SELF-INSTRUCTION MANUALS AND DATA COLLECTION

Self-Instruction Manuals and Data Collection: Increasing Effective Practices Among Parents
_______________________
A Dissertation
Presented to
The College of Graduate and Professional Studies
Department of Special Education
Slippery Rock University
Slippery Rock, Pennsylvania
______________________
In Partial Fulfillment
of the Requirements for the Degree
Doctorate of Special Education
_______________________
by
Kathleen Lynagh
July 2025
ã Kathleen Lynagh, 2025

Keywords: autism spectrum disorders, family support, parents, applied behavior analysis, inhome support, function-based intervention, parent training, data collection

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COMMITTEE MEMBERS

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ABSTRACT
This study serves to examine strategies to better equip caregivers to identify functions of
behavior, utilize function-based strategies independently, and generalize those interventions to
various community settings. This was identified as a need area due to clinicians not providing
sufficient parent training and caregivers facing barriers in attending trainings that are available,
all for various reasons. Participants were six single caregivers residing in Lancaster County with
varying backgrounds with receiving ABA services. Single caregivers were chosen specifically as
research has demonstrated increased stress levels and decreased opportunities for community
involvement among this demographic. Participants collected three-term contingency behavior
data and provided responses to open-ended interview questions so data could be collected
through a sequential exploratory method that utilized both quantitative and qualitative data. The
open-ended responses were coded via content analysis to analyze effectiveness and ease of
implementation of prescribed function-based interventions. All participants saw a decrease in
perceived intensity of behaviors targeted for reduction and were able to implement functionbased strategies in both the home and community settings.

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DEDICATION
This dissertation is dedicated to my parents, Sallie and Fritz Lynagh, my sister Marie
Lynagh, and my brother John Lynagh…surprise!
To my mom who borrowed the phrase from Charles Schulz that has been true in just
about every aspect of my life, “Everything you have, you have because of me”: Thank you for
your unwavering support to be a strong advocate for the children we serve. Thank you for never
allowing me to have a minute of downtime with my continuing education so I can be the best
provider for my students and clients. No, I am not going to law school.
To my dad: Thank you for your encouragement and sense of humor through this process.
The many laughs provided me with much needed breaks to refocus and keep moving.
To my sister, Marie: Thank you for your motivation to be a better writer so I could maybe
one day get a better score than you on a standardized test. I have shown you my thanks by not
asking you to edit this paper for me.
Finally to my brother, John: Even though you won’t read this, there is no doubt in my
mind that I never would have achieved the many things I have, both personally and
professionally, without having the honor of being your sister. You have made me into a better
educator, behavior analyst, advocate, and most importantly a better and more understanding
person.
The doctor is real in…

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ACKNOWLEDGEMENTS
I want to begin by acknowledging my family for their constant support throughout this
process. Despite the many challenges, delays, and moments of frustration over the past year,
you’ve been there to listen to me vent, help me problem solve, encourage me to stay focused on
the end goal, and keep me moving forward. Your support has truly meant everything to me.
I would also like to acknowledge my friends who have stood by me through this process
as well. Thank you for your patience through all the “I can’t yet, I have to write”s you have
heard over the last year, and for adjusting your schedules to allow me ample time to finish this
journey and not miss out on our experiences. Your jokes, encouragement, and repeatedly calling
me “Almost Doctor” have motivated me to continue working, and for that I am eternally
grateful.
To the educators and clinicians I have had the pleasure of previously or currently working
with, thank you for modeling best practices and helping me stay current on research and trends
so I can be an effective clinician.
Finally, a sincere thank you to my doctoral committee of Dr. Richael Barger-Anderson,
Dr. Toni Mild, and Dr. Eric Bieniek. I have never done anything like this before and could not
have ever done so without your positive and constructive feedback throughout this process. You
all have made me a better writer, researcher, and clinician. Thank you for your never-ending
encouragement and support.

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TABLE OF CONTENTS
ABSTRACT..................................................................................................................................iii
DEDICATION...............................................................................................................................iv
ACKNOWLEDGMENTS..............................................................................................................v
LIST OF TABLES.........................................................................................................................x
LIST OF FIGURES........................................................................................................................xi
CHAPTER 1: Introduction............................................................................................................12
Overview of the Topic.......................................................................................................12
Summary of the Problem...................................................................................................13
Organizational Context......................................................................................................14
Existing Research...............................................................................................................15
Significance of Study.........................................................................................................19
Delimitations......................................................................................................................22
Definition of Terms............................................................................................................23
Conclusion.........................................................................................................................27
CHAPTER 2: Review of the Literature.........................................................................................30
Introduction........................................................................................................................30
Parent Training – Current Research and Needs.................................................................30
Determining and Addressing the Function of Behavior....................................................47
Antecedent Strategies for Parents......................................................................................52
Noncontingent Reinforcement...............................................................................53
Using NCR with Positive Reinforcement..................................................53
Using NCR with Negative Reinforcement................................................54

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Considerations of using NCR....................................................................54
High-Probability Request Sequence......................................................................56
Benefits of High-P.....................................................................................56
Application of High-P................................................................................57
Functional Communication Training.....................................................................58
History of FCT...........................................................................................58
Preference Assessments.........................................................................................59
Consequent Strategies for Parents.....................................................................................60
Differential Reinforcement....................................................................................61
Token Economy.....................................................................................................63
Example of Use of Token Economy..........................................................63
Considerations of Token Economy............................................................64
Planned Ignoring....................................................................................................64
Considerations of Implementing Planned Ignoring...................................65
Steps for Developing Interventions using Planned Ignoring.....................65
Examples of Planned Ignoring...................................................................66
Time-Out................................................................................................................66
Considerations of Implementing Time-Out...............................................67
Perceptions of Time-Out............................................................................69
Examples of Time-Out...............................................................................69
Purpose of the Study..........................................................................................................70
Research Questions............................................................................................................70
Need for the Study.............................................................................................................72

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Summary............................................................................................................................74
CHAPTER 3: Methodology...........................................................................................................75
Introduction........................................................................................................................75
Procedures..........................................................................................................................75
Participants……………………………………………………………………………….78
Data Collection..................................................................................................................78
Data Analysis.....................................................................................................................81
Site Permission..................................................................................................................83
Presentation of Results.......................................................................................................83
Limitations.........................................................................................................................83
Conclusion.........................................................................................................................85
CHAPTER 4: Results……………………………………………………………………………87
Introduction………………………………………………………………………………87
Recruitment Summary…………………………………………………………………...89
Open-Ended Questions…………………………………………………………………..89
Participant Summary……………………………………………………………………..96
Participant One…………………………………………………………………...96
Participant Two…………………………………………………………………..99
Participant Three………………………………………………………………..101
Participant Four…………………………………………………………………104
Participant Five…………………………………………………………………107
Participant Six…………………………………………………………………..109
Findings………………………………………………………………………………...112

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Research Question 1……………………………………………………………112
Research Question 2……………………………………………………………115
Research Question 3……………………………………………………………120
CHAPTER 5: Discussion……………………………………………………………………….128
Introduction……………………………………………………………………………..128
Summary and Key Findings…………………………………………………………….128
Implications……………………………………………………………………………..133
Practical Implications for Children……………………………………………..133
Practical Implications for Caregivers…………………………………………...135
Practical Implications for Clinicians……………………………………………136
Implications Related to Ethics and Safety……………………………………...138
Practical Implications Regarding Long-Term Benefits………………………...138
Limitations and Recommendations for Further Research……………………………...139
Conclusion……………………………………………………………………………...141
REFERENCES............................................................................................................................143
APPENDIX A: Open-Ended Questions.......................................................................................163
APPENDIX B: Preference Assessment.......................................................................................165
APPENDIX C: Behavior Data Collection...................................................................................166
APPENDIX D: Recruitment Materials........................................................................................169
APPENDIX E: Informed Consent Checklist and Form...............................................................170

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LIST OF TABLES
Table 1. Matrix Questionnaire Form…………………………………………………………….79
Table 2. Summary of Demographic and Backfound Information for Participants ……………...90
Table 3. Function-Based Interventions and Effectiveness and Ease of Implementation……….117
Table 4. Summary of Individual Results……………………………………………………….120
Table 4. Function-Based Interventions and Effectiveness and Ease of Implementation in the
Community……………………………………………………………………………..125

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LIST OF FIGURES
Figure 1. Number of Functions Named Per Participant…………………………………...……..94
Figure 2. Number of Functions Labeled Accurately…………………………………………….94
Figure 3. Number of Function-Based Interventions Mentioned…………………………………95
Figure 4. Average Intensity Per Week for Participant One……………………………………...97
Figure 5. Average Intensity Per Week for Participant Two…………………………………….100
Figure 6. Average Intensity Per Week for Participant Three…………………………………...103
Figure 7. Average Intensity Per Week for Participant Four……………………………………105
Figure 8. Average Intensity Per Week for Participant Five…………………………………….108
Figure 9. Average Intensity Per Week for Participant Six……………………………………...111
Figure 10. Content Analysis of Open-Ended Questions and Frequency of Function-Based
Interventions……………………………………………………………………………….113

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CHAPTER 1
Introduction
Overview of the Topic
Applied Behavior Analysis (ABA) is one of the most effective ways to support skill
acquisition and reduce maladaptive behaviors among children with autism (National Autism
Center, 2009). Due to this, it is one of the most commonly requested treatments for children with
autism. ABA involves environmental manipulation, skill acquisition, and the decrease of
problem behavior and can also be used to improve academic outcomes, motor skills, and daily
living skills (Baier et al., 1968; Cooper et al., 2019; Adelson et al., 2024). The prevalence of
autism is continuing to grow, 1 in 36 children as of 2020 (Center for Disease Control, 2020).
With that, it is crucial that families have some basic understanding of ABA, primarily identifying
the function of behavior and knowing antecedent and consequent strategies to use when problem
behaviors do occur. A clinician typically supports with identifying functions of maladaptive
behaviors, however clinicians are not available to support in every instance of problem behavior.
Parent trainings on function-based interventions do exist but are often not easily accessible by
families (Heitzman-Powell et al., 2014).
Parent trainings are an evidence-based practice and the use of evidence-based practices
among those diagnosed as having autism shows improvements in skill acquisition and decreases
in problem behaviors (Beidas & Kendall, 2010; Adelson et al., 2024). However, clinicians are
not trained in how to most effectively train parents and cite high caseloads as their most common
reason for not conducting such trainings (Ingersoll et al., 2020). Clinicians also cite the
perception of parent disinterest as another reason for not conducting parent trainings (Stocco &

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Thompson, 2015). This identifies a need for clinicians and practitioners to build inner capacity
within families to understand and implement behavior analytic strategies.
Summary of the Problem
Parents are often motivated to learn about Applied Behavior Analysis but have a difficult
time finding time and resources to do so (Heitzman-Powell et al., 2014). Despite their best
intentions, parents will often use consequent strategies that do not address the function of
behavior or inadvertently reinforce their child’s maladaptive behaviors due to child effects, or
when the child’s behavior influences the parents’ behavior (Stocco & Thompson, 2015; Lansford
et al., 2018). Parents will often fall into a negative reinforcement trap or a positive reinforcement
trap. With a negative reinforcement trap, parents’ behavior will become escape-maintained
meaning will not place demands on their children in order to not evoke problem behavior from
their child (Patterson, 2002; Vollmer, 2001). With a positive reinforcement trap, a parent might
allow their child to engage in a preferred task before an aversive activity is about to begin, such
as cuddling before school, then the parent might be more likely to allow the child to be late to
school so they can continue to access that time with their child (Stocco & Thompson, 2015;
Patterson, 2002).
Parents will often limit demands or experiences in the community due to not knowing the
way to properly identify the function of behavior and being unsure of the most effective ways to
address it when it does occur. Parents often feel overwhelmed by conversations with clinicians
and school teams and do not feel as though they are met with a collaborative approach (Straiton
et al., 2021; Burke, 2013). Due to this, parents should be informed of some antecedent and
consequent strategies that can help decrease their child’s problem behavior while still allowing

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them to maintain demands and structure in their homes and successfully access other settings
while maintaining dignity (Dillenburger et al., 2002; Taylor et al., 2019).
Parents being unsure of how to most effectively address problem behavior and limiting
their own experiences due to their children’s problem behavior are two deficit areas that have
been apparent in recent work with families. Through anecdotal reports it has been noted that
parents avoid placing demands or taking their children into the community due to safety
concerns as well as not wanting to deal with or knowing how to manage their child’s problem
behaviors and therefore tend to participate in more non-inclusive activities (Lam et al., 2010).
Clinicians also identify parent trainings as a difficult aspect of their job due to parents not being
actively involved in sessions, frequent parent cancelations, or families not allowing treatment
teams into their homes, the perception being due to clinicians not being sufficiently trained in
conducting these trainings (Ingersoll et al., 2020). Parents also believe that there is a perception
that they are uninterested in attending trainings, when in reality some parents are possibly not
attending trainings due to logistical barriers, family stressors or family structures, and financial
strains (Straiton et al., 2021).
Organizational Context
Agencies that support families in settings such as the school, home, or community have
parent and caregiver trainings as a billable service to help ensure clinicians conduct such
trainings. While there is a maximum of hours per month that insurance companies approve, there
is often not a minimum of hours that must be conducted. While conducting these trainings is
encouraged, there is no penalty for not doing so. Clinicians have also stated that their
organizations do not train them on the best ways to conduct parent trainings, so they tend to
avoid the task due to being uncomfortable or not feeling equipped enough to do so (Ingersoll et

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al., 2020; Pomales-Ramos et al., 2023). Clinicians then do not always seek out ways to better
train and communicate with families due to their own high caseloads and extremely busy
schedules (Ingersoll et al., 2020; Pomales-Ramos et al., 2023).
According to Ingersoll et al. (2020), who have done extensive research in barriers related
to involving parents, sessions in the home are often done with the parents not present as it is
perceived as a time for them to complete necessary tasks while someone else is working with
their child, therefore best practices are not always transferred to the parent (Ingersoll et al.,
2020). Clinicians often perceive this to be disinterest on the parents’ part and therefore do not
actively engage parents in their sessions (Stocco & Thompson, 2015; Taylor et al., 2019). Other
barriers to in-home agency support are that families frequently cancel sessions or would prefer
that services not take place in the homes. This occurs for many reasons including busy schedules
after school or families wanting time to relax without additional people in their homes (Ingersoll
et al., 2020; Taylor et al. 2018).
Another important organizational consideration is that clinicians are Masters-level
clinicians often required to work with families of low socioeconomic status or from ethnic or
minority backgrounds (Ingersoll et al., 2020; DeCarlo et al., 2011). With that, clinicians are not
able to always effectively communicate with people from varying backgrounds. Parents have
cited that they feel as though clinicians do not approach them in a collaborative manner and often
feel overwhelmed and discouraged by conversations with clinicians (Stocco & Thompson, 2015;
Crane et al., 2021, Taylor et al., 2019). Families from lower socioeconomic backgrounds also
tend to receive less behavioral health supports in general, highlighting a need for organizations to
better address this deficit (Straiton et al., 2021; DeCarlo et al., 2011).
Existing Research

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Current parent training needs and previous research was the first topic researched to
understand the problem and develop research questions and design an intervention. The need for
more robust parent trainings in Applied Behavior Analysis is made apparent with the prevalence
of autism, currently 1 in 36 children (Center for Disease Control, 2020). To best support the
students referenced thus far, a Board Certified Behavior Analyst is regarded as the preferred
interventionist to provide these services, however as of January 2, 2024, there are only 66,339
Board Certified Behavior Analysts (Behavior Analyst Certification Board, 2024). ABA has been
shown to improve problem behavior, expressive and receptive language skills, academic
outcomes, motor skills, and daily living skills (Cooper et al, 2019; Gitimoghaddam et al, 2022;
da Silva et al., 2023). In fact, it is the most effective way to support skill acquisition and reduce
problem behavior among children with autism (National Autism Center, 2009; Yu et al., 2020;
Gitimoghaddam et al., 2022; Adelson et al., 2024). Early intensive behavioral interventions
(EIBI) have been shown to lead to better long-term management of maladaptive behaviors and
stronger maintenance of functional communication and adaptive skills (Fisher et al., 2020).
Therefore, ABA is highly requested by parents to support their children, but the prevalence is
beginning to outgrow the number of clinicians who can effectively support families and waitlists
are ever growing (Garikipati et al., 2024).
This identifies parent training as a major need area so families are able to support their
children in the homes. Clinicians with large caseloads often only have time to see families at
most once a week. Parents, however, struggle to find the time to access these trainings on their
own (Heitzman-Powell, 2014). One solution to this barrier is the use of telehealth to reduce
lengthy waitlists and parents have also demonstrated improvements in their implementation of
EIBI after virtual training and remote coaching (Fisher et al., 2020). It was found that telehealth

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is an effective option for families in remote areas (Heitzman-Powell et al., 2014; Ferguson et al.,
2019; Pomales-Ramos et al., 2023).
Parent training is an evidence-based practice with many identified benefits for children.
Children of parents who participated in trainings received lower ratings on the Autism
Diagnostic Observation Schedule (ADOS) compared to a group of autistic children whose
parents did not participate in training (Aldred et al., 2004). Effective parent training has been
linked to improved communication and social skills in general (Heitzman-Powell et al., 2014).
Compliance with demands has also been shown to significantly increase when parents are trained
in and use function-based interventions (Fettig & Barton, 2014). Children who participated in
Intensive Applied Behavior Analysis group combined with their parents receiving training also
achieved higher scores on the Stanford-Binet Intelligence Scale, Bayley Scales of Infant
Development-Mental Development Index, and the Merrill-Palmer Scale of Mental Tests, as well
as marked behavioral improvements (Smith et al., 2000). These studies show that ABA
combined with effective parent training provide the most comprehensive improvements for
children with autism (Adelson et al., 2024).
In order for parents to better understand why interventions are developed and implemented,
they must understand the functions of behavior. All behavior, both adaptive and maladaptive, is
learned through conditioning, and interactions between behavior and the environment are what
establish either positive or negative contingencies (Cooper et al., 2019; de Haan & Simon, 2024).
The clinician will conduct a Functional Behavior Assessment (FBA) which highlights what
stimuli in the child’s environment are evoking maladaptive behaviors. Behaviors sometimes
serve multiple functions, so it is important for parents to know what intervention to use based on
what function. Heitzman-Powell et al. (2014) helped parents make these connections through the

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completion of a Problem Behavior Recording form in which parents outlined antecedentbehavior-consequence chains in order to allow them to visually analyze the data to see which
behaviors were most often related to which antecedent and consequence. Though parents are not
conducting the Functional Behavior Assessment themselves, in order to build the capacity to
address maladaptive behaviors on their own without the support of an intensive school team or
treatment team, they must understand the function of behavior and ensure their interventions are
not inadvertently reinforcing those maladaptive behaviors (Cooper et al., 2019; van der Oord &
Tripp, 2020).
Once the results of an FBA identify the functions, function-based interventions are
developed that include reinforcement strategies and functionally-equivalent socially valid
replacement behaviors. These are chosen to strengthen adaptive or communicative skills targeted
for skill acquisition (Cooper et al., 2019). Cooper et al. (2019) identify three evidence-based
antecedent interventions: noncontingent reinforcement, high-probability request sequence, and
functional communication training. Identified consequent strategies are differential
reinforcement, or reinforcing only those responses within a responds class that meets a specific
criterion along some dimension (i.e. frequency, topography, duration, latency, or magnitude)
(Cooper et al., 2019). The next is token economies, or a system whereby participants earn
generalized conditioned reinforcers (e.g. tokens, chips, points) as an immediate consequence for
specific behaviors; participants accumulate tokens and exchange them for items and activities
from a menu of backup reinforcer (Cooper et al., 2019). Another is planned ignoring, or a
strategy where specific behaviors are deliberately ignored to reduce their future occurrence
(Cooper et al., 2019). The last identified consequent strategy is time out, evidence-based practice
used as a punishment procedure to decrease the future probability of problem behavior, in which

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a child is moved to a less reinforcing setting after engaging in behaviors targeted for reduction
(Donaldson & Vollmer, 2011; Bearss et al., 2018). These are all less intrusive strategies that are
easier to implement and therefore can be done by just one parent or caregiver, and can also be
used to address multiple functions (Cooper et al., 2019).
Significance of Study
This study will work to answer three questions. First, how familiar are caregivers with the
functions of behavior and how accurately do they identify them? Parents being trained in
properly identifying functions of behavior is essential as parents will often use consequent
strategies that do not address the function of behavior or inadvertently reinforce their child’s
maladaptive behaviors due to child effects, or when the child’s behavior influences the parents’
behavior (Stocco & Thompson, 2015; Lansford et al., 2018).
Next, it will seek to answer how nontraditional families, specifically single-parent
families, build the inner capacity in order to safely address their child’s behavior by function. It
is important to focus on single parent families as single mothers have significantly higher rates of
stress than mothers of neurotypical children, with child-related stress factors falling in the 99th
percentile of mothers of children with autism (Dyches et al., 2015; Bradley et al., 2024). Parent
training has been shown to increase parental knowledge, enhanced competence in advocating for
the child, decrease parental stress and a reduced sense of isolation (Bearss et al., 2015). Capacity
is defined as "a functional determination that an individual is or is not capable of making a
medical decision within a given situation" (Libby et al., 2023). This study will look to assess the
effectiveness of parents identifying functions of behavior and implementing function-based
interventions using low intensity programming with just a brief consultation with a clinician
(Bearss et al., 2015).

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Finally, what strategies can be safely and effectively implemented in the home and
community settings by just one to two people? By focusing on safe interventions that maintain
the dignity of the child, it can foster more therapeutic relationships with families and lead to
better clinical outcomes (Taylor et al., 2019). By using compassionate and empathic care,
clinicians can help families utilize ethical evidence-based practices that can be implemented in
multiple settings and reduce maladaptive behaviors, making them safe and effective (Taylor et
al. 2018). By focusing on low intensity interventions such as differential reinforcement,
noncontingent reinforcement, and functional communication training, it allows parents to
implement these strategies that can occur in natural contexts while also being mindful of the
demands placed on parents every day (Bacotti et al., 2022). Differential reinforcement and
noncontingent reinforcement specifically have been found to be easily generalizable because it
can be utilized during (1) self-care or daily living activities, (2) physical activity, and (3)
preferred learning activities, and likely involve parents interacting with their child, lead to better
clinical outcomes, and allow for data collection on relevant parent and child behavior (Bacotti et
al., 2022). For this study, community will be defined as any setting outside the home or school,
such as parks, playgrounds, after-school programs, daycares, grocery stores, restaurants, and
other extracurricular events such as sports or clubs.
Multidisciplinary school teams who support students who exhibit problem behaviors in
the school setting are extensive. This team is made up of any combination of special educators,
regular educators, behavior analysts, school psychologists, school counselors, and administration
(Pennsylvania Code, 2001). Each member of the team brings a unique skillset to support students
who exhibit problem behaviors, have academic skill deficits, have endured trauma, or a variety
of other needs and typically understand the principles of ABA and are able to implement them

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(Helton & Alber-Morgan, 2018; Bohnenkamp et al., 2023). The physical school environment
itself has separate rooms or spaces for students to go to deescalate or be in a safe environment
until they are able to deescalate. If problem behavior escalates to the point of posing a threat to
themselves or others, this extensive team is able to utilize physical interventions in order to
further maintain safety (Pennsylvania Code, 2001).
Parent involvement is directly related to positive student outcomes (Beidas & Kendall,
2010; Fisher et al., 2020; VanValkenburgh et al., 2021). However teachers express varying
perceptions of parent involvement, with some of those perceptions being negative and the
National Education Association noted the lack of parental involvement was the single biggest
problem facing the nation’s schools in 2008. In speaking to members of these teams, teachers
have expressed that they are frustrated parents are unable to come into the school during the
school day to meet and believe parents have poor perceptions of education, therefore do not
make an effort to learn themselves or promote education in the home (Heitzman-Powell, 2014;
VanValkenburgh et al., 2021). What some multidisciplinary teams fail to realize, however, is that
family training is not always easily accessible, and in one study 50% of parents stated that the
school does not help them learn about parenting and supporting their children (VanValkenburgh
et al., 2021). Though families are told during the evaluation or IEP process what the school
team’s plans are and how they intend to decrease problem behavior, no actual parent training
occurs regarding how families can best support (Helton & Alber-Morgan, 2018). Families often
have busy schedules with parents’ jobs, needs of other siblings, or families will decrease
expectations in the home for their children or limit community opportunities as they are unable
to safely manage their child’s problem behavior, leading to feelings of isolation among these
families and participation in less inclusive settings (Lam et al., 2010; Devenish et al., 2020).

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It is essential to empower families, especially those who may only have one or two
caregivers available to support their child, to understand and utilize strategies that can continue
to promote skill acquisition, decrease maladaptive behaviors, and implement these strategies in a
way that maintains the safety of all stakeholders (Heitzman-Powell et al., 2014; Taylor et al.,
2019). For these reasons, parents should be informed of how to determine the function of
behavior in the moment and be able to implement less restrictive antecedent and consequent
strategies that can easily be used by one to two people and generalized to more than one setting
and maintain the dignity of the child (Lam et al., 2010; Heitzman-Powell et al., 2014; Lane et al.,
2018).
Delimitations
The focus of this study is to focus on nontraditional family structures. Parents often
sacrifice their structure in their homes or their involvement within the community due to problem
behavior exhibited by their child (Beyers et al. 2003; Lam et al., 2010; Devenish et al., 2020). It
is important to focus on single parent families as single mothers have significantly higher rates of
stress than mothers of neurotypical children, with child-related stress factors falling in the 99th
percentile of mothers of children with autism (Dyches et al., 2015; Bradley et al., 2024).
Participants from traditional family structures will be excluded for these reasons.
These families can live in either rural, urban, or suburban settings as location or
socioeconomic status is not a variable in the study, though if variability in the data among
settings is found at the end of the study, it will be reported. Participants outside of Lancaster
County, Pennsylvania will not be included. This will allow for easier communication between
the families and the researcher.

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This study will also focus on building the inner capacity to utilize function-based
interventions through identifying functions of behavior as well as identifying antecedent and
consequent strategies that can be used safely and effectively by just one to two people and easily
generalized to multiple settings. Early intervention of function-based strategies has been shown
to be most effective based on previous research (McConachie & Diggle, 2007; Barton & Fettig,
2013). Applied Behavior Analysis is also most widely used with children with autism (National
Autism Center, 2009). Due to these conditions, this study will focus on strategies for elementaryaged children or children receiving services through early intervention, specifically diagnosed as
having autism spectrum disorder, therefore eliminating secondary-aged children and adult
participants as well as participants not diagnosed as having autism from this study (McConachie
& Diggle, 2007; Barton & Fettig, 2013; Fisher et al., 2020).
Definition of Terms
•

Applied Behavior Analysis (ABA): the study of behavior and its application to socially
important problems in the natural environment. It is not one specific program, however it
is an all-encompassing method that requires environmental manipulation, skill
acquisition, and the decrease of problem behavior (Baer et al., 1968).

•

Antecedent: environmental conditions or stimulus changes that exist or occur prior to the
behavior of interest (Cooper et al., 2019).

•

Behavior Health Technician: BHTs follow specific plans developed by BCBAs to
address behavioral goals, such as communication, social skills, and self-help skills.
Under the direction of a BCBA, the BHT will collect data on skill acquisition goals and
behaviors targeted for reduction, provide direct therapy as prescribed by a BCBA, and

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implement treatment plans developed by a BCBA (Matrix Behavior Solutions, 2024;
Attain ABA 2025)
•

Board Certified Behavior Analyst: The Board Certified Behavior Analyst® (BCBA®)
certification is a graduate-level certification in behavior analysis. BCBAs are
independent practitioners who can provide behavior-analytic services and supervise the
work of RBTs, BCaBAs, and other professionals who implement behavior-analytic
interventions (BACB, 2025)

•

Child effects: the influence of child behavior on parent behavior (Stocco & Thompson,
2015).

•

Consequence: “a stimulus change that follows a behavior of interest” (Cooper et al.,
2019).

•

Differential reinforcement: “reinforcing only those responses within a response class that
meets a specific criterion along some dimension (i.e. frequency, topography, duration,
latency, or magnitude) and placing all other responses in the class on extinction.”
(Cooper et al., 2019).

•

Directive strategies: First follow a specific sequence of steps, determine the accuracy of
the child’s response to the prompt, and reinforce the child’s attempt to communicate
(Roberts et al., 2023).

•

Early intensive behavioral interventions (EIBI): an evidence-based intervention using
principles and procedures from Applied Behavior Analysis to teach adaptive behaviors
to young children with autism spectrum disorders (Reichow et al., 2018).

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Evidence based practice (EBP): model of professional decision-making in which
practitioners integrate the best available evidence with client values/context and clinical
expertise in order to provide services for their clients (Slocum et al., 2014).

•

Extinction: “a procedure occurs when reinforcement of a previously reinforced behavior
is discontinued; as a result, the frequency of that behavior decreases in the future”
(Cooper et al., 2019).

•

Functional behavior assessment (FBA): a systematic method of assessment for obtaining
information about the purposes a problem behavior services for a person, results are used
to guide the design of an intervention for decreasing the problem behavior and
increasing the appropriate behavior (Cooper et al., 2019).

•

Functional communication training (FCT): An antecedent intervention in which an
appropriate communicative behavior is taught as a replacement behaviors for problem
behavior usually evoked by an establishing operation; involves differential
reinforcement of alternative behavior (Cooper et al., 2019).

•

Functionally-equivalent: For example, if the problem behavior serves as an escape
function, then the intervention should provide escape for a more appropriate response or
involve altering task demands in a fashion that makes escape less reinforcing (Cooper et
al., 2019).

•

High-probability (high-p) request sequence: also referred to as behavioral momentum,
uses the fast-paced delivery of previously mastered skills (high-p) in order to increase
compliance on a more difficult or nonpreferred task (low-p) (Cooper et al., 2019).

•

Motivating operation (MO): An environmental variable that (a) alters (increases or
decreases) the reinforcing effectiveness of some stimulus, object, or event; and (b) alters

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(increases or decreases) the current frequency of all behavior that have been reinforced
by that stimulus, object, or event (Cooper et al., 2019).
•

Negative reinforcement: also increases the future frequency of behavior, but due to the
removal of an aversive stimulus, often conditioned through escaping or avoiding
aversive tasks, which develops into escape-maintained behavior (Cooper et al, 2019).

•

Neurodiversity: the range of differences in individual brain function and behavioral
traits, regarded as part of normal variation in the human population (used especially in
the context of autistic spectrum disorders) (Oxford University Press, 1998).

•

Noncontingent reinforcement: “an antecedent intervention in which stimuli with known
reinforcing properties are delivered on a fixed-time or variable-time schedule
independent of the learner’s behavior” (Cooper et al., 2019).

•

People-first language: puts the person before the disability and describes what a person
has, not who a person is. Example – a child with autism (Sutcliffe, 2006).

•

Positive reinforcement: occurs when a behavior is followed immediately by the
presentation of a stimulus that increases the future frequency of the behavior in similar
conditions (Cooper et al., 2019).

•

Preference assessment: a type of procedure that is used to determine what types of
stimuli a person prefers and determine valuable reinforcers and the ability to rank them
from highly preferred to less valuable (Cooper et al., 2019).

•

Responsive strategies: First identify the communicative act of the child, determine the
meaning of the act, and then respond in a way that corresponds with the child’s
developmental level (Roberts et al., 2023).

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27

Socially-mediated reinforcement: another person must be present to deliver the stimulus
that increases the future probability of behavior (Cooper et al, 2019).

•

Socially valid: Refers to the extent to which target behaviors are appropriate,
intervention procedures are acceptable, and important and significant changes in target
and collateral behaviors are produced (Cooper et al., 2019).

•

Token economy: “a system whereby participants earn generalized conditioned
reinforcers (e.g. tokens, chips, points) as an immediate consequence for specific
behaviors; participants accumulate tokens and exchange them for items and activities
from a menu of backup reinforcers” (Cooper et al., 2019).

•

Verbal behavior: Behavior whose reinforcement is mediated by a listener; includes both
vocal-verbal behavior (e.g., saying “Water please?” to get water) and nonvocal-verbal
behavior (pointing to a glass of water to get water. Encompasses the subject matter
usually treated as language and topics such as thinking, grammar, composition, and
understanding (Cooper et al., 2019).

Conclusion
Applied Behavior Analysis has been found to be one of the most effective ways to
support skill acquisition and reduce maladaptive behaviors in children with autism (National
Autism Center, 2009). It is one of the most highly requested supports for children with autism,
but trainings are not consistently available for parents, or parents struggle to find the time and
resources to do so (Heitzman-Powell et al., 2014). Parents do not always have access to
consistent ABA services in their home either due to the ever-growing prevalence of autism,
therefore do not always use best practices in order to address their child’s problem behavior
(Center for Disease Control, 2020; Stocco & Thompson, 2015; Patterson, 2022). Even when

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parents do receive these services, sessions are often not seen as collaborative due to a variety of
barriers including differing cultures, socioeconomic status, and levels of education (Straiton et
al., 2021; Ingersoll et al., 2020).
Parent training also does not consistently occur due to clinicians not being comfortable in
delivering them and receiving little to no training on how to effectively conduct them. Clinicians
also cite overwhelming caseloads and their own busy schedules as reasons to not prioritize these
trainings (Ingersoll et al., 2020). Parents also sometimes use the time with additional support in
the home to conduct their own business and address other family needs, so are not active
participants in the sessions, or they decline in-home services altogether (Ingersoll et al., 2020).
Parent training, however, is an evidence-based practice found to have many benefits for
children with autism. Effective parent training has been linked to improved communication and
social skills and compliance with demands has been found to increase when parents use functionbased interventions (Heitzman-Powell et al., 2014; Fettig & Barton, 2014). Due to these benefits,
it is crucial to identify ways to support parents despite the barriers (Stocco & Thompson, 2015).
The following chapters will provide a more comprehensive look at the problem regarding
Applied Behavior Analysis and parent training. Chapter Two will analyze the literature related to
the topic, including background of the issue and function-based strategies that families can
utilize. Chapter three will explain the methodology that will attempt to solve the problem. More
specifically, it will include the participants, how data will be collected, how the data will be
analyzed, and any limitations. Chapter four will then explain the data that will be collected, both
qualitative and quantitative, and provide participant summaries. Chapter five will summarize the
data, the themes collected from the qualitative data, and provide considerations for future
research.

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CHAPTER 2
Review of the Literature
Introduction
This chapter will provide more detailed information regarding the limitations in regards
to providing ample behavioral support to families and the factors that attribute to those
limitations. It will also outline the benefits of parent training as an evidence-based practice as
well as the benefits of function-based interventions, and why it is crucial for the barriers to be
addressed in order for children to receive comprehensive ABA therapy.
Parent Training – Current Research and Needs
So much remains unknown about autism and there is no one uniform way for families to
meet the needs of their autistic children. In fact, there is limited research to show whether or not
it is even beneficial to disclose an autism diagnose to children (Crane, et al., 2021). Some
reasons parents choose not to disclose are bullying or a stigma associated with disabilities,
however some parents believe that it is important to be honest and communicate openly about
the diagnosis to best support their children, that way they can continue to have those open
conversations regarding the children’s needs and how to best meet them (Ng & Ng, 2022).
Crane, et al. (2021) sought out to find the benefits of this disclosure, if any, through surveying
parents regarding if diagnoses were disclosed, determine parental satisfaction with the disclosure
and subsequent support received, and to overall better understand discussions surrounding autism
with families.
The authors developed a questionnaire sent to autistic parents in the United Kingdom
who had at least one autistic child. For families with more than one autistic child, the parents
were directed to respond to the questions about their oldest autistic child. The survey comprised

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of six sections, developed by Crane et al (2021). The first three sections were used to gather
demographic information about the parents and their families, and a “yes” or “no” question about
whether or not they had discussed their own diagnosis with their child. Section 4 then went on to
address whether the parents had disclosed the child’s diagnosis with the child. If the families
answered in the affirmative, they were asked about their satisfaction with the disclosure and then
were presented open-ended questions about any positive or negative impacts of the conversation.
Section 5 focused on supports the family had received and their satisfaction of the support
received, if any. The final section included open-ended questions regarding the day-to-day
conversations in the home about autism. Parents shared topics of conversation that had gone
well, topics that had not, if they use people-first language or diagnosis-first language, and any
advice they felt important to pass on to other parents (Crane et al., 2021).
The authors found that 94% of parents surveyed had disclosed their child’s diagnosis to
them, and over half of those were satisfied with the manner in which it was disclosed, though
most families did not choose to receive support in having this conversation with their child. Four
themes were able to be identified from the data: (1) open, honest discussions about being autistic
are part of our everyday lives; (2) shared understanding: ‘I tell them I get it’; (3) discussions
should be framed positively; and (4) tailoring discussions to children’s specific needs (Crane et
al., 2021). For the first theme, parents believed that disclosing the diagnosis at a young age
allowed families the opportunity to start fresh and without any baggage or time for children to
develop preconceived notions regarding their disability and you can develop your own narrative
around the diagnosis. For the second theme, parents tended to use their own experiences to direct
these conversations, which built trust between the children and their autistic parents and allowed
for children to continue having open conversations with their parents about their lived

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experiences. Regarding the third theme, overall parents felt it was important to keep the
conversations positive and focus on neurodiversity and how brains simply work differently.
Through these conversations, parents were able to tailor their discussions to best meet their
child’s needs, as all parties were able to be open and honest during these conversations, which
was the fourth theme found in reviewing the results of the questionnaire (Crane, et al., 2021).
This research is important as the authors state that autistic parents tend to feel
misunderstood when communicating with non-autistic professionals. By identifying ways of
communicating with families that are successful, clinicians can develop stronger, more effective
ways to support these families (Taylor et al., 2019; Roberts et al., 2023).
Though Crane et al. (2021)’s research shows that there are effective ways to discuss an
autism diagnosis, there is still not a singular guide on how to support these autistic children in the
home (Doda et al., 2024; Garikipati et al., 2024). Roberts et al. (2023) sought to identify
effective strategies to use in this setting. They compared the effects of different language
facilitation strategies – directive strategies versus responsive strategies. These two strategies fall
under Naturalistic Development Behavioral Intervention (NBDI; Schreibman et al., 2015)
strategies with responsiveness being defined as synchrony of parent talk to child interests that are
informed by developmental theory and parent directives or prompts for language that are
informed by behavioral learning theory (Roberts et al., 2023). In order to develop a responsive
approach, one must first identify the communicative act of the child, determine the meaning of
the act, and then respond appropriately in a way that corresponds with the child’s developmental
level. For the directive strategy, the parent would follow a specific sequence of steps, determine
the accuracy of their child’s response to the prompt, and then reinforce the child’s attempt to
communicate. Participants included 119 children diagnosed as having autism spectrum disorder

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and their mothers recruited through early intervention providers. The two interventions as
described above were taught to the mothers through weekly, hour-long, instructional sessions in
the home for eight weeks, the first session outlining the strategies and the following seven
sessions utilizing the Teach-Model-Coach-Review format (Roberts et al., 2014).
The authors found that mothers who utilized responsive strategies saw better outcomes
related to language facilitate strategies than mothers who were taught and used directive
strategies. However, both strategies still require the mother to be insightful, leaving this study
open to subjectivity. In the responsive condition, the mother responds to a child’s verbal
behavior with a comment about what the child said, and in the directive condition the mother
responds to the child’s verbal behavior with a prompt to elicit a more complex communication
according to the outlined sequence. Mothers who were found to be more insightful in
preintervention saw better results (Roberts et al., 2023). Another limitation to this study is that
despite this research, there is still a lack of consensus among NBDIs about the most effective
pacing and teaching strategies in which to use to train people on using the strategies. It is noted
as a future research need by the authors (Roberts et al., 2023).
By focusing on effective ways to support children about their diagnosis and next how to
clearly communicate in a way that ensures their needs are met and by expanding on ways to
reinforce and elicit more complex communicative strategies, it can help the field of Applied
Behavior Analysis determine consistent, effective ways to communicate with the children
receiving these services (Taylor et al., 2019; Crane et al., 2021; Ng & Ng, 2022; Roberts et al.,
2023). Behavior analysts and clinicians can use these strategies to support families in the home
settings by effectively communicating with and interacting with the children, as well as better

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train families to utilize behavior analytic strategies with their children (Taylor et al, 2018;
Bacotti et al., 2022; Adelson et al., 2024).
A crucial aspect of successful strategies for support autistic children is to build capacity
within the families who are supporting these children. The prevalence of autism is ever growing,
with the Center for Disease Control and Prevention (CDC) currently stating that 1 in 36 children
have been identified with autism spectrum disorder (Center for Disease Control, 2020; Maenner
et al., 2023) and parents must be empowered to support their children as it is important to
generalize skills to all settings the child accesses and parents often lose confidence in their ability
as parents when their child is diagnosed with autism spectrum disorder (McConachie & Diggle,
2007; Taylor et al., 2019). Early intervention is crucial as children need to learn essential skills,
including but not limited to learn joint attention, imitation of others, communicating wants and
needs, understanding language of others, toy play, and tolerating change (Toth et al., 2006:
McConachie & Diggle, 2007; Schertz & Odom, 2007). Because intervention is more effective
before children reach school age, it makes parent involvement that much more vital.
McConachie and Diggle (2007) conducted a systematic review of parent-led
interventions for their children with autism. In their review they found a study that showed that
children of parents who participated in a parent training group had lower ratings on the Autism
Diagnostic Observation Schedule (ADOS) compared to a group of autistic children whose
parents did not participate primarily on the communication domain of the assessment related to
the child’s vocabulary (Aldred et al., 2004). Another study conducted by Smith et al. (2000)
showed that children who participated in an Intensive Applied Behavior Analysis group achieved
higher scores on the Stanford-Binet Intelligence Scale, Bayley Scales of Infant DevelopmentMental Development Index, and the Merrill-Palmer Scale of Mental Tests than the children in

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the parent training groups, however both groups saw marked behavioral improvements,
demonstrating the importance of parents being trained in Applied Behavior Analysis. Parents
who received training also had lower stress levels and the parents themselves were observed to
demonstrate better communication in the form of giving information, praise, correct responses,
direct responses, and more utterances in general therefore enriching their children’s environment
with more vocabulary (Smith et al., 2000).
Applied Behavior Analysis has the most empirical support regarding its effectiveness of
behavioral interventions for children with autism (Eikeseth, 2009; Yu et al., 2020; da Silva et al.,
2023; Garikipati et al., 2024; Adelson et al., 2024). However, fidelity with parent training in
utilizing these strategies has long been an issue. In fact, Dumas (1984) found that 60% of parents
in a study were unable to correctly utilize time-out or point-reward systems for children,
demonstrating that this has been an issue for an extensive amount of time. Family demographics
and the intensity of problem behavior are factors that attribute to the incorrect use of behavior
analytic strategies, however these factors are typically unchanged, so it is important to find why
these factors have such a high rate of failure among parent implementation (Stocco &
Thompson, 2015; Adelson et al., 2024).
A great deal of focus of implementation is on child behavior, so Stocco and Thompson
(2015) focused on parent behavior in order to determine why implementation of interventions
was failing at such a high rate. For example, a behavior analyst could determine a child’s
tantrums are attention-maintained and recommend that the caregivers remove attention while this
behavior is being exhibited. However, the caregivers’ learning history has taught them that the
tantrum will end if they provide attention. The cessation of the tantrum reinforces the parents’
behavior of providing the attention, therefore increasing the probability of the caregiver

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continuing to repeat that pattern. The authors refer to this as child effects, or the influence of
child behavior on parent behavior (Stocco & Thompson, 2015; Lansford et al., 2018).
In order to better understand child effects, contingencies regarding both negative and
positive reinforcement must be understood. The example above can be referred to as a negative
reinforcement trap (Vollmer, 2001; Patterson, 2002). For this contingency, parent responses to
child behavior play a crucial role in the child’s learning history and development of their
problem behavior. Parents’ behavior will become escape or avoidant-maintained in that they do
not deliver demands so as to escape or avoid their child’s problem behavior (Stocco &
Thompson, 2015; Landford et al., 2018). For positive reinforcement contingencies, there is also a
positive reinforcement trap (Wahler, 1976) that can also lead to an increase in problem behavior.
An example of this would be if a child cuddles with a parent before an aversive activity is about
the begin, such as getting ready for school, this could increase the parents’ behavior of allowing
the child to miss or be late to school (Stocco & Thompson, 2015).
In order to better understand and account for parent behavior, the authors offered three
methods that control for child behavior to better manipulate parent responses to that behavior.
One example was to use child confederates instead of children, with specific responses being
dictated to the confederates. Another suggestion was video clips in which child behavior is
shown and parents report how they would react. Lastly was manipulation by proxy in which
researchers provide direct reinforcement contingencies for parent behavior for their interaction
with child proxies. All of these methods are not without limitations, so finding effective ways to
address the negative- and positive- reinforcement contingencies of parent behavior listed above
and train parents continues to require further research (Stocco & Thompson, 2015).

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The first training method mentioned is function-based parent training. Training typically
involves the basics of roleplay, performance feedback, and modeling to deal with a wide variety
of problem behavior. However, a better understanding of why parents are responding to their
child’s behavior would lend itself to more individualized and efficient training to address those
variables (Stocco & Thompson, 2015). For example, for attention-maintained behavior in
children, parents are often told to ensure they are providing ample attention when the child is
engaging in appropriate replacement behaviors. Parents, however, often do not receive
reinforcement from the child and therefore do not engage in this behavior frequently enough for
it to have significant impact on their child’s behavior. Parents will instead frequently reprimand
their children which reinforces attention-maintained problem behavior. Instead, parents could be
trained to withhold the reprimand and instead have a discussion about the incident further
removed from the problem behavior, so enough time has passed that the child is not receiving
immediate attention for their problem behavior. Children could also be taught to say “thank you”
so their behavior is reinforcing the parents’ behavior of providing attention to socially valid
replacement behaviors (Stocco & Thompson, 2015).
Focusing on functional communication training (FCT) for both the child and their parents
could also provide more individualized attention that addresses the function of the behavior
(Tiger et al., 2008; Bondy et al., 2020). An example of this would be the parent asking their
spouse for a break from their tantruming child instead of inadvertently reinforcing the child’s
tantruming behavior in order to end the tantrum (Stocco & Thompson, 2015). Most importantly
is training parents and creating a learning history that endures child effects and their problem
behaviors. Though behavior analysts are ethically obligated to utilize reinforcement strategies
before relying on punishment procedures (Bailey & Burch, 2005) punishment procedures paired

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with reinforcement for alternative behavior lead to quicker cessation of problem behavior and the
authors suggest this could be a strategy for parents to utilize before burnout occurs (Hanley et al.,
2005; Stocco & Thompson, 2015). Another suggestion is that parents practice socially
appropriate skills with children in contrived situations that evoke problem behavior. Frequent
practice of these, ignoring whining for example, can then be generalized to community settings,
allowing families the opportunity to access their community with their children (Stocco &
Thompson, 2015). Additionally, research supports that having parents teach their children new
skills leads to positive outcomes for both children and their parents and therefore better child
effects (Barton & Fettig, 2013; Lansford et al., 2018).
With a better understanding of what leads to implementation failure by parents and some
ways to address it, it is important to know when parents should be learning these strategies and
effective ways to teach these strategies to parents. Early intervention has been shown to reduce
problem behavior and increase social and adaptive behaviors (Toth et al., 2006; McConachie &
Diggle, 2007; Barton & Fettig, 2013). Children who receive these supports have outperformed
their peers in these areas who have received other types of services not based on the principles of
Applied Behavior Analysis and parents who receive training utilizing these principles,
specifically early intensive behavioral interventions (EIBI), have demonstrated better long-term
management of maladaptive behaviors and stronger maintenance of functional communication
and adaptive skills (Strauss et al., 2012; Reichow et al., 2018; Fisher et al., 2020). In order for
effective parent training to occur, there must be high implementation fidelity which leads to high
intervention fidelity of implementation of evidence-based intervention. These will lead to
positive behavior changes in children (Strauss et al., 2012; Barton & Fettig, 2013).

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Barton and Fettig (2013) reviewed research related to parent trainings and child outcomes
related to those trainings. The studies reviewed involved reducing maladaptive behaviors or skill
acquisition goals such as communication, social, or adaptive skills. The training practices used in
the studies were (a) focus on routines, (b) collaborative progress monitoring, (c) live or video
modeling, (d) video self-reflections, (e) self-reflection, (f) role-play, (g) opportunities to practice
new skills, (h) performance-based feedback, (i) motivation for practice between sessions, (j)
written directions or manual, and (k) problem solving discussions (Barton & Fettig, 2013). Of
these, the most commonly used were modeling, providing opportunities to practice skills,
performance-based feedback, and manuals.
For parent interventions to be effective, they must be run with fidelity. Barton and Fettig
(2013) analyzed themes in measurements of intervention fidelity throughout the studies. They
found that 19 of the 24 studies used measured and reported on intervention fidelity. However, all
of the studies hypothesized that better outcomes would be due to the parent using the strategies
with high fidelity, so all studies should have reported on fidelity (Barton and Fettig, 2013).
Implementation fidelity, defined in this study as the practices used to train parents to use
intervention procedures, also must be measured to ensure parents are able to carry out these
evidence-based practices. However, only seven studies reviewed reported on this. Interventions
also need to be generalized across settings, people, and materials with fidelity in order to be
effective, however only 9 of the studies measured generalization. Overall, all 24 of the studies
reviewed did note that parent-implemented interventions were effective. However, due to the low
number of studies that measured fidelity, the authors note this as a limitation in much of the
research conducted up until this point. Without information related to the combination of the

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implementation of evidence-based practices and what are actually effective parent training
practices, how does one know what is truly effective?
One way to increase the efficacy of parent trainings is to make them more easily
accessible to families (Tomlinson, Gore, & McGill, 2018; Fisher et al., 2020). An important
recent development is the use of telehealth in order to address this and reduce time on lengthy
waitlists, and parents have shown improvements in their implementation of EIBI after virtual
training and that remote coaching can “(a) enhance parents’ knowledge about and confidence
when delivering ABA interventions; (b) increase the integrity with which they implement ABA
interventions; (c) positively impact parents’ mental health, and (d) produce clinically significant
changes to their child’s behavior” (Fisher et al., 2020). Parents have also found that telehealth
was easy to use and effective. Telehealth has been a viable and effective option for several years
for families in remote areas (Heitzman-Powell et al., 2014; Tomlinson, Gore, & McGill, 2018).
Heitzman-Powell et al. (2014) used the OASIS (Online and Applied System for
Intervention Skills) Training Program to help facilitate this. Part of this model is based on the
research stating that early intervention is critical in order to systemically fade services as students
age. For early intervention to be effective, the providers must be well-trained, which requires
performance-based measurement to assess the efficacy (Heitzman-Powell et al., 2014). The
OASIS model uses these key components combined with web-based instructional models and
supervised hands-on experience with parents to support their children with autism.
The OASIS program uses the Research-to-Practice Outreach Training model. What this
means is that the OASIS Training Program, which provides flexible training in ABA procedures
for parents to use, as well as monitoring of parent implantation for fidelity, leads to effective
implementation of evidence-based, individualized ABA therapy, which leads to better child

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outcomes. With these outcomes, such as improved communication and social skills, the program
sees better family outcomes in that families are less stressed and therefore experience a higher
quality of life (Heitzman-Powell et al., 2014).
Eight modules were developed for the OASIS program and delivered through
telemedicine sessions. The modules were: Introduction to Autism and Behavioral Treatment,
Defining and Observing Behavior, Principles of Behavior, Stimulus Control, Effective Teaching
Strategies, Decreasing Behaviors: Antecedent Controls, Decreasing Behaviors, Consequential
Control, and Pulling it All Together (Heitzman-Powell et al., 2014). Seven parents from four
families worked through the modules, each paired with direct coaching sessions, and pre- and
posttests. The coaching activities were where it was determined whether or not a parent was
implementing skills taught with fidelity. The online Learning Management System (LMS)
modules recorded scores on assessments and allowed for the trainers to deliver explicit feedback
to parents. The assessments in the modules were comprised of 20 multiple-choice questions and
parents had three opportunities to meet 90% accuracy on these before moving to the next
module. Live distance coaching sessions followed completion of the modules and corresponding
assessments during which coaches would review the content, discuss strategies being used in the
home, and observe parents utilizing these strategies and provide direct feedback on
implementation of those strategies. Once the LMS modules were completed, parents were
instructed to use strategies taught in their homes, and coaching sessions continued to review the
strategies used. In order to prepare for these sessions, parents were asked to complete a Problem
Behavior Report (PBR) in which parents notated the antecedent-behavior-consequence chain of
maladaptive behaviors, and the Incidental Teaching Checklist (ITC) on which parents discussed
strategies they used to teach their child a skill, how effective the strategy was, and how it

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affected their child’s behavior. This information was then reviewed during follow-up coaching
sessions (Heitzman-Powell et al., 2014). Overall, this method saw an increase from 53.13%
accuracy on the pre-test to 92.25% on the post-test, showing growth in both knowledge and skill
gains. Parents also reported being satisfied with the telehealth process and still felt sufficiently
supported. This is important research highlighting the effectiveness of distance learning, as
attempting to travel and schedule appointments with children with autism is identified as a
barrier accessing these services (Buzhardt & Heitzman-Powell, 2005; Heitzman-Powell et al.,
2014).
Previous studies regarding the use of telehealth had limited posttest opportunities as
children exhibited lower rates of problem behavior during treatment, which is the goal but then
allowed for limited opportunities to observe whether or not families continued to use strategies
taught to them (Heitzman-Powell et al., 2014). Fisher et al. (2020) wanted to control for posttest
conditions to better assess how families carried out treatment after training, and therefore utilized
a confederate child, or an adult chose to act as a child with autism spectrum disorder, whose
responses were scripted. Parents were included who had not previously received any training in
applied behavior analytic procedures and were not currently receiving any parent training.
Pretest and posttest skills were assessed using the Behavioral Implementation of Skills for Work
Activities (BISWA) and Behavioral Implementation of Skills for Play Activities (BISPA), which
simply marks whether or not the parent was observed to implement the skill correctly. The skills
targeted under the BISWA were instruction delivery, responding to correct responses and
problem behavior, and prompting, while the BISPA targeted descriptive praise, reinforcement
delivery, and extinction (Fisher et al., 2020). The confederates’ scripted responses allowed for
each skill area to be targeted sufficiently to ensure accurate data collection and were instructed

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how to respond by the instructors to control for this. The study also included a 13-item social
validity questionnaire to determine parent satisfaction with the remote coaching.
Coaching was done through nine 35-60 minutes modules. Six of the modules contained
roleplaying scenarios where the researcher would observe the parent demonstrating the skill to
the confederate, and these modules were only accessed after the parent received an 80% or
higher on the corresponding quiz. Each role-play included 20 trials, giving the parent ample
opportunities to demonstrate their learning and for the confederate to deliver a variety of
responses requiring different parent responses. Behavior-specific praise was delivered to the
parent by the researcher (Fisher et al., 2020).
The mean duration of the parent training was 5.2 months. For the BISWA, all parents in
the control group saw a significant increase in mastery of these skills through the virtual
trainings except for one, who only mastered 60% of skills, while no parents in the control group
mastered any skills. The BISPA did not see as clinically sound results, with eight parents
mastering all of the skills, two mastering 70% of the skills, and three mastering 33% of the skills,
however the control group also saw 0% mastery of skills. Parents were also overall satisfied with
the coaching they received and the flexibility of the course as they were able to self-pace the
modules (Fisher et al., 2020).
One limitation to the study is that it does not fully allow for practice to respond to reallife scenarios. For example, aggression was a response that the confederates were instructed to
use, however a slight hit or kick was used, which is not always the case with children. Emotions
can run high during stressful situations such as high-intensity aggression, and so parents may not
always respond in the way they were coached. However, this study is crucial in identifying ways
to make teaching the principles of applied behavior analysis more accessible to parents and to

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identify strategies that saw statistically significant improvements in outcomes (Fisher et al.,
2020).
The previous study limits itself to EIBI, but it is imperative to find ways to support
families for the long-term as parent training has been shown to promote social communication in
children and decrease maladaptive behaviors (Fisher et al., 2020). Parent training has been found
to, in fact, be quite underutilized despite these benefits (Ingersoll et al., 2020). Barriers that
attribute to this are limited time and resources, low family engagement, and limited
organizational support, especially among families of low socioeconomic status or from ethnic or
minority backgrounds (Ingersoll et al., 2020; Kaiser et al., 2022; Wallace-Watkin et al. 2022).
Scheduling with caregivers while also having full-time jobs and other children and family
matters to attend to also pose as a barrier. Additionally, behavior analysts have the
knowledgebase to teach children, but have had no training in adult learning theory and do not
know how to effectively teach adults, therefore struggle to engage parents (Taylor et al. 2018;
Ingersoll et al., 2020).
Typically, treatment manuals have been utilized, however those have been found to not
be sufficient (Henggeler & Schoenwald, 2002; Bearss et al., 2015). Ingersoll et al. (2020) sought
to find what training ABA providers were receiving in relation to parent training, what role the
training received and distributed manuals played in the parent training, and determine whether
those training experiences or manuals influence parent training use via their impact on the
barriers listed above. Participants responsible for delivering training to parents were recruited
through the Behavior Analyst Certification Board (BACB) registry, so were all registered ABA
providers, ranging from doctoral to bachelor’s levels. Participants received a questionnaire to
determine their experience with training on delivering parent trainings. Participants were also

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asked whether or not they used a manual to provide parent trainings. Extensiveness of parent
training was the next aspect measured, and participants used a 5-point scale to rate their practices
regarding whether or not they provided trainings, how many sessions a month they provided
them, and the quality of the parent training sessions provided. Participants then rated 13 common
barriers to their parent trainings using a 5-point Likert scale (Ingersoll et al., 2020).
Overall it was found that the manner in which parent trainings were provided greatly
varied. Most providers said they provided training to all of their clients at least once in the last 6
months and that they typically conducted them once or twice a month. Participants also reported
they received between 0 to 8 different types of training on conducting parent trainings, the most
common types being having received supervision and observing another professional providing
parent training. Internships, self-guided learnings, and attending workshops were also rated
highly. One of the least commonly used strategies was receiving training specifically in
conducting parent trainings (Ingersoll et al., 2020).
Parent training has been found to be an evidence-based practice (EBP). Research has also
demonstrated that training in specific EBPs related to autism spectrum disorder (ASD) showed
greater improvement in the field among practitioners utilizing them (Beidas & Kendall, 2010;
Strauss et al., 2012; Adelson et al., 2024). Supervision, the most commonly used source of
training, along with having been trained in specific parent-training strategies were the biggest
predictors of parent training effectiveness, in addition to having taken a course that also covered
parent training (Ingersoll et al., 2020). However, only 27% of participants stated that they had
taken such a course, leading the authors to suggest that this could be a point of focus for ABA
curricula. Regarding the use of manuals, the authors did find that a manualized parent training
program did in fact promote the use of evidence-based parent strategies by ABA providers,

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though only 15% of providers stated that they used a manual. This is because the use if a manual
limits the use of personalized client-specific training or does not address the wide array of issues
that are addressed through Applied Behavior Analysis such as communication, feeding, sleeping,
and adaptive self-care needs (Ingersoll et al., 2020). With that, practitioners have listed high
caseloads as a barrier to providing effective parent training, so the use of a manual and holding
larger group, more generalized parent trainings could address this barrier.
Straiton et al. (2021) sought to identify other barriers to parent training, specifically with
Medicaid-enrolled clients with autism. Themes were established for barriers at family-, provider, and organization-levels. The authors felt it crucial to analyze barriers among Medicaid-enrolled
clients as families of children from lower socioeconomic status backgrounds tend to receive less
behavioral health supports (Straiton et al., 2021). In this review, surveys were sent to agency
staff who supervised services for those identified as having autism spectrum disorder in
Michigan, as the state of Michigan had authorized a Medicaid Autism Benefit for Behavioral
Health Treatment to fund ABA services for Medicaid-enrolled clients with autism. These
providers were then asked to measure the quality and frequency of parent training provided using
a 5-point Likert scale (Barton & Fettig, 2013).
According to providers, the largest barrier to parent training was difficulty in engaging
families, followed closely by lack of agency-based trainings in how to conduct these trainings, as
well as the perception that families were not interested in attending the trainings (Straiton et al.,
2021). Five main themes of barriers were determined as a result of the surveys: logistical
barriers, limited family engagement and/or interest in parent training, limited support and/or
agency norms regarding parent training, limited pre-service and in-service training, and family
stressors or family structures, such as single parent households or financial strains (Straiton et al.,

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2021). As providers are typically Masters-level clinicians, there is also a cultural or
socioeconomic barrier to serving families of lower socioeconomic status or even just a
perception of disinterest among those families (Stocco & Thompson, 2015). Parents have then
stated that they feel as though providers are not approaching them in a collaborative manner due
to these perceptions (Taylor et al., 2019; Straiton et al., 2021).
The study also focused on facilitators to family involvement, and important development
in the research as much of it focuses on the barriers. The themes of facilitators largely mirrored
the themes of the barriers. Logistical factors such as convenience of scheduling training at the
beginning or end of a session or group formats were a main theme, as well as agency support in
conducting trainings, high family interest, and professional training on how to conduct parent
trainings (Straiton et al., 2021). Identifying these facilitators is imperative as agencies should
attempt to capitalize them in order to better reach families.
The research of Ingersoll et al. (2020) and Straiton et al. (2021) is crucial in that their
studies identify a need to establish some core strategies for parents to focus on and excel in order
to provide support in the home and community for their children. They both identify barriers that
agencies can use to continue the work to try to overcome. Straiton et al. (2021) is also one of the
few to focus on effective ways to facilitate these necessary trainings. Agencies should focus on
developing better defined guidelines for parent training and ensure these guidelines dictate
evidence-based practices with a focus on modeling and immediate feedback to parents when they
roleplay or use these practices in real time.
Determining and Addressing the Function of Behavior
In order for parents to effectively manage their child’s behavior, it must first be ensured
that the behavior is being addressed by function (Bearss et al., 2016). This is done through a

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functional behavior assessment (FBA), defined as “a systematic method of assessment for
obtaining information about the purposes (functions) a problem behavior serves for a person;
results are used to guide the design of an intervention for decreasing the problem behavior and
increasing the appropriate behavior” (Cooper et al., 2019). The FBA is conducted by a clinician
working with the child, however the clinician is not always available, so it is crucial to teach
parents to address behavior according to function. All behavior, both adaptive and maladaptive,
is learned through conditioning, and interactions between behavior and the environment are what
establish either positive or negative contingencies (Catania, 1998; Iwata, 1994; Hanley et al.,
2003; Cooper at al., 2019). The FBA is used to highlight what those contingencies are so that a
plan can be developed to effectively reduce maladaptive behaviors (Gresham et al., 2001).
These contingencies and the function of behavior are established either through positive
or negative reinforcement or punishment (Iwata, 2006). Positive reinforcement “occurs when a
behavior is followed immediately by the presentation of a stimulus that increases the future
frequency of the behavior in similar conditions” (Cooper et al., 2019). This typically occurs by
previously gaining attention or access to tangible items or attention for exhibiting challenging
behaviors. Negative reinforcement also increases the future frequency of behavior, but due to the
removal of an aversive stimulus, often conditioned through escaping or avoiding aversive tasks,
which develops into escape-maintained behavior (Hanley et al., 2003; Gresham et al., 2001;
Iwata, 2006). Those are all examples of socially-mediated reinforcement, meaning another
person must be present to deliver the stimulus that increases the future probability of behavior
(Hanley et al., 2003). Both positive and negative reinforcement can be achieved through
automatic reinforcement (Iwata et al., 1994; Hanley et al., 2003). An example of automatic
positive reinforcement is thumb sucking as the child is gaining access to some sort of stimulation

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through engaging in this behavior, whereas automatic negative reinforcement is typically related
to pain attenuation, such as putting lotion on dry or itchy skin (Hanley et al., 2003; Cooper et al.,
2019).
In order to determine the function or functions of a child’s behavior, a clinician will
collect data in the environments which are evoking maladaptive behaviors and observe three
parts of the behavior chain: (a) the antecedent, or “environmental conditions or stimulus changes
that exist or occur prior to the behavior of interest” (Cooper et al., 2019), (b) the behavior, and
(c) the consequence, or “a stimulus change that follows a behavior of interest” (Cooper et al.,
2019). For example, if it is observed that a child is seated alone and they begin to engage in
tantruming behavior and the caregiver reprimands the child, the caregiver has just given that
child attention for the tantruming behavior. Another example is if a child is directed to wash their
hands before lunch, the child engages in a tantrum, and the caregiver directs them to go to
timeout, they have just been allowed to escape this aversive activity. Consequences combine
with antecedent conditions to determine what is learned (Iwata et al., 1994; Gresham et al., 2001;
Cooper et al, 2019). Therefore, parents must be mindful of this to ensure they are not
inadvertently reinforcing their child’s challenging behavior.
In order to avoid this, interventions that match the function of the problem behavior
would be developed by a clinician. The interventions used in these plans should be functionally
equivalent to the problem behavior, meaning if the problem behavior serves an escape function,
then the intervention should provide escape for a more socially valid response. (Geiger, Carr, &
LeBlanc, 2010; Cooper et al, 2019). One example would be if a child tantrums in order to escape
academic tasks and that child is taught to appropriately use functional communication to request
a break, when that request is honored it is a functionally-equivalent behavior that is contacting

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reinforcement (Tiger et al. 2008). The FBA would also rule out ineffective interventions once it
is determined a behavior is maintained by escape, such as time out procedures or planned
ignoring (Gresham et al., 2001; Cooper et al., 2019). A crucial aspect of this assessment is that it
is never “done” and ongoing analysis of behavior and the reinforcement the behavior is
contacting must occur (Iwata, 1994). One way to help parents be more mindful of this and their
approaches to their child’s behavior is to have them collect data on these events for them to
review with a clinician (Heitzman-Powell et al., 2014).
Heitzman-Powell et al. (2014) as part of their coaching had parents complete a Problem
Behavior Recording (PBR) form in which parents had to write down the antecedent-behaviorconsequence chain of maladaptive behaviors in order to help engage parents into determining
function of behavior. Parents also completed the Incidental Teaching Checklist (ITC) on which
they reported strategies they used to teach their child that day, how effective it was, and how it
affected their child’s behavior as a tool to monitor self-reflection on instruction. The PBR and
ITC were then reviewed during coaching sessions. Though parents are not conducting the
Functional Behavior Assessment themselves, in order to build the capacity to address
maladaptive behaviors on their own without the support of an intensive school team or treatment
team, they must understand the function of behavior and ensure their interventions are not
inadvertently reinforcing those maladaptive behaviors (Cooper et al., 2019).
Fettig and Barton (2014) conducted a literature review to analyze the effectiveness of
parent implementation of function-based interventions. In order for families to effectively used
function-based interventions, they must be thoroughly coached on these strategies. Studies that
incorporated all or a combination of prevention strategies, teaching replacement skills, and new
responses to challenging behaviors were targeted in this review. To teach these skills, pre-

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intervention training was required. During this training, strategies were modeled, practiced, and
then specific performance-based feedback was delivered when parents practiced a variety of
strategies. One study used a manual to better explain to parents the function of behavior, how to
record a behavior, how parents themselves could determine the function of behavior, and how to
determine a functionally equivalent replacement behavior (Fettig & Barton, 2014).
Post-training also occurred, in which a clinician would provide coaching and
performance-based feedback on the function-based interventions. Of important note is that the
children in the studies reviewed did exhibit intensive maladaptive behaviors, including prolonged
tantrums and property destruction. All studies did find that function-based parent interventions,
in combination with quality training and follow-up coaching, were effective in decreasing
maladaptive behaviors among their children. In fact, the research states that the lack of follow-up
coaching is ineffective and that parents who continued to receive coaching saw more positive
outcomes regarding parent behavior and lower levels of children’s maladaptive behaviors (Fettig
& Barton, 2014). Compliance specifically increased when parents used function-based
interventions with a high level of fidelity.
Fettig and Barton (2014) note an area that is lacking among the research is that regarding
assessing the fidelity of these interventions. There is ample research in school settings
demonstrating positive outcomes for students with autism who are part of programming
implemented with a high level of fidelity. The students performed better with regards to
cognition, language, social, problem behaviors, and autism symptomatology than those in
classrooms with low- to moderate-fidelity implementation (Fettig & Barton, 2014). This lack of
research may be due to parents not consistently utilizing function-based practices, and without
this information it is difficult for clinicians to use data-based decision making to modify their

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coaching of parents. The authors state that future research should also include implementation
fidelity in addition to eventually systematically fading supports. Even with these gaps in the
research, overall it was found that parent-implementation of function-based interventions based
on the results of an FBA were effective in reducing challenging behaviors (Fettig & Barton,
2014). By relying on strategies developed from the results of an FBA, it is more likely that the
treatment team will utilize reinforcement strategies as opposite to punishment (Cooper et al.,
2019). By teaching parents how to ensure their practices are addressing the function of behavior,
it allows for consistency in programming as opposed to relying on a behavior analyst to visit the
home on a weekly basis (Heitzman-Powell et al, 2014).
In order to develop a behavior change plan with reinforcement strategies, functionallyequivalent socially valid replacement behaviors must be determined and operationally defined to
ensure consistency among all stakeholders (Hanley et al., 2003). Behaviors that are socially valid
are those that change a person’s life in a positive and meaningful way (Cooper et al., 2019).
These are chosen to strengthen adaptive or communicative skills targeted for skill acquisition.
For example, if a child pulls the hair of a peer in order to gain their attention, appropriately
gaining attention such as tapping a peer on the shoulder or using functional communication could
be a replacement behavior target. That is the behavior that would receive reinforcement now
instead of the hair pulling (Tiger et al., 2008).
Antecedent Strategies for Parents
The results of the FBA can identify antecedent manipulation that can occur to alleviate
challenging behaviors and make them less likely to occur (Smith & Iwata, 1997). By doing so,
the treatment team is eliminating or decreasing the motivating operation to engage in the
problem behavior or removing the stimulus in the environment that is evoking the problem

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behavior (Cooper et al, 2019). Plans based on the results of an FBA should focus on
preventative, or antecedent manipulation, such as providing more frequent reinforcement,
opportunities to request breaks, or teaching the child ways to access help with difficult tasks
(Iwata et al., 1994). Cooper et al., (2019) identify three evidence-based antecedent interventions:
noncontingent reinforcement, high-probability request sequence, and functional communication
training.
Noncontingent Reinforcement
Noncontingent reinforcement (NCR) is defined as “an antecedent intervention in which
stimuli with known reinforcing properties are delivered on a fixed-time or variable-time schedule
independent of the learner’s behavior” (Cooper et al., 2019). This is an effective practice because
the reinforcers that previously controlled the learner’s behavior are more freely available,
decreasing motivation to engage in challenging behaviors to access them. NCR can be used with
both positive and negative reinforcement (Vollmer et al., 1993; Marcus et al., 1996).
Using NCR with Positive Reinforcement. NCR with positive reinforcement requires the
delivery of a preferred stimulus or reinforcer and is an intervention used when the learner
engages in problem behavior in order to gain access to that reinforcer. Kahng et al. (2000)
demonstrated the effects of this with adults who engaged in self-injurious behavior in order to
gain access to attention. The intervention dictated that the adults received attention initially every
five seconds, with the schedule being thinned as data showed it was able to be. This intervention
led to decreases in self-injurious behavior for all adults in the study. Delivering this type of
attention also conditions people as reinforcers. Heitzman-Powell et al., (2014) as part of their
training asked parents to “make him/her the happiest kid in the world” while being observed in
order to establish parents as conditioned reinforcers. Receiving this high density of attention

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from their parents before problem behavior occurred led to decreases in those maladaptive
behaviors.
Using NCR with Negative Reinforcement. NCR with negative reinforcement is
typically used to decrease problem behavior related to task completion or compliance with
demands. Kodak, Miltenberger, and Romaniuk (2003) used this intervention with two boys who
engaged in problem behavior when instructed to complete tasks. The behaviors included
property destruction and aggression. Initially, the children were allowed to escape the task every
10 seconds by the task being removed, the clinician turning away from the client for 10 seconds,
and the representing the demand, continuing that schedule of being allowed to escape the
demand every 10 seconds. That schedule was able to eventually be thinned to every two minutes
and showed significant improvements in compliance and decrease of problem behaviors (Kodak,
Miltenberger, & Romaniuk, 2003).
Considerations of using NCR. An important consideration of implementing NCR is
satiation. Previous research has stated that the effects of NCR are due to satiation, so Fisher et.
al. (1999) sought to see if this hypothesis was true. The authors state that one of the reasons NCR
is so effective is it because it eliminates the response-reinforcer contingency, or extinction
component, but that the schedule of delivery of the reinforcer is able to be faded due to satiation.
In other words, the learner is less motivated to access the reinforcer so he tolerates the delay in
receiving it. NCR without the use of extinction has been found to be effective because the learner
is contacting reinforcement before even having the opportunity to engage in problem behavior
(Hanley et. al., 1997). This study wanted to show that the effects of NCR were due to choice
responding rather than satiation. “That is, the participants may have chosen to consume free
reinforcement when it was available and chosen to emit the target response (due to its prior

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history of reinforcement) only when free reinforcement was unavailable” (Fisher et. al., 1999). In
this study, three children were used who all engaged in problem behavior maintained by
attention. Two conditions were used, NCR with extinction and NCR without extinction. In the
extinction condition, a verbal reprimand was given each time a destructive behavior was
exhibited and all other responses were ignored for two participants. For the third participant, she
received praise every time the replacement behavior was exhibited, and all other responses were
ignored. In the condition in which extinction was not being used, the participants received
attention on a predetermined schedule, either in the form of verbal praise or a reprimand
dependent on the behavior occurring during that time (Fisher et. al., 1999).
Overall, the authors found that NCR reduced destructive behavior by altering the
response’s establish operation, or by reducing motivation. NCR requires less response effort as
there is no contingency required in order to access reinforcement. However, because functionally
equivalent replacement behaviors were also observed in this study, it was found that the
participants were also less motivated to engage in those replacement behaviors as well while
receiving NCR. So while problem behavior was reduced, additional research should focus on
effective ways to increase replacement behaviors as well (Fisher et. al., 1999).
Hanley et. al. (1997) states one way to account for satiation is to identify a wide variety
of reinforcers. This study included participants whose problem behavior was maintained by
attention with the purpose of seeing if other reinforcers would be an effective substitute for
attention. First a functional analysis was conducted to ensure that the researchers were
addressing the correct function of behavior, then a stimulus choice assessment was conducted to
begin to identify other potential reinforcers. The authors found that the use of NCR resulted in
dramatic reduction of problem behavior without an extinction burst and that for behavior

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maintained by attention, a tangible reinforcer was also an effective substitute (Hanley et. al.
1997).
High-Probability Request Sequence
The second identified effective antecedent strategy is the high-probability request
sequence. The high-probability (high-p) request sequences, also referred to as behavioral
momentum, uses the fast-paced delivery of previously mastered skills (high-p) in order to
increase compliance on a more difficult or nonpreferred task (low-p) (Cooper et al., 2019).
Sprague and Horner (1990) used this antecedent intervention in order to help a child learn how to
dress themselves. The task of putting on a shirt typically elicited tantrum behaviors. The teacher
of this child then presented two previously mastered or easier high-p tasks before placing the
demand to put on his shirt. With this sequence, the child demonstrated increased compliance
with putting on his shirt. A crucial aspect of using high-p sequences is to ensure that the high-p
targets are being chosen from the child’s current repertoire of mastered skills, or skills with
which there is consistent compliance, and behavior-specific praise and valuable reinforcers
should immediately be delivered upon compliance with the low-p demand (Cooper et al., 2019;
Maag, 2025).
Benefits of High-P. High-p has been identified as a low-intensity strategy, making it
easy for just one person to implement, and has been identified as a strategy that promotes growth
in academic, behavioral, and social domains (Bross et al., 2018). Though effective at addressing
noncompliance as described above, high-p request sequence (HPRS) can also be used to promote
positive classroom culture as it better elicits desired behavior and reduces problem behavior,
creating a safe environment for students in which they can thrive (Banda & Kubina, 2009). The
use of HPRS reduces the number of confrontations and difficult tasks a student experiences

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throughout the school day, setting students up for success and the ability to earn reinforcement
more frequently due to increased compliance therefore leading to higher rates of engagement
with tasks (Bross et al., 2018). It can be used for functional skills or academic skills, making it
easily generalizable (Banda et al., 2008; Banda & Kubina, 2009).
Application of High-P. Bross et al. (2018) authors developed a step-by-step process for
developing a high-p sequence and state that although this study was done in the classroom
setting, the process is easily generalizable to other settings such as the home or community. The
first step is to identify the low-probability (low-p) behavior. This is the skill that is difficult for
the child to complete and therefore historically elicited noncompliance. This can be a difficult
math problem, a social situation that has been previously identified as aversive, or completing
independent seat work. The second step is to generate a list of high-p behaviors that are similar
to the low-p behavior identified in step one. These behaviors should already be in the learner’s
repertoire and are used to build behavioral momentum toward completing the low-p task. For
example, if a child struggles with transitions, the high-p requests would also be physical
movements. The third step is to test the high-p behaviors by giving the requests 10 times each.
This ensures that the high-p behaviors are mastered skills and easy for the child to demonstrate
with a high rate of compliance. The fourth step is to administer three to five of those high-p
requests in succession, followed by praise for demonstrating those behaviors. Behavior-specific
praise should be used so that the child is learning exactly what it is that is gaining access to
reinforcement. The fifth step is to deliver the low-p request within 10 seconds of the last high-p
request. This must happen quickly so the behavioral momentum is not lost before the low-p
request. The sixth step is then to praise and immediately reinforce the low-p behavior once
compliance is demonstrated, also using behavior-specific praise (Bross et al., 2018). It is also

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recommended that teachers collaborate with parents and seek their feedback on the learning
goals. This ensures that all stakeholders are using behaviors that are truly high-p and low-p
behaviors. This leads to consistency in programming which allows skills to be easily generalized
across settings (Bross et al., 2018).
Functional Communication Training
Functional communication training (FCT), the third identified antecedent strategy,
teaches children an alternative behavior in the form of communicative skills required to request
their wants and needs rather than engaging in maladaptive behaviors in order to address that
same function (Tiger et al., 2008; Cooper et al., 2019). These would all be considered examples
of replacement behaviors. By children engaging in a lower response effort behavior of manding
for, or requesting, access to a preferred item or a break from an aversive activity and receiving
reinforcement for engaging in that behavior instead of maladaptive behaviors, it has been proven
to be an effective way to decrease those maladaptive behaviors (Ghaemmaghami et al., 2021).
FCT is done in combination with a dense schedule of reinforcement so that the alternative
behavior of appropriately manding is contacting frequent reinforcement. Children with emerging
communication skills who require this type of training can become prompt depending on vocal
prompts, so another consideration is to try to reduce those to promote more independent
responding (Cooper et al., 2019). Examples of skills taught in FCT are asking for help, a break,
attention, or for any preferred item or activity.
History of FCT. In order for FCT to be effective, its function must first be determined
(Lambert et al., 2012). At the time of this study, no previous research existed that demonstrated
the efficacy of teachers in early childhood settings conducting trial-based functional analyses to
treat problem behavior with a function-based intervention. This specific body of research is

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essential to show that stakeholders beyond clinicians extensively trained in Applied Behavior
Analysis are able to determine the function of behavior using trial-based functional analyses.
Three children, ages 3-4 years old, diagnosed as having developmental delay and receiving
special education services were participants in this study. All three participants had emerging
communicative skills and used a combination of gestures, picture cards, or one-syllable
vocalizations. The participants also exhibited maladaptive behaviors of aggression and tantrums
(Lambert et al., 2012)
For the study, FCT sessions were divided into one-minute intervals, during which
frequency of problem behavior and alternative responses were recorded in each interval. Ten to
twelve trials of attention, escape, tangible, and ignore were used on a weekly basis as part of the
analysis and became part of the students’ regular educational programming. A multiple-stimulus
without replacement preference assessment was conducted to identify highly and moderately
valued tangible reinforcers. Two-minute control segments (motivating operation absent) were
followed by two-minute test segments (motivating operation present) for all four functions. If
problem behavior occurred during the control segment, the segment ended and the test segment
began. If problem behavior occurred during the test segment, the reinforcer for that specific
function was delivered and the trial ended. Based on the results of the trial-based functional
analysis, interventions were developed using differential reinforcement of appropriate, or
functional, communication. In all instances, the teacher was able to identify one function for
problem behavior and saw significant decreases in problem behavior related to that function
using FCT (Lambert et al., 2012).
Preference Assessments

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Reinforcement must be valuable in order of these antecedent strategies to be effective.
The preference assessment is an essential part of the process of establishing antecedent
consequences so caregivers can reliably be prepared to reinforce socially valid replacement
behaviors (DeLeon & Iwata, 1996). This is typically formally conducted by the clinician if
enough valuable reinforcers have not been previously identified, as the treatment team will want
to avoid satiation with the learner (Roane et al., 1998).
Satiation is defined as a decrease in the frequency of operant behavior presumed to be the
result of continued contact with or consumption of a reinforcer that has followed the behavior
(Cooper et al., 2019). When satiation occurs, the client becomes less likely to engage in the
replacement behaviors being taught as they are less motivated to access the reinforcer. The
preference assessment is then also used to identify reinforcing properties among previously
identified reinforcers so a wider variety of valuable reinforcers can be established or conditioned
(Roane et al., 1998). With the previously identified barriers to ABA implementation and training,
self-instruction manuals have become more popular in the field, and these manuals have been
shown to effectively teach how to conduct preference assessments (Graff & Karsten, 2012).
Participants in this study were teachers who had no previous training in conducting preference
assessments, demonstrating that the results could be generalized to parents who also lack formal
training. With enhanced written instructions, enhanced meaning that pictures, examples, and
minimal technical jargon were included, all teachers were able to implement preference
assessments with at least 90% accuracy across two consecutive sessions (Graff & Karsten,
2012).
Consequent Strategies for Parents

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The results of the FBA also identify what reinforcement the behavior was historically
contacting and function-based interventions based on those results would address those to allow
for children to receive reinforcement for functionally-equivalent replacement behaviors instead
(Cooper et al, 2019). Reinforcement for target replacement behaviors as described above is one
of the most commonly used consequent strategies. Reinforcement can be delivered in a variety of
ways.
Differential Reinforcement
Differential reinforcement is defined as “reinforcing only those responses within a
response class that meets a specific criterion along some dimension (i.e. frequency, topography,
duration, latency, or magnitude) and placing all other responses in the class on extinction.”
(Cooper et al., 2019). This requires specific reinforcement procedures, more simply stated
providing more valuable reinforcement for more independent responding, and less valuable
reinforcement for responses that perhaps require multiple prompts or account for longer latency
periods (Piazza et al., 1996). There are different types of differential reinforcement, the most
common being differential reinforcement for alternative behavior (DRA), differential
reinforcement for incompatible behavior (DRI), and differential reinforcement for other behavior
(DRO) (Azrin & Holz, 1966; Repp et al., 1983; Carr & Durand, 1985; Cooper et al., 2019).
Differential reinforcement requires some kind of reinforcement occurring, dependent on
responses. This is in contrast to extinction, defined as: “a procedure occurs when reinforcement
of a previously reinforced behavior is discontinued; as a result, the frequency of that behavior
decreases in the future” (Cooper et al., 2019). Extinction procedures involve ignoring the
problem behavior, not the learner, and often times an extinction burst occurs. This is when the
problem behavior being placed on extinction gets worse before it starts to get better (Lerman &

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Iwata, 1995). Both procedures are only successful when the function of the behavior is
determined. Common practice had been to use DRA procedures combined with extinction,
however extinction is not always ethical or feasible (MacNaul & Neely, 2018). While effective at
reducing problem behavior, a caregiver would be unable to use extinction procedures with a
large or combative individual or there is the possibility that a caregiver would not consistently
implement extinction procedures, which is essential in order for extinction to be effective
(Athens & Vollmer, 2010).
With increasing focus on differential reinforcement procedures, effective of
noncontingent reinforcement (NCR) also became an important consideration regarding effective
antecedent strategies, as mentioned above (Cooper et al., 2019; Kahng et al., 2000). Fritz et al.
(2017) wanted to see the effects of NCR without extinction on rates problem behavior. NCR is
typically delivered on a time-based schedule, regardless of learners’ responses. Typically, NCR
is combined with extinction, in which reinforcement is withheld following problem behavior.
However, since extinction is not always feasible, especially with families with just one caregiver
as extinction procedures can be dangerous, the authors wanted to examine the effectiveness of
instead combining NCR with DRA procedures. Five participants diagnosed with autism who
attended day treatment centers were used in this study. All participants engaged in behavior
maintained by socially mediated positive reinforcement. Overall, solely NCR with a thinning
schedule was effective for three of the five participants. One participant’s problem behavior was
completely eliminated and participants were able to maintain low levels of problem behavior
when the schedule was thinned to FI 5 minutes. For the two participants whose behavior was not
impacted by just NCR, NCR combined with DRA did reduce their levels of problem behavior
(Fritz et al., 2017).

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Token Economy
Another effective reinforcement strategy is the use of a token economy (Kazdin, 1982). A
token economy is defined as: “a system whereby participants earn generalized conditioned
reinforcers (e.g. tokens, chips, points) as an immediate consequence for specific behaviors;
participants accumulate tokens and exchange them for items and activities from a menu of
backup reinforcers” (Cooper et al., 2019). To achieve this, tokens are delivered in conjunction
with unconditioned or terminal reinforcers, such as food (Kazdin, 2008; Hackenberg, 2018).
Example of Use of Token Economy. Andzik et al. (2022) utilized a token economy to
treat escape-maintained problem behavior without the use of extinction. This research is crucial
as it takes place in school and home settings, where extinction is not always possible, and
focused on increasing tasking completion, finding that extinction was not necessary to eliminate
escape-maintained problem behavior. For each task, least to most prompt hierarchy (verbal,
model, physical) was used giving the participants 10 seconds to respond at each level before the
next invasive prompt was delivered. Both a preference assessment and FBA were conducted to
ensure the researchers were utilizing a function-based intervention and that the reinforcement
would be valuable to the participant. The delivery of the token was delayed based on the level of
prompting that needed to be used, and students exchanged them for a terminal reinforcer after
earning six tokens (Andzik, et al., 2022).
At the onset of this study, none of the participants had previously utilized a token
economy. The first step was conditioning it, and this was done by pairing the delivery of a token
with verbal praise, which was previously identified as a valuable reinforcer for the participants.
Even with the novelty of the token economy, the results of the study showed an increase in the
percentage of compliance for all four participants (Andzik, et al., 2022). The use of the token

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economy enabled participants to spend more time in their classrooms and engaged in learning
and less time engaging in problem behavior, thereby providing more teaching opportunities.
Andzik et al. (2022) stated that there is extremely limited research on the effect of
delayed terminal reinforcement with the use of a token economy without extinction. The token
economy is an effective way to reduce the number of times a student needs to return a terminal
reinforcer, so the use of a token economy is an effective antecedent strategy to reduce problem
behavior related to relinquishing reinforcement.
Considerations of Token Economy. The token economy is also able to be easily
generalized to other educational settings, such as a regular education classroom, allowing
students to more readily access their least restrictive environments and generalize adaptive
behavior to multiple settings (Kim et al., 2021). It can also be used when a program is
implemented across multiple children (Kazdin, 2008). This is an important shift in developing
more inclusive practices (Andzik et al., 2022). The use of a token economy can also be used for a
wide variety of skill acquisition areas such as vocational, self-care and communication, making it
a strategy that could be generalized between the school, home, and community settings and to
the skillsets required to safely access those settings (Kazdin, 1982; Matson & Boisjoli, 2009;
Hackenberg, 2018).
Planned Ignoring
Reinforcement procedures are proven to be effective in decreasing maladaptive
behaviors, however sometimes punishment procedures need to be used when reinforcement
procedures have been exhausted (Everett et al., 2010; Justus et al., 2023). Planned ignoring is a
punishment procedure in that it is used to decrease the future probability of behavior and help
children discriminate between appropriate and inappropriate behavior (Hester et al., 2009;

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Cooper et al., 2019). It is used to address maladaptive behaviors that serve the function of
gaining access to attention (Justus et al., 2023; Gerlach, 2024). This procedure requires the use of
extinction in which unwanted maladaptive behaviors are ignored and requires the clinician to
consider many aspects before implementation, such as reinforcement of alternative behaviors as
that has been found to increase the efficacy of punishment (Kazdin, 2008).
Considerations of Implementing Planned Ignoring. An important consideration of
using planned ignoring is ensuring that socially valid replacement behaviors that meet the same
function of the behavior being ignored, such as conversational skills (Hester et al., 2009;
Gerlach, 2024). Other concerns are that planned ignoring is sometimes dangerous to use, it is
impossible to ignore certain behaviors, use of planned ignoring may not address the function of
the behavior, and the term is sometimes used incorrectly in that people who implement it will
sometimes ignore the child or client completely rather than just the behavior, therefore
inadvertently reinforcing any escape- or sensory-maintained behavior (Lloveras et al., 2023).
Some potential solutions for these problems are to ensure that procedures are specifically spelled
out, that an attention-seeking function has been identified, and that safety procedures are clearly
outlined (Lloveras et al., 2023). Using these solutions helps make certain that a child’s needs are
not overlooked and that children are not made to feel unwanted (Gerlach, 2024).
Steps for Developing Interventions using Planned Ignoring. First, it is essential to
operationally define the behaviors targeted for reduction to ensure the FBA is done with fidelity.
Next, the clinician will conduct the FBA. If the function of the behavior is determined to be in
order to gain access to attention, then the clinician must review the risks of the use of planned
ignoring. If the risks are deemed not dangerous, then the plan is developed with explicit
instructions of when and how to implement the procedure, as well as data collection procedures

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to ensure it is effective. If it is deemed too dangerous, such as self-harm behavior, then it is not a
practical option and other interventions must be developed (Justus et al., 2023; Gerlach, 2024). A
clinician must determine through the FBA that there is not an escape-maintained or automatic
function to the behavior, or else that behavior will be inadvertently reinforced (Hester et al.,
2009; Lloveras et al., 2023). By following these steps, it helps ensure that interventions are
ethical (Justus et al., 2023).
Examples of Planned Ignoring. A frequently used example of planned ignoring in the
school setting is to ignore whining, calling out behavior, or other vocalizations inappropriate for
the school setting. Instead, a teacher may call on a student who is quietly raising their hand or
will prompt a student to “use your words”, modeling the appropriate replacement behavior and
pairing the behavior of using the replacement behavior with behavior-specific praise (Hester et
al., 2009). A similar example can be used in the home setting, with a parent ignoring comments
that previously led to arguments with their children and instead modeling or responding to
functional communication (Lakes et al., 2011). As previously stated, it is important to teach a
replacement behavior, such as functional communication training, and reinforce those behaviors
instead (Kazdin, 2008; Hester et al., 2009; Gerlach, 2024).
Time-Out
Time-out is evidence-based practice used as a punishment procedure to decrease the
future probability of problem behavior, in which a child is moved to a less reinforcing setting
after engaging in behaviors targeted for reduction (Everett et al., 2010; Donaldson & Vollmer,
2011; Canning et al., 2023). Time-out can be either exclusionary, in which the child is moved to
a different area, or non-exclusionary in which the child remains in the setting where the
maladaptive behavior occurred (Morawska & Sanders, 2011). It is one of the most commonly

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used strategies among parents and is used to address various functions and topographies of
behavior, primarily externalizing behaviors (Everett et al., 2010; Donaldson & Vollmer, 2011;
Riley et al., 2017; McLean et al., 2023). Behaviors can include property destruction, aggression,
verbal aggression as defined by yelling or screaming, or noncompliance (Donaldson & Vollmer,
2011). In time-out, reinforcement is withheld contingent on exhibiting maladaptive behaviors,
typically by the child being placed in a setting in which there are no reinforcing properties
(Everett et al., 2007; Riley et al., 2017). Time-out is also effective in that it allows the child time
to deescalate and learn independent coping skills (Morawska & Sanders, 2011). Overall, parents
perceive the use of time-out to be effective with their children, and to be most effective with a
single warning that time-out was going to be a consequence (Everett et al., 2007; Everett et al.,
2010; Riley et al., 2017).
Considerations of Implementing Time-Out. In order for time-out to be effective, it
should occur immediately upon the child exhibiting a behavior targeted for reduction. Repeated
warnings or conversations regarding the behavior should not occur (Riley et al., 2017). Instead,
one verbal warning paired with a verbal reason as to why time-out was initiated has been shown
to be most effective, with the time-out being implemented immediately after noncompliance with
the first warning (Everett et al., 2007; Corralejo et al., 2018). All reinforcing stimuli should be
reduced or completely eliminated from the setting, such as toys, attention, or other preferred
items, and time-out should be a minimum duration, such as two to three minutes, as longer
durations have been shown to be ineffective (Riley et al., 2017). No maladaptive behaviors
should occur during a specific amount of time, either the entire duration of the time-out or for a
specified time at the end of the predetermined duration (Cooper et al., 2009; Donaldson &

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Vollmer, 2011). Exit criteria should also be clear to the child (Everett et al., 2010; Riley et al.,
2017).
When implementing time-out procedures, it must also be clear to the child when they are
accessing “time-in” to help them discriminate between the two settings. During time-in, the child
has access to reinforcers and preferred items or activities (Donaldson & Vollmer, 2011;
Morawska & Sanders, 2011). The more sterile the time-out environment is and the more
enriching the time-in environment is, the more effective time-out procedures are and the less
they are needed (Morawska & Sanders, 2011). As with planned ignoring, teaching and
reinforcement of replacement behaviors needs to occur, so positive reinforcement and behaviorspecific praise of engaging in appropriate behaviors should occur in the time-in setting (Everett
et al., 2010; Morawska & Sanders, 2011; Riley et al., 2017). The use of time-out is more
effective when parents refrain from using punitive forms of punishment in conjunction with
time-out (Corralejo et al., 2018). Parents should also ensure they have a back-up strategy for
when their child attempts to escape time-out, such as repeatedly returning the child to the timeout setting or blocking the exit (Everett et al., 2010; Donaldson & Vollmer, 2011; Riley et al.
2017).
Another important consideration is to be trauma-informed, and children can feel rejected
by their parents when they are subjected to time-out (Corralejo et al., 2018). Time-out as a
standalone procedure does not teach children how to problem-solve, express their feelings, or
learn appropriate replacement behaviors (Morawska & Sanders, 2011). For these reasons, it is
essential that the time-in setting be satiated with reinforcement and praise (Everett et al., 2010;
Riley et al., 2017). It should also be used only as a consequence for predetermined behaviors
targeted for reduction such as aggression or property destruction, and not when a child is feeling

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scared or distressed due to an accident in order to maintain a positive parent-child relationship
(Morawska & Sanders, 2011). One way to promote this positive relationship is to use language
that is centered around the behavior rather than the child (Morawska & Sanders, 2011).
Perceptions of Time-Out. Parent perceptions of time-out vary. Some studies show that
parents find it to be effective and reduce stress levels (Everett et al., 2007; Everett et al., 2010;
Riley et al., 2017). Time-out has also been proven to be effective with reducing conduct
problems and peer problems (McLean et al., 2023). Parents are more receptive to utilizing timeout if they trust their clinicians recommending the procedure (Canning, Jugovac, & Pasalich,
2023). However, a review of literature also shows that parents choose not to use time-out due to
their upbringing and negative parenting they experienced. Some parents also believe that timeout is harmful, does not teach skills, damages the parent-child relationship, and does not
effectively address the deficits contributing to the problem behavior (Canning, Jugovac, &
Pasalich, 2023). In fact, some parents equate the use of time-out and the rejection a child feels
from that commensurate with physical pain (McLean et al., 2023). These negative perceptions
further highlight the need to ensure time-out is used with other direct teaching and reinforcement
strategies (Morawska & Sanders, 2011; Corralejo et al., 2018).
Examples of Time-Out. Time-out can be used in a variety of settings (Everett et al.,
2007; Donaldson & Vollmer, 2011). In the home setting, a parent may have their child sit in their
bedroom for fighting with a sibling (Kazdin, 2008). In the school setting, a teacher may have a
student sit in a sterile corner of the classroom for throwing a toy at a peer (Donaldson &
Vollmer, 2011). Time-out has also been shown to be effective across multiple functions. Timeout is typically recommended for behaviors maintained by positive reinforcement, however
Everett et al. (2007) found that use of time-out for escape-maintained compliance actually

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increased rates of compliance across four children. This was achieved by the children returning
to the same demand immediately upon exiting time-out so they were unable to escape the
demand (Everett et al., 2007). Despite time-out being effective across functions, it is still
essential to determine the reason for the child’s maladaptive behaviors (Hanley et al., 2003).
Purpose of the Study
Parents have encountered several barriers in accessing effective care for their autistic
children. Families specifically in rural areas have been heavily impacted by this as these families
make up 20% of the population with autism just as prevalent there as in more suburban or urban
areas (Heitzman-Powell et al., 2014). The prevalence is ever increasing so it is becoming
increasingly difficult for clinicians to keep up with the demand for effective ABA treatment and
therapy. Current online trainings available are geared more toward clinicians working to obtain
their licensure in ABA, so the material is not easily accessible to or understood by parents
(Heitzman-Powell, 2014). With that, it is essential for parents to have the tools to support their
children when clinicians and treatment teams are not present. This study will assess parents’
knowledge and ability to identify functions of behaviors, as well as their knowledge and ease of
implementation of antecedent and consequent strategies that can be safely used with just one to
two people and easily generalized to multiple settings, such as between the home and
community.
Research Question(s)
1) How familiar are caregivers with the functions of behavior and how accurately do they
identify them? Parents being trained in properly identifying functions of behavior is essential as
parents will often use consequent strategies that do not address the function of behavior or
inadvertently reinforce their child’s maladaptive behaviors due to child effects, or when the

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child’s behavior influences the parents’ behavior (Stocco & Thompson, 2015; Lansford et al.,
2018).
2) How can nontraditional families, specifically single-parent families, build the inner
capacity in order to safely address their child’s behavior by function? It is important to focus on
single parent families as single mothers have significantly higher rates of stress than mothers of
neurotypical children, with child-related stress factors falling in the 99th percentile of mothers of
children with autism (Dyches et al., 2015; Bradley et al., 2024). Parent training has been shown
to increase parental knowledge, enhanced competence in advocating for the child, decrease
parental stress and a reduced sense of isolation (Bearss et al., 2015). Capacity is defined as "a
functional determination that an individual is or is not capable of making a medical decision
within a given situation" (Libby et al., 2023). This study will look to assess the effectiveness of
parents identifying functions of behavior and implementing function-based interventions using
low intensity programming with just a brief consultation with a clinician (Bearss et al., 2015).
3) What strategies can be safely and effectively implemented in the home and community
settings by just one to two people? By focusing on safe interventions that maintain the dignity of
the child, it can foster more therapeutic relationships with families and lead to better clinical
outcomes (Taylor et al., 2019). By using compassionate and empathic care, clinicians can help
families utilize ethical evidence-based practices that can be implemented in multiple settings and
reduce maladaptive behaviors, making them safe and effective (Taylor et al. 2018). By focusing
on low intensity interventions such as differential reinforcement, noncontingent reinforcement,
and functional communication training, it allows parents to implement these strategies that can
occur in natural contexts while also being mindful of the demands placed on parents every day
(Bacotti et al., 2022). Differential reinforcement and noncontingent reinforcement specifically

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have been found to be easily generalizable because it can be utilized during (1) self-care or daily
living activities, (2) physical activity, and (3) preferred learning activities, and likely involve
parents interacting with their child, lead to better clinical outcomes, and allow for data collection
on relevant parent and child behavior (Bacotti et al., 2022). For this study, community will be
defined as any setting outside the home or school, such as parks, playgrounds, after-school
programs, daycares, grocery stores, restaurants, and other extracurricular events such as sports or
clubs.
Need for the Study
Applied Behavior Analysis is one of the most effective ways to support skill acquisition
and reduce maladaptive behaviors among children with autism (National Autism Center, 2009).
In spite of this, training in such has been proven difficult for parents to receive. Much of the
training material is geared towards practitioners obtaining licensure in ABA (Heitzman-Powell et
al., 2014). Due to this, children who require instruction that uses the principles of Applied
Behavior Analysis are primarily receiving this in the school setting. In the school setting,
students have daily access for several hours a day to at least one special education teacher, a
school psychologist, and school counselor, often a Board Certified Behavior Analyst, multiple
therapists, and an administrative team that make up the child’s school-based multidisciplinary
team. When the child goes home from school, it is often just the parents for the remainder of the
night. The parents typically have limited knowledge or training in best practices in order to
continue to promote the generalization of skills in the home setting, plus additional
responsibilities such as other children to tend to or basic household duties. Parent-training is an
evidence-based practice that has been shown to have overall positive effects for autistic children,

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therefore it is crucial to ensure parents are easily accessing the necessary trainings and building
the inner capacity to support their children (Beidas & Kendall, 2010).
The stress of caring for a child with autism is taxing on families. Delivering constant care
adds higher stress levels and social-emotional challenges to families (Benn et al., 2012). In
addition to the level of care required to tend to their child on the day to day, parents often feel
discouraged and lose their confidence in their ability to be effective parents once they learn of
their child’s autism diagnosis (McConachie & Diggle, 2007). Dumas (1984) found that 60% of
parents were unable to implement with fidelity a time-out or point-reward system, further
highlighting the need to build capacity within families. By making families more aware of the
contingencies shaping their own behavior, for example providing attention to their child
engaging in tantrum behaviors in order to gain attention in order to end the tantrum more
quickly, it allows them to better analyze the function of their child’s behavior as well (Stocco &
Thompson, 2015). In addition to feeling discouraged, families often feel overwhelmed by
conversations with their clinicians, leading them to become more disengaged with training and
care (Stocco & Thompson, 2015). Parents have then stated that they feel as though providers are
not approaching them in a collaborative manner due to perceptions of factors such as
socioeconomic status or disinterest (Straiton et al., 2021).
By giving the parents the ability to accurately identify functions of behavior and to
implement function-based interventions, it promotes skill acquisition and decreases problem
behavior when a clinician is not always able to be present due to the limitations described above.
A seemingly simple task of going to the grocery store can be impossible for families due to a
child’s unsafe problem behavior in that setting. By parents learning to effectively manage their
child’s problem behaviors, it improves their child’s quality of life as well as their own.

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Summary
As previously stated, applied Behavior Analysis (ABA) is one of the most effective ways
to support skill acquisition and reduce maladaptive behaviors among children with autism
(National Autism Center, 2009). However, the prevalence of autism continues to increase,
leading to increased caseloads for BCBAs and making it more difficult to deliver effective care.
For these reasons, clinicians must find ways to better support families with the use of functionbased interventions and evidence-based practices (Beidas & Kendall, 2010). There are, however,
many barriers to this including lack of effective communication between clinicians and families,
financial strains, family stressors, and structures, socioeconomic or cultural barriers, and lack of
training for clinicians on how to train families (Stocco & Thompson, 2015, Ingersoll et al., 2020;
Crane et al., 2021; Straiton et al., 2021).
Despite these barriers, parent training has been found to effectively reduce problem
behavior and promote skill acquisition, so it is important to find a way to continue to deliver
these trainings (McConachie and Diggle, 2007; Aldred et al., 2004; Smith et al., 2000).
Comprehensive ABA services promote the development of joint attention, imitation of others,
communicating wants and needs, understanding language of others, and tolerating change
(McConachie & Diggle, 2007). Because intervention is more effective before children reach
school age, it makes parent involvement that much more vital.
In the following chapter, the methodology of the study intended to address these barriers
and better equip parents to use function-based interventions will be explained. The chapter will
include details regarding the steps of the study. Information about the data collected, how it will
be collected, and how it will be analyzed will be outlined in this chapter as well. The end of the
chapter will outline limitations with the study.

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CHAPTER 3
Methodology
Introduction
This study worked to identify how accurately caregivers can identify the function of
behavior, determine how can nontraditional families, specifically single-parent families, can
build the inner capacity in order to safely address their child’s behavior by function, and identify
strategies caregivers can use in multiple settings to demonstrate generalization while also
maintaining the dignity of the child. With all the noted benefits of using evidence-based practice
and function-based interventions with children with autism, in conjunction with the limited
availability of and barriers to effective parent training, a way must be found to disseminate ABA
principles to parents in a way they can easily access, understand, and implement. Research has
demonstrated the success of self-instruction manuals as a way to teach skills to parents who have
not received formal training in ABA, and the effectiveness of implementation of function-based
interventions when parents collect and analyze their own data on maladaptive behaviors (Graff &
Karsten, 2012; Heitzman-Powell et al., 2014). The methodology of this research will expand on
both of those bodies of research in order to empower families to successfully implement
function-based interventions considering the barriers to consistent, formalized parent training.
Procedures
After informed consent was received families were surveyed via Appendix A to collect
baseline data regarding their ability to name the functions of behavior. It is important for families
to be able to identify the function as caregivers delivering function-based consequences has been
shown to promote clearer outcomes (Hanley et al., 2003). They were then asked to watch videos
of children engaging in problem behavior addressing various functions with videos from Parent

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Training for Disruptive Behavior: The RUBI Autism Network and asked to determine those
functions (Bearss et al., 2018). This addressed the research question of assessing how accurately
caregivers can identify the function of behavior. Families were then interviewed via Appendix A
regarding whether or not they are receiving services, how often they receive formal parent
trainings through these services, and the content covered in these. To address the next part of the
research, they were asked if they regularly (twice a week minimally) access the community, and
asked to state what is going well and what they wish was going better. If they were not accessing
the community, they were asked to identify the barriers that are preventing them from doing this.
This worked to answer the research question of determining effective interventions that maintain
the dignity of the child that can be used in multiple settings.
Additionally, caregivers were asked to list minimally 10 reinforcers for their child so they
are aware of these and can readily deliver them throughout the study as a form of preference
assessment (DeLeon & Iwata, 1996; Roane et al., 1998; Hanratty & Hanley, 2021). This number
has been chosen to avoid satiation as a possible variable contributing to maladaptive behaviors,
and using a variety of reinforcers has been shown to be more resistant to change and distraction
(Milo et al., 2010). If a parent was unable to identify 10, they worked with the researcher via a
preference assessment to identify similar properties among the previously identified reinforcers
so the team can identify what the reinforcing properties are and attempt to expand on those (Da
Fonte et al., 2016).
After the baseline data was collected, families were provided with an ABC form in order
to collect antecedent, behavior, and consequence data (Appendix C) . This addressed the research
question of determining if families are able to identify the functions and utilize function-based
interventions. They were asked to fill this out minimally five times a week over the course of six

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weeks, with minimally two occurrences per week to take place in the community setting. This
was done through momentary time sampling. This method of data collection had been chosen
because it has been shown to reduce observer fatigue, lessening the burden of parents collecting
their own data (Cook & Snyder, 2019). Because it was just a brief momentary time sample where
frequency or interval recording would not be applicable, families were asked to rate the intensity
of the behavior on a 5-point scale. Of the function-based antecedent and consequence
interventions, families also wrote down which was used and how effective they perceived it to
be. Families briefly met with the researcher weekly in order to more realistically mimic actual
conditions and barriers in which clinicians are typically touching base weekly but not delivering
formal parent trainings that often to mimic low intensity services (Bearss et al., 2015). The
researcher used Parent Training for Disruptive Behavior: The RUBI Autism Network (Bearss et
al., 2018) to guide these sessions. During these sessions, the researcher and families discussed
the behaviors observed and recorded since the last session, and engaged in role play or possible
direct coaching if maladaptive behaviors occur during the online coaching session (Bearss et al.,
2018).
Families were also given information from Parent Training for Disruptive Behavior: The
RUBI Autism Network outlining the antecedent and consequent strategies listed above (Bearss et
al., 2018). These manuals included definitions and specific examples of how they can be used to
address multiple functions of behavior. For example, functional communication training included
procedures for manding for attention, tangibles, or a break (Ghaemmaghami et al., 2021). High-p
sequence included having a child make an easier transition of a shorter distance before the skill is
generalized to longer distances for children who exhibit problem behavior due to demands to
transition (Bross et al., 2018). Minimally three times a week, parents were asked to document

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what function-based intervention was used during problem behavior. At the completion of the
study, parents were asked to provide open-ended feedback regarding their understanding of the
self-instruction manual and how useful they perceived it to be.
In order to assess the effectiveness, parents were then asked, similarly to the baseline
state, to identify functions of behavior in videos they watch. Families were also asked if they feel
better equipped to manage episodes of problem behavior while no treatment team is present. The
ABC data form was used to assess effectiveness per the 5-point scale and assess whether the
intensity of using function-based interventions increases or decreases the intensity of behavior.
Participants
Participants were single-parent or caregiver homes with a child receiving ABA therapy
through agency support and/or in the school setting, minimally six children in order for the study
to still be statistically significant, with a maximum of 10 in order to avoid data saturation (Guest
et al., 2006; Gravetter & Wallnau, 2017). Whether or not the families receive agency support in
the homes will account as a variable comparing how well families identify the function of
behaviors and how effectively they implement strategies discussed. Families who are currently
receiving ABA therapy were recruited through Lancaster County Facebook parent groups and
participated virtually. The families from Lancaster County were located in rural, suburban, or
urban areas and if data is shown to be variable across location then that was considered a
variable of this study, with barriers further analyzed based on location.
Data Collection
Data collection happened after recruiting and receiving informed consent (Appendices D
& E). The data collection occurred through researcher-created surveys provided over a secure
online platform, via sharing links to the documents via Microsoft that include no identifying

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information about the children or their families. Parents filled out questionnaires (Appendix A)
regarding functions of behavior. Links to videos were e-mailed to families, and parents were able
to answer questions regarding the videos on the same form. They also listed the barriers and
additional information regarding their community experiences on that form. The survey also
included demographic information in order to document the age of the children, how many
children, where the family lives (rural, urban, or suburban), the family structure, and information
regarding the ABA services they are currently receiving, if any. Postvention data was be
collected in the same manner. How each research question will be answered from the
Appendices is reflected in Table 1.
Table 1
Matrix Questionnaire Form
How familiar are
caregivers with the
functions of behavior and
how accurately do they
identify them?

1. List the functions of behavior, or as many as you know:
2. Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#35
1024210 - Video 1.1:
3. Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#35
1024210 Video 2.1:
4. Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#35
1024210 Video 2.2:
5. Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#35
1024210 Video 2.3:
Read the following scenarios and describe how you would respond:
1. Your child is wearing a shirt with a tag that is rubbing
against his neck. Your family is out at the grocery store and
he starts tugging at the back of his shirt. When that does not
help, he starts to take his shirt off:
2. Your child threw some cereal on the ground and you have
asked them to pick it up. They take the box of cereal, throw
it, and run upstairs to their bedroom:

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3. Your child is playing with a toy, then sees their sister has a
toy they want. They run up to their sister, pull her hair, and
take the toy out of their hands:
4. You are on the phone and your child calls you from the other
room. When you do not immediately respond, they start
screaming and knocking chairs over:
How can nontraditional
families, specifically
single-parent families,
build the inner capacity in
order to safely address their
child’s behavior by
function?
What strategies can be
safely and effectively
implemented in the home
and community settings by
just one to two people?

1. Are you currently receiving ABA services? If so, in which
settings (home, community, school)?
2. Are you receiving these supports through an IEP, agency
support, or both?
3. If receiving services through agency support, are you
receiving formal parent trainings from your clinician? If so,
how often are these happening?
4. What is the content covered?
1. How often do you take your child into the community (parks,
grocery store, movie theater, restaurants, etc.)?
2. What are some things that go well in the community?
3. What are some things you wish were going better in the
community?
4. If you are not regularly (minimally twice a week) accessing
the community setting, what are barriers to that?

Families then received a document, shared individually so information cannot be shared
across families, on which they will collect ABC data (Appendix C). Families were given the
choice to fill this form out electronically to be shared in real-time with the researcher or they can
print it out and scan it, whichever way allows for easier but accurate data collection. The form
included a date column, an antecedent column and a key so they can easily notate antecedents.
Examples are “N” for denied access, “T” for transitions, “D” for demands placed, etc. Families
were also able to add their own if they are not included in the premade key. The column had
space so families can write more specifically what the antecedent was, such as “Child was told to
put plate in the sink”.
The behavior column had a similar key, including “A” for aggression, “P” for property
destruction, etc. For the consequence column, families were asked to notate what happened

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immediately after the behavior occurred, such as “attention was removed”, “access to preferred
item was given”, etc. The final column asked families to rate the intensity of the behavior on a 5point Likert scale. In order to control for validity, guidance was given regarding scoring, for
example 1-3 instances of the behavior or duration of less than one minute would be assigned a 1,
and so on. This helped quantify the subjectivity of the 5-point scale (Creswell, 2003). Parents
received coaching through either modeling or role playing during their weekly sessions with the
clinician. These sessions were in place in order to attempt to control for reliability and accuracy
of parent reporting. Through either role playing or modeling, the researcher gave specific
examples of how the parent should rate behaviors based on the definitions of each rating on the
Likert scale. These sessions paired with a self-instruction manual have been found to be effective
in controlling for reliability (Graff & Karsten, 2012).
Data Analysis
This was a mixed methods study using the framework of a sequential exploratory
strategy. This method had been chosen as it allows for parents to provide qualitative feedback
regarding their knowledge of the functions of behavior, allow them opportunities to reflect on
what went well or identify areas of further support when problem behavior does occur, and to
provide feedback on the study itself. By allowing parents the opportunity to provide such
feedback, it fosters collaborative and empathic relationships between the clinician and families
(Taylor et al., 2019). This qualitative aspect is the priority of the study, with this aspect and the
behavioral quantitative aspect being integrated during the interpretation phase (Creswell, 2003).
The focus on the qualitative aspect also allows for smaller sample sizes (Roberts & Hyatt, 2018).
The qualitative aspect was implemented with coding of themes from interviews being
established while families collect behavioral data. With these interviews, families were asked to

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report on if they are receiving services, how often they receive formal parent trainings through
these services, and the content covered in these. Their opportunities to participate in community
activities were also part of the open-ended interview process, as well as barriers to those
opportunities if they are not happening regularly. If variability among location was found per the
results of this data collection, then themes related to those results would have been analyzed and
established, possibly pertaining to race, culture, or socioeconomic status.
Families were also given scenarios and asked open-ended questions pertaining to how
they would respond to the children’s maladaptive behaviors in those scenarios. Responses to
these scenarios were analyzed based on the criteria listed above regarding current ABA services
and frequency of parent training, providing an additional qualitative component to the study. The
initial responses were also compared to the responses at the completion of the behavior data
collection portion of the research and analyzed to determine if parents have a better
understanding of the functions and ABA principles.
For the quantitative portion, percentage of accuracy of identifying functions was
calculated. These same data points were compared to postvention when families were asked to
again identify functions of behavior. The descriptive statistics regarding this information was
calculated and displayed in a table to easily see how percentages have changed postvention.
An additional quantitative component was added at the end of the study for the analysis
of the behavioral data. For the behavior data collection, the average intensity of each episode of
problem behavior was graphed on a line graph to visually analyze trends regarding intensity
across the intervention. All three components were interpreted at the end of the entire analysis,
with limitations regarding the subjectivity 5-point Likert scale of intensity described (Cresswell,
2003). Families also answered open-ended questions regarding their overall opinion of the study,

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including how informative or effective they thought it was and if they perceived it to be helpful
in addressing their child’s maladaptive behaviors using function-based strategies. This
exploratory sequential study concluded by compiling the behavior data and graphing it,
comparing baseline and postvention scores, and included both visual representations of the data
as well as narratives.
Site Permission
Informed consent was obtained from these parents through Facebook. Site permission
was not required from the moderator of the Facebook groups from which participants were
recruited.
Presentation of Results
Examples of the data sheets were provided as shown in Appendix C. All data was
presented in tables or figures, with specific details outlining the number of participants (n),
percentages comparing baseline and postvention results for each child. Behavior intensity was
graphed with so all stakeholders can easily analyze the effectiveness of the study. These graphs
and tables also included narratives to explained the data in more depth. Additionally, the coding
and themes that were established in the qualitative component of interview analysis were
included in a qualitative narrative with the tables with explanations regarding how those themes
have impacted the quantitative data. A qualitative narrative of the feedback provided by parents
regarding their ease of understanding the self-instruction manual was be included in the
presentation of results.
Limitations
This study, intentionally, did not provide extensive ABA training to families in order to
mimic current reported conditions, as parent training is not extensively occurring (Bearss et al.,

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2015). Research has demonstrated the effectiveness of self-instruction manuals (Graff &
Karsten, 2012). However, the limited formal parent training and lack of in-home support outside
of coaching sessions could serve as a barrier and allow for ineffective implementation of ABA
strategies (Heitzman-Powell et al., 2014).
Parents in an effort to appear more effective in managing their child’s behavior may have
skewed the results themselves of the intensity of behavior on the 5-point rating scale. Using the
measure of intensity itself lends itself to be subjective (Cooper et al., 2019). However, without a
clinician present to track continuous data and with needing to find a way that is easiest for
caregivers to document, intensity was an effective way to address this. This was somewhat
controlled with guidelines associated with each ranking in order to attempt to quantify the
subjectivity of intensity. Operational definitions of each rating will be crucial to attempt to
control for this limitation, and including guidance regarding more objective measures such as
frequency or duration will help better quantify the rating scale (Cooper et al., 2019).
The use of a variation of momentary time sampling is another possible limitation.
Momentary time sampling is typically not recommended for behaviors of low duration or low
frequency (Cooper et al., 2019). However, this method is chosen intentionally due to limitations
of family members to be able to continuously record data.
Participants will be a mix of those recruited through social media and clients with whom
the researcher has a direct relationship. This may be a limitation related to researcher bias as the
researcher may be more readily available for her own clients than with those receiving support
on a more remote basis (Heitzman-Powell et al., 2014).
Lack of control over parent reporting was another possible limitation of the study.
Parents, in an effort to appear more effective may be unwilling to accurately report. Previous

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research has shown that stressors can affect parents’ perception of possible problems, so parents
may underreport or overreport on intensity based on their own distress levels. The research did
show, however, that the parents under greater distress actually more accurately reported on
problems. (Veldhuizen et al., 2017).
Conclusion
This exploratory sequential study computed both quantitative and qualitative data.
Quantitative data included accuracy of caregivers’ ability to define and identify functions of
behavior, as well as behavior data collected by the caregivers regarding the antecedent to
behavior, the behavior itself, and the perceived intensity of that behavior. This data was reviewed
to assess for any changes in intensity as caregivers collect their own data and identify
antecedents to the behavior, and therefore use function-based interventions based on those
antecedents. Qualitative data included analysis and coding of open-ended questions regarding
how caregivers would handle certain scenarios in which problem behavior is involved, insight
into their experiences in the community and any barriers surrounding those due to problem
behavior, and finally caregivers were asked to report their perception of the study in open-ended
form, particularly about what was effective or ineffective about the process, and whether or not
they found it helpful to better identify and be more in tune with their child’s functions of
behavior.
The goal of this mixed methods study was to address the lack of parent trainings
occurring and the extensive caseloads of Board Certified Behavior Analysts due to the growing
prevalence of autism in a way that empowers families to successfully implement function-based
interventions in spite of aforementioned barriers. Research has demonstrated that self-instruction
manuals and function-based interventions can be used effectively by caregivers who collect and

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analyze their own data (Graff & Karsten, 2012; Heitzman-Powell et al., 2014). By the conclusion
of this study, caregivers were better be able to identify the functions of behavior, safely manage
their own child’s behavior with the use of function-based strategies, and more safely access their
community.
The following chapter will include a summary of each participant. It will outline the
maladaptive behaviors that families wanted to decrease, as well as function-based interventions
used to address those behaviors, and the results of caregiver-implementation of those
interventions. Data will be visually displayed and analyzed.

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CHAPTER 4
Results
Introduction
This chapter aims to outline the results of the six-week study that took place with parents
in an effort to improve their knowledge, understanding, and independence with application of
function-based interventions. The information in this chapter will start with a recruitment
summary regarding how participants were recruited to participate in the study. Next the chapter
will include tables and coding summaries regarding responses to the open-ended questions found
in Appendix A, in the same order as the Participant Summary. Then will be a summary of the
demographic and background information of each participant regarding their current ABA
services. Information regarding why each participant agreed to participate in the study will be
included, as well as a summary of the behavior data collected over the six weeks, which was
used on the forms located in Appendix C. Participants will be referred to by number throughout
the chapter to maintain anonymity of each participant, and the order by which they were
numbered was randomized to further maintain anonymity. At the conclusion of the chapter a
summary will provide an overview of the experiences and perceptions extrapolated from each
participants’ behavior data and responses.
Research participants were recruited to participate in the study to answer three
researching questions:
1. How familiar are caregivers with the functions of behavior and how accurately do they
identify them?
2. How can nontraditional families, specifically single-parent families, build the inner
capacity in order to safely address their child’s behavior by function?

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3. What strategies can be safely and effectively implemented in the home and community
settings by just one to two people?
This was a mixed methods study using the framework of a sequential exploratory strategy
(Creswell, 2003). This method was chosen as it allows for parents to provide qualitative
feedback regarding their knowledge of the functions of behavior, allow them opportunities to
reflect on what went well or identify areas of further support when problem behavior does occur,
and to provide feedback on the study itself. By allowing parents the opportunity to provide such
feedback, it fosters collaborative and empathic relationships between the clinician and families
(Heitzman-Powell et al., 2014; Taylor et al., 2018). Participants answered open-ended questions
that were shared through Microsoft Word, a HIPAA compliant platform, in order to ensure
responses remained confidential. Responses were coded via content analysis to identify
reoccurring words and phrases. The codes used are explained as they pertain to each research
question and how caregiver responses answer those questions in the chapter. Participants were
also asked to collect behavior data, which was also collected through Microsoft Word. All
coding and graphing were manual and no software beyond Microsoft Word and Excel was used.
Participants participated in brief weekly coaching meetings, no longer than 15 minutes,
that were conducted over Microsoft Teams, a HIPAA compliant platform to ensure all
information shared remained confidential. These were recorded and the researcher would take
notes as well as read the transcription from each meeting. The transcripts were also reviewed
using content analysis to identify reoccurring words and phrases as caregivers described their
experiences throughout the study and their perceptions of their effectiveness of using functionbased interventions, as well as their perception of the study itself. These questions and the
behavior data collection form can be found in Appendix A-C. These appendices can be found

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after the References at the end of this paper. Appendix A includes the open-ended questions
where the researcher obtained background information regarding ABA services and where they
were asked to list and identify functions of behavior and respond to hypothetical scenarios.
Appendix B is an example of a preference used to help caregivers identify minimally ten
reinforcers for their child. Appendix C is an example of the data sheet used to collect three term
contingency data throughout the six week study.
Recruitment Summary
Participants were recruited through a Lancaster-based Facebook group of parents of
children with autism in Lancaster County, Pennsylvania using simple random sampling. A
review of the group shows that the group is primarily used as a parent support group. In this
group, parents ask questions about supports other parents are receiving or how they can receive
additional support. Parents also ask questions or provide input on their experiences with IEP
processes, community outings involving other children with autism, as well as their frustrations
or things that went well. Parents respond to posts in the comments with sympathy, praise,
validation, or suggestions of interventions they found helpful. Thirteen parents out of 899 total
members in the group responded to the recruitment flyer, Appendix D, by emailing the
researcher. One parent was excluded due to not being a single caregiver and one other did not
complete the study due to being overwhelmed by the data collection process. After providing
informed consent via Appendix E, six caregivers participated in the study to completion and
information is included about them below.
Open-Ended Questions

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The first part of the open-ended interview questions involved demographic information
and background information regarding current ABA services, as outlined above in the participant
summary and summarized in Table 2.
Table 2
Summary of Demographic and Background Information for Participants
Participants

Relation to Child

Setting of Current Parent
ABA Services
Training
home/school
yes

Type of Services

Mother

Demographic
Setting
Urban

One

Two

Father

Rural

school

no

School: consultative with
BCBA

Three

Mother

Rural

home/school

yes

Home: BHT-ABA
10hours/week, BC 1
hour/week; School: BHTABA 12 hours/week, BC
3 hours/week

Four

Mother

Urban

school

no

School: consultative with
BCBA minimally 30
minutes/month

Five

Grandmother

Suburban

school

no

School: consultative with
BCBA minimally 60
hours/month

Six

Mother

Rural

home/school

yes

Home: BHT-ABA 12
hours/week, BC 3
hours/week; School: BHTABA 30 hours/week, BC
hours 4 hours/week,
consultative with BCBA
minimally 30
minutes/month

Home: BHT-ABA 12
hours/week, BC 3
hours/week; School:
BCBA consultative with
teachers

Note: The table provides a summary of how each participant is related to the child, where
they lived, the setting where the family is currently receiving services, and whether their services
include parent training.

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Four mothers, one father, and one grandmother participated in the study. Three
participants lived in what they considered rural settings (Participant Two, Participant Three, and
Participant Six), two in urban settings (Participant One and Participant Four), and one in a
suburban setting (Participant Five). Three participants stated that their child was receiving ABA
services just in the school setting (Participant One, Participant Three, and Participant Six), and
three participants stated their child was receiving ABA services in both the school and home
settings (Participant Two, Participant Four, and Participant Five). For the three receiving services
in the home, all reported they also received formal parent training as part of their in-home
programming. These topics covered establishing routines, various antecedent strategies, reducing
vocalizations during periods of maladaptive behaviors, differential reinforcement, and
responding to intensive maladaptive behaviors or crisis situations. This information was provided
via open-ended questions in Appendix A.
Next caregivers were asked to identify the function of behaviors in videos from the
Parent Training for Disruptive Behavior: The RUBI Autism Network supplemental materials
(Bearss et al., 2018). Caregivers were then given hypothetical scenarios and asked how they
would respond. Themes for those responses were developed through content analysis based on
how frequently the caregivers used the strategies that were explicitly taught to them throughout
the course of the program, such as “differential reinforcement”, “high-p”, “token economy”,
“time out”, “planned ignoring”, etc. These questions were also part of the questions provided in
Appendix A. Information regarding participant responses is included below, as well as specific
coding information that was conducted via content analysis to analyze for reoccurring words
identified as categories and themes.

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Participant One. The first participant was able to name two functions of behavior when
asked to list them during baseline data collection and was able to list all four at the conclusion of
the six weeks (Figure 1). She correctly identified the function in one of the four videos in
baseline data collection. At the end of the six weeks, she was able to identify the function in all
four videos (Figure 2). When asked how she would respond to the four scenarios, she mentioned
function-based interventions zero times. When the scenarios were presented again at the end of
the six weeks, she mentioned three function-based interventions: functional communication
training, planned ignoring, and time out (Figure 3).
Participant Two. When asked to list the functions of behavior, this participant was able
to list zero functions at the start of the study. At the conclusion of the six weeks, he was able to
list all four functions (Figure 1). Upon watching the videos provided through the Parent Training
for Disruptive Behavior: The RUBI Autism Network supplemental materials (Bearss et al., 2018),
he correctly named zero functions of behavior during baseline data collection. At the conclusion
of the study, he was able to correctly identify three out of four functions in the videos (Figure 2).
The father was then given hypothetical scenarios and asked how he would respond to those. He
mentioned function-based interventions zero times during baseline data collection, and
mentioned three interventions at the conclusion of the study: functional communication training,
planned ignoring, and time out (Figure 3).
Participant Three. During baseline data collection, this participant was able to name two
functions of behavior when asked to list them, which increased to being able to list all four at the
conclusion of the six weeks (Figure 1). The mother was able to correctly identify one function of
behavior when watching the videos during baseline data collection. She was able to accurately
identify all four functions correctly (Figure 2). She mentioned one function-based intervention

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during baseline collection, which was time out. At the conclusion of the study, she mentioned
time-out, high-p, differential reinforcement, functional communication training, and planned
ignoring (Figure 3).
Participant Four. This participant was able to list one function. At the end of the study,
the participant was able to list all four (Figure 1). When asked to identify the functions of the
videos provided, she was able to accurately identify one function. After six weeks of coaching,
she could correctly identify the function in all four videos (Figure 2). When responding to the
scenarios, she mentioned one function-based intervention, time out. At the end of six weeks, she
mentioned four interventions: time-out, noncontingent reinforcement, functional communication
training, and time out (Figure 3).
Participant Five. This participant was unable to list any functions of behavior during
baseline data collection, however was able to list three of the four by the conclusion of the six
weeks of coaching (Figure 1). When watching the videos from the supplemental materials, she
was initially unable to identify any functions of behavior. At the end of the six weeks, she was
able to correctly identify two functions of the four videos provided (Figure 2). When asked to
respond to how she would respond to hypothetical situations, she named zero function-based
interventions at the start of the study. At the conclusion of the study she was able to state two
function-based interventions that she would use which were time-out and planned ignoring
(Figure 3).
Participant Six. This participant was able to list the four functions of behavior and
correctly identify the functions in all four videos during baseline data collection, and did so again
at the completion of the six weeks (Figure 1, Figure 2). Regarding the scenarios, she mentioned
functional communication training and time out during baseline data collection. At the end of the

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program, she mentioned those two plus differential reinforcement and planned ignoring (Figure
3).
Figure 1
Number of Functions Named Per Participant

Note: This figure reflects the number of functions out of four that participants were able
to list when they were asked to name the four functions of behavior. “Week 1” shows the number
of functions listed during baseline data collection; “Week 6” reflects the number of functions
listed at the conclusion of the six weeks of coaching with the researcher.
Figure 2
Number of Functions Labeled Accurately

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Note: This figure shows the number of functions that participants were able to accurately label
upon watching the four videos. “Week 1” reflects the number of functions that participants were
able to accurately identify during baseline data collection for each participant, compared to the
number of functions correctly identified at the conclusion of the study, labeled “Week 6”.
Figure 3
Number of Function-Based Interventions Mentioned

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Note: This figure shows the number of function-based interventions mentioned when participants
were asked to respond to open-ended scenarios, comparing baseline data collection labeled
“Week 1” to the conclusion of the study labeled “Week 6”.
The next section will provide greater detail regarding the participant backgrounds and
behavior data collected. Next will be information regarding the needs of the participant and why
they agreed to participate in the study. This will be followed by the interventions prescribed, a
visual representation of the results for each participant, and a narrative describing the results.
Participant Summary
Participant One
Background. The first participant was the mother of a seven-year-old female diagnosed
with Autism Spectrum Disorder living in an urban setting. The family is receiving Applied
Behavior Analysis therapy services in the home setting with a Behavior Health Technician in the
home four days a week for three hours per session and three hours with a Behavior Consultant
for minimally three hours a week. When asked if parent training occurred, the mother reported
that she had frequent conversations with the clinician about progress in other settings and
suggestions were shared during this time. The child is also receiving consultation from a Board
Certified Behavior Analysis in the school setting through her Individualized Education Plan.
Needs. When asked about community outings, the first participant reported that they did
not frequently access the community. The mother reported through responses to the open-ended
questions that she had concerns related to the child wandering away and a lack of “stranger
danger”. The child would often approach adults and not respond to the mother’s directives to
stop or return to the mother. The mother reported that the child would stay with the mother for
longer durations when asked to help push the cart, but this was not always effective.

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Through weekly coaching and behavior data collection, parent also reported that their
child engaged in the most intense maladaptive behaviors, rated a weekly average of 4.6 on the
intensity scale, for the first two weeks of the study as the demand to start the bedtime routine led
to frequent aggression and property destruction with tantruming behavior. Review of the
qualitative open-ended interview questions stated that this was what the caregiver required the
most support with and the caregiver reported they felt “helpless”.
Interventions Used. Through weekly coaching with the clinician and information
provided from the Parent Training for Disruptive Behavior: The RUBI Autism Network (Bearss
et al., 2018), the most effective antecedent strategies in the home setting for this participant were
determined to be the use of timers, consistent routines, and break down the demand of “time to
go to bed” into more manageable steps. For example, the caregiver would say “it’s time to brush
your teeth”, “it’s time to brush your hair”, etc. rather than simply stating “it’s time for bed”.
Through this task analysis, it was discovered that the child being left alone in her bedroom was
the specific step that elicited the most intensive maladaptive behaviors. Due to this, compliance
with each of the steps contacted reinforcement in the form of a token economy which correlated
to the number of minutes the caregiver would lie with the child in bed. The caregiver also
utilized non-contingent reinforcement in the form of attention for an hour before bedtime to work
to satiate the child with caregiver attention. Initially when the child would go to bed, vocal
disruptions would occur and planned ignoring was utilized until the child fell asleep. By the end
of the six weeks, the intensity of maladaptive behaviors decreased to a weekly average of 1.8,
per caregiver report, see Figure 4.
Figure 4
Average Intensity Per Week for Participant One

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Note. This figure shows the average perceived intensity of behavior data collected five times a
week over six weeks.
Results. As shown in Figure 1, the intensity over the first three weeks remained stable,
with an average of 4.6, 4.4, and 4.4 respectively. The fourth week started to see a more
significant decrease in intensity, decreasing to an average of 3, then the decreases continued to
average intensities of 2.4 and 1.8 through weeks five and six. During the coaching session during
week three when asked what was going well, the participant said she felt like her daughter
understood that the tokens equated to earning time with her mother. The visual analysis of the
data seems to reflect that maladaptive behaviors decreased as routines remained consistent and
the value of the token was conditioned.
The same antecedent strategies were generalized to the community setting as well. The
caregiver implemented consistent routines in the grocery store, primarily going into the same
aisles in the same order for each trip. The caregiver also utilized a promise reinforcer in the
grocery store and delivered frequent noncontingent attention to the child, which decreased her
motivation to elope from her caregiver. The intensity of maladaptive behaviors recorded in the

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community was similar to the intensity in the home setting. During the first week of data
collection, the behaviors in the home setting were rated a 5, a 4, and a 5. In the community
setting, the two data points were a 4 and a 5. The data in the community setting followed the
same downward trend as the data in the home setting. During the final week of data collection,
the behaviors in the home setting were rated a 2, a 2, and a 1, and in the community setting the
intensity was also rated a 2 and a 1.
Participant Two
Background. This participant was a father residing in a rural setting who has custody of
his 9-year-old autistic child 50% of the time. He is not currently receiving any Applied Behavior
Analysis services in his home setting, but the child does receive services at school. Due to this,
the father has not received any formal training in Applied Behavior Analysis. He did not report
any concerns or barriers in the community setting, and noted that his child is in fact quite active
in the community. The child plays baseball and participates in practices, camps, and clinics
associated with that, and displays good sportsmanship with other teammates and teams. He will
sometimes become agitated if he does not perceive he played well, but does not become more
observably agitated than his neurotypical peers on the team and will typically remain quiet in the
car rides home with a brief vocal outburst at home. The family frequently accesses the grocery
store, movies, and goes clothes shopping when father has custody. Due to his child’s success in
the community setting, no maladaptive behaviors were observed in those settings over the six
weeks.
Needs. The father requested to participate in the study due to reported issues of sharing
with his sister and was seeking support with that. The child will often grab toys from his sister,
then engage in tantrums defined as yelling above conversation volume and/or crying lasting

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longer than ten seconds and property defined as throwing the toys destruction when instructed to
return them.
Interventions Used. Functional communication training paired with differential
reinforcement were found to be effective strategies to manage these maladaptive behaviors,
paired with time-out. The father prompted the child to mand for toys instead, then provided
differential reinforcement of access to the toys based on the independence and appropriateness of
the tone of voice when the child manded for the object. If the child engaged in behaviors targeted
for reduction, he was given one concise warning of “you need to ask your sister to use that or
else you are going to time-out". If he continued to engage in maladaptive behaviors, he was told
to go to time-out. The father designated a chair in the living room as the space he would go, and
the child was directed to stay there for two minutes with the absence of maladaptive behaviors. If
the child did engage in any behaviors, the timer would reset. Parent reported an average intensity
of 3.6 at the start of collecting behavior data, and this decreased to a 1.4 through the
implementation of these antecedent and consequent strategies over six weeks, as shown in Figure
5.
Figure 5
Average Intensity Per Week for Participant Two

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Note: This figure demonstrates the average perceived intensity of behavior data collected five
times a week over six weeks.
Results. Similarly to the data for Participant 1, data remained stable throughout the first
three weeks of data collection, with a weekly average of 3.6, 3.8, and 3.6, all recorded in the
home setting. The father reported that the child was initially resistant to time-out, which led to a
slight increase in intensity during the second week of data collection. The father reported that
after the first three weeks, he felt as though he was more consistent with reducing vocalizations
and not engaging in negotiating with his son leading up to time-out. The intensity did decrease
upon that report to an average of 2.6 in the fourth week, and 2.4 in the fifth week, and a 1.8 in
the sixth week.
Participant Three
Background. The third participant was a mother of a five-year-old child diagnosed with
autism who reside in a rural setting. The mother has a roommate who occasionally assists with
childcare when her schedule allows. The family receives ABA therapy services in the home and
school settings through agency support, with a BHT-ABA reporting four hours per day in the

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school setting and two hours per day in the home setting. The mother reports she receives formal
parent training one time a month from her child’s clinician, and the content covered in these
trainings is focused on establishing routines, various antecedent strategies, and reducing
vocalizations during periods of maladaptive behaviors.
Needs. The mother agreed to participate to learn about additional strategies not covered
in parent training sessions with her current level of support. The mother also reported that the
antecedent to maladaptive behavior in the community setting is waiting for food, and he will
sometimes try to take food from other people, so they typically choose fast food options and rely
on an iPad. She would like to expand their options and opportunities, and give her child
additional strategies to sit and wait rather than solely rely on his iPad.
Interventions Used. During data collection and weekly coaching sessions, the demand to
“wait” was the antecedent to most frequent episodes problem behavior in the home setting as
well. The intensity of maladaptive behavior in this setting was a weekly average of 4.6. The
mother implemented a wait protocol where the child was first told to wait for brief periods of
time, then the duration of wait increased as the child showed he could wait without exhibiting
any maladaptive behaviors. The first step was for the child to be told to “wait”, then the
reinforcer that was requested was immediately delivered before maladaptive behaviors could
occur. This paired the word “wait” with valuable reinforcers. Differential reinforcement was
utilized based on the duration the child waited. The child was also taught to respond to different
discriminative stimuli that all meant “wait”, such as “not right now”, “in a bit”, “soon”, et. cetera
to promote generalization of this skill. When this was mastered up to three minutes in the home
setting, the mother used this same language in restaurants and the child demonstrated that he was
able to wait for longer periods of time before requesting his iPad. The iPad was still utilized

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when appropriately requested via functional communication training in order to help the child
remain deescalated in public settings. These strategies decreased the intensity to a weekly
average of 2.6, shown in Figure 6.
Figure 6
Average Intensity Per Week for Participant Three

Note: This figure demonstrates the average perceived intensity of behavior data collected five
times a week over the course of six weeks.
Results. The intensity of behaviors when told to “wait” were slightly elevated during the
second week, with an average intensity of five. This could be due to an extinction burst, in which
behaviors that were previously reinforced stop contacting reinforcement, leading to an increase
in intensity of maladaptive behaviors. After an extinction burst, there is often a quick decrease in
the intensity of maladaptive behaviors as a client realizes those behaviors will no longer contact
reinforcement (Lerman & Iwata, 1995). The average intensity of maladaptive behaviors did
decrease and remain stable during weeks three through five at 3.6, 3.4, and 3.6, then decrease
further in week six to an average of 2.6.

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Similarly to Participant 1, the intensity of behavior between the home and community
settings remained stable across data points. During the first week of data collection was rated a 4,
a 5, and a 5 in the home setting, and a 4 and a 5 for the two data points in the community setting.
In the second week, all recorded instances of maladaptive behavior were rated a 5. At the
conclusion of the six weeks of data collection, the behaviors in the home setting were rated an
intensity of 3, 3, and 2 while in the community setting they were rated a 2 and a 3. Both settings
saw a similar downward trend in the intensity of maladaptive behaviors.
Teaching the replacement behavior of waiting was used in conjunction with
noncontingent reinforcement in order to increase the value of the mother’s attention during times
when an iPad was not available. For a half hour each day, the mother would spend time with the
child without the iPad present. During this time they would watch TV, play with toys, and paint
or do other arts and crafts. The mother would bring a coloring book or small figurine toys to
restaurants and would engage in those activities with her son which did delay the time before the
child out ask for the iPad.
Participant Four
Background. The next participant was a single mother of a 10-year-old boy diagnosed
with autism residing in an urban setting. This child was only receiving ABA services in his
school setting through his IEP with a BCBA consulting with teachers minimally 30 minutes a
month per his IEP and PBSP.
Needs. The mother reported that the child’s biggest barrier in both the school and
community settings was that he frequently aggressed towards others, both peers and adults.
Through a Functional Behavior Assessment, the school team had determined the function of his
behavior was to gain access to attention, typically of familiar peers and adults, and the behavior

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collected weekly by the parent reflected the same as the child was typically left alone when this
occurred.
Interventions Used. The researcher worked with the mother to implement both
noncontingent reinforcement in the form of attention and focus on functional communication
training to appropriately mand for attention by modeling socially valid replacement behaviors.
Previously the child’s behavior of aggression, typically pushing another person or pulling their
hair, received a consequence of time-out with no other explicit teaching of replacement
behaviors occurring. The researcher worked with the mother to maintain proximity to the child
when he was engaging with others so she could quickly respond, use planned ignoring of the
aggression, and redirect the child to either tap a peer on the shoulder and wave or say “hi”.
Planned ignoring of the maladaptive behavior paired with these antecedent strategies was
effective. This was achieved by not directly vocally addressing the behavior and instead the
mother would prompt “excuse me, mom” or tap herself on the shoulder, then would immediately
deliver attention upon the child engaging in these replacement behaviors. The intensity of
aggression rated by the parent decreased from a weekly average of 3.2 to a 1.8, as shown in
Figure 7.
Figure 7
Average Intensity Per Week for Participant Four

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Note: This figure demonstrates the average perceived intensity of behavior data collected five
times a week over the course of six weeks.
Results. The intensity of the maladaptive behaviors started with a 3.2, which allowed the
team to utilize planned ignoring of the aggression as the behavior was not causing harm to self or
others. Weeks two and three slightly reduced to a 3 and 2.6, respectively. The clinician worked
with the mother to ensure that the child was immediately receiving attention when the socially
valid replacement behavior of either tapping on the shoulder or using functional communication
to mand for attention. When asked what was going well, the mother reported she felt as though
she was becoming increasingly consistent with the immediate delivery of attention for her child
engaging in taught replacement behaviors. The average intensity did reduce to a 2 in week 3,
with a slight resurgence to a 2.6 in week 4, and decreased to a 1.8 in week 6. A resurgence
occurs when a previously extinguished behavior recovers, or is observed again (Doughty &
Oken, 2008). In this instance, the aggression was no longer contacting reinforcement and only
the replacement behaviors were. Through visually analyzing the data in the fifth week, one could
infer that there was a recovery in aggression during this time.

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Intensity of maladaptive behavior was rated similarly between both the home and
community settings. During the first week of data collection, the intensity of behavior was rated
a 3, a 3, and a 4. In the community settings, the two data points were a 3 and a 4. In the sixth
week, the intensity in the home setting was rated a 2, a 2, and a 1, while in the community setting
it was also rated a 2 and 1. Both settings saw a similar downward trend in intensity of
maladaptive behaviors.
Participant Five
Background. The fifth participant was a grandmother caring for her 10-year-old
grandson diagnosed as having autism and Down’s syndrome residing in a suburban setting. This
participant was not receiving any ABA services in the home setting, but her grandson did have a
Positive Behavior Support Plan as part of his Individualized Education Plan that included schoolbased consultation with a Board Certified Behavior Analyst minimally 60 minutes a month.
Needs. The grandmother reports that there are neighborhood peers who invite her
grandson to play with them, but he will typically play by himself instead of engaging with his
peers. Though intensity of maladaptive behavior with his peers remains low, the grandmother
would like to see him engage more with these peers. The behavior targeted for reduction in this
case was elopement from his peers.
Interventions Used. Behavioral momentum and functional communication training were
used as antecedent strategies to this. First the clinician worked with the grandmother to establish
preferred activities through a preference assessment that could be done with one or two peers,
then model easier, prerequisite social skills such as manding for preferred items or tacting parts
or actions in a game. These skills were then used as behavior momentum to have the child label
parts of the game he was playing so a peer could comment on what was said. By targeting easier,

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high-p skills and having the peers initiate the low-p skill of interacting with peers, the child
became more comfortable in increasing proximity to peers. He did not yet initiate interacting
with them but would respond to mands when the peers came over and asked him to play. He
would use the playground equipment alongside the peers but did not independently initiate with
peers before the end of the six weeks. The intensity of elopement, however, did decrease from a
weekly intensity of 2.2 to 1.4 at the end of the six weeks, as shown in Figure 8.
Figure 8
Average Intensity Per Week for Participant Five

Note: This figure demonstrates the average perceived intensity of behavior data collected five
times a week over the course of six weeks.
Results. Intensity of elopement was low at the start of the study, with a weekly average
of 2.2. Throughout the study, the intensity remained relatively stable in both the home and
community settings with a slight decrease from a 2 in weeks two and three, to 1.8 in weeks four
and five, finally to 1.4 in the sixth week. Despite using preferred activities and decreasing the
number of peers engaging with her grandson, the grandmother reported that he still did not seem

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motivated to engage with his peers. Elopement from his peers did decrease, but he did typically
prefer to play alone. His grandmother reported he would respond to peers but not independently
initiate to them. A consideration for this participant would be to work with the family for longer
than six weeks to utilize additional strategies to increase motivation to engage with peers.
Participant Six
Background. The sixth participant was a mother of a 9-year-old girl diagnosed with
autism residing in a rural setting. The family receives ABA services in the home setting through
agency support in conjunction with weekly parent training, and in the school setting through a
school-based BCBA minimally 30 minutes a month as outlined in her IEP. The family receives
12 hours a week of BHT-ABA support in the home per week and 30 hours per week in the
school setting.
Needs. The mother reported she is overall pleased with the services she receives and feels
as though she has a strong understanding of functions of behavior due to the support she receives
in the home and school settings. The mother agreed to participate as a way to possibly learn
about additional strategies that had not been covered in parent training sessions with her current
level of support. The mother also stated she wanted to learn more about data collection as that
had not been previously covered in her caregiver training sessions.
The mother stated she has been working with her current clinician to increase
independence with skills of daily living, such as preparing simple snacks, being able to recognize
when a vessel for food or a drink is full and she needs to stop filling it, and cleaning up after
herself, the latter being what elicits the most frequent and intense problem behavior. The child
will engage in self-injury of hitting her head against the floor or another close object (kitchen
counter, pantry door, etc.) paired with verbal aggression when directed to clean up. In the

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community setting, this same behavior was observed with the antecedent of being told to return
something she would take before manding for it, such as a preferred item in the grocery store.
Interventions Used. The mother stated planned ignoring was used when the demand to
clean up the materials was placed because the self-injury behavior was not hard enough to cause
harm, however this still raised ethical concerns. The researcher worked with the parent to modify
the use of planned ignoring and clarify the purpose of using this consequent strategy, which
included response blocking but not directly addressing the behavior or using phrases such as
“stop hitting your head”, “don’t do that”, etc. Instead vocalizations were completely removed
from the intervention in order to help the client more quickly deescalate as repeating the demand
was shown to prolong maladaptive behaviors. This consequence was paired with antecedent
strategies of frequent practice of cleaning up, the use of high-p, functional communication
training of appropriately asking for help to clean up or to mand for an object, and differential
reinforcement for utilizing functional communication or compliance with cleaning up or
returning items where they belonged.
With high-p, the parent worked to use skills that the child perceived as “easy” to gain
behavior momentum. Examples of these were “open the cabinet”, “grab the bowl”, “put that on
the counter”, “throw this away please”. This was paired with differential reinforcement, for
example if the child immediately complied with throwing something away they were given a
greater amount of the snack they had requested paired with behavior-specific praise. Another
example was if the child accidentally spilled something, the mother would help clean up more of
the mess as a form of negative reinforcement if the child immediately complied with the
directive to clean up. These strategies reduced the intensity of self-injury from a perceived
weekly intensity of a four to a 2.8 as shown in Figure 9.

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In the community setting, primarily the grocery store as the mother reported that is where
she observed the most frequent maladaptive behaviors, the parent also implemented high-p of
gaining momentum to have her child pick specific items off the shelf, push the cart, then hand
the item to her mother that the child had taken off the shelf. This was paired with teaching
functional communication of prompting the child to mand for the item. If she manded for the
item, the mother allowed her to keep the item. In the second week where the mother rated the
intensity of 5, it was because the item was put back on the shelf because the child would not
mand for it. With consistency of implementation of interventions, the child demonstrated the
ability to mand for preferred items and used functional communication to do so for the remainder
of the six weeks.
Figure 9
Average Intensity Per Week for Participant Six

Note: This figure demonstrates the average perceived intensity of behavior data collected five
times a week over the course of six weeks.

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Results. The average intensity of this behavior was rated a 4 per caregiver data
collection, with a slight increase to 4.6 in week two. Because the parent had received
comprehensive parent training before the start of this study, she learned and applied concepts
quickly and with fidelity. She demonstrated she was able to immediately modify her planned
ignoring strategies, which could have attributed to an extinction burst as the child was previously
receiving attention during her maladaptive behaviors and this was quickly removed during
intervention. The mother reported that one of her strengths was that she felt as though she could
implement strategies with fidelity, and visual analysis of the data shows that the behavior may
have gone through an extinction burst during the second week, with a decrease in intensity in
each week following that. Week three was a reported intensity of 4, week four was an average of
3.6, week five was an average of 3, and week six was an average of 2.8.
During the first week of data collection, the intensity of maladaptive behaviors was rated
a 4, a 3, and a 4. The community setting, specifically the grocery store, saw an increased
intensity rated a 5 due to the denied access and needing to return an item, as the mother has
historically allowed her child to have the item. However, with using the strategies outlined above
the behavior in the community setting followed a similar trend to the home setting. Week six the
behaviors in the home setting were rated an intensity of 3, 4, 3, and in the community setting the
two data points were rated a 2 and a 3.
Findings
Research Question 1
This study worked to answer three research questions. The first was: how familiar are
caregivers with the functions of behavior and how accurately do they identify them? Overall,
caregivers who were already receiving parent training and ABA services in the home setting at

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the start of the study were able to more accurately list and identify the functions of behavior
during baseline data collection than participants who were not receiving parent training (Figures
1 and 2). Three of the six participants were receiving ABA services in the home and these three
participants were able to list a mean of 2.7 functions of behavior during baseline data collection
(Participant One, Participant Three, Participant Six). The total each participant was able to name
is reflected in Figure 1. Regarding identifying functions of behavior, these participants accurately
identified a mean of 2 functions in the videos during baseline data collection, which increased to
a mean of 4 functions at the conclusion of the six week study. For the three participants who
were not receiving services in the home setting, they listed a mean of 0.3 functions during
baseline data collection. (Participant Two, Participant Four, Participant Five) At the conclusion
of the six weeks, the three participants who had not originally received services in the home
setting were able to list a mean of 3.7 functions, totals reflected in Figure 2. When watching the
videos, these participants correctly identified a mean of 0.3 functions when collecting baseline
data, which increased to a mean of 3 correct functions in the videos at the completion of the six
weeks. The total each participant was able to identify is reflected in Figure 3.
Participants were also provided hypothetical scenarios and asked via open-ended written
interview how they would respond to those scenarios. This occurred during baseline data
collection and again at the conclusion of the study, and the totals of interventions named is
reflected in Figure 10.
Figure 10
Content Analysis of Open-Ended Questions and Frequency of Function-Based Interventions

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Note: This figure shows a comparison of the frequency with which function-based interventions
were mentioned when participants were given hypothetical scenarios and asked how they would
respond.
Upon completion of the six weeks, coding was conducted on both sets of responses via
content analysis through counting the frequency of the use of function-based interventions in
caregiver responses. This method was chosen as a way to demonstrate that the caregivers
understood how to implement the function-based interventions that were included in this study,
therefore the function-based interventions that were included in this analysis were interventions
that were explicitly taught throughout the six weeks. If another strategy was not mentioned, it
was not included in the coding. During baseline data collection, caregivers named function-based
interventions a total of four times, with a mean of 0.67 per participant. At the conclusion of the
six weeks, caregivers named function-based interventions a total of 19 times with a mean of 3.17
function-based interventions per participant. Of the interventions mentioned, time-out was
mentioned six times, functional communication training was mentioned five times, planned
ignoring was mentioned five times, high-p was mentioned one time, noncontingent

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reinforcement was named one time, and differential reinforcement was named one time. Token
economy was not named at all when asked to respond to the scenarios and time-out was the most
frequently mentioned among the participants. Participants reported that they mentioned time-out
because it was a common practice they were aware of even before their children started receiving
ABA services (Figure 10).
The data shown above in Figure 1 and Figure 2 shows that at the onset of the study, only
one participant was able to accurately list and identify more than two functions of behavior. By
the conclusion of the six weeks, only one participant could not list all four functions of behavior,
Participant Five, with that one participant still being able to list three. Similarly, at the conclusion
of the six weeks, only two participants could not correctly identify all four functions of behavior
in the provided videos (Participant Two and Participant Five). When asked how caregivers
would respond to hypothetical scenarios, all participants were able to identify at least two more
function-based strategies at the conclusion of the study than they could during baseline data
collection. This paired with the data collection outlined in Figures 4 through 9 shows that all
participants demonstrated an improved understanding of the functions of behavior and
implementation of function-based intervention throughout the six weeks of coaching and use of
information from the Parent Training for Disruptive Behavior: The RUBI Autism Network
(Bearss et al., 2018).
Research Question 2
The second research question was: how can nontraditional families, specifically singleparent families, build the inner capacity in order to safely address their child’s behavior by
function? This certain family structure was chosen as these parents often sacrifice their structure
in their homes or their involvement within the community due to problem behavior exhibited by

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their child (Beyers et al. 2003; Lam et al., 2010; Devenish et al., 2020). It is important to focus
on single parent families as single mothers have significantly higher rates of stress than mothers
of neurotypical children, with child-related stress factors falling in the 99th percentile of mothers
of children with autism (Dyches et al., 2015; Bradley et al., 2024).
This research question was answered via open-ended feedback regarding the
participants’, all of whom were single caregivers, background with regarding parent training and
their perceived effectiveness of the study, as well as visual analysis of the data summarized in
Figures 4 through 9. Three participants were receiving parent training as part of ABA services
through agency support in the home setting before they agreed to participate in the study, and
they did report overall lower intensity of maladaptive behaviors upon agreeing to participate in
the study compared to the three participants who were not receiving training. These participants
were asked what content was covered through parent trainings and the responses were coded via
content analysis to determine common themes. Caregivers reported that trainings covered
positive reinforcement across three caregivers, the three-term contingency or “ABC”s
(antecedent-behavior-consequence) across two caregivers, functions of behavior by one
caregiver, manding specifically across three caregivers, increasing more general expressive
language skills across three caregivers, increasing receptive language skills across three
caregivers, and response blocking during maladaptive behaviors or crisis management across two
caregivers. Caregivers and clinicians also discussed general updates such as recent doctor
appointments, reviewing treatment plan graphs, progress in the school setting, and reviewing
paperwork from the school setting such as the Individualized Education Plan or Positive
Behavior Support Plan.

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All caregivers were asked to rate intensity of behavior on a 5-point scale, and the
average was calculated and graphed weekly. This data was visually analyzed each week to assess
the intensity of maladaptive behaviors and reviewed during weekly coaching sessions with
parents (Figures 4 through 9). Participants were also asked to report via interview what went well
that week or in what areas caregivers felt they needed additional support, and covering this
content was a focal point of the weekly coaching sessions. When asked to provide feedback on
use of the interventions during conversation at the conclusion of the study, caregivers responses
regarding efficacy and ease of implementation were coded as “highly effective”, “effective”,
“somewhat effective”, “neutral”, and “not effective”, as well as “easy to implement”, “difficult
to implement”, or “neutral”. Caregivers were given a chance to explain in their own words why
they chose each rating, and coding was done using the themes above. A summary of responses is
shown in Table 3.
Table 3
Function-Based Interventions and Effectiveness and Ease of Implementation
Function-Based Intervention

Effectiveness

Ease of Implementation

Noncontingent Reinforcement

Effective

Easy, Difficult, Neutral

High-p

Somewhat

Easy

Functional Communication Training Effective, Highly Effective

Easy

Differential Reinforcement

Neutral, Effective

Neutral, Difficult

Token Economy

Neutral

Easy

Planned Ignoring

Highly Effective

Difficult

Time-Out

Highly

Easy

Note: This table outlines the function-based interventions prescribed to participants as
well as each participants’ rating of their effectiveness and ease of implementation. They are

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listed in order of how they were introduced in the literature in Chapter 2, with antecedent
strategies listed first of noncontingent reinforcement, high-p, functional communication training,
followed by consequent strategies of differential reinforcement, token economy, planned
ignoring, and time-out.
Of the three caregivers who were prescribed the treatment of planned ignoring,
Participant 1 and Participant 4 reported that was the most difficult to consistently utilize
specifically due to child effects, or the influence of child behavior on parent behavior (Stocco &
Thompson, 2015; Landsford et al., 2018). Participant 1 stated: “I just wanted to give her what
she wanted so she would stop crying”. All three caregivers (Participant 1, Participant 4, and
Participant 6) reported that it was difficult to not address the behavior such as staying “no”,
“stop”, etc. and struggled with “waiting out” the maladaptive behaviors.
Only Participant 2 was prescribed time-out as a consequent strategy reported it was easy
to implement, stating it is a widely-known parenting strategy. This participant did report that
they believed they were engaging in too much conversation regarding time-out, and found it to
be more effective when vocalizations were reduced and expectations made clear and consistent.
This participant reported: “I felt like I was negotiating too much before and that was just making
both of us mad.”
Noncontingent reinforcement was reported by Participant 1, Participant 3, and Participant
4 to be perceived as effective, however with mixed perceptions on ease of implementation.
Participant 3 stated it was difficult to implement and said “I had a hard time finding
uninterrupted time to dedicate to this. There is always something around the house that needs to
be done. But I tried to prioritize other chores to make sure I had time for this because I saw it

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worked”. Participant 1 said it was easy to implement by stating “It was a fun way for both of us
to unwind at the end of the day before bed. We really loved the time we spent together”.
High-p was prescribed to Participant 5, who stated they felt it was somewhat effective
and easy to implement. When asked to elaborate, they said “I tried to make it fun into a game
and had him do fun things, like Simon Says, and his friends liked that too”.
Functional communication training was used by Participant 2, Participant 3, and
Participant 5. Participant 2 stated he found this intervention to be effective easy. He used it to
prompt his son to mand for items from his sister instead of grabbing them. He stated “When I
was paying attention and able to jump on it quickly, it was easy to block him and tell him what to
say or ask for what he wanted. He followed the directions pretty easily”. Participant 3 stated it
was highly effective and easy to implement, as said her child would request the iPad easily as her
child was highly motivated for it. Participant 5 used it to try to increase language used with
peers, and stated that she found it effective but felt neutral about its ease of use, stating “it was
hard to find things to say that he wanted to talk about with his peers, but him hearing me talk to
them a lot seemed to help and make him more comfortable”.
Differential reinforcement was prescribed to Participant 3 and Participant 6, who stated
they felt it was neutral as far as effectiveness and somewhat effective, respectively. Participant 3
used it when working with her child to wait and said she wasn’t always sure how much of a
reinforcer to give to differentiate among the wait time. Participant 6 felt differential was easy to
use. This was prescribed as a form of negative reinforcement for her child in helping her clean
up. She stated “it was easy to jump in and help clean up when she just started it herself. I wanted
to make it easier for her since she started it right away on her own”.

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Token economy was used by Participant 1 in order to earn time spent together before
bedtime. She stated she felt neutral about effectiveness but that it was easy to implement. She
said, “I’m not sure my kid fully understood the point of it, but I used pictures she liked for the
tokens so it was easy to give them to her”.
As previously stated, caregivers who were already receiving parent training as part of
their programming all reported lower intensity of behaviors at the onset of the study than
caregivers who were not receiving any formalized parent training. However, all caregivers did
see a decrease in the intensity of maladaptive behaviors in both the home and community
settings over the course of the study, demonstrating that their effectiveness in implementing
these strategies while in these settings without additional support did improve.
Research Question 3
The third research question was: what strategies can be safely and effectively
implemented in the home and community settings by just one to two people? This research
question was answered via open-ended interviews regarding the participants’ experiences in the
community, specific coaching to address the issues mentioned, a review of the behavior data, and
feedback regarding perceived effectiveness of the study. All caregivers were able to access to the
community at least twice a week throughout the six weeks and record any maladaptive behaviors
on the sheet provided. Through behavior data collection and weekly coaching, all participants
who observed maladaptive behavior in the community setting saw an overall decrease in the
intensity of maladaptive behaviors in the community setting, as described in the Participant
Summary. This information is reflected in Table 4, summarizing the information outlined
previously that is used to support the findings for this research question.
Table 4

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Summary of Individual Results

Participant 1

Background of Services
Primary Area of
Interventions
Received
Need/Interest
Implemented
• Home: BHT-ABA
• frequent elopement
• Noncontingent
12 hours/week, BC
reinforcement
• lack of safety
3 hours/week
awareness skills
• School: BCBA
consultative with
teachers

Participant 2

•

School:
consultative with
BCBA

•

Participant 3

•

Home: BHT-ABA
10hours/week, BC
1 hour/week
School: BHT-ABA
12 hours/week, BC
3 hours/week

•

•

N/A - child did not
exhibit
maladaptive
behaviors in
community
setting
waiting

•

•
•
•

N/A - child did not
exhibit
maladaptive
behaviors in
community
setting
Noncontingent
reinforcement
Differential
reinforcement
Functional
communication
training
Planned ignoring
Functional
communication
training

Participant 4

•

School:
consultative with
BCBA minimally
30 minutes/month

•

Aggression in order
to gain attention

•
•

Participant 5

•

School:
consultative with
BCBA minimally
60 hours/month

•

Increase
opportunities for
socialization

•
•

High-p
Functional
communication
training

Participant 6

•

Home: BHT-ABA
12 hours/week, BC
3 hours/week
School: BHT-ABA
30 hours/week, BC
hours 4 hours/week,
consultative with
BCBA minimally
30 minutes/month

•

Caregiver wanted
to learn more
strategies and about
data collection

•
•

High-p
Functional
communication
training

•

Note: This table summarizes the background of services provided by each caregiver and
their primary area of need or interest, specifically why they agreed to participate in the study.
The last column lists the interventions implemented. Following this will be a brief summary of
the effectiveness of the prescribed interventions.

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For Participant 1, the caregiver initially reported that they did not frequently access the
community due to frequent elopement and lack of safety awareness skills. Through the use of
promise reinforcers and noncontingent attention, this caregiver reported a decrease in intensity of
maladaptive behaviors in the community setting. When asked what she felt went well in the
community setting, she stated that she believed the noncontingent reinforcement delivered in the
home setting and the use of a promise reinforcer in community was highly effective and easy to
implement.
The second participant stated that his child did not engage in any maladaptive behaviors
in the community setting throughout the six weeks, and stated to the researcher that her child
typically did not engage in any behaviors of concern before the start of the study. This
participant collected all data in the home setting.
The third participant stated that her child struggled with extended wait periods. Through
the use of noncontingent reinforcement and differential reinforcement, the caregiver was able to
increase the wait times with the absence of problem behavior in both the home and community
settings with her child. The caregiver also worked on functional communication training with her
child in order to teach them to appropriately mand for objects, such as the iPad while the family
was out to eat. The mother reported a decrease in intensity of maladaptive behaviors in the
community setting due to the antecedent strategies that were utilized in the home setting,
showing generalization of the skills between the two settings. When asked what went well in the
community, the mother reported that she felt as though noncontingent reinforcement was
difficult to implement, as she struggled to provide uninterrupted attention to her child due to
other responsibilities in the home, however she found it effective despite this barrier which
increased her motivation to utilize the strategy. She reported that functional communication

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training to prompt the appropriate mand for the iPad was both highly effective and easy to
implement.
The fourth participant was the mother of a child who engaged in aggression in both the
home and community settings in order to gain access to attention of peers and adults. This parent
was prescribed planned ignoring of the aggression, when safe and appropriate, paired with
functional communication training to prompt the mand for attention while modeling a socially
valid replacement behavior. When asked to report on effectiveness and ease of the interventions,
she stated that she believed both strategies were highly effective. She stated the functional
communication training was easy to implement, and believed the planned ignoring is difficult to
implement as she believed it was counterintuitive upon first implementing the strategy. However,
she stated she did immediately see the effectiveness of the strategy so while she found it difficult
to refrain herself from saying “no” or “stop”, she did work to prevent herself from doing so.
The fifth participant was the grandmother caring for her grandson who wanted to increase
his opportunities for socialization. Peers from the neighborhood would invite him to play and he
would elope from then and prefer to play alone. Behavior momentum and high-p paired with
functional communication training were recommended strategies. The clinician worked with the
grandmother to establish preferred activities that could be done with one or two peers, then
model easier, prerequisite social skills such as manding for preferred items or tacting parts or
actions in a game. These skills were then used as behavior momentum to have the child label
parts of the game he was playing so a peer could comment on what was said. By targeting easier,
high-p skills and having the peers initiate the low-p skill of interacting with peers, the child
became more comfortable in increasing proximity to peers. Per visual analysis of the data in
Figure 5, these strategies were shown to decrease elopement from peers, though the grandmother

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stated he still did not initiative interacting with his peers. When asked to report on the
effectiveness of the strategies used and their ease of implementation, she stated she perceived
high-p to be somewhat effective and easy to implement, and perceived the functional
communication training as effective and felt neutral about ease of implementation.
The sixth participant was the mother of an autistic daughter. She volunteered to
participate in order to possibly learn additional strategies not covered in her current parent
training repertoire, and to learn more about data collection. The mother reported that her child
would take preferred items off the shelf and the denied access and demand of returning the items
would elicit maladaptive behaviors. The mother utilized high-p in order to build behavior
momentum to give the item to her mother, paired with functional communication training to
prompt the child to mand for the item rather than taking it. Visual analysis of the data in Figure 6
shows that these strategies did decrease the intensity of the behavior in the community setting.
When asked to report on the effectiveness of the prescribed interventions and the ease of
implementation, the mother responded that she perceived both high-p and functional
communication training were effective and easy to implement.
In reviewing the participants’ open-ended feedback regarding the effectiveness of
interventions and the ease of implementation of the functions, the responses were coded as
“highly effective”, “effective”, “somewhat effective”, “neutral”, and “not effective”, as well as
“easy to implement”, “difficult to implement”, or “neutral”. Differential reinforcement was
prescribed to one participant in the community setting, and this participant stated that she felt
neutral about its implementation and its effectiveness, which is the lowest rating of the functionbased interventions prescribed. High-p was prescribed to two participants and rated both
effective and somewhat effective, and both participants stated it was easy to implement.

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Noncontingent reinforcement was prescribed to two participants and both perceived the
intervention as being effective, though one stated it was easy to implement and one stated it was
difficult to implement. Planned ignoring was used by one participant, and they perceived the
intervention to be highly effective but difficult to consistently implement. Functional
communication training was utilized by four participants in the community setting, with one
participant rating it was effective and the three others stating it was highly effective. One
participant stated they were neutral about its ease of implementation, with three participants
finding it easy to implement. This is reflected in Table 5.
Table 5
Function-Based Interventions and Effectiveness and Ease of Implementation in the Community
Function-Based Intervention

Effectiveness

Ease of Implementation

Differential Reinforcement

Neutral

Neutral

High-p

Somewhat Effective, Effective

Easy

Noncontingent Reinforcement

Effective

Difficult, Easy

Planned Ignoring

Highly Effective

Difficult

Functional Communication Training Effective, Highly Effective

Neutral, Easy

Note: This table outlines the function-based interventions prescribed to participants in the
community setting, as well as each participants’ rating of their effectiveness and ease of
implementation. They are listed in order from least effective to most effective based on
participant perception and coding of their open-ended responses regarding implementation.
No participants stated any intervention was ineffective. Differential reinforcement
received the most neutral responses, and caregiver report stated that they felt the concept was
abstract and had difficulty deciding what behavior contacted what value of reinforcement. The

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caregiver who described high-p as somewhat effective stated that her child did not consistently
comply with the directives given which led her to rate it as she did, but still found it easy to
implement. The caregiver who described noncontingent reinforcement as difficult to
implemented stated it was difficult to implement as it was done in the home setting in order to
establish better rapport between her and her child, and she found it difficult to find time that
could be interrupted in order to implement it, though she did see the value of doing so as her
child’s maladaptive behaviors did decrease with implementation of this. Planned ignoring was
stated to be highly effective but difficult to use, as the caregiver struggled to not directly vocally
address the behavior and model the replacement behaviors instead. Functional communication
training was found to be the most effective and easiest to implement when open-ended responses
were coded.
Summary
Overall, participants felt the recommended strategies were able to be safely and
effectively used in the community settings by just one caregiver. These open-ended responses
were similar to the responses provided when answering the second research question, also
demonstrating the ability to generalize the interventions to the community setting to obtain
similar results. All caregivers stated that collecting three-term contingency data allowed them to
focus on the function of the behavior and made utilizing function-based interventions less of an
abstract concept, and seeing the effectiveness of the strategies increased their buy-in with the
amount of work required of them. Three caregivers did state they felt as though the data, while
beneficial, was cumbersome to collect and believed the frequency of data collection could be
faded over time as they developed the ability to implement the strategies with increased fidelity.

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The next chapter will work to provide an overall summary of the results and findings of
this study. It will then outline the implications associated with the study, as well as limitations.
Finally the researcher will provide recommendations for additional research, based on the
findings and limitations of this study.

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CHAPTER 5
Discussion
Introduction
This chapter will serve to present the findings of the research study. First, the findings
will be summarized. The implications of the study will be outlined next. Finally,
recommendations for future research will be included.
Summary and Key Findings
The purpose of this study was to address barriers related to a shortage of clinicians and
insufficient parent training related to Applied Behavior Analysis as a result of this shortage. This
was done through answering three questions:
1. How familiar are caregivers with the functions of behavior and how accurately do they
identify them?
2. How can nontraditional families, specifically single-parent families, build the inner
capacity in order to safely address their child’s behavior by function?
3. What strategies can be safely and effectively implemented in the home and community
settings by just one to two people?
These research questions were answered using the framework of a sequential exploratory
strategy. This method was chosen as it allowed for parents to provide qualitative feedback
regarding their knowledge of the functions of behavior, allowed them opportunities to reflect on
what went well or identify areas of further support when problem behavior does occur, and to
provide feedback on the study itself. While the behavior data collected in the study was crucial to
help identify the effectiveness of the interventions used, it is imperative that clinicians consider
caregiver perspectives of interventions to foster therapeutic relationships and increase parent

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buy-in (Taylor et al., 2019). Quantitative behavior data was also tracked and graphed, shown in
Figures 1-6. With this study, caregivers were able to collect and visually analyze data to directly
observe the effectiveness of the interventions used, refer to self-instruction manuals throughout
the week for additional support, which for this study was information from Parent Training for
Disruptive Behavior: The RUBI Autism Network (Bearss et al., 2018) and provide qualitative
feedback to the clinician regarding their perceptions of effectiveness and ease of
implementation.
For the quantitative aspect of the study, caregivers were asked to collect behavior data
five times a week, with minimally two of those times being in the community setting. The
purpose of this was to monitor generalization of interventions among settings and evaluate how
effective parents perceived the interventions to be and how easily they felt as though they could
be implemented in each setting. This data was important to address the fact that parents avoid
placing demands or taking their children into the community due to safety concerns as well as
not wanting to deal with or knowing how to manage their child’s problem behaviors and
therefore tend to participate in more non-inclusive activities (Lam et al., 2010).
The behavior was collected through an individualized five-point Likert scale of perceived
intensity of the maladaptive behavior. Previous research has shown that stressors can affect
parents’ perception of possible problems, so parents may underreport or overreport on intensity
based on their own distress levels. Research does show, however, that the parents under greater
distress actually more accurately reported on problems. (Veldhuizen et al., 2017). The scale for
each participant was individualized regarding parent report regarding concrete measures of
behavior such as frequency or duration. For example, for one participant, a “5” was defined as
10+ aggressions, with a “1” being 1-2 instances of aggression. This worked to better

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operationally define each rating to help guide parents to accurately record data in order to control
for validity with data collection.
Overall, all participants observed a reduction regarding intensity of behavior over the
course of six weeks. Participant 1, Participant 2, and Participant 5 all saw a gradual decrease of
maladaptive behaviors with a steady downward trend, as shown in Figures 1, 2, and 5
respectively. A visual analysis of the data collected by Participant 3 and Participant 6 shows that
there may have been an extinction bursts with both children, followed by a decrease in intensity
directly after these. When an extinction burst occurs, there is an increase in intensity of
maladaptive behaviors. After an extinction burst, there is often a quick decrease in the intensity
of maladaptive behaviors as a client learns those behaviors will no longer contact reinforcement
(Lerman & Iwata, 1995). A visual analysis of this data supports the findings of that research.
Participant 4 did see a resurgence of aggression during the fifth week of data collection as the
aggression was no longer contacting reinforcement and only the replacement behaviors were.
Despite these brief increases in intensity of maladaptive behavior, data collected by Participant 3,
Participant 4, and Participant 6 still reported decreased intensity throughout the duration of the
study.
In summary, though there were variations in data, all participants did observe a decrease
in intensity of maladaptive behaviors over the course of the six weeks. While caregivers who
received parent training before the onset of the study reported lower intensity on average
compared to participants who did not receive training, all six participants stated that they found
collecting the three-term contingency data to be beneficial. All stated that it enabled them to
focus on the functions of behavior and ensure they were utilizing appropriate function-based
strategies that they learned through weekly coaching sessions or from referring to the

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information provided to them from Parent Training for Disruptive Behavior: The RUBI Autism
Network (Bearss et al., 2018). Specifically, Participant 2 said “The behavior data helped me
realize I was giving a lot of attention to behaviors and it would just go on forever. Collecting the
data made me check myself and stop talk to him so much during tantrums, which helped.”
Three caregivers did state they felt as though the data, while beneficial, was cumbersome
to collect and believed the frequency of data collection could be faded over time as they
developed the ability to implement the strategies with increased fidelity. Participant feedback on
this aspect of the study supports previous research that collecting their own data helps caregivers
be mindful of their approaches to their child’s behavior and helps ensure they are not
inadvertently reinforcing behaviors targeted for reduction (Heitzman-Powell et al., 2014; van der
Oord & Tripp, 2020).
The qualitative aspect of the study included open-ended questions for the participants to
respond to (Appendix A). The first part of the open-ended interview questions involved
demographic information and background information regarding current ABA services, as
outlined above in the participant summary and summarized in Table 2. Next caregivers were
asked to list the functions of behavior and identify the function of behaviors in videos from the
Parent Training for Disruptive Behavior: The RUBI Autism Network supplemental materials
(Bearss et al., 2018). Data for these responses is reflected in Table 3 and Table 4. Caregivers
were then given hypothetical scenarios and asked how they would respond. Themes for those
responses were developed through content analysis based on how frequently the caregivers used
the strategies that were explicitly taught to them throughout the course of the study. The data for
responses to these questions and the themes coded from the responses is found in Table 5.
Finally, caregivers were asked to report on their perceived effectiveness of the interventions and

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how easy they found them to implement. This data is reflected in Table 7 and Table 8. Table 7
focuses on all strategies covered and Table 8 summarizes this data specific to the community
setting.
The open-ended responses regarding the ease of implementation and effectiveness as well
as feedback provided during the weekly coaching sessions were reviewed and coded via content
analysis, where reoccurring words and phrases were categorized. In reviewing the participants’
open-ended feedback regarding the effectiveness of interventions and the ease of implementation
of the functions, the responses were coded as “highly effective”, “effective”, “somewhat
effective”, “neutral”, and “not effective”, as well as “easy to implement”, “difficult to
implement”, or “neutral”.
Overall, none of the strategies utilized in this study were perceived as “not effective” by
any participant. Planned ignoring was generally perceived to be the most effective but also the
most difficult to use, as caregivers stated they struggled to not vocally attend to the behavior that
was occurring. Specifically, Participant 1 stated: “I just wanted to give her what she wanted so
she would stop crying”, but did still find it to be a highly effective intervention. Functional
communication training was overall found to be the most effective and the easiest to implement
by caregivers, as they reported it was easy for them to model appropriate forms of
communication. Participant 2 said about Functional Communication Training: “When I was
paying attention and able to jump on it quickly, it was easy to block him and tell him what to say
or ask for what he wanted. He followed the directions pretty easily”. Responses regarding ease
and effectiveness were similar between the home and community settings, further supporting the
ability to generalize implementation of these across multiple settings.

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In summary, participants largely felt as though most of strategies utilized could be
effectively and easily used across multiple settings. They were found to not be intrusive, and
because of this it allowed families more opportunities to access the community when historically
that had been a struggle for them. Participants stated how relieved they were to have a better
understanding of the functions of behavior and function-based interventions as they felt as
though they were largely limiting experiences for both themselves and their children. Participant
1 said: “What a relief it was to just be able to go to the grocery store! These are the things you
take advantage of before having children, and such a simple task became so hard. It feels so good
to have a sense of normalcy in our lives.” Participant 4 said: “I think my kid might finally be able
to make some friends now that we’re getting this under control. It makes me so happy to think
about that opportunity for him.” By reducing maladaptive behaviors, and therefore stress levels,
there was an overall improvement in quality of life, as reported when participants were asked for
feedback regarding the study itself.
Implications
Practical Implications for Children
This study has many practical implications regarding parent training in ABA. One major
implication is the benefits for children. Parent training is an evidence-based practice with many
known benefits for children. Applied Behavior Analysis (ABA) is one of the most effective ways
to support skill acquisition and reduce maladaptive behaviors among children with autism
(National Autism Center, 2009). Due to this, it is one of the most commonly requested
treatments for children with autism. Applied Behavior Analysis involves environmental
manipulation, skill acquisition, and the decrease of problem behavior and can also be used to
improve academic outcomes, motor skills, and daily living skills for children (Baier et al., 1968;

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Cooper et al., 2019). Parent training is an evidence-based practice and the use of evidence-based
practices among those diagnosed as having autism shows improvements in skill acquisition as
described above and decreases in problem behaviors (Beidas & Kendall, 2010). Effective parent
training has been linked to improved communication and social skills in general and compliance
with demands has also been shown to significantly increase when parents are trained in and use
function-based interventions (Fettig & Barton, 2014; Heitzman-Powell et al., 2014). More
specifically, children who participated in Intensive Applied Behavior Analysis groups combined
with their parents receiving training received lower ratings on the Autism Diagnostic
Observation Schedule (ADOS), and also achieved higher scores on the Stanford-Binet
Intelligence Scale, Bayley Scales of Infant Development-Mental Development Index, and the
Merrill-Palmer Scale of Mental Tests, as well as marked behavioral improvements (Smith et al.,
2000; Aldred et al., 2004). These studies show that ABA combined with effective parent training
provide the most comprehensive improvements for children with autism (Adelson et al., 2024).
Despite these many benefits, clinicians have largely reported that they struggle to provide
caregiver trainings. Clinicians cite overwhelming caseloads and their own busy schedules as
reasons to not prioritize these trainings (Ingersoll et al., 2020). Parents also sometimes use the
time with additional support in the home to conduct their own business and address other family
needs, so are not active participants in the sessions, or they decline in-home services altogether
(Ingersoll et al., 2020). By focusing on ways to provide less intensive parent trainings, such as
self-instruction manuals paired with collecting and visually analyze their own data, it works to
empower families to provide more comprehensive care to their children with the shortage of
clinicians or lack of parent training, leading to better outcomes for their children as described
above. This aligns with the findings of the study in that participants reported that they felt better

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equipped to respond to maladaptive behaviors with the use of a self-instruction manual and brief
weekly coaching sessions. In addition to decreased maladaptive behaviors, participants noted
improved communication skills and better relationships with their children as well as decreased
stress levels in the home.
Practical Implications for Caregivers
This study also has practical implications regarding benefits to the family in addition to
just the child. Specifically with single parent families, these family structures have significantly
higher rates of stress than mothers of neurotypical children, with child-related stress factors
falling in the 99th percentile of mothers of children with autism (Dyches et al., 2015; Bradley et
al., 2024). Parents also often sacrifice their structure in their homes or their involvement within
the community due to problem behavior exhibited by their child (Beyers et al. 2003; Lam et al.,
2010; Devenish et al., 2020). This puts the onus on clinicians to find ways to better support
parents with these stressors. Parent training has been shown to increase parental knowledge,
enhanced competence in advocating for the child, decrease parental stress and a reduced sense of
isolation (Bearss et al., 2015). Parents who participated in trainings identified lower stress levels
and that their own behavior changed in that they demonstrated better communication in the form
of giving praise and information, and using more utterances in general therefore enriching their
children’s environment with more vocabulary (Smith et al., 2000). When parents have access to
parent training, they see better outcomes in that families are less stressed and therefore
experience a higher quality of life (Heitzman-Powell et al., 2014).
This existing research aligns with participant feedback provided throughout this study.
Many participants stated that they avoided community outings and felt isolated from being able
to do things their peers were doing with their children, such as sports or other clubs and

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extracurricular activities. Caregivers of children with disabilities spend much of their lives
focusing on their children’s needs, putting their wants and needs secondary to their children’s,
and this was supported by the participants in the study. By learning and implementing functionbased interventions, participants reported that they felt as though this would provide
opportunities for them to reconnect with their peers, allow their children to interact with each
other, and provide similar opportunities for their children that their neurotypical peers are
accessing. Reducing maladaptive behaviors decreases stress in the home setting, and caregivers
having opportunities to connect with their peers and build an external support system also can
lead to reduced stress levels. These findings are supported through direct quotes from
participants.
Practical Implications for Clinicians
In addition to the implications and benefits for parents and children, focusing on ways to
train parents given the shortage of clinicians also has practical implications regarding how
clinicians can improve their collaboration with families. Parents have long felt that clinicians do
not consistently approach them in a collaborative manner due to various perceptions (Taylor et
al., 2019; Straiton et al., 2021). One barrier to this is clinicians are Masters-level clinicians often
required to work with families of low socioeconomic status or from ethnic or minority
backgrounds and clinicians tend to use technical language that is not always easily understood by
those not in the field (Ingersoll et al., 2020; DeCarlo et al., 2011). Clinicians also identify parent
trainings as a difficult aspect of their job due to parents not being actively involved in sessions,
frequent parent cancelations, or families not allowing treatment teams into their homes, the
perception being due to clinicians not being sufficiently trained in conducting these trainings
(Ingersoll et al., 2020). Parents also believe that there is a perception that they are uninterested in

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attending trainings, when in reality some parents are possibly not attending trainings due to
logistical barriers, family stressors or family structures, and financial strains (Straiton et al.,
2021). Clinicians have the knowledgebase to teach children, but have had no training in adult
learning theory and do not know how to effectively teach adults, therefore struggle to engage
parents (Taylor et al. 2018; Ingersoll et al., 2020). However, by identifying ways of
communicating with families that are successful, clinicians can develop stronger, more effective
ways to support these families (Taylor et al., 2019; Roberts et al., 2023).
In discussing this research with other clinicians and Board Certified Behavior Analysts, it
is a noted area of weakness with the same barriers as the research dictates. By teaching parents to
collect and visually analyze their own data, it encourages parent buy-in. Having the data for the
clinician to review also serves as a way to start the conversation about what went well and what
caregivers struggled with between times the clinician is able to service the client. Two
participants reported that they were sometimes embarrassed to have an honest discussion with
clinicians regarding problem behavior, so having the data to serve as an initial talking point
could serve as a means to facilitate that conversation. Participant 3 stated: “It’s hard to admit and
talk about how hard it is sometimes. Sometimes I don’t know how to start the conversation, so
having the data helped.”
By providing caregivers with opportunities to frequently discuss barriers to
implementation of plans, it opens avenues to engage in open and honest conversations about how
clinicians can support remotely and what information can be provided through a self-instruction
manual to empower families to implement function-based strategies without intensive support
from a clinician. By providing self-instruction manuals to families to frequently reference, it also
allows them to quickly access information in a way that is more easily accessible to them. With

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the previously identified barriers to ABA implementation and training, self-instruction manuals
have become more popular in the field as a way to teach skills to parents who have not received
formal training in ABA, and use of these to support implementation of function-based
interventions when parents collect and analyze their own data on maladaptive behaviors has been
shown to be effective (Graff & Karsten, 2012; Heitzman-Powell et al., 2014). Participant 5 said”
It was super helpful to go back and look between meetings.”
Implications Related to Ethics and Safety
One implication that was not a direct purpose of the study but still crucial to note is that
all caregivers were able to see reduction of maladaptive behaviors without the use of aversive
extinction procedures. While effective at reducing problem behavior, a caregiver would often be
unable to use extinction procedures with a large or combative individual or there is the
possibility that a caregiver would not consistently implement extinction procedures, which is
essential in order for extinction to be effective (Athens & Vollmer, 2010). Differential
reinforcement is often used in conjunction with extinction, however extinction is not always
ethical or feasible (MacNaul & Neely, 2018). Therefore it is often to empower families to learn
and use a variety of interventions so harmful extinction procedures do not have to be used. There
is not participant feedback related to extinction as it was not an intervention discussed, but
participants utilized other less intrusive strategies that all led to a decrease in maladaptive
behavior with no injuries reported throughout the six weeks.
Practical Implications Regarding Long-Term Benefits
Finally, the focus on parent training has long-term implications. Parents who utilize these
strategies demonstrate better long-term management of maladaptive behaviors and strong
maintenance of functional communication and adaptive skills (Fisher et al., 2020). Using these

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function-based interventions through early intervention has been shown to lead to better longterm management of maladaptive behaviors and stronger maintenance of functional
communication and adaptive skills (Strauss et al., 2012; Reichow et al., 2018; Fisher et al.,
2020). Early intervention has been shown to reduce problem behavior and increase social and
adaptive behaviors, and the intensity with which these interventions are initially implemented
can be faded out over time if implemented with fidelity (Toth et al., 2006; McConachie &
Diggle, 2007; Barton & Fettig, 2013). Though this was not a longitudinal study to assess the
long-term benefits for these participants specifically, research shows that early intervention and
the use of function-based interventions leads to stronger long-term outcomes for families.
Limitations and Recommendations for Further Research
As stated when discussing long-term implications for this study, this study was done over
the course of six weeks and was not a longitudinal study. Conducting this research as a
longitudinal study would provide more comprehensive information and address many of the
limitations of the study. One limitation is the lack of data and participant feedback to support the
research of the long-term benefits of ABA and parent training.
In addition to not having information that supports the research related to long-term
benefits, the six week study also does not allow the opportunity to assess the long-term benefits
of the interventions prescribed specifically in this study. For example, Participant 3 was
attempting to fade out her child’s reliance on the iPad in community settings. This was not
completely faded out by the end of the study so it would be important to see how effective the
participant was, with the support of a clinician, able to fade out its use and find other strategies to
use in the community setting.

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Some participants reported that the amount of data collection was beneficial but
cumbersome, which is another limitation of the study. Participants reported that they believed the
frequency of data collection could be faded over time as they developed the ability to implement
the strategies with increased fidelity. An additional area of research would be to assess if this
were possible and if caregivers still implemented function-based interventions with fidelity
without collecting the three-term contingency data as quickly, or if the behavior data collected
could be modified in a way that it was easier for caregivers to track.
The sample size was also a limitation of this study. Specifically, Participant 2 did not
report any maladaptive behaviors in the community setting, so was not able to contribute data
related to that which was a key point of this study. An important consideration of the research
would be to include a larger sample size to have more data to better demonstrate generalization
of interventions across multiple settings.
Though intensity of behavior for data collection was defined and quantified to help
caregivers collect data accurately, caregivers all reported varying levels of intensity when
participating in the study. All participants saw a decrease in overall intensity of behavior, but a
further area of research would be to assess the effectiveness of these strategies across similar
levels of maladaptive behaviors. Having additional data related to that would better highlight the
effectiveness of these strategies for similar topographies and intensities of maladaptive
behaviors.
Similarly, even though all participants reported a decrease in intensity of behavior over
the course of the six weeks, it was only asked that it be collected five times throughout the
course of the week, with two of those times being in a community setting. This was chosen to
alleviate the stress of needing to collect the data while also intervening on the maladaptive

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behaviors. However, children may have engaged in maladaptive behaviors more than five times
over a week, with varying intensities, so it is unknown if strategies were used for more or less
intense behaviors that were not recorded and if they were effective. Participants did report via
open-ended feedback that they felt as though having a better understanding of the strategies did
help them throughout the course of the entire week, even when it was not recorded. A further
area of research would be to look deeper into this, as it would also help answer the question
raised by caregivers if the data collection point was completely necessary and could it be faded
out over time.
Conclusion
Despite the limitations noted, this study presented key findings that are crucial for the
field of Applied Behavior Analysis in assessing ways for clinicians to more effectively support
parents and caregivers. Given the growing prevalence of autism and the shortage of clinicians in
addition to their increasing job duties, parent training often gets overlooked and not prioritized as
a part of services provided to families (Ingersoll et al., 2020). This is due to barriers that impede
both the parents’ and clinicians’ ability to conduct these. For parents, the trainings are not always
easily accessible and perceive that clinicians do not approach them in a collaborative manner
(Burke, 2013; Heitzman-Powell et al., 2014; Straiton et al. 2021). For clinicians, they are often
not trained in teaching adults and cite high caseloads as a barrier, and often perceive that parents
are not interested in trainings (Stocco & Thompson, 2015; Ingersoll et al., 2020).
This study worked to answer three research questions as described above as a way to
address these barriers and more effectively equip parents to respond to maladaptive behaviors,
especially when a clinician is not present. As a result, all caregivers were able to reduce intensity
of maladaptive behaviors through the use of function-based interventions as highlighted in

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Figures 1-3. Caregivers were also able to demonstrate independence with implementation of
these function-based interventions, demonstrate an increased understanding in identifying
functions of behavior, and through this, also decrease levels of stress in their homes. By
providing opportunities for parents to collect data and then discuss it and provide feedback on its
effectiveness to clinicians, it also helped enable conversation and therefore foster therapeutic
relationships between the participants and researcher, which provides better outcomes for
children and their families (Taylor et al., 2019).
This study was important and has many practical implications in that caregivers reported
that they often felt isolated from their community and their own peers. Through participation in
this study, it also enabled families to access community settings, an area that was noted as
something they were typically not able to consistently do, therefore increasing quality of life for
these families. The use of self-instruction manuals that are easy for families to access paired with
data collection and brief coaching sessions would be one way to address the barriers listed and
provide comprehensive care to children with autism, which also has practical implications for
children. There are other recommended areas of research to expand on this study, however this
study did serve as a way to empower families to support their children in the home and
community settings and increase their opportunities to access the community, all while
decreasing maladaptive behaviors.

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APPENDIX A: OPEN ENDED QUESTIONS
Please read through the open-ended questions and answer to the best of your ability.
1. Do you live in an urban/suburban/or rural area of Lancaster County?
2. How old is your child?
3. Briefly describe your family structure (number of caregivers, how many other persons
living in the home, any additional babysitters/caregivers/etc.):
4. Are you currently receiving ABA services? If so, in which settings (home, community,
school)?
5. Are you receiving these supports through an IEP, agency support, or both?
6. If receiving services through agency support, are you receiving formal parent trainings
from your clinician?
7. If so, how often are these happening?
8. What is the content covered?
9. How often do you take your child into the community (parks, grocery store, movie
theater, restaurants, etc.)?
10. What are some things that go well in the community?
11. What are some things you wish were going better in the community?
12. If you are not regularly (minimally twice a week) accessing the community setting, what
are barriers to that?

The Functions of BehaviorList the functions of behavior, or as many as you know:
Watch this video and identify the function -

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https://academic.oup.com/book/1248/chapter/140180523#351024210 - Video 1.1:
Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#351024210 Video 2.1:
Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#351024210 Video 2.2:
Watch this video and identify the function https://academic.oup.com/book/1248/chapter/140180523#351024210 Video 2.3:

Read the following scenarios and describe how you would respond:
1. Your child is wearing a shirt with a tag that is rubbing against his neck. Your family is out
at the grocery store and he starts tugging at the back of his shirt. When that does not help, he
starts to take his shirt off:
2. Your child threw some cereal on the ground and you have asked them to pick it up. They
take the box of cereal, throw it, and run upstairs to their bedroom:
3. Your child is playing with a toy, then sees their sister has a toy they want. They run up to
their sister, pull her hair, and take the toy out of their hands:
4. You are on the phone and your child calls you from the other room. When you do not
immediately respond, they start screaming and knocking chairs over:

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APPENDIX B: PREFERENCE ASSESSMENT
Please list minimally 10 reinforcers for your child:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

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APPENDIX C: BEHAVIOR DATA COLLECTION
ABC Data Sheet
Week _____:
Date:

Time:

Antecedent:

Bx 1:

Bx 2:

Bx 3:

Consequence:

Intensity:

Location:

1.

2.

3.

4.

5.

If the antecedent is not included in the key, what was it? (Can put N/A if Antecedent is listed in
the table)
• 1:
• 2:
• 3:
• 4:
• 5:
What antecedent strategies did you use?
•
•
•
•

1:
2:
3:
4:

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•

5:

What consequent strategies did you use?
•
•
•
•
•

1:
2:
3:
4:
5:

How effective did you perceive them to be?
•
•
•
•
•

1:
2:
3:
4:
5:

What went well?

What do you need more help with?

Example Key:
Antecedent:
•
•
•
•

A – attention
N – denied access, told “no”
T – transition
D – demand (academic, functional, etc.)

Intensity Rating Scale (to be individualized based on baseline data collected from parent
surveys):
•
•

1 – 1-2 instances of the behavior, 1-2 minutes in duration, etc.
2 – 3-5 instances of the behavior, 3-5 minutes in duration, etc.

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•
•
•

3 – 6-8 instances of the behavior, 6-8 minutes in duration, etc.
4 – 8-10 instances of the behavior, 8-10 minutes in duration, etc.
5 – 10+ instances of the behavior, 10+ minutes in duration, etc.

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APPENDIX D: RECRUITMENT MATERIALS

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APPENDIX E: INFORMED CONSENT CHECKLIST AND FORM

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