First Applied Project – Increasing a Target behavior

by

Simos Kalogirou
Teaching a child with autism to greet in the school environment using

Discrete Trial Training (DTT)

Abstract

Greet is the beginning of social interaction; it is one of the many prerequisite

skills for proper communication. Greeting another student or friend is important

because it shows respect and opens the door for communication which could

eventually lead to a friendship. The aim of the current study is to teach a child

with autism to greet in the school environment using Discrete Trial Training. An

A-B design was used to evaluate the effectiveness of DTT with the results

supporting the hypothesis that "DTT is one of the most important instructional

method for children with autism" (Smith, 2001). With the use of this strategy the

child learned a new social skill within 7 days of intervention therefore the results

of this study suggest that Discrete Trial Training was effective in teaching a

child with autism how to respond to the greet of his teachers and RBT.

Greet is a vital part of conversations. For students who have

communication disorders, they are usually one of the first things speech

therapists address. Greet is really the first step to an interaction; they begin

conversations. From the moment students master the act of saying hi (or its

variations, i.e. hello, what's up? smile, give 5, etc) they are ready to work on
more difficult skills such as joining a group or having conversations. Greet is so

important because it is the actual first step towards communication. The aim of

this study was to teach a child with autism to greet in the school environment

using Discrete Trial Training. As Myles and Simpson (2001, pg. 279, 280)

explain: "Social skills represents a complex area within human behavior.

Although somewhat rule-governed, these rules vary across location, situations,

people, age, and culture, making it difficult to acquire and subsequently

generalize these skills. A greeting, for example, is a social skill that is thought to

be simple. However, further analysis shows this skill, which most take for

granted, to be extremely complex. How a child greets a friend in the classroom

differs from the type of greeting that would be used if the two met at the local

mall. The greeting used the first time the child sees a friend differs from the

greeting exchanged when they see each other 30 minutes later. Further, words

and actions for greetings differ, depending on whether the child is greeting a

teacher or a peer. Thus, greetings are complex, as are most social skills"

According to Wang and Spillane's study titled Evidenced-Based Social

Skills Interventions for children with Autism: A Meta- Analysis (2009, p.318)

"There have been many interventions used to teach social skills to individuals

with ASD. These include social stories (e.g. Delano & Snell, 2006), peer-

mediated strategies, (e.g. Laushey & Heflin, 2000), video modeling (e.g.

Paterson & Arco, 2007), cognitive behavioral training (e.g. Bock, 2007), pivotal
response training (e.g. Jones & Freely, 2007), Theory of Mind (e.g. Chin,

Bernard - Opitz, 2000), among others". And they conclude: "While Social

Stories, Peer-Mediated, and Video-Modeling all met the criteria for evidence

based, a closer look at percentage of non overlapping data points (PND) shows

that only Video-Modeling meets criteria for being evidence-based as well as

demonstrating high effectiveness as an intervention strategy".

"Discrete Trial Training (DTT) is one of the most important instructional

methods for children with autism" (Smith, 2001, p86). In the literature "discrete

trial procedure", "discrete trial instruction" and "discrete trial teaching" are

terms meaning the same as discrete trial training (Cosgrave, 2015). For

simplicity this study will refer to "RBTs" for Registered Behavioral Technicians

and "students/children". However, it should be noted that not only RBTs

[teachers] but also professional and nonprofessional therapists, including family

members, can implement DTT, and that both children and adults with autism

can benefit (Smith, 1993). According to Smith (2001), DTT is a method of

teaching in simplified and structured steps; instead of teaching an entire skill in

one go, the skill is broken down and built up using discrete trials that teach each

step one at a time. Lovaas (1981) defined a trial as "single teaching unit"; to

simplify it think of DTT as a series of teaching challenges with each challenge

called a "discrete trial" or just "trial".

For example, assuming we wanted to teach a student to identify his

teachers by name by asking him to point the correct picture corresponding the
correct name when placed in front of him. The teaching challenge could be

scripted like this, Trial one: 1. RBT places two pictures one of each teacher on

the table in front of the student, 2. RBT says show me Mr. X, 3. Student shows

Mr. X, 4. RBT would say in an enthusiastic manner "That's correct"!! "Bravo"!!

and/or give the child edible or preferred toy, 5. Between trials there should be

always a short pause. In the above scenario the difference in Trial 2 would be

that the RBT in step 2 would say show me Miss Y, student responds correctly,

RBT would reinforce by saying "Good job", "That's right", give edible or toy.

As before there should be a short pause between ongoing trials (Cosgrave,

2015).

In the trials illustrated above there are 5 parts: 1. Antecedent: is the first

part of the trial and it initiates the response. In the above example the antecedent

was the RBTs' instruction "show me" and the teachers' pictures. The antecedent

is abbreviated as (A); the use of few and consistent words is preferred (Texas

Statewide Leadership for Autism, 2013). 2. Prompting: Based on the student's

learning level and the complexity of the tasks the RBT gives appropriate

prompts to trigger the desired response. The prompt level is abbreviated as (P).

3. Response: The student responds to the teaching and prompting; the

responding behavior must be measurable and is abbreviated as (R). 4.

Consequence: The RBT gives immediate feedback and reinforcement after

students' response to enhance skill acquisition; this is abbreviated as (R). 5.

Inter-trial interval: A clear wait time is inserted after a trial completion before

moving into the next trial (Texas Statewide Leadership for Autism, 2013).

Malott and Trojan-Suarez (2006) suggest the inter-trial interval must be as short

as possible, just a few seconds at most.

According to Cosgrave (2015) there are six and not five steps in a DTT

because usually as he claims authors in general at Step 4, which is Consequence

for either correct or incorrect response are regarded as one part. Cosgrave (2015)

argues that is better to separate the step into two steps in order to show that there

are two possible consequences and that both need to be clearly defined.

According to the same author when there is an Incorrect Response a correction

procedure must be followed by the teacher in order to show the child which was

the correct response/behavior. This correction would use a pre-chosen prompt to

guide the child and help them understand what the response/behavior was.

Correction is abbreviated with "Corr" or "C2" to denote the fact that this is the

"second" possible consequence (the first is the consequence for a correct

response) (Cosgrave, 2015). For incorrect responses no reinforcement is given,

even after the correction; this is because if reinforcement was given even for

incorrect response why would the child be bothered getting a correct response?

Instead the teacher would go through the correction and then begin a new trial

(Cosgrave, 2015).
 In the above example we had a Consequence for correct response which

was positive reinforcement. In their book "Applied Behavior Analysis" Cooper,

Herron and Heward (2007, pg. 287) clearly state: "Positive reinforcement is the

most important and most widely applied principle of behavior analysis". There

are four types of reinforcement: positive, negative, punishment and extinction

(Cooper et al, 2007). In positive reinforcement we add something in order to

increase a response, in the above example the RBT praised and/or rewarded the

child which is the most common type of positive reinforcement. The opposite

happens in negative reinforcement where something negative is being removed

in order to increase the response. Punishment refers to adding something

aversive in order to decrease a behavior and extinction occurs when there is a

discontinuation of a previously reinforced behavior in order to minimize or

ultimately cease the behavior from occurring. During extinction there might be

an extinction burst which is an increase in the frequency of the responding

during the initial stage of the extinction procedure (Cooper, Heron and Heward,

2007, p. 695, 700, 701).

The amount or type of reinforcement to be given is called a "Schedule of

Reinforcement". Applying one of the four types of reinforcement every time the

behavior occurs is called a "continuous schedule of reinforcement" (Heffner,

2015). There are two types of continuous schedules, Fixed Ratio abbreviated

(FR) and Fixed Interval abbreviated (FI) (Cooper et al, 2007). During Fixed
Ratio the reinforcer is being applied after a specific number of desired behaviors

where as Fixed Interval the reinforcer is being applied after a specific amount of

time. When reinforcement is being applied on an irregular basis, they are called

Variable Schedules (Cooper et al, 2007). Again there are 2 types of Variable

Schedules, Variable Ratio abbreviated (VR) and it happens when applying a

reinforcer after a variable number of desired responses and Variable Interval

abbreviated (VI) takes place when reinforcer is being applied after a variable

amount of time (Cooper et al, 2007) .

The simplest definition in the literature for prompting and prompt fading

is probably given by Alberto and Troutman (2003); prompts are used to increase

the likelihood that a student will provide a desired response where as fading is

gradually reducing the prompt. According to the same scientists there are six

types of prompts. The first is Physical prompt in which we physically guide the

student to perform a skill, Verbal prompts are verbal cues which give

information to help the student respond correctly, Model is when an educator or

peer demonstrates the desired skill, Gestural prompt occurs when we use

gestures, such as pointing in order to guide the student to the correct response,

Visual prompts such as pictures, symbols and text that can assist a student to

respond correctly, and last but not least Positional prompt happens when placing

materials in a location or sequence that ensures successful completion of an

activity (Alberto and Troutman, 2003).

 There are some considerations to be taken in mind before deciding to use

a prompt; for example the type of prompt used will depend not only on the skill

being taught but also based on the students' current abilities (Alberto and

Troutman, 2003). All prompts need to be faded over time or when the student is

successful in order to prevent prompt dependency, but not too quickly otherwise

errors may be made by the learner; if this occurs, returning to the prompt level

that the student was successful with for a while longer is essential, and then try

fading the prompts again Alberto and Troutman, 2003). Finally verbal prompts

can be the most difficult to fade so they have to be used wisely only when

needed and always reinforce all unprompted correct responses which are defined

as independent or sometimes shortened to "IND". (Alberto and Troutman,

2003). In the words of Cooper et al (2007, p.262) "behaviors are reinforced, not

people". For example statements such as, "The teacher reinforced Bobby when

he asked a question" is incorrect. The correct argument would be Bobby's

teacher reinforced question asking, not Bobby (Cooper et al, 2007).

 Method

Participants

For anonymity purposes the child's name will not be revealed so for the

purposes of this study he will be called Max. Max is a 10 year old boy who is

diagnosed with autism. He lives with his parents who are Georgian; his native

language is Russian but his guardians want him to learn English as they believe

Russian will not be useful to him apart from communicating with his Georgian

relatives and his father since he is living in a foreign country where the main

spoken languages are Greek and English. At home they speak Russian because

as mentioned above his father doesn't speak English; he also receives 1:1 lessons

by his mother in Russian with the help of a Russian Supervisor.

Max is vocal-verbal with very limited expressive and some receptive

skills in English (according to his parents his language skills expressive and

receptive are much better in Russian but there is no way at this point to verify

that since none of his therapist speaks Russian). Max has a history of problem

behaviors mainly SIBs (self injurious behaviors) such as pinching self and

others, hitting shoulders, wrist biting, inappropriate laughing with no obvious

reason, constant and loud vocalizations as well as echolalia and sometimes

screaming. He attends a private school where he receives 1:1 assistant in a

separate room mainly because of his problem behaviors' mentioned above as he

can get quite noisy. He also participates in some class lessons as part of his

inclusion program such as P.E. and Computers always accompanied by his RBT.

Max's educational activities are provided by an independent professional

(trainee behavior analyst) assigned by the family who also supervises the child's

RBT. His level of performance has been assessed using the Assessment of Basic

Language and Learning Skills-Revised (ABLLS-R) by the trainee behavior

analyst who is reviewing the data that are collected by the RBT at the end of

each week and is responsible to determine whether changes in the plan are

necessary. Even though Max is mastering target skills relatively fast primarily

with the use of DTT, his academic and functional performance is significantly

below than that of the same age neurotypical children.

Dependent and Independent Variable

The dependent variable is Max greets back his teachers every time they

greet him independently within 5 sec. A frequency measurement system was

used with 100% correct answers on all trials for 3 consecutive days as a

mastered criterion using Discrete Trial Training as teaching method

(independent variable). There were 16 total trials per day, 10 from RBT and 6

from the teachers.

Experimental Design

For the purpose of this study A-B design was used. An A-B design is a

two phase design composed of a baseline (‘A phase’) with no changes and a

treatment or intervention (‘B phase’). Even though A-B design has the limitation

to show only correlations instead of functional relations (which makes strong

conclusions difficult) (Stokes, 2000) it was chosen because A-B-A design

couldn’t be implemented for ethical and practical reasons. It is unethical to end

an experiment on a baseline measure if the treatment is self-sustaining and

highly beneficial and/or related to health. It is unpractical because some skills

once learned they cannot be unlearned (Kazdin, 1982). Both criteria unpractical

and unethical were met in this study so A-B design was chosen.

Baseline

During the baseline Max's teachers randomly entered the ABA room 3

times per day for 3 days saying the greet "Good morning Max". At this point

the RBT and the teachers scored (–) if he didn’t respond to the greeting within

3-5 sec, and a (+) if he returned the greeting by saying ‘Good morning’
independently within 3-5 sec. The RBT had one DTT per day and he would

score (-) if Max didn’t respond to the greeting and a (+) if he would

independently within 3-5 sec.

Inter observer agreement (IOA)

For the purpose of this study the observations were contacted by the 2

teachers (Observers) and the RBT (experimenter); they independently recorded

on a data sheet whether the response emitted from the child was correct or

incorrect. Correct answer was considered an independent/ unprompted greet

within 3-5 sec where as wrong answer was considered a no answer/ prompted

answer within 3-5 sec. IOA is computed by taking the number of agreements

between the independent observers and dividing by the total number of

agreements plus disagreements. The coefficient is then multiplied by 100 to

compute the percentage (%) of agreement (Kelly, 2015). Due to the small

amount of data the agreement was set to 100%. At the end of the recordings

teachers and RBT compared their scorings with the average mean being 100%.

Settings - Materials and Procedure

 All training sessions were conducted in a separate room approximately 4

x 4 meters were Max receives his 1:1 training (hereafter called ABA room) in

his private school. ABA room contains a round table with 3 chairs, 1 regular

school desk with 2 chairs, a TV set, a carpet 2 x 1.5 meter with pillows and

various games that functions as his brake time corner when he is on DTT brakes.

There is also a whiteboard and materials needed to conduct training according to

his individualized education program. Also data collection form for data

collection with the use of pen or pencil which included student's name, task

name, target behavior, date, trials and total percentage. During intervention RBT

sat at the desk with the student on the opposite site and the verbal stimuli "Good

morning Max" was delivered. If there was no answer the RBT verbally

prompted the student by saying: "Say, Good morning" with continuous

reinforcement for each correct response. The reinforcements were edible items

such as nesquik cereals (1-2 pieces each time) and verbal praise i.e. Bravo!!!

Well Done!!! Excellent!!! Good Boy!! . The teachers were randomly entering

the ABA room 3 times per day each (6 times total) delivering the stimulus

"Good morning Max". As the student got more independent the following trials

were followed by a lesser intrusive prompt until he was fully independent; for

example "say, Goodm...." then "say, Good ....." then "Say, G......" and so on until

he answered independently. The student's responses were recorded on the data

sheet mentioned above. Each trial consisted with a (+) that was equal to correct

and independent response without any prompt and within 3-5 sec and a (-) that
was equal to no-response or prompt response within 3-5 sec and lasted from 20

sec to 5 minutes consisting 16 trials, 10 trials with the RBT and 6 with the

teachers. The RBT contacted 1 Discrete Trial Session per day containing 10

trials because Max had already ongoing behavior interventions as well as

ongoing Education Programs there was no extra time for the intervention.
 Results

During baseline assessment Max had zero correct responses. During the

first 3 days of intervention Max had a top range of correct responses 40%. Day

four had an astonishing 90% correct response followed by the mastery criterion

which was 100% correct answers for 3 consecutive days, across teachers (see

figure 1).

100%
90%
percentage of correct answers

80%
70%
60%
50%
40%
30%
20%
10%
0%
1 2 3
Days

Figure 1. Percentage of correct answers (Greetings) per day across 3 trainers .

 Discussion

The purpose of this study was to teach a child with autism to learn how to

greet in the school environment using Discrete Trial Learning. This study

confirmed the hypothesis that DTT is one of the most important instructional

method for children with autism" (Smith, 2001). With the use of this strategy the

child learned a new social skill within 7 days of intervention therefore the results

of this study suggest that Discrete Trial Training was effective in teaching a

child with autism how to respond to the greet of his teachers and RBT. During

the baseline there were no correct answers and this is quite normal since the

child did not have any prior knowledge of the taught skill. As soon as the

intervention started there was 10% of correct answers indicating that it had a

positive effect followed by 20% on the second day and 40% the third day.

During the fourth day the student had 90% correct answers which was a clear

sign the intervention was being effective. During the following three days the

student was able to respond to his teachers' and RBTs' greet independently and

being 100% correct. The data show that verbal prompt and continuous

reinforcement can be very effective for the establishment of intraverbal behavior

for a child with autism. After the implementation of the Discrete Trial Training

and the implementation of the verbal prompts combined with the continuous
reinforcement the number of questions answered doubled every day the

intervention was implemented. A child who could not respond to a greet for 3

days across 3 different people managed to master a new skill 4 days after the

intervention started. The generality of these findings for other children with

autism is unknown. However, efficiency is only one consideration when

choosing among prompting tactics when DTT is implemented. In some cases

verbal prompts might be indicated simply because they are easy to apply

whereas some others are not applicable to some targets i.e. use of picture

prompts to prompt a sound (Alberto and Troutman, 2003). The participant in

this study has a history of verbal prompts and DTT which makes it possible to

have responded more effectively to this type of intervention. Despite the fact

that Video Modeling is being evidenced-based and probably the most widely

method used to teach social skills (Wang P., Spillane A., 2009) it could not be

implemented in this case as an intervention method because there was a strict

school policy about the use of videos and video equipment concerning the

privacy of students. Video modeling interventions involve a child watching

videotapes of positive example of adults, peers, or him or herself engaging in a

behavior that is being taught (Monica D., 2007).

It is important to consider reasons that may explain why DTT was

successful in teaching a child with autism how to greet in the school

environment. One reason may be the structure that DTT provides when teaching
a relatively complex task suck as greetings which is a form of conversation.

Children with autism often fail to learn in the same ways as typically developing

children and often require a more highly structured learning approaches

(Schreidman, 2005). With the use of DTT the steps were broken down and thus

the greeting process became more structured, simplified and easier to be learned.

One additional reason DTT may have been effective was the familiarity the

child had with the procedure as DTT's is the primary teaching method of the

particular student for more than 2 years.

A number of limitations of this study need to be acknowledge regarding

the effectiveness of DTT as a method for teaching children with autism how to

greet. An important limitation is the small sample size used. Given only one

child participated in the present study, the external validity is extremely limited.

External validity is the validity of generalized (causal) inferences in scientific

research, usually based on experiments as experimental validity (Mitchel M.,

Jolley J. 2001). In other words, it is the extent to which the results of a study can

be generalized to other situations and to other people (Aronson, E., Wilson, T.

D., Akert, R. M., & Fehr, B., 2007). Another limitation would be the design

used. For the purpose of this study an A-B design was used which has the

limitation to show only correlations instead of functional relations (Stokes,

2000). A final limitation to consider is the number of DTT conducted per day.

The RBT contacted 1 Discrete Trial Session per day because there were already
ongoing behavior interventions as well as ongoing Education Programs and at

the time it wasn't possible to spend more time on the intervention.

Future research should investigate additional gains that may result from

learning more complex conversational skills. For example, do students initiate

communication once basic conversational skills have been acquired? Do

students play more interactively with peers once basic communications has been

established? Another accompanying gain to be investigated is eye contact.

Because in general children with autism have poor eye contact (Greer and Ross,

2007) it should be not only interesting but also significant to determine if there

is any association with learning complex social skills, such as conversational

skills would increase eye contact. According to Carbone V., O' Brien L.,

Sweeney-Kerwin E. and Albert K. (2013) because of the various social

functions eye contact may serve, failure to emit this important behavior may

have significant implications for children with autism. Specifically, previous

research has suggested that the diversity of prelinguistic pragmatic skills

exhibited (e.g., eye contact, joint attention) is predictive of the rate of

subsequent vocabulary acquisition (Kleinke, 1986) and it has also been

suggested that poor eye contact may adversely affect the educational gains of

children with autism due to the relationship between eye contact and attending

to the teacher and instructional demands (Greer & Ross, 2007). The present

study tried to teach a child how to respond to greeting so it would be challenging

to try and teach children with developmental disabilities to initiate

communications. Some limited generalization skills in the current study were

restricted to the teachers and the RBT; It would be interesting to see how the

new skills once mastered can be applied across people and settings. Finally,

replication of this study should add additional strength to the implication of this

intervention. Future replication should include additional participants with

different diagnoses with no prior DTT experience to provide further evidence of

the effectiveness of Discrete Trial Training. Accurate research designs and

measures of treatment integrity are necessary to demonstrate a functional

relation between the independent and dependent variable under study and to

explain the specific role of each variable more accurately since this study's main

limitation failed to prove any functional relation.

 References

AB (Baseline And Intervention) Design," Introduction to Single Subject

Designs, 2000 https://www.msu.edu/user/sw/ssd/issd10b.htm (retrieved 2
July 2012 as cited in Wikipedia available at:
https://en.wikipedia.org/wiki/Single-subject_research#cite_note-6

Alberto, A.A., & Troutman, A.C. (2003). Applied behavior analysis for
teacher. (6th edition). NJ: Merrill Prentice Hall. Cited in Prompting and
Fading [PDF] Available at: http://www.tcse.us/wp-
content/uploads/2011/02/prompting_and_fadingtguide.pdf

Anne Spillane, Peishi Wang (2009). Evidence-Based Social Skills

Interventions for Children with Autism: A Meta-analysis. Education and
Training in Developmental Disabilities, 2009, 44(3), 318–342. Available
at :http://www.qc.edu/rcautism/publications/Wang%20social%20skills.pd
f

Amanda L. Kelly (2015). Welcome to Behaviour Baby. Available at:

http://www.behaviorbabe.com/

Aronson, E., Wilson, T. D., Akert, R. M., & Fehr, B. (2007). Social
psychology. (4 ed.). Toronto, ON: Pearson Education. As cited in
Wikipedia. Available at: https://en.wikipedia.org/wiki/External_validity

Bock, M. A. (2007). The impact of social-behavioral learning strategy on the

social interaction skills of four students with asperger syndrome. Focus
on Autism and Other Developmental Disorders, 22, 88-95. As cited in Anne
S. , Peishi W. (2009).
Christopher L. Heffner (2015). Chapter 4: Section 3: Reinforcement and
Reinforcement Schedules. Available at:
http://allpsych.com/psychology101/reinforcement/#.VeRS6ZXov3g

Chin, H. Y. & Bernard-Opitz, V. (2000). Teaching conversational skills to

children with autism: Effect of the development of a theory of mind.
Journal of Autism and Developmental Disorders, 30, 569-583. As cited in
Anne S. , Peishi W. (2009).

Cooper, J., Heron, T., & Heward, W. (2007). Applied Behaviour Analysis.
New Jersey: Pearson Education, pg. 257, 262, 695,700, 701

Cosgrave, G. (2015) Discrete Trial Training. Educate Autism. Available at:

http://www.educateautism.com/applied-behaviour analysis/discrete-trial-
training.html

Delano, M. E., & Snell, M. E. (2006). The effects of social stories on the
social engagement of children with autism. Journal of Positive Behavior
Interventions, 8, 29-42. As cited in Anne S. , Peishi W. (2009).

Greer, D. R., & Ross, D. E. (2007). Verbal behavior analysis. New York, NY:
Pearson Education. As cited in Carbone Clinic, Available at:
http://www.carboneclinic.com/wp-content/uploads/2013/02/Carbone-et-
al.-Eye-Contact.pdf

Jones, E. A. & Feeley, K. M. (2007). Parent implemented joint attention

intervention for preschoolers with autism. SLP-ABA, 2, 253-268. As cited
in Anne S. , Peishi W. (2009).
Kazdin, Alan (1982). Single-Case Research Designs. New York: Oxford
University Press. ISBN 0-19-503021-4 as cited in Wikipedia available
at: https://en.wikipedia.org/wiki/Singlesubject_research#cite_note-6

Kleinke, C. L. (1986). Gaze and eye contact: A research review.

Psychological Bulletin, 100(1), 78–100. As cited in Carbone Clinic,
Available at:
http://www.carboneclinic.com/wpcontent/uploads/2013/02/Carbone-et-
al.-Eye-Contact.pdf

Laushey, K. M., & Heflin, L. J. (2000). Enhancing social skills of

kindergarten children with autism through the training of
multiple peers as tutors. Journal of Autism and Developmental Disorders,
30, 183-193. As cited in Anne S. , Peishi W. (2009).

Lovas, O. I. (1981). Teaching developmentally disabled children: The me

book. Baltimore: University Park Press. Cited in Target: Texas Guide For
Effective Teaching (2013)

Malott, R. & Trojan-Suarez, E. (2004) and (2006) Principles of Behaviour.

New Jersey: Pearson Prentice Hall. Cited in Cosgrave (2015)

Mitchell, M. & Jolley, J. (2001). Research Design Explained (4th Ed) New
York:Harcourt. As cited in Wikipedia. Available at:
https://en.wikipedia.org/wiki/External_validity

Myles, B. S., & Simpson, R. L. (2001). Understanding the hidden

curriculum: An essential social skill for children and youth with Asperger
syndrome. Intervention in School and Clinic, May 2001 ProQuest
Education Journals 36(5), pg. 279-286. DOI:
10.1177/105345120103600504

Paterson, C. R., & Arco, L. (2007). Using video modeling for generalizing
toy play in children with autism. Behavior Modification, 31, 660-681.
As cited in Anne S. , Peishi W. (2009).

Smith, T. (1993). Autism. In T. R. Giles (Ed.), Effective Psychotherapies (pp.

107 - 133). New York: Plenum. Cited in Smith, T. (2001) pg.86.

Smith, T. (2001). Discrete Trial training in The treatment of Autism. Focus on

autism and other developmental disabilities, Summer 2001; 16, 2;
ProQuest Education Journals pg. 86-92.

Smith, T. (2001). Discrete Trial training in The treatment of Autism.

Focus on autism and other developmental disabilities, 16, 86-92. DOI:
10.1177/108835760101600204. Cited in Cosgrave (2015)

Target: Texas Guide For Effective Teaching (2013). Discrete Trial Training
Available at: http://www.txautism.net/uploads/target/DTT.pdf
 Appendix A

Students' Responses