Abstract
Behavioral skills training (BST) is a performance- and competency-based training package composed of instructions, modeling, rehearsal, and feedback. Previous reviews have demonstrated that BST is an effective training package to teach interventionists to implement behavior analytic interventions (Kirkpatrick et al. in Journal of Behavioral Education, 28, 344–361, Kirkpatrick et al., Journal of Behavioral Education 28344–361, 2019). The purpose of this review was to examine the characteristics of BST for training adult interventionists to implement behavior analytic procedures with children with autism spectrum disorder (ASD). Also, we investigated various factors that may lead to efficient BST delivery, compiled the external validity indicators included in BST research, and investigated the methodological quality of BST research studies. In this systematic review of 30 studies from 2004 to 2019, we found that trainers consistently taught the four BST components, yet implementation varied substantially across studies. Inconsistent reporting of factors affecting efficiency limited our ability to analyze which components and delivery methods was most efficient. External validity measures, such as generalization and outcome measures for children receiving the behavior analytic intervention, were often reported. The evidence quality and design quality were mixed. BST is generally accepted as an effective intervention for training a wide range of interventions; however, more high-quality research studies are needed including evaluation of explicit descriptions for all BST components.
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References
References marked with an asterisk indicate studies included in the systematic review.
Akers, J. S., Pyle, N., Higbee, T. S., Pyle, D., & Gerenscer, K. R. (2016). A synthesis of script fading effects with individuals with autism spectrum disorder: A 20-year review. Review Journal of Autism and Developmental Disorders, 3(1), 1–17. https://doi.org/10.1007/s40489-015-0062-9
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91. https://doi.org/10.1901/jaba.1968.1-91
Bartley, J. J. (2006). An update on autism: Science, gender, and the law. Gender Medicine, 3(2), 73–78. https://doi.org/10.1016/s1550-8579(06)80197-x
Belisle, J., Rowsey, K. E., & Dixon, M. R. (2016). The use of in situ behavioral skills training to improve staff implementation of the PEAK relational training system. Journal of Organizational Behavior Management, 36(1), 71–79. https://doi.org/10.1080/01608061.2016.1152210
Bernhard, B. (2019, October 1). Autism insurance coverage now required in all 50 states. Disability Scoop. https://www.disabilityscoop.com/2019/10/01/autism-insurance-coverage-now-required-50-states/27223/
*Bolton, J., & Mayer, M. D. (2008). Promoting the generalization of paraprofessional discrete trial teaching skills. Focus on Autism and Other Developmental Disabilities, 23(2), 103–111. https://doi.org/10.1177/1088357608316269
Brock, M. E., Cannella-Malone, H. I., Seaman, R. L., Andzik, N. R., Schaefer, J. M., Page, E. J., Barczak, M. A., & Dueker, S. A. (2017). Findings across practitioner training studies in special education: A comprehensive review and meta-analysis. Exceptional Children, 84(1), 7–26. https://doi.org/10.1177/0014402917698008
CDC. (2020). Data & Statistics on Autism Spectrum Disorder. https://www.cdc.gov/ncbddd/autism/data.html
*Clayton, M., & Headley, A. (2019). The use of behavioral skills training to improve staff performance of discrete trial training. Behavioral Interventions, 34(1), 136–143. https://doi.org/10.1002/bin.1656
*Conklin, S. M., & Wallace, M. D. (2019). Pyramidal parent training using behavioral skills training: Training caregivers in the use of a differential reinforcement procedure. Behavioral Interventions, 34(3), 377–387. https://doi.org/10.1002/bin.1668
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Pearson.
*Crockett, J. L., Fleming, R. K., Doepke, K. J., & Stevens, J. S. (2007). Parent training: Acquisition and generalization of discrete trials teaching skills with parents of children with autism. Research in Developmental Disabilities, 28(1), 23–36. https://doi.org/10.1016/j.ridd.2005.10.003
DiGenarro Reed, F., & Henley, A. J. (2015). A survey of staff training and performance management practices: The good, the bad, and the ugly. Behavior Analysis Practice, 8, 16–26. https://doi.org/10.1007/s40617-015-0044-5
Dillenburger, K., McKerr, L., & Jordan, J. A. (2014). Lost in translation: Public policies, evidence-based practice, and autism spectrum disorder. International Journal of Disability, Development and Education, 61(2), 134–151. https://doi.org/10.1080/1034912x.2014.905059
Dixon, D. R., Linstead, E., Granpeesheh, D., Novack, M. N., French, R., Stevens, E., Stevens, L., & Powell, A. (2016). An evaluation of the impact of supervision intensity, supervisor qualifications, and caseload on outcomes in the treatment of autism spectrum disorder. Behavior Analysis in Practice, 9(4), 339–348. https://doi.org/10.1007/s40617-016-0132-1
*Dogan, R. K., King, M. L., Fischetti, A. T., Lake, C. M., Mathews, T. L., & Warzak, W. J. (2017). Parent-implemented behavioral skills training of social skills. Journal of Applied Behavior Analysis, 50(4), 805–818. https://doi.org/10.1002/jaba.411
*Eid, A. M., Aljaser, S. M., AlSaud, A. N., Asfahani, S. M., Alhaqbani, O. A., Mohtasib, R. S., Aldhalaan, H. M., & Fryling, M. (2017). Training parents in Saudi Arabia to implement discrete trial teaching with their children with autism spectrum disorder. Behavior Analysis in Practice, 10(4), 402–406. https://doi.org/10.1007/s40617-016-0167-3
Elliott, S. N., Witt, J. C., Galvin, G. A., & Peterson, R. (1984). Acceptability of positive and reductive behavioral interventions: Factors that influence teachers’ decisions. Journal of School Psychology, 22(4), 353–360. https://doi.org/10.1016/0022-4405(84)90022-0
Erath, T. G., DiGennaro Reed, F. D., Sundermeyer, H. W., Brand, D., Novak, M. D., Harbison, M. J., & Shears, R. (2020). Enhancing the training integrity of human service staff using pyramidal behavioral skills training. Journal of Applied Behavior Analysis, 53(1), 449–464. https://doi.org/10.1002/jaba.608
Giannakakos, A. R., Vladescu, J. C., & Simon, R. (2018). Teaching installation and use of child passenger safety restraints. Journal of Applied Behavior Analysis, 51(4), 915–923. https://doi.org/10.1002/jaba.493
*Gianoumis, S., Seiverling, L., & Sturmey, P. (2012). The effects of behavior skills training on correct teacher implementation of natural language paradigm teaching skills and child behavior. Behavioral Interventions, 27(2), 57–74. https://doi.org/10.1002/bin.1334
*Giles, A., Swain, S., Quinn, L., & Weifenbach, B. (2018). Teacher-implemented response interruption and redirection: Training, evaluation, and descriptive analysis of treatment integrity. Behavior Modification, 42(1), 148–169. https://doi.org/10.1177/0145445517731061
Granpeesheh, D., Tarbox, J., & Dixon, D. R. (2009). Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry, 21(3), 162–173.
*Graudins, M. M., Rehfeldt, R. A., DeMattei, R., Baker, J. C., & Scaglia, F. (2012). Exploring the efficacy of behavioral skills training to teach basic behavior analytic techniques to oral care providers. Research in Autism Spectrum Disorders, 6(3), 978–987. https://doi.org/10.1016/j.rasd.2011.12.010
Gravina, N., Villacorta, J., Albert, K., Clark, R., Curry, S., & Wilder, D. (2018). A literature review of organizational behavior management interventions in human service settings from 1990 to 2016. Journal of Organizational Behavior Management, 38(2–3), 191–224. https://doi.org/10.1080/01608061.2018.1454872
Hahs, A. D., & Jarynowski, J. (2018). Targeting staff treatment integrity of the peak relational training system using behavioral skills training. Behavior Analysis in Practice, 12(1), 209–215. https://doi.org/10.1007/s40617-018-00278-6
Hassan, M., Thomson, K. M., Khan, M., Burnham Riosa, P., & Weiss, J. A. (2017). Behavioral skills training for graduate students providing cognitive behavior therapy to children with autism spectrum disorder. Behavior Analysis: Research and Practice, 17(2), 155–165. https://doi.org/10.1037/bar0000078
*Hassan, M., Simpson, A., Danaher, K., Haesen, J., Makela, T., & Thomson, K. (2018). An evaluation of behavioral skills training for teaching caregivers how to support social skill development in their child with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(6), 1957–1970. https://doi.org/10.1007/ß0803-017-3455-z
*Hogan, A., Knez, N., & Kahng, S. (2015). Evaluating the use of behavioral skills training to improve school staffs’ implementation of behavior intervention plans. Journal of Behavioral Education, 24(2), 242–254. https://doi.org/10.1007/ß0864-014-9213-9
*Homlitas, C., Rosales, R., & Candel, L. (2014). A further evaluation of behavioral skills training for implementation of the picture exchange communication system. Journal of Applied Behavior Analysis, 47(1), 198–203. https://doi.org/10.1002/jaba.99
*Hsieh, H. H., Wilder, D. A., & Abellon, O. E. (2011). The effects of training on caregiver implementation of incidental teaching. Journal of Applied Behavior Analysis, 44(1), 199–203. https://doi.org/10.1901/jaba.2011.44-199
Kazdin, A. E. (2011). Single-case research designs. Methods for Clinical and Applied Settings (2nd ed.). Oxford University Press.
Kirkpatrick, M., Akers, J., & Rivera, G. (2019). Use of behavioral skills training with teachers: A systematic review. Journal of Behavioral Education, 28 344–361. https://doi.org/10.1007/s10864-019-09322-z
*Jimenez-Gomez, C., McGarry, K., Crochet, E., & Chong, I. M. (2019). Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training. Behavioral Interventions, 34(3), 396–404. https://doi.org/10.1002/bin.1666
Landa, R. J. (2018). Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders. International Review of Psychiatry, 30(1), 25–39. https://doi.org/10.1080/09540261.2018.1432574
*Lerman, D. C., Hawkins, L., Hoffman, R., & Caccavale, M. (2013). Training adults with an autism spectrum disorder to conduct discrete-trial training for young children with autism: A pilot study. Journal of Applied Behavior Analysis, 46(2), 465–478. https://doi.org/10.1002/jaba.50
*Lerman, D. C., Hawkins, L., Hillman, C., Shireman, M., & Nissen, M. A. (2015). Adults with autism spectrum disorder as behavior technicians for young children with autism: Outcomes of a behavioral skills training program. Journal of Applied Behavior Analysis, 48(2), 233–256. https://doi.org/10.1002/jaba.196
Lindgren, S., & Doobay, A. (2011). Evidence-based interventions for autism spectrum disorders (pp. 1–24). The University of Iowa.
Mack, A. (2011). Prevalence of autism spectrum disorders - autism and developmental disabilities monitoring network, United States, 2006. Yearbook of Psychiatry and Applied Mental Health, 2011, 37–39. https://doi.org/10.1016/j.ypsy.2010.11.009
*Madzharova, M. S., Sturmey, P., & Jones, E. A. (2012). Training staff to increase manding in students with autism: Two preliminary case studies. Behavioral Interventions, 27(4), 224–235. https://doi.org/10.1002/bin.1349
Maenner, M. J., Shaw, K. A., & Bakian, A. V., Bilder, D. A, Durkin, M. S., Esler, A., Furnier, S. M., Hallas, L., Hall-Lande, J., Hudson, A., Hughes, M. M., Patrick, M., Pierce, K., Poynter, J. N., Salinas, A., Shenouda, J., Vehorn, A., Warren, Z., Constantino, J. N., . . . Cogswell, M. E. (2021). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2018. MMWR Surveillance Summaries, 2021, 70(No. SS-11), 1–16. https://doi.org/10.15585/mmwr.ss7011a1
Maffei-Almodovar, L., Feliciano, G., Fienup, D. M., & Sturmey, P. (2017). The use of behavioral skills training to improve staff performance of discrete trial training. Behavior Analysis in Practice, 10(4), 355–362. https://doi.org/10.1007/s40617-017-0199-3
Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 418–425. https://doi.org/10.1016/j.rasd.2010.06.004
Matthews, N. L., Orr, B. C., Harris, B., McIntosh, R., Openden, D., & Smith, C. J. (2018). Parent and child outcomes of JumpStart™, an education and training program for parents of children with autism spectrum disorder. Research in Autism Spectrum Disorders, 56, 21–35. https://doi.org/10.1016/j.rasd.2018.08.009
Miltenberger, R. G., Zerger, H. M., Novotny, M., & Livingston, C. P. (2017). Behavioral skills training to promote social behavior of individuals with autism. In J. B. Leaf (Ed.), Handbook of social skills and autism spectrum disorder: Assessment, curricula, and intervention (pp. 325–342). https://doi.org/10.1007/978-3-319-62995-7_19
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
National Autism Center. (2015). Evidence-Based Practice and Autism in the Schools, 2nd ed. https://nationalautismcenter.org/090605-2/
*Nigro-Bruzzi, D., & Sturmey, P. (2010). The effects of behavioral skills training on mand training by staff and unprompted vocal mands by children. Journal of Applied Behavior Analysis, 43(4), 757–761. https://doi.org/10.1901/jaba.2010.43-757
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372(71), 1–9. https://doi.org/10.1136/bmj.n71
Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2012). Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice, 5(2), 2–11. https://doi.org/10.1007/bf03391819
Presmanes Hill, A., Zuckerman, K., & Fombonne, E. (2015). Epidemiology of autism spectrum disorders. In M. Robinson-Agramonte (Ed.) Translational Approaches to Autism Spectrum Disorder (pp 13–38). Springer. https://doi.org/10.1007/978-3-319-16321-5_2
Roane, H. S., Fisher, W. W., & Carr, J. E. (2016). Applied behavior analysis as treatment for autism spectrum disorder. The Journal of Pediatrics, 175, 27–32. https://doi.org/10.1016/j.jpeds.2016.04.023
*Sarokoff, R. A., & Sturmey, P. (2004). The effects of behavioral skills training on staff implementation of discrete-trial teaching. Journal of Applied Behavior Analysis, 37(4), 535–538. https://doi.org/10.1901/jaba.2004.37-535
*Sarokoff, R. A., & Sturmey, P. (2008). The effects of instructions, rehearsal, modeling, and feedback on acquisition and generalization of staff use of discrete trial teaching and student correct responses. Research in Autism Spectrum Disorders, 2(1), 125–136. https://doi.org/10.10166/j.rasd.2007.04.002
*Seiverling, L., Williams, K., Sturmey, P., & Hart, S. (2012). Effects of behavioral skills training on parental treatment of children’s food selectivity. Journal of Applied Behavior Analysis, 45(1), 197–203. https://doi.org/10.1901/jaba.2012.45-197
Shapiro, M., & Kazemi, E. (2017). A review of training strategies to teach individuals implementation of behavioral interventions. Journal of Organizational Behavior Management, 37(1), 32–62. https://doi.org/10.1080/01608061.2016.1257066
*Shireman, M. L., Lerman, D. C., & Hillman, C. B. (2016). Teaching social play skills to adults and children with autism as an approach to building rapport. Journal of Applied Behavior Analysis, 49(3), 512–531. https://doi.org/10.1002/jaba.299
Slane, M., & Lieberman-Betz, R. G. (2021). Using behavioral skills training to teach implementation of behavioral interventions to teachers and other professionals: A systematic review. Behavioral Interventions, 36(4), 984–1002. https://doi.org/10.1002/bin.1828
Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014). The evidence-based practice of applied behavior analysis. The Behavior Analyst, 37(1), 41–56. https://doi.org/10.1007/s40614-014-0005-2
*Subramaniam, S., Brunson, L. Y., Cook, J. E., Larson, N. A., Poe, S. G., & St. Peter, C. C. (2017). Maintenance of parent-implemented discrete-trial instruction during videoconferencing. Journal of Behavioral Education, 26(1), 1–26. https://doi.org/10.1007/ß0864-016-9258-z
Sump, L. A., Richman, D. M., Schaefer, A. M., Grubb, L. M., & Brewer, A. T. (2018). Telehealth and in-person training outcomes for novice discrete trial training therapists. Journal of Applied Behavior Analysis, 51(3), 466–481. https://doi.org/10.1002/jaba.461
Vismara, L. A., & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder: What do we know? Annual Review of Clinical Psychology, 6(1), 447–468. https://doi.org/10.1146/annurev.clinpsy.121208.131151
Ward-Horner, J., & Sturmey, P. (2012). Component analysis of behavior skills training in functional analysis. Behavioral Interventions, 27(2), 75–92. https://doi.org/10.1002/bin.1339
What Works Clearinghouse. (2020). What works clearinghouse procedures handbook, version Washington, DC: U.S. Department of Education, Institute of Education Sciences, https://ies.ed.gov/ncee/wwc/handbooks
Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. https://doi.org/10.1007/s10803-014-2351-z
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Smith, S.G., Mattson, S.L., Aguilar, J. et al. Behavioral Skills Training with Adult Interventionists: a Systematic Review. Rev J Autism Dev Disord 11, 296–319 (2024). https://doi.org/10.1007/s40489-022-00339-1
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DOI: https://doi.org/10.1007/s40489-022-00339-1