BEHAVIORTHERAPY27, 353-372, 1996

Errorless Compliance to Parental Requests II1:

Group Parent Training With Parent Observational Data
and Long-Term Follow-Up
JOSEPH M. DUCHARME
Chedoke-McMaster Hospitals and
University of Toronto

MICHELE POPYNICK

EDITE PONTES

SHARON STEELE
Surrey Place Centre

Errorless compliance training has recently been developed as a nonintrusive ap-

proach to improving generalized child cooperation (Ducharme & Popynick, 1993;
Ducharme et al., 1994). In the present study, we investigated issues of efficiency,
durability, and generality of treatment effects to ensure optimal treatment utility. Par-
ents of five children with developmental disabilities and severe oppositional behavior
were trained in a group format to conduct errorless compliance assessment and treat-
ment procedures. Parent-collected data and research assistant-collected videotape
data were used to determine generality of effects. We examined long-term mainte-
nance by conducting intensive follow-up assessment up to 15 months after treatment
completion. Both parent and research assistant-collected data suggested that the
group format for errorless compliance training was effective in enhancing treatment
and generalization effects. The effects were also durable, with all children demon-
strating high levels of compliance during long-term follow-up assessment.

Child noncompliance with requests or instructions of parents and other

care providers is one of the most common reasons for referral to agencies
serving children with behavioral disorders (Wells & Forehand, 1985). Clin-
ical researchers have made substantial progress in the development and eval-
uation of effective strategies for increasing child compliance through parent-
mediated compliance training (Forehand & McMahon, 1981; Forehand &

The authors would like to thank Tom Bowman for his support of this research, Zhu-hui Li
for assistance with data summary, and Tina Pecile for computer graphics. Requests for reprints
should be sent to Joe Ducharme, Centre for Behavioural Rehabilitation, Acquired Brain Injury
Program, Chedoke-McMaster Hospitals, Box 2000, Hamilton, Ontario, L8N 3Z5.

353 0005-7894/96/0353-037251.00/0
Copyright 1996 by Associationfor Advancementof BehaviorTherapy
All rights of reproduction in any form reserved.
354 DUCHARME ET AL.

Long, 1988). With this approach, parents serve as intervention agents and
are typically trained to deliver effective requests, to reinforce child coopera-
tion, and to apply consequences for noncompliance, such as time-out and
manual guidance.
Extensions of this research have recently been conducted to determine strat-
egies for increasing compliance while reducing the need for physical inter-
ventions contingent on noncompliance. Although such consequences have
been demonstrated effective (e.g., Forehand & King, 1977; Peed, Roberts,
& Forehand, 1977; Parrish et al., 1986), implementation may require the use
of force and may result in resistance and confrontation (Roberts, 1982, 1984).
Recent research on "errorless" compliance training (Ducharme & Popynick,
1993; Ducharme et al., 1994; Ducharme, in press) has demonstrated that
many children, with or without clinical diagnoses, who exhibit severe non-
compliance (levels that would typically result in a clinical referral) can be
taught generalized compliance without need for physical consequences.
Errorless compliance training involves observational assessment to deter-
mine probability of child compliance to a range of parental requests and sub-
sequent development of a hierarchy of four request probability levels, specific
to the individual child, based on these compliance probabilities. During as-
sessment and subsequent treatment, parents deliver requests in a naturalistic
manner at times when the request is relevant to the family schedule.
At treatment initiation, children are exposed almost exclusively to requests
from the first compliance probability level (requests empirically determined
to yield high levels of compliance). Opportunities for parents to provide abun-
dant contingent reinforcement are thus frequent. Succeeding probability
levels are systematically introduced over several weeks until the child even-
tually demonstrates increased compliance to requests from the fourth prob-
ability level (those that posed serious pretreatment difficulty to parents.)
We labeled this approach "errorless" because the observational assessment
of compliance probabilities enables systematic introduction of increasingly
more demanding requests at a gradual rate that is easily manageable to the
child. Response errors (i.e., noncompliant responses) are thus greatly re-
duced throughout treatment, rendering decelerative consequences, and the
stressful physical encounters that sometimes accompany them, unnecessary.
With the errorless compliance intervention, the child learns to cooperate
while experiencing high levels of success and parent praise.
We examined several important treatment issues in the first two errorless
compliance studies. In Ducharme and Popynick (1993), we conducted the
first evaluation of this strategy, and demonstrated substantial treatment
effects, generalization to requests not included in training and covariant
improvements in behaviors not specifically targeted for intervention. The
procedure used in this investigation was labor-intensive, however, and we
evaluated a more efficient strategy, abbreviated along several treatment param-
eters, in the Ducharme et al. (1994) study. We found similar treatment, gen-
eralization, and covariant effects using the abbreviated approach.
 G R O U P ERRORLESS C O M P L I A N C E T R A I N I N G 355

We conducted the present study to further advance the literature on error-

less compliance training by addressing treatment issues of efficiency, dura-
bility, and generality of effects. Our first objective was to examine the error-
less compliance training approach in a clinic-based group format. Although
we improved clinical practicality with the abbreviated approach used in Du-
charme et al. (1994), the actual training of the parents was completed in an
individual format in the family homes. Individual training required several
home visits to train parents to conduct assessment and treatment procedures.
A group format would allow a substantial reduction of training .and travel
time for the clinician, as parent training could be completed in the clinic with
several parents simultaneously. With the group training used in the present
study, home visits were not clinically required and were used only to monitor
the effects of the treatment in the home for research purposes.
The second research question pertained to maintenance of treatment
effects. New clinical interventions require protracted follow-up assessment
to determine durability of change (Hayes, Rincover, & Solnick, 1980). In the
first two errorless compliance studies, follow-ups of more than 2 months
were completed for only two children and no child was monitored beyond
4 months. By including longer follow-up durations and intensive measure-
ment throughout the follow-up period in the current study, we wished to de-
termine whether the treatment effects obtained with errorless compliance
training were transitory or enduring.
Our final objective was to conduct an evaluation of the generality of treat-
ment gains with the errorless compliance training approach. In previous
studies (Ducharme & Popynick, 1993; Ducharme et al., 1994), all evaluation
data were collected by research assistants rather than by parents. For this
reason, no observational measure of child compliance was available when
the research assistant was absent. The addition of parent-collected data
would provide an observational measure collected under more naturalistic cir-
cumstances and potentially less contaminated by reactivity of subjects to the
research assistant (Barlow, Hayes, & Nelson, 1984; Barlow & Hersen, 1984;
Baum, Forehand, & Zegiob, 1979). In the current study, parents were trained
to collect data in the presence and absence of the research assistant during
all phases of the intervention to provide a means of assessing generality of
treatment effects. Additionally, the combination of parent- and research as-
sistant-collected data provided a means of assessing interobserver agreement
on the parent-collected data.

Method
Participants and Setting
Subjects were four boys and one girl randomly selected from a larger pool
of children who had been referred to an outpatient mental retardation center
because of noncompliance to parental requests and other oppositional be-
havior. All five children exhibited severe levels on noncompliance (failure
356 DUCHARME ET AL.

to respond appropriately to more than 60 percent of important requests pro-

vided by parents).
All parents provided written informed consent for treatment, research eval-
uation, and videotaping (one family participated in the group sessions but
was not included in the research because consent for videotaping was with-
drawn after training was initiated). All families were Caucasian and spoke
English. All were Canadian-born except the parents of Child 5 who were of
Middle Eastern ethnicity.
Child 1 and 2 were both 4-year-old boys. Child 1 was assessed in the
borderline to mild range of delay (Vineland Adaptive Behavior Scales); Child
2 had an IQ of 64 (Stanford-Binet, 4th ed.). Child 3 and Child 4 were 5-year-
old boys. Child 3 had IQ assessments ranging from 45 (Leiter) to 50 (Stanford-
Binet, 4th ed.); Child 4 was assessed in the mild to moderate range of delay
(Vineland Adaptive Behavior Scales). Child 5 was a 5-year-old girl with
Down syndrome (no intelligence scores or assessments available). All intel-
ligence assessment information was drawn from agency casebooks. All five
children were living at home with their parents.
The mothers of Child 1, 2, 3, and 5 and the father of Child 4 served as
intervention agents and data recorders. All other parents participated in treat-
ment but were not evaluated for research purposes because their schedules
were less flexible than their partners. Educational background of parents who
participated ranged from high school (Child 1 and 5) to college diplomas
(Child 2, 3, and 4). We conducted all sessions in various settings of the family
homes, depending on the request provided to the child.
The first author led all group training sessions. Two female research as-
sistants (the second and third authors) conducted other clinical duties (i.e.,
assisting with group training sessions, collecting data from parents, orga-
nizing observational assessments into hierarchies, constructing data sheets
for use during baseline and treatment) and responsibilities that were neces-
sary only for research purposes (i.e., videotaping in the home, data coding,
and summary). Both research assistants were employees of the treatment
center. One had obtained a community college diploma in Early Childhood
Education and the other possessed a bachelor's degree in psychology. Three
volunteer university students (one male and two female) served as observers
conducting additional interobserver agreement checks on the videotaped
data. Experimental naivet6 of observers was attempted but not always fea-
sible because of manifest changes in parent behavior from baseline to treat-
ment. Training for all persons doing videotaping coding was exactly as in
the previous two errorless compliance studies.
Design
A multiple baseline across-groups design with simultaneous replication
was employed (Barlow & Hersen, 1984; Kelly, 1980). Although there were
only two groups in the study (multiple baseline designs typically require
more than two time-lagged baselines), each subject in the group was eval-
 GROUP ERRORLESS COMPLIANCE TRAINING 357

uated independently, providing multiple replications of the effects within

each group.
Throughout treatment we conducted a total of four parent group training
sessions. The first session was introductory. In the second session, we taught
the parents to initiate baseline assessment procedures. Both groups received
this group training session simultaneously to fulfill the multiple baseline de-
sign requirement that baselines be initiated concurrently for all individuals.
In the third parent group training session, parents learned how to initiate treat-
ment procedures. This group training session was time-lagged approximately
1 week for Group 2, to ensure that treatment was initiated sequentially across
the two groups, another multiple baseline requirement. The fourth session
was conducted to assist the parents in maintaining treatment effects after
termination.
Due to scheduling problems and drop-out before the initiation of the first
group session, Group 1 comprised only two mothers and their children
(Child 1 and 2). Fathers of Child 1 and 2 were unable to attend the group
in both cases. Group 2 comprised seven parents (three couples and one
mother whose husband could not attend) and their children (Child 3, 4, and
5, and an additional child). We evaluated only three of the four children in
Group 2 for research proposes because parent data collection for the fourth
child was inconsistent and parents prohibited videotaping due to the camera
reactivity of the child.

Measures and Recording

Both parent-collected and videotape data (collected by the research as-
sistant) were used to monitor the dependent measure of child compliance in
the home. Parents learned to collect data during the second group training
session and subsequently recorded child compliance in the home throughout
all phases (see Parent-conducted Baseline Assessment Sessions and Parent-
conducted Treatment Sessions, below). For research evaluation purposes, re-
search assistants videotaped child responses to parent-delivered requests
during these parent-conducted sessions approximately twice per week, again
throughout all phases of the study. Data gathered from these videotapes were
subsequently compared to the parent-collected data to determine interobserver
agreement. One or two sessions of videotaping were conducted before formal
data collection to reduce the child's reactivity to the camera and observer.

Compliance
Child compliance to parental requests was the dependent measure. The
child was considered compliant if the appropriate motor response to the re-
quest was initiated within 10 s of the request, and completed within 40 s.
Failure to exhibit a motor response, failure to initiate within 10 s, or failure
to complete within 40 s, even if the appropriate motor response was exhib-
ited, were considered noncompliance.
Event recording was used to code all compliance data. Each event was ini-
358 DUCHARME ET AL.

tiated by a request provided by the parent and ended by one of three alter-
natives: (a) the failure of the child to initiate the task within 10 s, (b) the failure
of the child to complete the task within 40 s, or (c) the successful completion
of the task within 40 s of the request (the latter two options were considered
only if the child initiated the requested activity within 10 s of the request).

Interobserver Agreement
The reliability of parent-collected data was examined through comparisons
with the videotaped data. Videotaping was conducted for 44% of parent ses-
sions (30% of baseline assessment, 37% of Phase 1, 24% of Phase 2, 32%
of Phase 3, 42% of Phase 4, 41% of transitions, 100% of generalization
probes, and 100% of follow-up sessions). Overall agreement was calculated
on a trial-by-trial basis, with number of agreements per event divided by the
number of agreements plus disagreements and multiplied by 100%. Inter-
observer agreement averaged 90% for baseline assessment (range 71% to
100%), 87% for Phase 1 (range 62% to 100%), 86% for Phase 2 (range 56%
to 100%), 83% for Phase 3 (69% to 100%), 85% for Phase 4 (range 44% to
100%), 98% for transitions (range 94% to 100%), 88% for generalization
probes (range 63% to 100%), and 95% for follow-up sessions (range 44%
to 100%).
Interobserver agreement checks on the videotape coding were conducted
on 92% of the videotaped sessions (100% of baseline assessment, 100% of
Phase 1, 89% of Phase 2, 100% of Phase 3, 100% of Phase 4, 83% of tran-
sition, 100% of generalization, and 76% of follow-up sessions). Overall agree-
ment was calculated as above and averaged 98% for baseline assessment
(range 92% to 100%), 97% for Phase 1 (range 85% to 100%), 96% for Phase
2 (range 93% to 100%), 96% for Phase 3 (range 92% to 100%), 96% for Phase
4 (range 87% to 100%), 100% for transitions, 96% for generalization probes
(range 88% to 100%), and 96% for follow-up sessions (range 69% to 100%).

Procedures
All parent training of assessment and treatment procedures occurred in a
series of four group training workshops (two assessment sessions and two
treatment sessions) conducted by the first author and one of the research
assistants in a small clinic conference room. Each group training session was
approximately 2 hours in length. This training in assessment and treatment
was conducted individually in the family homes in previous studies (Ducharme
& Popynick, 1993; Ducharme et al., 1994), thereby requiring considerably
more training and travel time.
Group Parent Trainingfor Assessment of Compliance Probabilities
Group Training Session 1: Estimation of compliance probabilities. In the
first parent training session, parents introduced themselves to each other and
provided a brief overview of the kinds of problems they were experiencing
 GROUP ERRORLESS COMPLIANCE TRAINING 359

with their child's behavior. The trainer followed this discussion with a de-
tailed description of the treatment procedure and rationale.
Parents used the remaining session time to provide a cursory estimate of
the probability of child compliance to each request on a list of approximately
200 commonly used household requests. This procedure was included as a
means of determining which requests to include in the observational assess-
ment of compliance probabilities (see below). The list sampled several do-
mains of compliance, such as dressing (e.g., "put on your sweater"), hygiene
(e.g., "wash your hands"), leisure (e.g., "throw me the ball"), and social inter-
action (e.g., "shake my hand"). Parents rated each request according to the
likelihood of compliance by the child, as follows: (a) "almost always" (76%
to 100% of the time), (b)"usually" (51% to75% of the time), (c)"occasion-
ally" (26% to 50% of the time), and (d) "rarely" (0% to 25% of the time).
Group Training Session 2: Request delivery and data collection. After the
first group session, trainers selected approximately 32 requests for each child
from the list of requests rated by each parent (approximately 8 requests from
each of the 4 probability levels, as rated by the parents). Trainers recorded
these requests on data sheets that were provided to the parents in this group
session.
The trainers used modeling, rehearsal, and performance-feedback proce-
dures to teach parents to complete the baseline assessment of compliance
probabilities. Parents learned several components of appropriate request de-
livery, including using a single component request, delivering the request in
the imperative, maintaining eye contact and proximity, using a polite but firm
tone of voice, avoiding prompts or discussion after the request, providing the
child with time to respond, and avoiding repetitions of the request. Request
training was provided prior to baseline to ensure consistency of request de-
livery throughout all phases of the study and to decrease the likelihood that
child noncompliance was the result of poor request delivery.
Trainers taught parents to involve themselves in activities that were part
of their daily routine when conducting compliance sessions to ensure natural
request presentation. Parents were asked to follow their typical practice in
response to their child's compliance or noncompliance to requests. Parents
also learned to collect data on child compliance, using the operational defini-
tion of compliance described above.
Baseline Assessment
Parent-conducted baseline assessment sessions. After Group Session 2
was completed, baseline assessment of compliance probabilities was initiated
in each participant's home. Parents conducted sessions in which they
presented their child with the 32 requests selected from the questionnaire.
Parents also collected data on the child's response to each request. All base-
line data on compliance were gathered from these sessions.
The number of baseline assessment sessions, which averaged about 45 min
in length, ranged from 10 to 17 for parent-collected data. Of these, research
360 DUCHARME ET AL.

assistants videotaped 2 to 6 sessions. In each session, parents presented the

32 requests once each, in random order, every 30 to 90 s.
Hierarchical categorization of requests. All parents submitted compli-
ance data from the baseline observational assessment to the trainers, who ar-
ranged the requests in order of lowest to highest probability of compliance
based on these data. The trainers then divided the requests into four cate-
gories, approximating the four compliance probability levels. From the 32
requests assessed, 6 requests were chosen for each probability level. A broad
range of compliance domains (e.g., hygiene, dressing) was sampled for each
family to ensure generalization to requests that were not part of the treatment
protocol (e.g., Ducharme & Feldman, 1992; Ducharme & Popynick, 1993;
Ducharme et al., 1994; Sprague &Horner, 1984).

Parent Training for Treatment and Maintenance

Group Training Session 3: Treatment procedures. In this training session,
parents learned the skills required to begin conducting treatment sessions
with their children, including reinforcement procedures for compliance and
appropriate responses to child noncompliance. Trainers used modeling, re-
hearsal, and performance feedback procedures, as in Group Session 2. Par-
ents learned to provide enthusiastic praise and physical contact (e.g., hugs,
kisses, pats) after each compliant response. Parental reports and observations
by members of the research team indicated that all participant children en-
joyed praise and physical interaction. Trainers taught parents to use no con-
sequence for noncompliance other than to continue with ongoing household
activities and to proceed with the next request on the list after approximately
60 s. Parents were also taught to avoid consecutive repetitions of the same
request. Trainers reviewed request delivery procedures and asked parents to
continue using these procedures in treatment.
Outside of sessions, trainers taught parents to do one of two things: (a)
avoid providing requests from untrained probability levels, or (b) do tasks
for the child that correspond to requests from untrained levels. These pro-
cedures were included to keep everyday compliance situations as compatible
with ongoing treatment as possible.
Trainers provided parents with the data sheets that they would need to con-
duct the first phase of treatment. The list of Level 1 requests was printed on
the sheet for the parents. Parents were informed that the data for each treat-
ment phase would be monitored by the research assistant assigned, with new
data sheets provided when a phase change was appropriate.
Group Training Session 4: Maintenance. We conducted this session after
treatment completion to provide an opportunity for parents to discuss treat-
ment progress and impediments and to provide strategies for maintaining
treatment effects (e.g., general behavioral procedures such as differential re-
inforcement and extinction strategies). Parents also filled out a consumer
satisfaction questionnaire.
 G R O U P ERRORLESS C O M P L I A N C E T R A I N I N G 361

Treatment
Parent-conducted treatment sessions: Phase 1 (Level 1 requests). Parents
conducted treatment sessions in the home approximately three to five times
per week using request delivery and data collection procedures taught in
Group Training Session 2 and treatment procedures taught in Group Training
Session 3. The data from these sessions (as well as from all subsequent
phases and transitions) were used to evaluate the effects of treatment. During
each session, parents provided each of 4 requests from Level 1 three times.
Only 4 of the 6 requests per level were used in treatment because 2 requests
per level were allocated to generalization assessment (see Parent-conducted
Generalization Sessions, below). As in baseline, the research assistant video-
taped treatment sessions approximately twice a week.
Parent-conducted transition sessions. Decisions about shifts to subse-
quent probability levels were based on compliance data submitted to trainers.
If a shift was deemed appropriate (e.g., the child was compliant to over 75%
of requests delivered over two consecutive sessions), parents conducted tran-
sition sessions in the home to allow a smooth progression between levels.
In transition sessions, parents provided requests to the child from both ad-
joining probability levels. Parents repeated transition sessions if the child's
compliance in the first transition did not continue at levels consistent with
or above the previous phase.
Parent-conducted treatment sessions: Phase 2, 3, and 4 (Level 2, 3, and
4 requests). Parents conducted these sessions in the home exactly as in Phase
1, with the exception that they issued only Level 2 requests in Phase 2, Level
3 requests in Phase 3, and Level 4 requests in Phase 4.
Parent-conducted generalization sessions. Each parent/child dyad was
videotaped in the home in generalization sessions during all phases. These
sessions were conducted for research evaluation purposes to determine the
extent of generalization obtained during treatment (Ducharme & Popynick,
1993; Ducharme et al., 1994). Parents conducted one generalization session
per treatment phase on the same day as a treatment session, after several treat-
ment sessions from that phase had already been conducted.
During generalization sessions, parents issued requests from all four prob-
ability levels. Of the 6 requests designated to each level during the hierar-
chical categorization, 4 requests per level were included as part of each gen-
eralization session (i.e., 16 requests in total). Two of these 4 requests per
level (i.e., 8 total requests) were not included in the treatment sessions. These
requests (generalization requests) served as measures of generalization to re-
quests at the same probability level. The other 2 requests (training requests)
were included in the treatment sessions and thus served as a comparative mea-
sure of compliance to specifically trained requests. Mode of request presenta-
tion and consequence procedures during generalization probes were identical
to the empirical probability analysis and baseline sessions.
Generalization probes provided two distinct measures of generalization:
(a) within-level generalization and (b) across-level generalization. Within-
362 D U C H A R M E ET AL.

level generalization was defined as the extent of correspondence between per-

centage of compliance to training requests and generalization requests within
the same probability level. This provided a measure of the children's response
after treatment at a specific probability level to requests at the same level that
had not been included in treatment.
Across-level generalization was defined as the extent of correspondence be-
tween percentages of compliance to requests from the probability level being
trained and each of the remaining untrained probability levels after each
phase of treatment. With this measure, we could determine after treatment
at a specific probability level whether the children generalized to requests
from other probability levels not yet trained. Across-level generalization as-
sessment thus provided a means of establishing the number of probability
levels of requests requiring training before widespread generalization to all
probability levels was obtained.
Consumer Satisfaction
A consumer satisfaction questionnaire, which was based on a workshop
evaluation questionnaire developed by Harris (1983), comprised 7 questions
related to various aspects of the intervention, including parental feelings of
competence with employing the procedures taught, the relevance of the tech-
niques used in the group sessions, the degree to which the child's behavior
improved, and general feelings about the intervention. Each question was fol-
lowed by a 5-point Likert scale for rating satisfaction with each aspect of the
intervention. Although this questionnaire was not psychometrically validated
and the data are nonexperimental, responses to this survey provided a cur-
sory impression of the parents' satisfaction with the intervention, as a means
of socially validating the observational findings (Wolf, 1978).
Follow-up
Parents conducted follow-up sessions at 1-, 2-, and 6-week, 3-, 6-, and
15-month intervals for Child 1; 2-week, 2-, 3-, 6-, and 14-month intervals
for Child 2; 2-, 3-, and 6-week, 3-, 4-, 6-, and 15-month intervals for Child
3; 3- and 6-week, 3-, 6-, and 14-month intervals for Child 4; 1-, 4-, and
6-week, 2-, 3-, and 6-month intervals for Child 5. All follow-up sessions
were videotaped. During follow-up sessions, parents issued requests from
all four levels, as in baseline.

Results
Baseline Assessment
Percentages of compliance to requests from the four probability levels for
both parent and videotaped data before treatment are presented in Figure 1.
Given that interobserver agreement between parent-collected and videotape
data was high and parent data were much more extensive, all descriptive
statistics presented in the Results are based on the parent-collected data.
 GROUP ERRORLESS COMPLIANCE TRAINING 363

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SESSIONS

FIG. 1. Percentage of compliance to requests from the four probability levels graphed sep-
arately across sessions for both parent-collected and videotape data in baseline.
364 DUCHARME ET AL.

Scores for Level 1 requests in baseline were consistently high across all five
children.
Compliance to all Level 1 requests occurred in 51% of all baseline sessions.
Compliance to Level 4 requests was low, as children complied to 20% or
fewer of these requests in 54% of the sessions. Requests from Level 2 and
3 yielded highly variable child responses. Responses to these requests ap-
peared to be affected more by situational factors, such as the mood of the
child or his/her level of hunger or fatigue, than requests from Levels 1
and 4.
Mean percentages of compliance across all five children in baseline were
88% for Level 1, 67% for Level 2, 51% for Level 3, and 26% for Level 4.

Changes During Treatment Phases

Compliance data for all phases and for both parent and videotaped data
are presented in Figure 2. Data points for baseline sessions represent the per-
centage of compliance to requests from Level 4. Child responses to these re-
quests were used for baseline purposes because Level 4 requests yielded the
lowest levels of compliance and responses to these requests were therefore
the ultimate target for intervention (Ducharme & Popynick, 1993; Ducharme
et al., 1994).
Each treatment point in Figure 2 represents compliance to requests from
the specific level being trained (e.g., the data points in Phase 1 of treatment
represent compliance to requests from Level 1, etc.) and transition points rep-
resent compliance to a combination of requests from the two adjacent prob-
ability levels. Shaded areas represent the mean baseline percentage of child
compliance to requests from the probability level being trained in that phase.
Comparisons can therefore be made between baseline and treatment levels
of compliance at each probability level.
As expected, all five children exhibited compliance levels in Phase 1 of
treatment that were similar to their baseline responses to the same Level 1
requests. Overall (across all children) compliance to Level 1 requests in
Phase 1 of treatment was 82%, which was actually 6 percentage points lower
than the overall baseline response to these requests. This decrease presented
no concern, however, as both baseline and treatment compliance to Level 1
requests was well within the high probability range of child compliance.
As slightly more difficult requests were introduced in Phase 2 of treatment,
the overall mean for Level 2 requests improved to 77%, an increase of 10
percentage points over baseline compliance to Level 2 requests. The differ-
ences between baseline and treatment means increased further for Level 3
requests in Phase 3 of treatment, with an overall mean increase of 34 per-
centage points.
In Phase 4, the widest divergence between baseline and treatment mean
levels was achieved, with an overall increase of 58 percentage points over
baseline levels, to 84%. These findings demonstrated that during treatment,
 GROUP ERRORLESS COMPLIANCE TRAINING 365

BASELINE TREATMENT FOLLOW-UP

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VIDEO D A T A
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Fro. 2. Percentage of compliance across children and treatment phases for both parent-
collected and videotaped data. Shaded areas represent mean baseline compliance levels to re-
quests from 'the probability level being trained in that phase. Timing of group training sessions
is indicated at the bottom of the graph. Group Training Session 1 is not indicated because it
occurred before initiation of data collection. Group Training Session 3 (GT3) occurred imme-
diately prior to treatment for both groups and was therefore time-lagged for Group 2.
366 DUCHARME ET AL.

PRETREATMENT
TREATMENT PHASES
ASSESSMENT
Level 1 Level 2 Level 3 Level 4
100

90

80
8
n 70
E
8 60
"6
g 50

40
(1)
0-
30

b
20

10

0 i i i i

1 2 3 4 1 2 3 4
Probability Levels

I"TrainingRequests[]GeneralizafionRequests
I
FIG. 3. Overall mean percentage of compliance to training and generalization requests in
baseline and the four treatment phases during generalization probe sessions.

children consistently responded at high compliance probability levels to re-

quests that had posed serious problems to parents prior to treatment. Tran-
sition data were typically consistent with data collected during treatment
phases for all children, showing levels of compliance that were typically
over 75%.

Generalization
Within-level generalization. Generalization within each compliance prob-
ability level (i.e., generalization to requests at the same probability level as
requests currently being trained at the time of the generalization session) is
shown in Figure 3. Generalization data for all five subjects were combined.
Generalization to requests of the same level being trained was demonstrated
in all phases except Phase 2. Compliance to Level 2 training and generali-
zation requests during Phase 2 generalization sessions was unexpectedly low,
showing decreases of 17 and 11 percentage points respectively from baseline
levels. This finding is counterintuitive, contrary to previous evidence (Du-
 GROUP ERRORLESS COMPLIANCE TRAINING 367

charme & Popynick, 1993; Ducharme et al., 1994), and may represent
random fluctuations in child behavior that were evident due to the small
number of generalization probes conducted in each phase.
Within-level generalization is most relevant in Phases 3 and 4 because re-
quests in these phases had been low probability in baseline and therefore prob-
lematic to parents before treatment. Mean percentage of compliance to gen-
eralization requests for Phase 3 and 4 was 70% for each phase, an increase
over baseline levels of 14% for Level 3 generalization requests and 47% for
Level 4 generalization requests. These findings suggest that when children
were trained on requests from a specific level during treatment, compliance
to generalization requests from the same probability level increased.
Across-level generalization. During generalization sessions in specific
phases of treatment, generalization to requests from subsequent untrained
levels was also measured to determine the number of probability levels that
must be trained before widespread generalization to all probability levels was
obtained. Across-level generalization means are depicted in Figure 4. These

PRETREATMENT
ASSESSMENT TREATMENT PHASES
Level1 Level2 Level3 Level4
100

90

°!
8O

70

6O

5O

4O

30

20

10

[] Level 1 [ ] Level2 [ ] Level3 []

Requests Level4
Requests Requests Requests

FIG. 4. Overall mean percentage of compliance to requests from all four probability levels
in baseline and the four treatment phases during generalization probe sessions.
368 DUCHARME ET AL.

data indicate that generalized compliance gains to Level 3 and Level 4 re-
quests were not obtained after training with Level 1 and/or Level 2 requests.
In general, only after requests from a specific probability level were included
in training was generalization to requests from that level obtained, although
slight and gradual improvements were noted.
For example, in Phase 1, the overall level of compliance to Level 4 requests
improved only 6 percentage points over the baseline level of 26 %. When
Level 2 requests were introduced in Phase 2, compliance to Level 4 requests
increased another 15 percentage points, to 47 %. In Phase 3, an increase of
16 percentage points to 63 % can be observed. Finally, in Phase 4, compliance
to Level 4 reached its peak, with a total increase of 42 percentage points over
the baseline level.

Consumer Satisfaction
All participant parents completed the consumer satisfaction questionnaire.
With a score of 5.0 representing the highest degree of satisfaction, parents
of Child 2 and 4 both rated the intervention highest with mean ratings of 4.6.
Parents of Child 1 and Child 5 provided mean ratings of 4.4 and 4.0, respec-
tively. The parent of Child 3 provided the lowest consumer satisfaction rating
of 3.3. The overall mean consumer satisfaction score was 4.2.

Follow-up
Child compliance to Level 4 follow-up requests can be seen in Figure 2.
Compliance to Level 4 requests was used for follow-up to demonstrate the
degree of improvement over baseline levels of compliance to Level 4 requests
after treatment (as noted above, compliance to Level 4 was used to illustrate
baseline levels of compliance). These follow-up data demonstrated that com-
pliance to the most problematic requests continued at a high level long after
treatment completion. Overall mean compliance to Level 4 requests across
all children and follow-up sessions was 86%. Overall mean compliance
across all four request levels, children, and follow-up sessions was 89%.
Of most significance to the present study were the levels of long-term
follow-up at assessment sessions of 6 months and more than 1 year. The over-
all mean level of compliance across all children for the 6-month follow-up
was 95% to all requests and 89% to Level 4 requests. We conducted follow-
up assessment after more than 14 months for four of the five children. Overall
compliance was 95% to all requests and 93% to Level 4 requests.

Discussion
We addressed several important issues related to the effective use of error-
less compliance training in this study. The results suggest that the errorless
approach can be taught to parents in a highly efficient clinic-based group
format with minimal loss of treatment and generalization effects. Throughout
all phases of the study, parents collected data on child compliance suggesting
 G R O U P ERRORLESS C O M P L I A N C E T R A I N I N G 369

that improvements in child compliance occurred outside of sessions attended

by the research assistant. Long-term follow-up data demonstrated mainte-
nance of treatment gains after up to 6 months for all children and more than
1 year for the four available children.
By the end of treatment, compliance of all children increased to levels com-
parable to those achieved through the individualized parent training of the
previous errorless compliance studies. The group format of the present study
was much more efficient than the individualized approach, allowing a sub-
stantial reduction in clinician travel and training time. In fact, travel was re-
quired only for research evaluation purposes. Training a group of parents
took approximately the same amount of time as individual training of one
parent. Thus, the amount of training time saved using the group format was
a direct function of the number of parents included in training. Although only
7 parents were trained in the larger of the two groups, our experience with
errorless group training suggests that up to 12 parents can be accommodated
in a group.
Besides efficiency, the group format provided occasions for support from
other parents who were not available in individual training. Parents could
share problems with others experiencing stresses caused or exacerbated by
the oppositional behavior of the child. Additionally, the group format
afforded educational opportunities inaccessible when training individual
families. When one of the group participants performed the required skills
in front of the others, all parents benefited from the modeling provided and
the performance feedback of the trainer.
The generalization results of the present study replicated those of the two
previous errorless compliance studies. These three studies have consistently
demonstrated two generalization findings. First, the errorless approach has
typically produced generalization to requests of the same probability level
as those being trained in the particular phase of treatment. Although the
Level 2 requests delivered in the Phase 2 generalization probes of the present
study yielded lower than expected levels of compliance, mean compliance
to generalization requests from Levels 3 and 4 was comparable to previous
studies. Second, generalization to requests from lower probability levels has
generally not occurred until the child has been systematically exposed to all
preceding probability levels. This result underscores the importance of the
graduated component of this intervention.
The use of multiple observational outcome measures provided suggestive
evidence that training effects were not confined to videotaped treatment ses-
sions, as both parent- and research assistant-collected data consistently re-
vealed substantial treatment effects. It should be noted that although inter-
observer agreement between videotaped and parent-collected data was high,
one cannot draw firm conclusions about parent recording outside videotaped
sessions. The high interobserver agreement indicated that parents could col-
lect reliable data in the presence of the research assistant, but did not guar-
370 DUCHARME ET AL.

antee that parents were similarly accurate when recording on their own. The
correspondence in parent data trends between sessions with and without the
research assistant, however, suggests that parent recording accuracy under
the two circumstances was comparable.
Child compliance to parental requests during follow-up was often higher
than compliance levels during the intervention. Based on follow-up data and
verbal reports of parents during the follow-up period, child noncompliance
was no longer an issue in the families after treatment. Considering that the
treatment was nonintrusive, with no punitive consequence employed for non-
compliance, these maintenance results are promising and provide the first em-
pirical evidence that errorless compliance training can produce gains that en-
dure far beyond treatment termination.
Because errorless compliance training is substantially different from con-
ventional compliance training approaches, we have attempted with this series
of studies to systematically evaluate treatment parameters necessary to ensure
effectiveness and practicality for clinicians. The results have been encour-
aging. There are, however, several limitations that suggest methodological
adaptations in future research.
First, the current study and previous errorless compliance investigations
(Ducharme & Popynick, 1993; Ducharme et al., 1994) were conducted with
small samples. Although small N samples are useful to determine initial effec-
tiveness of new behavioral interventions and to establish an efficient training
protocol, a randomized trials design with a much larger sample is necessary
to provide evidence of generality to specific clinical populations. The mul-
tiple baseline across-groups design used in this study presented a related con-
cern. Although this design provided for simultaneous replication within each
group, the presence of only one time-lagged baseline reduced the experi-
mental rigor (Barlow & Hersen, 1984).
The evaluation of errorless compliance training could also benefit from pre-
and post-assessment with standardized measures of child behavior, such as
the Child Behavior Checklist (Achenbach & Edelbrock, 1983). Significant
change on such measures from baseline to posttreatment would provide
strong evidence that the errorless intervention produces widespread and clin-
ically significant treatment effects.
Finally, the group format, although highly efficient, presents practicality
problems if parents miss group sessions or if parents are unmotivated to col-
lect accurate data consistently or conduct other program procedures indepen-
dently. Missed sessions would require rescheduling in an individual format
and data collection problems might require the inclusion of motivational sys-
tems for parents. For example, provision of tickets to be exchanged for
tangible rewards, such as children's clothing or toys, contingent on appro-
priate program participation, might be effective for enhancing parent coop-
eration, especially for parents of low socioeconomic status. Despite these
limitations, the group approach to errorless compliance training resulted in
much more efficient use of the clinician's time than individual visits to the
 GROUP ERRORLESSCOMPLIANCETRAINING 371

h o m e and shows promise as a practical treatment approach for children ex-

hibiting severe oppositional behavior.

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RECEIVED: August 24, 1995

ACCEPTED." July 1, 1996