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AUTHOR'S PROOF

Metadata of the article that will be visualized in OnlineFirst

1 Article Title Sibling-Implemented Script Fading to Promote Play-Based

Statements of Children w ith Autism
2 Article Sub- Title
3 Article Copyright - Association for Behav ior Analysis International 2018
Year (This w ill be the copyright line in the final PDF)
4 Journal Name Behavior Analysis in Practice
5 Family Name Akers
6 Particle
7 Given Name Jessica S.
8 Suffix
9 Organization Baylor University
10 Division Department of Educational Psychology
11 Corresponding Address One Bear Place #97301, Waco 76798, TX
12 Author Organization Utah State University
13 Division
14 Address Logan, UT
15 Organization Baylor University
16 Division Department of Educational Psychology
17 Address One Bear Place #97301, Waco 76798, TX
18 e-mail Jessica_akers@baylor.edu
19 Family Name Higbee
20 Particle
21 Given Name Thomas S.
22 Suffix
Author
23 Organization Utah State University
24 Division
25 Address Logan, UT
26 e-mail
27 Family Name Pollard
28 Particle
Author
29 Given Name Joy S.
30 Suffix
AUTHOR'S PROOF

31 Organization Utah State University

32 Division
33 Address Logan, UT
34 Organization Behavior Change Institute
35 Division
36 Address Oakland, CA
37 Organization Behavior Change Institute
38 Division
39 Address Oakland, CA
40 e-mail
41 Family Name Reinert
42 Particle
43 Given Name Kassidy S.
44 Suffix
Author
45 Organization Utah State University
46 Division
47 Address Logan, UT
48 e-mail
49 Received
50 Schedule Revised
51 Accepted
52 Abstract We trained three typically developing children to implement a
script-fading procedure with their younger siblings with autism. The
number of contextually appropriate statements made by the
children with autism increased once treatment was initiated.
Participants continued to emit higher levels of contextually
appropriate statements after the scripts were completely faded and
at a 4- or 11-week follow-up. The typically developing siblings were
able to implement the script-fading procedure with high levels of
fidelity.
53 Keywords Script fading - Autism - Sibling - Play - Language
separated by ' - '
54 Foot note • Young children with ASD often do not emit appropriate play
information statements while playing with toys.
• Script fading is an effective intervention for teaching children with
ASD to emit play-based statements.
• Typically developing siblings can implement script fading with
fidelity.
 AUTHOR'S PROOF JrnlID 40617_ArtID 257_Proof# 1 - 13/04/2018

Behavior Analysis in Practice

https://doi.org/10.1007/s40617-018-0257-5
1
3 BRIEF PRACTICE
2

4
5 Sibling-Implemented Script Fading to Promote Play-Based Statements
6 of Children with Autism
7 Jessica S. Akers 1,2 & Thomas S. Higbee 1 & Joy S. Pollard 1,3 & Kassidy S. Reinert 1
8
9
10 # Association for Behavior Analysis International 2018

11 Abstract

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12 We trained three typically developing children to implement a script-fading procedure with their younger siblings with autism.

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13 The number of contextually appropriate statements made by the children with autism increased once treatment was initiated.
14 Participants continued to emit higher levels of contextually appropriate statements after the scripts were completely faded and at a

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15 4- or 11-week follow-up. The typically developing siblings were able to implement the script-fading procedure with high levels

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16 of fidelity.

17 Keywords Script fading . Autism . Sibling . Play . Language

18
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19 One of the diagnostic criteria of autism spectrum disorder implementers in the majority of studies (Akers, Pyle, 33
20 (ASD) is deficit in the area of social communication Higbee, Pyle, & Gerencser, 2015). One notable exception is 34
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21 (DSM-5; American Psychiatric Association [APA], 2013). the implementation of script fading by parents (Reagon & 35
22 Script fading is a procedure that has been shown to increase Higbee, 2009). The parents in this study developed three 36
23 the number of appropriate vocalizations emitted by children scripted statements and systematically faded the scripted state- 37
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24 with ASD (Krantz & McClannahan, 1993). Script fading con- ments based on their child’s performance during play sessions. 38
25 sists of the following steps: (a) first, children are taught to emit The scripted statements (e.g., “Look, the car is going!”) were 39
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26 the scripted phrase using a textual (e.g., typed) or auditory related to one toy set, and two other toy sets were used to 40
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27 (e.g., recorder) script and (b) the script is systematically faded assess for generalization. Results showed that play initiations 41
28 42
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such that the child with ASD continues to emit the scripted increased with both the target and generalization toy sets.
29 phrase in the absence of the script. Once script fading is initi- The results reported by Reagon and Higbee (2009) are 43
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30 ated, children often emit untaught phrases in addition to those promising; however, it may be important to identify if 44
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31 that were directly taught. While script fading has been shown these results could be replicated with a more age appro- 45
32 to be effective, researchers or instructors have served as priate play partner. For many children with ASD, a com- 46
mon play partner might be a typically developing sibling. 47
Given the effectiveness of script-fading procedures with 48
Q2 Implications for practice parents delivering and fading scripts, we sought to sys- 49
• Young children with ASD often do not emit appropriate play statements tematically replicate these results with siblings serving as 50
while playing with toys. play partners. We measured the effects of the script fading 51
• Script fading is an effective intervention for teaching children with ASD
procedure on the number of contextually appropriate 52
to emit play-based statements.
• Typically developing siblings can implement script fading with fidelity. statements made by children with ASD. 53

* Jessica S. Akers
Jessica_akers@baylor.edu
Method 54

1
Q1 Utah State University, Logan, UT, USA Participants and Setting 55
2
Present address: Department of Educational Psychology, Baylor
University, One Bear Place #97301, Waco, TX 76798, USA Three children with ASD, who had previously attended or 56
3
Present address: Behavior Change Institute, Oakland, CA, USA were currently attending a university-based behavioral 57
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58 preschool, participated in the study along with a typically and recorded the number of comments via recorded video. 92
59 developing sibling. We recruited participants who (a) could IOA was calculated by dividing the number of agreements 93
60 emit at least three-word phrases, (b) had a generalized imita- by the number of agreements plus disagreements and 94
61 tion repertoire, (c) engaged in low levels of destructive behav- converting the result to a percentage. An agreement was de- 95
62 ior, and (d) played with toys appropriately but rarely fined as both coders (i.e., the first and fourth authors) record- 96
63 commented during play. Sadie (5) participated with her sister ing the same statement as contextually appropriate. Mean 97
64 Melissa (14), Cameron (7) participated with his brother agreement was 95% (range from 75 to 100%) for Sadie, 98
65 Landon (10), and Hank (4) participated with his sister 96% (range from 75 to 100%) for Cameron, and 97% (range 99
66 Mandy (6). A parent of each participant served as a research from 50 to 100%) for Hank. During the session with 50% 100
67 assistant for sessions. We conducted sessions in participants’ agreement, Hank only made two comments; therefore, one 101
68 homes in an open area that was cleared of distracting items. disagreement leads to this low percentage. 102
We assessed treatment fidelity for 50% of sessions. We 103
69 Materials assessed for the following components, whether the sibling 104
(a) oriented to the participant, (b) presented a script every 105

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70 Each sibling dyad was assigned three toy sets to interact with 30 s, (c) responded to the participant’s initiations, (d) used 106
the prompting procedure (described below), (e) did not ask 107

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71 during sessions (see Table 1). These toy sets were purchased
72 by the researcher and access was restricted outside of sessions. questions or provide directions, and (f) only made comments 108

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73 We designated one toy set to be used for the script fading about his/her own behavior. Treatment fidelity was calculated 109
intervention (hereafter called the “target toy”) and used the by dividing the number of correctly implemented components 110

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74
75 other two toy sets to assess generalization. The parents devel- by the total number of components and converting the result to 111
76 oped three 3–4-word scripts which were recorded on Mini-Me a percentage. Mean fidelity of implementation was 93% 112
77 ™ voice recorders. Siblings wore MotivAider timers to signal
D (range from 87 to 100%) for Sadie, 93% (range from 82 to 113
78 30-s intervals. 100%) for Cameron, and 88% (range from 62 to 100%) for 114
115
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Hank.
79 Measurement
116
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Experimental Procedures
80 Parents transcribed all statements made by participants during
81 sessions, and the transcription was then reviewed by the re- An adapted alternating treatment design embedded within a 117
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82 searcher to total the number of contextually appropriate state- multiple baseline design across participants was used to assess 118
83 ments. Statements were not scored if they were (a) not con- the effects of the script-fading procedure on the number of 119
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84 textually appropriate (e.g., “I need gas,” when playing with comments emitted by the participants. Prior to the study, a 120
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85 the playground), (b) one-word statements, (c) immediate rep- brief multiple-stimulus without replacement preference as- 121
86 etitions of statements, (d) excessive repetitions of statements, sessment (Carr, Nicolson, & Higbee, 2000) was conducted 122
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87 defined as using the same statement more than four times, (f) to identify the top three toy sets. 123
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88 stereotypic phrases, individually identified for each participant

(e.g., “good job”), or (g) completely unintelligible.
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89 Pretraining We trained the siblings to implement the 124

90 A second coder collected data for 33% of sessions to assess script-fading procedure using Behavioral Skills Training 125
91 interobserver agreement (IOA). The second coder transcribed (BST). Parents served as the role-play partner and provided 126

t1:1 Table 1 Session materials

t1:2 Toy sets Scripted statements

t1:3 Sadie Fisher-Price Little People® Playground (target) 1. Go down slide

t1:4 Fisher-Price Little People® Happy Sounds Home (GS1) 2. I want swing
t1:5 Fisher-Price Little People® Wheelies Airport (GS2) 3. Cross the bridge
t1:6 Cameron Fisher Price World of Little People® Emergency Fire Station (target) 1. Go get the hose
t1:7 Fisher-Price Little People® Playground (GS1) 2. To the rescue
t1:8 Fisher-Price Little People® Wheelies Airport (GS2) 3. Let us save them
t1:9 Hank Hot Wheels® City Tow and Tune Car Shop Play Set (target) 1. Fix the car
t1:10 Play-Doh® Brick Mill and Grinding Gravel Yard (GS1) 2. Down the hill
t1:11 Vtech® Go! Go! Smart Wheels Airport Playset (GS2) 3. Pick up car

Target target toy set, GS generalization toy set

AUTHOR'S PROOF JrnlID 40617_ArtID 257_Proof# 1 - 13/04/2018

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127 feedback to the sibling in conjunction with feedback provided Results 177
128 by the researcher. We specifically trained the siblings to (a)
129 orient to the participant during play, (b) refrain from asking Figure 1 displays the number of contextually appropriate 178
130 questions or giving directions, (c) respond to all of the partic- statements emitted by the three participants. The closed 179
131 ipant’s verbalizations, and (d) to comment on their own play data path denotes sessions for the target toy; this is the 180
132 actions. Siblings were instructed to present an auditory script only data path that includes scripted statements. The 181
133 every 30 s and wait for participant to emit the scripted phrase. large closed squares denote fading steps for the scripts. 182
134 If he or she did not repeat the scripted phrase, the sibling first Scripts were completely faded, including the removal of 183
135 physically guided him or her to press the voice recorder but- the recorders, for all participants. Once we introduced 184 Q3
136 ton. If this prompt was ineffective, the sibling provided a the script-fading procedures with the target toy, partici- 185
137 verbal prompt (e.g., “say, here comes the car”). Training end- pants’ responding increased for the generalization toy 186
138 ed when the sibling correctly implemented each component sets, as well as the target toy, indicating that commenting 187
139 with their parent with 95% or better accuracy. During behavior generalized across toy sets. 188
140 pretraining, the most common error was failing to respond to Sadie’s statements for the three toy sets greatly in- 189

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141 comments made by the parent. The siblings met mastery after creased from baseline (M = 6, target toy; M = 4.2, GS1; 190
142 one session that took approximately 30 min. and M = 4.4 GS2) to treatment (M = 17.77, target; M = 191

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15.22, GS1; and M = 17.27, GS2). Scripts were 192

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143 Baseline and Generalization Sessions We conducted three completely faded for Sadie in 17 sessions. We conducted 193
144 3-min sessions per day (i.e., one for each toy set). Prior to one booster session, denoted by the asterisk, before ses- 194

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145 each session, the parent cleared the environment to remove sion 46 because she was having a difficult time 195
146 possible distractions and provided the sibling with the appro- responding appropriately to the scripts at the second fad- 196
147 priate materials. The researcher video recorded sessions while
D ing level. During the booster session, Sadie was required 197
148 the parent simultaneously transcribed statements. The sibling to accurately emit each scripted statement (without the 198
149 began sessions by saying, “let us play.” Throughout the ses- 199
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toy present) for five consecutive trials. After this booster
150 sions, the siblings responded to all comments emitted by the session, scripts were completely faded in seven sessions. 200
151 child with ASD, and there were no other programmed conse- We conducted a follow-up session 11 weeks after the 201
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152 quences for commenting. final treatment session, and Sadie’s responding remained 202
at levels consistent with treatment even after this extend- 203
153 Script Fading The script-fading procedure was only imple- ed period of time. 204
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154 mented with the target toy. These sessions followed the Cameron’s statements for the three toy sets also in- 205
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155 same procedures as baseline and generalization sessions creased from baseline (M = 5.87, target toy; M = 7, GS1; 206
156 with the exception of the presence of the scripts. The and M = 5.62, GS2) to treatment (M = 14.29, target; M = 207
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157 sibling retained access of the recorders (i.e., scripts) and 15.16, GS1, and M = 13.87, GS2). We completely faded 208
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158 every 30 s presented one of the three scripts by holding the scripts for Cameron in 17 sessions. When playing 209
159 210
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the recorder in the participant’s line of vision and pro- with the target toy set, Cameron emitted siren sound
160 ceeding through the prompting steps when necessary. effects (e.g., “weeeoooeee”) at a high rate, which ad- 211
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161 We did not require play actions to match play statements versely effected his commenting. Therefore, at session 212
162 (e.g., the participant could say “cross the bridge” while 66 Landon began presenting scripts every 15 s instead 213
163 going down the slide); therefore, the sibling presented of every 30 s in order to interrupt these competing re- 214
164 scripts in a quasi-random order, unrelated to the child’s sponses. After implementing this modification, Cameron 215
165 play behavior. We initiated script fading once the child emitted more comments and continued to do so when the 216
166 with ASD independently followed the three scripts at scripts were completely faded. Cameron continued to 217
167 100% accuracy for two consecutive sessions. We faded emit higher levels of contextually appropriate statements 218
168 scripts one word at a time from the end to the beginning during the 4-week follow-up session. 219
169 with the final fading step being complete removal of the Hank’s statements also increased from baseline (M = 220
170 script (i.e., including the recorder). 0.8, target toy; M = 0.9, GS1; and M = 0.4, GS2) to 221
treatment (M = 9.95, target; M = 6.17, GS1, and M = 222
171 Follow-up We assessed for maintenance 4 weeks after the 8.26, GS2). We observed the most moderate treatment 223
172 completion of training for Cameron and Hank. Sadie’s effect for Hank; however, he also emitted the fewest 224
173 follow-up sessions occurred 11 weeks after the comple- number of comments during baseline. We completely 225
174 tion of training due to an unforeseeable family incident. faded scripts for Hank in 16 sessions. Hank continued 226
175 These sessions followed baseline procedures and the to emit higher levels of appropriate comments at the 227
176 scripts were not present. 4-week follow-up session. 228
AUTHOR'S PROOF
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Behav Analysis Practice

Fig. 1 The results for Sadie (top), Baseline Teaching Follow up

Cameron (middle), and Hank 30 Scripts
(bottom). The large closed completely faded
squares represent script-fading
25 *
steps. *booster session 20
Target Toy
15 Generalization Toy 1
Generalization Toy 2
10

5
Sadie
0
30 15-s script
Number of Comments presentation
25

20

15

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10

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Scripts
5 completely Cameron

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faded
0

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30

25 Scripts
completely
20 faded
D 15
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10

5
Hank
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0
0 10 20 30 40 50 60 70 80 90 100
Sessions
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229 Discussion implementer of the intervention and was conducted in the 251
natural environment (i.e., participants’ home). Siblings were 252
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230 The number of contextually appropriate statements increased selected to implement this intervention because we deter- 253
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231 after the treatment was initiated for all three participants. It is mined that it was likely that they would serve as a play partner 254
232 255
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important to note that these increases in commenting were for the child with ASD in the home environment. Despite the
233 observed in the absence of any artificial reinforcement. young age of some of the siblings, all three implemented pro- 256
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234 Many social skill interventions include additional reinforcers, cedures with fidelity, for which we recorded data during 50% 257
235 which are necessary for behavior change. However, within of the sessions. Future researchers could assess whether typi- 258
236 this intervention, we observed a change in behavior when cally developing peers could serve as implementers of the 259
237 the only consequence that followed the emission of comments script-fading procedure and to what extent this implementa- 260
238 was a verbal response from the sibling. We cannot state with tion would lead to a subsequent increase in commenting by 261
239 any certainty that the response functioned as a reinforcer, but it the child with ASD. 262
240 is possible. Future researchers could directly assess whether There are limitations of this study that are worth noting. 263
241 social responses function as reinforcers after implementing First, we did not specifically code for the complexity of the 264
242 script fading. We were able to completely fade the scripts for statements. While the overall number of statements increased, 265
243 participants without introducing any additional fading steps. It it is unknown whether there was an improvement in the qual- 266
244 is unlikely that this finding would be replicated across studies ity of the comments. Future researchers could develop more 267
245 as previous researchers have reported that complete fading sensitive measures to identify the effects of script fading on 268
246 was not achieved (Akers et al., 2015). Future researchers increasing comments with more advanced grammar and/or 269
247 should consider investigating conditions which promote suc- content. In addition, coding statements as novel, delayed im- 270
248 cessful fading. itation, and variations of previously emitted statements may 271
249 This study extends the script-fading literature as it includes provide useful information for future studies. Second, the ses- 272
250 naturalistic change agents (i.e., siblings) as the primary sion duration was relatively short. We arbitrarily selected 273
AUTHOR'S PROOF JrnlID 40617_ArtID 257_Proof# 1 - 13/04/2018

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274 3-min sessions because we felt the short session length would the utility of incorporating siblings as play partners to promote 313
275 reduce the risk of participants’ losing motivation to play with play-based commenting. These results again highlight the 314
276 the toys. However, it is unknown whether participants’ generative effects of script-fading procedures in that all three 315
277 responding would maintain during longer play sessions. participants learned to initiate both scripted and unscripted 316
278 Future researchers may wish to investigate this further. play statements as a result of being taught three scripted state- 317
279 Third, the change in level between Cameron’s baseline and ments with a single toy set. 318
280 initial treatment phase was less robust than for the other two
281 participants. Although the lack of an immediate effect is Compliance with Ethical Standards 319
282 concerning, the shift in level following the modification of
283 script presentation does provide a clear change from baseline Conflict of Interest The authors declare that they have no conflict of 320
284 to treatment. Fourth, we did not require play statements to interest. 321
285 match play actions (e.g., saying “down the ramp” while driv-
Ethical Approval All procedures performed in this study were in accor- 322
286 ing up). However, participants rarely, if ever, engaged in mis- dance with the ethical standards of the institutional committee and with 323
287 matched responses. While this did not become an issue for our the 1964 Helsinki Declaration and its latter amendments or comparable 324
325

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288 participants (likely because of our inclusion criteria), future ethical standards.
289 researchers could investigate procedures to increase corre-

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290 spondence between play and language, as this may be a skill Informed Consent Informed consent was obtained from the parents of 326
the children included in the study. 327

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291 deficit for many children with ASD.
292 A final limitation was our decision to train the siblings to

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293 comment about their own behavior. This is a deviation from
294 the Reagon and Higbee study, and it is possible that the sib-
References 328
329
295 lings’ modeling appropriate comments had an effect on par-
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296 ticipants’ commenting. Although siblings commented about
Akers, J. S., Pyle, N., Higbee, T. S., Pyle, D., & Gerencser, K. R. (2015). 330
297
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their own behavior across baseline and treatment, we did not A synthesis of script fading effects with individuals with autism 331
298 specifically hold the number of comments constant; therefore, spectrum disorder: a 20-year review. Review Journal of Autism 332
299 we cannot rule out the possibility that this alone led to an and Developmental Disorders, 3, 1–17. https://doi.org/10.1007/ 333
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300 increase in participants’ responding. We included this devia- s40489-015-0062-9. 334

American Psychiatric Association. (2013). Diagnostic and statistical 335
301 tion because we determined that due to the age of the siblings, manual of mental disorders (5th ed.). Arlington, VA: American 336
302 it was likely they would engage in some vocal verbal behavior 337
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Psychiatric Publishing.
303 during play; therefore, we decided the best way to ensure they Carr, J. E., Nicolson, A. C., & Higbee, T. S. (2000). Evaluation of a brief 338
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304 refrained from asking questions or giving directions was to multiple-stimulus preference assessment in a naturalistic context. 339
Journal of Applied Behavior Analysis, 33(3), 353–357. https://doi. 340
305 teach them to comment about their own behavior. In addition,
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org/10.1901/jaba.200.33-353. 341
306 we believed that training the siblings to refrain from speaking Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with 342
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307 unless they were responding to a participant comment would autism to initiate to peers: effects of a script-fading procedure. 343
308 344
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have been a detriment to the social validity of the study as this Journal of Applied Behavior Analysis, 26(1), 121–132. https://doi.
309 would not likely occur in the natural environment. org/10.1901/jaba.1993.26-121. 345
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Reagon, K. A., & Higbee, T. S. (2009). Parent-implemented script fading 346

310 The results of this study further support the use of script to promote play-based verbal initiations in children with autism. 347
311 fading to increase play statements for children with ASD in Journal of Applied Behavior Analysis, 42, 659–664. https://doi. 348
312 the home environment. In addition, this study demonstrates org/10.1901/jaba.2009.42-659. 349
350
AUTHOR'S PROOF
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