Increasing appropriate conversation skills using a behavioral skills training package for adults with intellectual disability and autism spectrum disorder

Abstract

The current research evaluates the effectiveness of a behavioral skills training (BST) package used to increase appropriate conversation interactions for six adults with autism spectrum disorder (ASD). Deficits in the area of social skills can become a significant feature for individuals with disabilities and in particular for those with ASD. A multiple probe design across participant dyads was employed to examine the effects of the intervention on conversation interactions. The BST package was delivered in small group instruction and included (i) instructions about having a conversation, (ii) modeling a conversation, (iii) practicing a conversation, and (iv) feedback on performance during each session. Results indicated that BST was effective for increasing appropriate conversation interactions for all six participants, and maintenance was evident 4 weeks post intervention. The findings were discussed in relation to the importance of social interactions and communication amongst this population.

Keywords

autism spectrum disorder adults social interaction conversation skills behavioral skills training

Typically developing children, by the age of 3 years, demonstrate turn-taking skills within a conversation with their peers and can develop a topic through conversation, request repetition, and clarification, in order to engage in a basic conversation (Riva et al., 2006). However, for many individuals with developmental disabilities, in particular those with autism spectrum disorder (ASD), conversation skills do not always develop as readily (DeMatteo et al., 2012). Core deficits including initiating social interactions, maintaining eye contact, and reciprocating conversations are evident in this population (APA, 2013). With increasing age these deficits become more apparent and may adversely impact the development of activities like peer friendship, social participation, dealing with conflict, and showing empathy (Koegel et al., 2013). Orsmond, Krauss and Seltzer (2004) reported that young adults with ASD failed to engage in social activities, as well as have few close reciprocal friendships. Following the completion of second-level education, the next social challenge for individuals with ASD is employment. Nevertheless, employment opportunities have traditionally been very limited for individuals with ASD (O’Brien and Dagget, 2006), due to deficits in communication and social skills (Müller et al., 2003). Therefore, in order to enable the successful integration and inclusion of individuals with ASD within society, their local community, and the employment sector, it is necessary to develop appropriate interventions to remediate these deficits.

Conversation skills can be described as maintaining a conversation topic for more than one exchange or engaging in appropriate nonvocal conversation behavior (e.g. standing at an appropriate distance and engaging in eye contact) (Nuernberger et al., 2013). Individuals with ASD often fail to display characteristics such as initiating conversations, taking turns during conversation, and maintaining a conversational topic (Chin and Bernard-Optiz, 2000). The absence of these skills further exacerbate the risk of social withdrawal and isolation (Koegel et al., 1994) for individuals with ASD. Two methods that have been found to be effective for teaching conversations skills to children and adults with ASD include the teaching interaction procedure (Leaf et al., 2009) and behavioral skills teaching or training (BST; Dotson et al., 2010). However, in comparison to the teaching interaction procedure, BST has been found to be more effective at skill generalization (Gross et al., 2007).

As described by Dib and Sturmey (2012), BST is a training package used to teach new skills through the use of instructions, modeling, rehearsal, and feedback. While each of these four components are central to BST, there can be variations in procedural implementation. For example, modeling could take place in person, through role play or using a video model. Additionally, feedback can be delivered immediately or can be delayed (Dib and Sturmey, 2012). In summary, BST is a robust method which has been effectively used to teach a variety of skills including pedestrian safety (Yeaton and Bailey, 1978) safety skills in relation to sexual abuse (Wurtele et al., 1989), parents skills such as behavior analytic feeding techniques (Seiverling et al., 2012), training professionals in the area of mand training (Nigro-Bruzzi and Sturmey, 2010), and the implementation of picture exchange com-munication (Rosales et al., 2009). More specifically a small number of studies have successfully implemented individual components of BST (Lalli et al., 1991; Mesibov, 1984) and the entire BST package to teach conversation skills (Kornacki et al., 2013; Minik et al., 1976; Nuernberger et al., 2013; Stewart et al., 2007). Similarly a recent review by Buck (2014) indicated that BST is a method that has been successful for teaching social skills, namely, increasing assertive conversational skills, such as eye contact, loudness of speech, speech duration, and requests to children with ASD (Bornstein et al., 1977).

In a recent study by Nuernberger et al. (2013), a BST package was used to teach conversation skills to two adults with ASD and one adult with Asperger’s syndrome and cerebral palsy. A multiple baseline design across participants was employed, in which a task analysis was developed for behavioral responses to be emitted during an appropriate conversation. BST involved the instructor modeling a conversation, allowing the participant to rehearse a conversation, and providing feedback during each session on the elements of the task analysis. This was followed by in situ training, whereby participants were asked to initiate a conversation with a peer about a topic of their choice. Access to a preferred item was used to reinforce the occurrence of appropriate conversation skills during in situ training. One to five sessions took place per day, for approximately 10 min. The results indicated that BST was effective for teaching vocal and nonvocal conversation skills and effects were maintained during 4–8-week follow-up observation (Nuernberger et al., 2013). The findings also reported that conversation skills generalized to the in situ (natural environment) with peers. However, two limitations presented by the authors indicated that primarily, it was unclear which components of the package were necessary for training conversation skills and furthermore, eye contact was omitted from the task analysis. According to Dotson et al. (2010), making and maintaining eye contact, while engaging in a conversation, is considered a conversational basic, and therefore should be included as a key skill when teaching appropriate conversation interactions.

A subsequent study by Kornacki et al. (2013) was conducted, which addressed the shortcomings of Nuernberger and colleagues by conducting a component analysis of BST to identify the necessary components for training conversation skills and the inclusion of eye contact to the task analysis. A multiple baseline design across participants was used with three individuals who presented with ASD, down syndrome, and intellectual disability, respectively. One to two 5–20-min sessions including instructions, modeling, rehearsal, and feedback were conducted per day for a 3-month period. The findings indicated that no individual component of the BST could be identified as solely responsible for the acquisition of conversation skills, but rather that all elements were required collectively for each participant to reach mastery. Furthermore, the systematic approach to introduce the BST components resulted in a slow rate of skill acquisition and a higher number of training sessions. This is evident in that when participants received the full BST package, only 3 sessions were required to achieve mastery (Nuernberger et al., 2013); whereas when participants received components of BST consecutively, on average 16–21 sessions were required to achieve mastery (Kornacki et al., 2013). However, these findings must take into consideration that the Kornacki et al. used a revised task analysis, which included eye contact, which may have increased the response effort for participants in reaching performance criteria.

The purpose of the current research was to extend on the findings of Nuemberger et al. (2013) and Kornacki et al. (2013) to increase appropriate conversation skills with adults with ASD. A BST package was selected due to previous findings, which indicated that it was conducive to greater generalization of skills to in situ environments (Nuemberger et al., 2013). The current research delivered and evaluated the entire BST package (Nuemberger et al., 2013) with the addition of making eye contact during each step of the task analysis (Kornacki et al., 2013) and the use of immediate feedback during BST. In addition, the study was the first to implement BST using dyadic instruction, in order to evaluate small group instruction as a most time-efficient method of teaching conversation skills. Furthermore, the study included a social validity assessment to examine the appropriateness of such an intervention for teaching appropriate conversation interactions to adult learners with ASD.

Method

Inclusion criteria for participation and measures

Inclusion criteria required participants to obtain an age equivalent language score of 3 years in order to engage in turn taking within conversations (Riva et al., 2006). Three screening assessments were conducted prior to intervention to measure language ability, autism severity, and social skills. The Autism Behavior Checklist (ABC; Krug et al., 1978) was administered to gain a detailed knowledge of severity of autism for each participant. The Oral and Written Language Scale- II (OWLs II; Carrow-Wollfolk, 2011) was administered to measure receptive and expressive language. The Social Responsive Scale-Adult Version (SRS-A; Constantino and Gruber, 2005) was utilized to assess social responsiveness. The measures of autism severity and social skills were provided to parents as self-completion measures. The measures of language ability was administered by the first author. In addition, a paired choice preference assessment (Fisher et al., 1992) was carried out to identify potential reinforcers that could be used during training sessions.

Participants and setting

Participants included six adults attending a rehabilitation facility providing behavioral and vocational support services for young adults with ASD. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review board of the School of Psychology, National University of Ireland, Galway, and National Learning Network, Castlebar and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval for the study was granted by both the institution, conducting the research, and the rehabilitation facility. Informed consent was obtained from the participants parents/guardians and assent was gathered from the participants. Participants were five males and one female aged 19–20 years of age. All participants had a diagnosis of ASD from an independent psychologist not affiliated with the research. As part of the screening assessments participants were found to range in autism severity from 40–83 (M = 52; Table 1). Social responsiveness as measured by the SRS-A ranged from 60–73 (M = 65), representative of a mild-to-moderate range of autistic social impairment for participants (see Table 1). Language scores were between 3 years 4 months and 7 years 10 months (M = 5 years 8 months) for receptive language and between 3 years 3 months and 5 years 9 months (M = 4 years 3 months) for expressive language (see Table 1). The study took place across two settings. Probes (baseline, in situ training and follow-up) were recorded in the classroom located in the rehabilitation facility, which included 8–10 peers and the researcher during individual work time. BST took place in a private observation room. The private observation room was located in the rehabilitation facility and included the researcher and research assistant.

Table 1.

Participant demographic information, scores for autism severity, social skills, and test age equivalent for language ability.

Participant	Age	Sex	Diagnosis	Autism severity	Social responsiveness scale score	Language test age equivalent
Participant	Age	Sex	Diagnosis	Autism severity	Social responsiveness scale score	Receptive	Expressive
1	20	Male	High functioning autism	42	60 (mild)	7 yrs 10 mths	5 yrs 9 mths
2	20	Male	Autism, mild Intellectual Disability, and depressive disorder	40	62 (mild)	5 yrs 10 mths	3 yrs 10 mths
3	20	Female	Autism and mild Intellectual Disability	83	69 (moderate)	4 yrs 7 mths	3 yrs 4 mths
4	19	Male	Autism and mild Intellectual Disability	44	73 (moderate)	5 yrs 1 mth	5 yrs 8 mths
5	19	Male	Autism, mild Intellectual Disability, and language disorder	44	63 (mild)	5 yrs 6 mths	3 yrs 11 mths
6	19	Male	Autism and moderate Intellectual Disability	55	63 (mild)	3 yrs 4 mths	3 yrs 3 mths

Design

A multiple probe design (Horner and Baer, 1978) across participants was conducted. The study comprised three phases including baseline, treatment (BST), and follow-up. Two participants were randomly allocated to each baseline. Each participant was exposed to three baseline probes. The initial baseline probe was conducted concurrently for all participants. Participants 1 and 2 received baseline probes on three consecutive days. For Participants 3, 4, 5, and 6, the second and third baseline probes were taken on two consecutive days directly before entering the treatment phase. Participant pairs received training with their peer. Follow-up probes were conducted, in which participants returned to baseline condition (i.e. all prompts and instructional procedures were withdrawn). Booster training sessions were conducted if performance was not maintained at follow-up (i.e. if criterion was not met at 100% once or 80% across three sessions) to reestablish mastery criteria of 80%.

Dependent measures

The conversation task analysis (with the addition of eye contact) including operational definitions for approach a peer, greeting, posing a question or making a statement, waiting for a response, and ending a conversation was based on the task analysis used by Kornacki et al. (2013) (see Figure 1). Engaging in eye contact was included in each step of the task analysis. Eye contact was defined as looking at or orientating toward another person’s face which included several short glances lasting approximately 3–5 s.

Procedure

Baseline probes in noninstructional setting

Baseline probes were conducted to determine the initial level of performance according to the task analysis. During baseline sessions, participants were asked to engage in a conversation with a peer, about a topic of their choice in the in situ environment, during individual work time. The researcher recorded the number of steps performed correctly according to the task analysis. Responses were recorded for the first three reciprocal conversational exchanges between the participant and peer; no feedback or correction was provided. Each session lasted the length of one conversation comprising at least three exchanges (maximum of 5 min in duration). If no conversational exchanges occurred within the 5 min, then the baseline session was ended. A paired stimulus preference assessment was administered for each participant prior to intervention to identify a potent reinforcer for each participant.

Behavioral skills training

Intervention took place in the private observation room. Participants were provided with rules (verbal and written instructions) describing how to have an appropriate conversation. Verbal instructions consisted of the researcher reading aloud the instructions directly to the two participants: “Begin by facing your friend. Remember we must respect personal space, don’t stand too close,” “Say hello to your friend, ‘Hi ________’, ‘how’s it going?’ ” Written instructions were also provided outlining how to have an appropriate conversation in an easy read format for participants.

Next, the researcher and research assistant modeled an appropriate conversation while both participants observed. Participants then took it in turns to practice having a conversation with the researcher while the second participant observed. The participant was provided with feedback in relation to their performance during the conversation. If the participant demonstrated appropriate conversation interactions according to the task analysis, these were recorded as correct responses and the researcher waited until the end of the conversation and reinforced the participant with verbal praise at the end of the interaction. If the participant failed to demonstrate appropriate responding for any step of the task analysis, the researcher immediately provided corrective feedback in the form of verbal and gestural prompts, and an incorrect response was recorded. If an incorrect response was recorded, the participant then practiced this step with the researcher and prompts including verbal instructions and modeling were used until the participant could perform the correct responses. Training was repeated until participants reached 80% across three consecutive sessions or 100% once, according to the task analysis. Any questions regarding the task analysis were answered. If one participant within a pair reached mastery criterion faster than their coparticipant, the remaining participant continued to receive intervention, during 1:1 instruction, until mastery criterion was met in this environment.

When criterion was reached in the training room, all subsequent training sessions were carried out in the in situ environment with the researcher (no peer present). The feedback was provided in the same manner during the in situ training with the addition of access to a preferred item delivered as reinforcement. Following the first in situ trial, participants received 3-min access to a preferred activity, noncontingent on performance. When the participant obtained a consistent or improved performance score from the first or previous in situ training session, they were further provided with 3 min of access to a preferred item, contingent on improved performance. In situ training was repeated until each participant obtained 80% or higher for three consecutive sessions or 100% of steps correctly once, according to the task analysis.

Follow-up probes in noninstructional setting

After reaching mastery criteria during BST, participants received follow-up probes. Probes were conducted once a week for four consecutive weeks following mastery. Each participant was instructed to initiate a conversation with a peer based on a topic of their choice. Follow-up probes were identical to baseline probes.

Booster training sessions

Booster training sessions were provided if participants emitted less than 60% correct responding during a 1-week follow-up session. During the booster sessions, participants were reexposed to BST within the private observation room. When criteria were met (80% across three sessions or 100% once) for booster sessions, a follow-up probe was conducted after a 1-week period and a further 2-week period.

Social validity

A modified version of the Treatment Acceptability Rating Form (TARF; Reimers and Wacker, 1988) was distributed to the parents/guardian of each participant, in order to assess the effectiveness of BST intervention after the completion of all follow-up probes. Parents were asked three open-ended questions and two closed questions. These included the following: (1) Do you think the intervention worked well for increasing appropriate conversation for ________ e.g. making eye contact, not standing too close, listening to a response, not interrupting, etc. (A lot-not at all)? (2) Describe how well you think the intervention worked for _______? (3) Did the intervention make a difference to __________ conversation skills? (4) Did you observe _________ engaging in an appropriate conversation at home? (5) Are you satisfied with the outcome of the intervention? (very satisfied–very unsatisfied).

Interobserver agreement

The researcher and an independent second observer recorded the number of steps performed correctly according to the task analysis, while participants engaged in an appropriate conversation. Interobserver agreement (IOA) was gathered for 25% of all sessions conducted, across participants. Agreement between observers was recorded if both observers recorded a correct response. Disagreement was based on one observer recording a correct response and the other recording an incorrect response for the same step or vice versa. These data were gathered in the private observation room and during the in situ training for performance based on the task analysis. IOA was calculated by dividing the number of agreements by agreements plus disagreements and multiplying by 100. The overall mean IOA was 88%.

Treatment integrity

Treatment integrity was analyzed by evaluating a treatment procedure checklist. This was completed by an independent observer (trained in the procedure) on the correct/incorrect implementation of the BST training package by the researcher. Treatment integrity was gathered for 17% of BST sessions, across participants, in the private observation room. Treatment fidelity was calculated by dividing the number of agreements by agreements plus disagreements and multiplied by 100. The mean treatment fidelity was 100% for all of these sessions.

Results

Intervention results

Visual analysis was used to analyze data across baseline, BST, follow-up, and booster sessions, for all six participants (see Figure 2). In addition, Cohen’s d calculations were also run to analyze and compare baseline scores to follow-up probes. Participant 1 was found to have an average of 52% correct responding at baseline (M = 52%, SD = 6.93). Following the implementation of BST, an increase in correct responding was observed; participant 1 achieved mastery criteria in four sessions (M = 89%, SD= 12.70). Correct responding was maintained at follow-up with participant 1 responding with 100% for each of the four sessions (M = 100%, SD = 0). Cohen’s d effect size value (d = 6.93) suggested a large practical significance between baseline and follow-up probes. Participant 2 demonstrated low responding during baseline (M = 14.67%, SD = 12.70). When BST was implemented, participant 2 showed a gradual increase in responding and reached criteria after 10 sessions (M = 72%, SD =26.50). During follow-up, participant 2 displayed 100% correct responding once a week, for four weeks (M = 100%, SD = 0). Cohen’s d effect size value (d = 6.71) suggested a large practical significance between baseline and follow-up probes.

Participant 3 showed ascending responding at 0%, 55%, and 67%, during baseline (M = 41%, SD = 35.93). An increase in correct responding occurred when BST was applied and criteria was met after five sessions (M = 89%, SD =11). During follow-up probes, responding was maintained at 89%, 100%, 100%, and 100%, respectively (M = 97.25, SD = 5.5). Cohen’s d effect size value (d =1.857) suggested a large practical significance between baseline and follow-up probes. Participant 4 showed low responding during baseline (M = 25.67%, SD = 6.35). Subsequent to the implementation of BST, mastery criteria was reached after 11 sessions (M = 79%, SD = 13.43). Follow-up scores indicated that correct responding was maintained at 78%, 78%, 78%, and 100%, respectively (M = 80.75%, SD = 5.5). Cohen’s d calculations suggested a large practical significance (d = 8.67) between baseline and follow-up probes.

Correct responding showed an ascending trend, moving from 0% to 33%, respectively, at baseline for participant 5 (M = 11%, SD = 19.05). When BST was employed, participant 5 showed an immediate increase in correct responding and met mastery criteria after 10 sessions (M = 78%, SD = 15.56). During follow-up, participant 5 maintained correct corresponding at 100%, 78%, 100%, and 78%, respectively (M = 89, SD = 12.70). Cohen’s d calculations suggested a large practical significance (d = 4.09) between baseline and follow-up probes. Participant 6 demonstrated a stable performance at baseline (M = 3.66%, SD = 6.35). A gradual increase in correct responding was observed when BST was implemented for participant 6. Percentage of correct responding was variable during in situ training and mastery criteria was met after 15 sessions (M = 67%, SD = 22.62). Cohen’s d effect size value (d = 11.7) suggested a large practical significance between baseline and follow-up probes. Participant 6 demonstrated performance below 60% after a 1-week follow-up (56%). Booster sessions were conducted for participant 6. After two sessions responding was recorded at 100%, respectively. Follow-up data showed that correct responding was 100% after 1 week and 78% following 2 further weeks.

Social validity

Parents/guardians of 5 out of the 6 participants completed and returned the modified TARF-Revised. When asked if the intervention worked well for increasing appropriate conversation (e.g. making eye contact, not standing too close, listening to a response, and not interrupting), four parents (80%) indicated that it had increased “A lot,” while another reported that it had “somewhat.” When asked to describe how well the intervention worked for their son/daughter, parental feedback indicated that some participants were more vocal in conversation, appeared more comfortable in conversation, and that the intervention worked “A lot.” Parents were asked if the intervention made a difference to their son/daughter’s conversation skills. All parents (100%) indicated that they felt it had made a difference. In response to being asked if they observed their son/daughter engaging in an appropriate conversation in the home environment, four parents (80%) indicated that they had observed their son/daughter engaging in appropriate conversation at home, while another reported that their son/daughter had always made conversation at home. Finally, parents were asked to rate how satisfied they were with this intervention. All five parents (100%) indicated that they were very satisfied after intervention.

Discussion

The BST package was found to be effective for increasing appropriate conversation interactions for adults with ASD. All six participants reached mastery criteria on BST within 4–15 sessions with a mean of 9 sessions. Furthermore, five participants demonstrated appropriate conversation interactions during follow-up, across four consecutive weeks following intervention. These findings support earlier research that BST can result in increases in appropriate conversation interactions for adults with ASD (Kornacki et al., 2013; Nuemberger et al., 2013) and BST resulted in generalization of the skills to in situ environment. At baseline all participants showed some presence of the skill according to the task analysis. In addition to visual analysis effect size was calculated using Cohen’s d, to compare responding between baseline and BST. Effect size analysis was found to exceed Cohen’s (1988) convention for a large effect (d = 0.80) for all six participants suggesting that acquisition of appropriate conversation interactions was a result of BST.

The current research, which used the same task analysis as Kornacki et al. (2013), found that mastery was achieved with a mean of 9 training sessions compared to 18 sessions (Kornacki et al., 2013), which indicates that the entire BST package taught simultaneously led to acquisition of the skill in less training sessions. However, the current findings also indicate that the delivery of small group instruction may have impacted on the number of sessions required per participant. Observing their peers during practice and feedback may have enhanced skill acquisition for participants and allowed for observational learning. This is in line with research, which suggests that peer observation can be efficacious for learning (Charlop et al., 1983). Therefore, it is noteworthy that small group instruction may be more efficient and practical for services when implementing such training packages (Johnson et al., 2005); therefore, future research needs to differentiate if quicker acquisition can be solely attributed to observational learning through the delivery of BST in small group instruction.

In contrast, the rapid rate of acquisition (3 sessions) noted for the three participants in Nuemberger et al. (2013) was not replicated. However, this discrepancy may be accounted for by the fact that Nuemberger et al. (2013) did not provide information on language ability or autism severity of participants; therefore, it is not possible to infer if participants presented with similar repertoires at baseline. In addition, it must be noted that the current study included eye contact as part of each step within the task analysis (as per Kornacki et al. (2013)), which may have increased the response effort for participants and subsequently resulted in a slower rate of acquisition.

Five of the participants required between 4 and 10 sessions to achieve mastery. However, participant 6 required 15 sessions. It is notable that participant 6 had the lowest level of language ability (with age equivalence for receptive and expressive falling within 3 years 4 months and 3 years 3 months, respectively) and moderate intellectual disability. It was found that participant 6 required a comparable number of sessions in the private observation room as participants 2, 4, and 5. However, he took much longer to reach mastery during in situ sessions. In addition, participant 6 failed to demonstrate maintenance of the skills (56%) at 1-week follow-up. Booster training sessions were conducted and correct responding increased to 100% following two BST sessions. Subsequent to a 1-week follow-up, correct responding was 100%. After a further 2-week period, correct responding was maintained at 78%. This finding indicated that the use of booster sessions may be an effective component for maintenance of skill acquisition. This is consistent with research, which suggests that booster sessions utilizing BST packages may be associated with the maintenance of skill performance over time (Miller et al., 2014). However, the inclusion of screening assessments may be useful to identify which repertoires may be associated with more positive outcomes and to identify participants who may require a longer period of instruction and/or booster sessions to achieve generalization.

In advancement of previous research (e.g. Kornacki et al., 2013; Nuernberger, et al., 2013), the current study conducted an assessment to determine the social impact of BST, for teaching appropriate conversation interactions, to adults with ASD. A social validity assessment was distributed to the parents/guardians of each participant and indicated that the outcomes of this research had a positive impact for learners. Parents were asked if the intervention worked well for teaching appropriate conversation interactions, with 80% reporting, it worked “A lot.” Positive outcomes were noted for initiating, responding, and making eye contact for some participants. All parents reported that they were very satisfied with the training package and noted that they had observed and noticed changes in their son/daughter’s conversational interactions at home. These findings highlight the clinical importance of such training procedures for teaching appropriate conversation interactions (Barlow, 1981). Future research could expand on this by incorporating social validity gathered from the participants on their perspective of the intervention.

The current research present some limitations. While conversational interactions were found to generalize to the natural environment, all sessions (baseline, training, and follow-up) were carried out with peers who attended the vocational training setting. In order to assess generalization of conversation skills, future research should examine if individuals engage in independent conversations from naturally occurring motivating operations, across settings and with typically developing peers. Second, during baseline correct responding showed an ascending performance for some participants during baseline. A multiple probe design was selected to avoid skill acquisition during baseline, based on the possibility that the participant may learn from their peer. However, the authors believe that as participants were adults, who would have had previous learning opportunities with their peer in this environment, that skill acquisition during baseline was not likely. However, it was noted that for participant 3 performance increased from 0% to 56% and 67%, respectively, across baseline probes. Therefore, the authors believe that the participant’s performance during the first probe was an under representation of her ability to engage in appropriate conversational interactions. Ideally, baselines should have continued until a stable level of performance was observed; however, this was not possible, as participants received intervention in dyads and therefore intervention was applied simultaneously to both participants after three probes. Finally, within the current research self-completion measures were administered to parents to assess autism severity and social skills. Future research should consider conducting alternative measure which may provide more accurate assessment results.

In summary, the current study provides preliminary evidence that BST can be effectively applied to teach appropriate conversation interactions using small group instruction (participant dyads). In accordance with previous research, the effects of BST were shown to generalize to the in situ environment. Furthermore, these results were maintained for five participants during follow-up and for one participant subsequent to booster training sessions. The findings from the current study indicate that this is an effective intervention for the acquisition and generalization of conversation skills, which may have a wider impact for other social skills, including the development of peer friendship or social inclusion and integration.

Footnotes

Authors’ note

The research was conducted by the first author under the supervision of the second author in partial fulfilment of the requirements for her MSc in Applied Behavior Analysis at National University of Ireland, Galway.

Acknowledgements

The authors would like to thank Peter Dooley and all staff from the National Learning Network, Castlebar. They also extend their sincere thanks to the learners from the National Learning Network, Castlebar, for without their participation this research would not have been possible.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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