Examination of Differential Valuation of Leisure Items and Attention as Reinforcers in Children With Autism
Condition: Autism
MeSH terms: Autistic Disorder
Study type: Interventional

Summary: 
      The purpose of this study is to compare how children with autism, typically developing
      children, and children with other developmental delays value social attention and toys. The
      first part of the study seeks to determine whether breakpoints when responding on progressive
      ratio (PR) schedules can be used to determine the value of leisure items and attention. By
      comparing the breakpoints obtained for leisure items and attention, the researchers will
      determine the differential valuation of leisure items and attention. It is anticipated that
      the manner in which individuals with an autism spectrum disorder (ASD) diagnosis and those
      who do not will differ with respect to the degree to which they value these two types of
      stimuli. The second part of the study seeks to determine whether an intervention in which
      social attention is paired with primary reinforcers impacts responding during the PR
      assessment, in children with ASD.
    

Detailed description: 
      The three core features of autism spectrum disorder (ASD) are impairments in social
      interaction, restricted range of interest, and stereotyped/repetitive behavior. However,
      autism is a heterogeneous disorder, and individuals with a diagnosis vary widely in specific
      presentation. For example, despite an overall impairment in social behavior, some individuals
      with an autism diagnosis still frequently initiate social interactions with others. In
      contrast, others may engage in problem behaviors maintained by escape or avoidance of social
      interactions.

      A progressive ratio (PR) assessment is one method for directly quantifying the degree to
      which an individual values a particular stimulus or event. Within a PR assessment,
      reinforcement occurs under schedule requirements that increase following each set of
      responses within a single session until responding ceases. The highest schedule requirement
      completed (i.e., breakpoint) can then be used as a measure of how much an individual is
      willing to respond for a given stimulus.

      The study will include about 65 children, 25 children with ASD and 15 typically developing
      children, and 25 children with developmental disabilities other than ASD. Children with
      autism, typically developing children, and children with non-ASD developmental delays other
      than ASD will be compared in terms of how they value social attention and toys. The child
      participants will be asked to do an action, such as pressing a button, to receive either an
      item or attention. At first, the participants will only be required to do the action once,
      but after the first time the children will be required do more and more before they can get
      the item or attention. Eventually, most children stop responding for the preferred item or
      attention. The study will consider the child as done working when they go for one minute
      without performing the action. Sessions will end after 30 minutes if the child keeps working
      without stopping. This study will examine how many times the child will respond for items and
      attention. 15 of the children with ASD will be asked to come back for an additional
      appointment one week after they complete the assessment of how they value attention and toys.
      The PR assessment will be repeated see if the children respond the same way at different
      times.

      The second part of the study will include 10 children diagnosed with ASD ranging in age from
      two to six. All of the procedures described in part one of the study will be included. The PR
      assessment will be completed prior to intervention and again after intervention. All
      appointments will be conducted over a maximum of 4 weeks. The intervention will be based on
      the principals of respondent conditioning; social interaction will be paired with the
      delivery of other reinforcers, such as edible items, to increase the value of social
      interaction. Sessions will be conducted 5 days per week and will be up to two hours long.
      Following the intervention, the participant will repeat the PR assessment in order to assess
      whether the intervention increased the value of social interaction.
    

Intervention name(s): Training trials; Progressive Ratio Session; Re-test; Pairing Protocol
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): A highly preferred edible item will be selected to teach the contingencies for the assessment. Materials to engage in the work response (i.e., button press) will be placed within arm's reach of the child, and the edible item will be in sight. The therapist will deliver a vocal prompt for the child to engage in the work response (e.g., "press the button and you can have some candy"). If the child engages in the response, the therapist immediately delivers the edible item. The therapist will guide the child to engage in the instrumental response, and will then gradually begin to fade the prompt level. If the child makes an error at any level of prompting, the therapist will guide the participant to emit a correct response. The edible item will be delivered to the child each time that the child responds correctly at any prompt level.; The child will be guided to engage in the instrumental response then the stimulus will be immediately delivered for 30 seconds. The leisure item or the individual who will provide attention will be directly outside of the session room. If the child emits the work response, they will be allowed access to either a leisure item or to attention (depending on the condition) for 30 seconds. The child is initially required to respond one time, then they will be required to respond two times to gain access to the item or attention (then 4, then 8, and so on) such that the response requirement progressively increases according to a pre-determined schedule. A minimum of 3 sessions will be conducted for each condition. The amount of time required for participation depends on the child's responding, and caregiver availability. Participation may take as little as a couple hours, or as long as 3-4 hours per day for approximately one week.; 10 children with ASD will return to repeat the progressive ratio (PR) assessment one week after completing it the first time to examine the reliability of the measure.; 15 children with ASD will receive an intervention designed to increase social approach after completing the PR assessment. Participants will attend 2 hour appointments 3-5 days per week in which a therapist will deliver highly preferred items, play with the child, work on teaching communication skills, and teach the child to comply with demands. After completing the intervention (once the child is willingly staying near and interacting with the therapist and complying with instructions), the PR assessment will be repeated to measure change due to the intervention.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Children with autism, typically developing children, and children with developmental disabilities will participate in the same intervention.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Autism Spectrum Disorder; Behavioral Research; Psychology; Cognitive Disorders