

Significance

Federal special education legislation outlines that students with autism who meet

the two-pronged criteria of eligibility receive a Free and Appropriate Public Education

(FAPE; IDEA, 2004), and legal precedents, such as the landmark Lovaas cases have
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supported that this standard includes “meaningful educational benefits” to the child

(Yell & Drasgow, 2000, p.2 07). Evidence-based practices are critical to improving

outcomes for students with autism, and Yell and Drasgow (2000) cited, “A school district

is on legally strong ground when it designs and implements programs derived from

empirical research” (p. 213). However, evidence-based practices must be implemented

with fidelity to produce desired outcomes, and researchers have documented some of the

challenges educators experience in implementing evidence-based practices with fidelity,

even when they have received much training, coaching, and support as part of a large-

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scale research study (Mandell et al., 2013). These issues have legal recourse, as courts

have ruled against school districts in cases where evidence-based practices were not
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implemented, were implemented by untrained staff members, or had no data

documenting the use and student progress as a result of the intervention (Yell &
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Drasgow, 2000).

This study is significant because federal laws, regulatory guidance, and court
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decisions require the use of evidence-based practices; however, substantial challenges are

associated with having educators implement them in school settings. With a sizeable

research-to-practice gap estimated to be as large as 17 years (Morris, Wooding, & Grant,

2011) and additional gaps in the literature, it is imperative to gain insight into whether

teachers have intentions to implement the evidence-based practice of PRT and understand

which factors influence their intentions and use of the practice to inform interventions to

address implementation efforts.

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Research Questions Focused on Solution Finding

This study explored factors that influenced kindergarten through fifth grade (K-5)

autism support teachers’ intentions to use PRT and examined how their intentions

predicted their use of PRT with students in their K-5 autistic support classrooms. The

following questions guided this research:

1. Do K-5 autism support teachers’ intentions to use pivotal response training

(PRT) predict their use of the practice?

2. What determinants of intentions (attitudes, social norms, and behavioral

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control) are most important in predicting intentions?

3. Among autism support teachers with strong intentions to use PRT, what
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factors affect their ability to act on those intentions?

Conceptual Framework
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Researcher Stances and Experiential Base

The researcher has strong pragmatist leanings and is ultimately informed by the
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process of actively seeking out knowledge, exploring how to best integrate this

knowledge to better understand the situations at hand, and then engaging in applying

these learnings in an effort to solve problems. To this end, learning about the RAA and

its predecessors (e.g., theory of reasoned action of Fishbein, 1979; theory of planned

behavior of Ajzen, 1991) in regard to their potential, history, and wealth of applications

compelled the researcher to select the RAA as a guiding theoretical framework for this

research study. Referencing the framework’s potential to predict behavior from one’s

intentions, Fishbein and Ajzen (2010) encapsulated its potential citing, “at the most

fundamental level we are trying to understand why people do or do not perform a given
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behavior” (p. 37). The application of this approach aligned with the researcher’s

pragmatic inclinations to ultimately come to an understanding of why some autism

support teachers implement PRT into their classrooms and others do not.

Beneath her pragmatist principles, the researcher also believes individuals create

their own meanings based on their experiences as a way of making meaning of their

world, a point of view that aligns with the paradigm of social constructivism. Research

of a social constructivist nature intentionally focuses on bringing the voices of its

participants to the forefront in order to hear how participants view and make sense of

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their world (Creswell & Poth, 2018). The researcher was also influenced by Theory U,

which Scharmer (2016) described as “applied phenomenology – a mindful

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phenomenological practice for investigating the social field” (p. 30). Her experiences

using PRT combined with an understanding of Scharmer’s Theory U has reinforced the
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power of being authentically present when making connections with others to co-create

and generate new learning experiences. Bloomberg and Volpe (2016) highlighted, “the
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purpose of phenomenological research is to investigate the meaning of the lived

experience of people to identify the core essence of human experience or phenomena as

described by research participants” (p. 48). Being fully aware of the complexities of

working in an autistic support classroom, the researcher was interested in employing a

phenomenological approach following the dominant quantitative direction of the study as

a means to add a deeper understanding of factors that facilitate or hinder autism support

teachers’ intentions to use PRT with their students with moderate and severe autism.

Having spent over a decade working as a K-5 autism support teacher prior to

becoming an autism support coordinator within the same, large, urban public school
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district, the researcher has substantial experience using PRT with students with

moderate to severe autism. In her current role as an autism support coordinator, she is

responsible for coordinating the delivery of comprehensive services supporting the needs

of students with autism including over 300 specialized autistic support classrooms

throughout nearly 200 of the district’s public schools. As part of this work, she is

working collaboratively with university partners, curriculum developers, and district staff

to strengthen the implementation of evidence-based practices within these specialized

classrooms and on a daily basis, comes face to face with many of the challenges and

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barriers described in the literature. As an Ed.D. doctoral student, her theoretical and

practical understanding of special education leadership and management actively informs

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her work and has been integral to her understanding of how to effect change on a system-

wide level.
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The researcher’s experience of using PRT has shaped her practice, motivating her

to take a deeper dive into the questions surrounding the implementation of evidence-
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based practices to try to capture autism support teachers’ attitudes, perceived norms, and

behavioral control towards the practice of PRT and the effect of these influences on

teachers’ intentions to use and resultant use of the practice. Having seen PRT work

firsthand with students with autism who have severe behavioral and communication

difficulties has greatly influenced and positively reinforced her continued use of this

intervention and continues to be her go-to intervention when working with students.

However, the researcher is also aware that her experiences might be quite different from

other autism support teachers and has stated her own views and background openly here

and bracketed them throughout the process to ensure the participants’ experiences,

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