Implementing Pivotal Response Treatment to Teach Question Asking to High School Students with Autism Spectrum Disorder
Saved in:
| Title: | Implementing Pivotal Response Treatment to Teach Question Asking to High School Students with Autism Spectrum Disorder |
|---|---|
| Language: | English |
| Authors: | Jennifer S. Kowitt (ORCID |
| Source: | Journal of Autism and Developmental Disorders. 2025 55(9):3065-3077. |
| Availability: | Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ |
| Peer Reviewed: | Y |
| Page Count: | 13 |
| Publication Date: | 2025 |
| Document Type: | Journal Articles Reports - Research |
| Education Level: | High Schools Secondary Education |
| Descriptors: | Teaching Methods, Questioning Techniques, High School Students, Autism Spectrum Disorders, Behavior Modification, Program Implementation, Fidelity, Interpersonal Communication, Adolescents, Outcomes of Treatment |
| DOI: | 10.1007/s10803-024-06405-3 |
| ISSN: | 0162-3257 1573-3432 |
| Abstract: | The purpose of this study was to test the use of Pivotal Response Treatment (PRT) in the secondary school setting. There were two main goals: (a) to evaluate secondary education providers' ability to implement PRT with fidelity following a PRT training program; and (b) to evaluate the effects of school-implemented PRT on the social communication skills of adolescents and young adults with ASD, specifically, question-asking behavior. This concurrent multiple baseline design study across dyads investigated the use of PRT in the secondary school setting with adolescents with ASD. Specifically, it examined the impact of PRT on question-asking behavior. Education providers (n = 3) were trained to implement PRT with a secondary student with ASD. All education providers improved in their ability to use PRT strategies, though struggled with fidelity. Two students exhibited clear effects with noteworthy improvement in their use of targeted question initiations. For targeted question initiations, the weighted value for the Tau-U phase contrast between aggregated baseline and intervention phases was 0.80 and statistically significant (p < 0.0001). PRT is a promising approach to increasing question-asking behavior in secondary students with ASD when implemented by a trained education provider. Continued research should be a matter of priority in order to expand social skills instruction for adolescents with ASD with the hope of ultimately making a positive difference in adult outcomes. |
| Abstractor: | As Provided |
| Entry Date: | 2025 |
| Accession Number: | EJ1481032 |
| Database: | ERIC |
|
Full text is not displayed to guests.
Login for full access.
|
|
| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwF9jqQdJIZ1vePHxsAvOjNSAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDHTKaPFQiOLIWBGw3QIBEICBm-sf9R-Prmk99QI_Ex2fc0C3psJ1Ox1E_vnhdYkpR5ZjLH09ZKzRfNvmWbADMbJFBgh6NgP_E74yrWtTrzhAFLM16sQdjQAlQBdXlArHvVGi4WkxZ6hCUOSG5GIeTi939ofztk3NGr6dNNC-YHKb5AKZ2bMUv6mzYU1M62_jZt8OfIcXM6IrYYLX8Dw9_QImXq07m2nwnHjlvmrG Text: Availability: 1 Value: <anid>AN0187434587;aut01sep.25;2025Aug22.05:47;v2.2.500</anid> <title id="AN0187434587-1">Implementing Pivotal Response Treatment to Teach Question Asking to High School Students with Autism Spectrum Disorder </title> <p>The purpose of this study was to test the use of Pivotal Response Treatment (PRT) in the secondary school setting. There were two main goals: (a) to evaluate secondary education providers' ability to implement PRT with fidelity following a PRT training program; and (b) to evaluate the effects of school-implemented PRT on the social communication skills of adolescents and young adults with ASD, specifically, question-asking behavior. This concurrent multiple baseline design study across dyads investigated the use of PRT in the secondary school setting with adolescents with ASD. Specifically, it examined the impact of PRT on question-asking behavior. Education providers (n = 3) were trained to implement PRT with a secondary student with ASD. All education providers improved in their ability to use PRT strategies, though struggled with fidelity. Two students exhibited clear effects with noteworthy improvement in their use of targeted question initiations. For targeted question initiations, the weighted value for the Tau-U phase contrast between aggregated baseline and intervention phases was 0.80 and statistically significant (p &lt;.0001). PRT is a promising approach to increasing question-asking behavior in secondary students with ASD when implemented by a trained education provider. Continued research should be a matter of priority in order to expand social skills instruction for adolescents with ASD with the hope of ultimately making a positive difference in adult outcomes.</p> <p>Keywords: Pivotal response treatment; Autism; Adolescents; Question asking; High school; Education Specialist Studies In Education Psychology and Cognitive Sciences Psychology</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Autism Spectrum Disorder (ASD) is characterized by persistent impacts on social communication and interaction across contexts, resulting in significant challenges in social and educational arenas (American Psychiatric Association, [<reflink idref="bib1" id="ref1">1</reflink>]). One particular area of challenge for many people with ASD is question asking. Question asking has been long understood to play important functions in social conversation, including sustaining interactions and avoiding awkward pauses between conversation partners (Kearsley, [<reflink idref="bib16" id="ref2">16</reflink>]). Indeed, questions are at the heart of conversational dialogue, which is made up of initiations (e.g., questions), followed by responses (Doggett et al., [<reflink idref="bib7" id="ref3">7</reflink>]). However, from an early age, individuals with ASD present relatively few initiations including questions, and this absence has been observed to persist across the lifespan (Koegel &amp; Koegel, [<reflink idref="bib18" id="ref4">18</reflink>]; Taylor &amp; Harris, [<reflink idref="bib38" id="ref5">38</reflink>]). Lack of question asking can present a challenge for many people with ASD due to the important functions the behavior serves in human interaction.</p> <p>Instruction in social skills, such as question-asking behavior, is a priority for educators of students with ASD. The National Autism Center ([<reflink idref="bib27" id="ref6">27</reflink>]) cites interpersonal skills as one of the developmental skill areas that educators should target. Researchers have developed and evaluated a range of options for improving social skills for children with ASD; however, the majority of these focus on young children (Camargo et al., [<reflink idref="bib4" id="ref7">4</reflink>]). With age comes new social challenges and experiences. As individuals age, their social relationships become more complex and varied (Parker et al., [<reflink idref="bib30" id="ref8">30</reflink>]). For individuals with ASD already struggling with social skills, this complexity can create a particularly difficult adolescence (Odom et al., [<reflink idref="bib29" id="ref9">29</reflink>]). Teens with ASD experience more loneliness and have significantly poorer friendship quality than their typically developing peers (Locke et al., [<reflink idref="bib24" id="ref10">24</reflink>]).</p> <p>Difficulty with social skills can hinder transition to postsecondary education and employment, areas in which people with ASD have poor outcomes (Newman et al., [<reflink idref="bib28" id="ref11">28</reflink>]). Research suggests that 21st century employers require workers who communicate effectively and solve problems collaboratively (e.g., Jerald, [<reflink idref="bib14" id="ref12">14</reflink>]). In higher education, social skills challenges may make it hard for students to navigate new settings and develop relationships, decreasing the likelihood of postsecondary success (Mason et al., [<reflink idref="bib25" id="ref13">25</reflink>]). It is not surprising then that social skills performance has been found to be a stronger predictor of positive adult outcomes for people with ASD than even IQ (Howlin et al., [<reflink idref="bib12" id="ref14">12</reflink>]). As such, there is an immediate need to develop and test ways to teach social skills to secondary students with ASD.</p> <p>Pivotal Response Treatment (PRT) is a scientifically-based behavioral intervention that provides opportunities for learning within the context of the child with ASD's natural activities and environment (Koegel &amp; Koegel, [<reflink idref="bib17" id="ref15">17</reflink>]). PRT is based on the principles of Applied Behavior Analysis (ABA) and relies on antecedent strategies and reinforcement to change behavior, while capitalizing on an individual's natural motivations (Koegel &amp; Koegel, [<reflink idref="bib18" id="ref16">18</reflink>]). Using specific strategies (see Table 1), PRT targets pivotal behaviors, improvements in which perpetuate further opportunities for learning and reinforcement. A pivotal behavior is defined as "a behavior that, when learned, produces corresponding modifications or covariation in other untrained behaviors" (Cooper et al., [<reflink idref="bib6" id="ref17">6</reflink>], p. 701). For example, self-initiation (which includes question asking) is considered a pivotal behavior for children with ASD because improvement in this behavior also leads to improvements in vocabulary and language development (Koegel &amp; Koegel, [<reflink idref="bib18" id="ref18">18</reflink>]). Another key feature of PRT is the emphasis on intervention taking place in the natural environment or within the context of typical activities. For example, a clinician may set up opportunities to elicit target behaviors while playing games with the child and parents are often trained to implement PRT at home. PRT is considered an evidence-based practice by the National Professional Development Center on Autism Spectrum Disorder (Wong et al., [<reflink idref="bib44" id="ref19">44</reflink>]) and is one of the 11 treatments categorized as "established" – the highest rating – by the National Autism Center National Standards Project (2015). Extensive research has demonstrated the efficacy of PRT in promoting language and social communication development in children with ASD (e.g., Wong et al., [<reflink idref="bib44" id="ref20">44</reflink>]) and multiple studies have found that PRT can be used to increase the number of questions asked by children with ASD (e.g., Koegel et al., [<reflink idref="bib21" id="ref21">21</reflink>]).</p> <p>Table 1 PRT strategies, definitions, examples, and non-examples</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;PRT Strategy&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Definition&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Example(s)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Non-Example(s)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Child attending&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Implementer must have student's attention prior to presenting an opportunity.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Student looks in direction of implementer; student not engaged in activity independent of implementer.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Student is not looking at implementer.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Clear opportunity&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The discriminative stimulus is clear and appropriate to the task. The opportunity may be verbal or nonverbal.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Implementer asks a question that makes sense within the context of the activity; implementer holds all game pieces and student must ask for a piece to proceed with game.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The implementer abruptly changes the topic of conversation.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Child choice&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Implementer follows student's choice of activities, and incorporates student preferences.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Giving the student the choice between two board games to play.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Telling the student which activity they are going to do that day.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Interspersal of maintenance &amp; acquisition tasks&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Acquisition (new) tasks are interspersed with maintenance tasks (ones student already knows).&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Student is working on asking "where," but already knows "what" questions. While working on the former, implementer intersperses trials for (and reinforces successful attempts) of the latter.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Implementer only provides opportunities for the student to ask "where" questions.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Contingent reinforcement&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Reinforcement must be based on and immediately follow the student's behavior.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Giving student the piece to the board game immediately after the student has said, "where is my piece for the game?"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Student asks, "where is my game piece?" Implementer asks student what color the piece is before giving it.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Natural reinforcement&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Reinforcement should be directly related to the behavior.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Giving student the piece to the board game immediately after the student has said, "where is my piece for the game?"&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Student asks, "where is my game piece?" and receives candy as reinforcement.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Reinforcement of attempts&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Any goal-directed attempt to respond to a question or instruction should be reinforced, regardless of 100% accuracy.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Implementer says, "I saw a friend this week." Student responds, "Who did I see?" Student receives reinforcement although the sentence is not correct.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Implementer says, "I saw a friend." Student says, "Who did I see?" Implementer corrects student, does not provide reinforcement.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Note.</emph> Definitions from R. L. Koegel and Koegel ([<reflink idref="bib17" id="ref22">17</reflink>])</p> <p>However, an evidence-based practice is only so if it is used with the population on and in the setting in which it has been tested (Freeman et al., [<reflink idref="bib10" id="ref23">10</reflink>]); in addition, the implementer (e.g., clinician, teacher) plays a critical role as well. Practices cannot be assumed to yield benefits for all individuals under all conditions (Horner et al., [<reflink idref="bib11" id="ref24">11</reflink>]); rather, results must be replicated across new conditions, including setting, groups of students, and implementer (Schmidt, [<reflink idref="bib33" id="ref25">33</reflink>]). Research on PRT has taken place primarily in the clinical setting, implemented by the researcher/clinician, and parents have been trained to use PRT at home – both primarily with elementary-age students. Although the number of school-based studies is small, the results are encouraging: paraprofessionals and teachers can be trained to implement PRT, resulting in positive outcomes for elementary students with ASD (e.g., Feldman &amp; Matos, [<reflink idref="bib8" id="ref26">8</reflink>]). Brock et al. ([<reflink idref="bib3" id="ref27">3</reflink>]) found that education providers (i.e., teachers, paraprofessionals) could be trained to implement PRT at recess, significantly increasing interactions between students with ASD (ages 10–12 years) and their peers. The few studies examining the effects of PRT on adolescents/young adults with ASD, also yielded promising results (e.g., Mohammadzaheri et al., [<reflink idref="bib26" id="ref28">26</reflink>]); however, more research is necessary in this area.</p> <p>The purpose of this study was to test the use of PRT in the secondary school setting. There were two main goals: first, this study evaluated secondary education providers' ability to implement PRT with fidelity following a PRT training program. Second, the study evaluated the effects of school-implemented PRT on the social communication skills of adolescents and young adults with ASD, specifically, question-asking behavior. Thus, the research questions were:</p> <p></p> <ulist> <item> What is the effect of school-implemented PRT on target social communication goals in secondary students with ASD, specifically question asking?</item> <p></p> <item> Can education providers at the secondary level (e.g., special education teachers, paraprofessionals) be trained to implement PRT with fidelity?</item> </ulist> <hd id="AN0187434587-2">Method</hd> <p></p> <hd id="AN0187434587-3">Research Design</hd> <p>In keeping with prior research on school-implemented PRT that employed single case experimental designs (e.g., Feldman &amp; Matos, [<reflink idref="bib8" id="ref29">8</reflink>]), this study used a concurrent multiple baseline design across participant pairs made up of an education provider (EP) and a student. In this kind of design, introduction of the intervention is staggered across participants over time, and comparisons are made within and between phases and participants (Kratochwill et al., [<reflink idref="bib22" id="ref30">22</reflink>]).</p> <hd id="AN0187434587-4">Settings and Participants</hd> <p></p> <hd id="AN0187434587-5">Education Providers (EPs)</hd> <p>Three EPs participated in the study. To be eligible, an EP had to work currently with at least one student with a diagnosis of ASD aged 14–21 years in a public high school, a transition program within the school, or an external transition program run by the local education agency (LEA). EP A was a 46-year-old, female, Caucasian paraprofessional working in a high school. She had a college degree and 7 years of experience as a paraprofessional. She had no prior experience with PRT, but reported some informal experience with ABA while working as a paraprofessional in an elementary school. EP B was a 29-years-old, female, Caucasian special education teacher in a high school with 11 years total experience. She had her M.A. and B.A. in special education and some experience with ABA, having worked at an ABA-based school as a paraprofessional. She reported that her training in ABA was primarily "on-the-job," though she had taken one related workshop. She reported using some components of ABA in her current teaching. She had no prior experience with or training in PRT. EP C was a 49-year-old Caucasian male working as a paraprofessional in a transition program in the LEA. He had been in his current position for about 5 years. He had a graduate degree in education and experience working with students with disabilities as a substitute teacher, though no formal training in ABA or PRT.</p> <hd id="AN0187434587-6">Student Participants</hd> <p>Each EP worked one-on-one with a student for the duration of the study. To participate, a student had to: (a) have a diagnosis of ASD (established based on review of the student's individualized education program), (b) have an IQ of 50–100, (c) speak at a minimum in simple sentences, (d) be enrolled in a public secondary school, (e) be aged 14–21 years, and (f) be identified by their teacher as having difficulty independently asking basic questions. The student also had to work with an EP participating in the study. We obtained student information through file review and used available data to describe participants below.</p> <p>Student A was 14 years old. He worked with EP A for the duration of the study (i.e., Pair A). He attended a rural public high school where he spent one-third of his time in an inclusive setting and the rest of the time in a self-contained special education classroom. His standard full-scale score on the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV; Wechsler, [<reflink idref="bib41" id="ref31">41</reflink>]) was a 58. For the audio/video recorded sessions of this study, Pair A met in their typical self-contained classroom, private classroom, or school library.</p> <p>Student B was 18 years old. He worked with EP B for the duration of the study (i.e., Pair B). Student B attended a rural public high school where he spent 50% of his time in the resource room. He had a full-scale IQ of 73 on the Wechsler Adult Intelligence Scale– Fourth Edition (Wechsler, [<reflink idref="bib42" id="ref32">42</reflink>]). When taking the Comprehensive Assessment of Spoken Language (Carrow-Woolfolk, [<reflink idref="bib5" id="ref33">5</reflink>]), Student B struggled to request pertinent information and clarification. His oral language score on the Woodcock-Johnson Tests of Cognitive Abilities – 3rd Edition (Woodcock et al., [<reflink idref="bib45" id="ref34">45</reflink>]) was in the very low to low range. All of Pair B's video/audio recordings took place in the resource room where they typically met.</p> <p>Student C was 19 years old and worked with EP C (i.e., Pair C). He had a full-scale IQ of 58 on the WISC-IV (Wechsler, [<reflink idref="bib41" id="ref35">41</reflink>]). On the Vineland Adaptive Behavior Scales, 2nd Edition Teacher Rating Form (Sparrow et al., [<reflink idref="bib35" id="ref36">35</reflink>]), his teacher reported his adaptive use of communication and his daily function to be in the mild deficit range and his socialization score in the moderately low range. He received below average scores on the Expressive Vocabulary Test – Second Edition (Williams, [<reflink idref="bib43" id="ref37">43</reflink>]). Student C received his education in a fulltime transition program. Pair C's video/audio recorded sessions took place in his classroom, a private classroom, seating area adjacent to the classroom, or instructional kitchen.</p> <hd id="AN0187434587-7">Independent Variable</hd> <p>The independent variable was the PRT provided by the EP to the student. The effectiveness of PRT derives from its structures and strategies (Table 1), which are grounded in behavioral theory (Koegel &amp; Koegel, [<reflink idref="bib18" id="ref38">18</reflink>]; Koegel et al., [<reflink idref="bib19" id="ref39">19</reflink>]). In PRT, the implementer uses child-preferred materials or topics of conversation. Activities are varied regularly, and the implementer prompts the child to attempt a combination of both learned and acquisition (new) tasks. The implementer and child interact with the stimulus, and the stimulus serves a purpose within the interaction (e.g., craft supplies when working on a craft project together). Procedures take place within the context of this naturally occurring activity.</p> <p>The principal investigator (PI) trained EPs in PRT (see section below for details). After completing the didactic training, the EP participated in in-vivo video feedback training, during which they implemented PRT with the target student. During this portion of the training, the EP read aloud to the student a script for a lesson introducing the target question stem for that day (i.e., who, what, and where) and then led a PRT session. This session was video/audio recorded and the PI and EP automatically reviewed the recording of the day's session with the PI providing performance feedback. As a component of the training, the in-vivo video feedback training phase lasted for three sessions, rather than the five preferred for a distinct phase in multiple baseline design (Kratochwill et al., [<reflink idref="bib22" id="ref40">22</reflink>]). After completing training, each EP automatically moved into the intervention phase and implemented PRT with their student. Consistent with prior research (e.g., Feldman &amp; Matos, [<reflink idref="bib8" id="ref41">8</reflink>]), video coders coded the first 15 min of PRT in each session for EP's fidelity of PRT implementation, defined as demonstrating each PRT component (i.e., child choice, child attending, clear opportunity, contingent reinforcement, natural reinforcement, reinforcement of attempts, and interspersion of maintenance/acquisition tasks) in 80% of opportunities (Koegel &amp; Koegel, [<reflink idref="bib17" id="ref42">17</reflink>]). EPs received performance feedback during the intervention phase only when their fidelity of implementation fell below the 80% criterion for fidelity. Prior research on school-based PRT has considered mastery of components to be correct implementation of each component 80% of the session (Suhrheinrich &amp; Chan, [<reflink idref="bib36" id="ref43">36</reflink>]). We used the adapted version of the standard PRT fidelity of implementation scoring sheet (Koegel &amp; Koegel, [<reflink idref="bib17" id="ref44">17</reflink>]), which is considered more appropriate for adolescents (i.e., typically there are eight PRT strategies, but this sheet does not include the "multiple cues" strategy), and calculates fidelity by opportunity, rather than per minute. In this study, an opportunity was defined as (a) a direct question (e.g., "What crayon do you want?" followed by three seconds of wait time); (b) a declarative utterance (e.g., "I want you to tell me about your cat"); (c) a discrete comment (e.g., "I did something fun today," followed by three seconds of wait time); (d) or three or more seconds of wait time. If the EP implemented all seven PRT components listed above in a given opportunity, the opportunity was determined to have been executed with fidelity. Percent of opportunities with fidelity was calculated as number of opportunities with fidelity divided by total number of opportunities, multiplied by 100.</p> <hd id="AN0187434587-8">Dependent Variables</hd> <p>The primary dependent variable for the study was student use of targeted question initiations. The secondary dependent variable for students was use of untargeted question initiations. All tools used to document fidelity and outcome variables are available from the first author. Video coders counted the total number of targeted questions asked by the student within the first 15 min of recorded PRT. To be considered a target question initiation, the student had to ask a question that (a) began with one of the three target stems (i.e., who, what, or where), (b) made sense given the context of the interaction, and (c) was not modeled by the implementer. Student self-corrections were counted as correct use of a targeted question initiation.</p> <p>Video coders also recorded the total number of untargeted questions posed by the student to evaluate general improvements in question-asking. Untargeted Question Initiations were question types not taught as part of the intervention (i.e., questions <emph>not</emph> beginning with who, what, and where) and that made sense given the context of the interaction. For example, if the pair worked on a craft project and the student asked "How did you do that?," this question was considered an untargeted question initiation. In contrast, if given the same scenario, the student asked "what did you do?" or "do you like cats?" these questions were not considered untargeted question initiations because they began with a target stem or were off-topic, respectively.</p> <hd id="AN0187434587-9">Social Validity</hd> <p>At the end of the study, EPs completed a questionnaire about satisfaction with training, based on similar questionnaires used in previous studies about school-implemented PRT (Feldman &amp; Matos, [<reflink idref="bib8" id="ref45">8</reflink>]; Robinson, [<reflink idref="bib32" id="ref46">32</reflink>]). This consisted of five open-ended qualitative and eight Likert-style questions about the training and intervention. Ratings were provided on a 5-point Likert-style scale ranging from "1" (<emph>strongly disagree</emph>) to "5" (<emph>strongly agree</emph>).</p> <hd id="AN0187434587-10">Reliability</hd> <p>In keeping with the What Works Clearinghouse single-case design standards (Kratochwill et al., [<reflink idref="bib22" id="ref47">22</reflink>]), inter-observer agreement (IOA) was calculated for each pair at each phase for at least 20% of the data points. For this study, IOA was calculated for both dependent variables and PRT fidelity for 32% of total sessions. IOA between the PI and a trained secondary coder had to be 80% or higher (Kazdin, [<reflink idref="bib15" id="ref48">15</reflink>]); if IOA fell below 80%, the PI and secondary coder reviewed operational definitions and coded practice videos of PRT implementation until a criterion of 85% inter-rater reliability was reached. For the independent variable (i.e., fidelity of implementation per opportunity), IOA was computed using trial-by-trial IOA and for student behaviors, IOA was computed using the mean count-per-interval method (Cooper et al., [<reflink idref="bib6" id="ref49">6</reflink>]). IOA for targeted question initiations was high throughout the study with a mean of 99.4% in baseline (Range 93.3 − 100.0%), 97.2% in the video feedback training (Range 93.3 − 100.0%), and 100.0% in intervention. The average IOA for untargeted question initiations was 99.17% (Range 86.7 − 100.0%). IOA for EP behavior was also high; total IOA was 90.16% (Range 77.4 − 100.0%).</p> <hd id="AN0187434587-11">Procedures</hd> <p>The study used a multiple baseline design across pairs. The study consisted of a acclimation period to reduce potential reactivity, baseline, EP training in PRT, and intervention.</p> <hd id="AN0187434587-12">Acclimation Period to Reduce Potential Reactivity</hd> <p>Twice before data collection, we video/audio recorded each pair engaging in their typical activities for 15 min. The purpose of this period was to acclimate participants to recording and the researcher's presence. Pairs were informed of the purpose of these sessions and instructed to engage in their typical one-on-one activities.</p> <hd id="AN0187434587-13">Baseline Phase</hd> <p>Baseline data were collected 1–2 times each week during regular activities in which the education provider and the student typically interacted one-on-one. This included time devoted to academics, life skills, or social skills instruction. In keeping with prior studies, no instruction or feedback was provided during this phase, other than prompting the EP to interact with the student as they usually did. Fifteen-minute sessions were video/audio recorded and coded for student question-asking behaviors and EP use of PRT components.</p> <hd id="AN0187434587-14">Education Provider Training in PRT</hd> <p>Intervention did not begin until baseline data were stable for all participants (i.e., five or more data points without substantive trend; Horner et al., [<reflink idref="bib11" id="ref50">11</reflink>]). EPs were randomly assigned to the order in which they received training. EP A was the first to receive training after six stable baseline data points. In order to maintain continuous data collection, an additional baseline session was scheduled for immediately before the training session, during which Student A presented an atypically high number of untargeted question initiations. This outlying data point was in the direction of desired change, but was not identified until after training had commenced (i.e., the video was coded after the training, which immediately followed the final baseline session).</p> <p>The PI provided training in PRT to each EP individually. The PI was trained in PRT and met fidelity. She was trained and supervised by a licensed psychologist who herself was trained in PRT by faculty of the Koegel Autism Program. The PI had five years of experience working with individuals with autism (particularly adolescents and young adults) and training in behavioral theory and practice. She received close supervision from an expert in training clinicians in PRT. Prior to beginning, the PI reviewed the Educator Behavior Contract with EPs to remind them that for the study's duration, they could not share what they learned with other educators or use PRT with other students. Elements of the training came from prior studies in which EPs were trained to implement PRT in their school setting (e.g., Feldman &amp; Matos, [<reflink idref="bib8" id="ref51">8</reflink>]). During the didactic training, the PI met individually with EPs to introduce the main concepts of PRT, review a modified version of the manual <emph>How to Teach Pivotal Behaviors to Children with Autism: A Training Manual</emph> (Koegel et al., [<reflink idref="bib20" id="ref52">20</reflink>]), and teach setting up motivating activities. The trainer introduced each EP to the definitions of PRT components and discussed a handout containing definitions, examples, and non-examples of each component (available from first author upon request). EPs also watched and discussed video examples of PRT instruction. In addition, the PI introduced the three different types of targeted questions (i.e., <emph>what, where</emph>, and, <emph>who</emph> questions; Doggett et al., [<reflink idref="bib7" id="ref53">7</reflink>]) and reviewed scripts for mini-lessons about the three types of questions. In sum, the didactic training phase lasted approximately two hours per EP. During the in-vivo video feedback training phase, the EP and student worked together. The EP began the session by reading aloud the script for one of the three target questions mini-lessons and then implemented PRT, providing opportunities for the student to utilize the target question taught that day. The PI provided performance feedback after each session, reviewing video recording of the most recent session with the EP and providing specific praise for correct use of PRT strategies, performance-based corrective feedback for incorrect use, and suggestions for improvement. There were three in-vivo video feedback training sessions (one for each target question mini-lesson) before the EP automatically moved into the intervention phase.</p> <hd id="AN0187434587-15">Intervention Phase</hd> <p>After completing training, intervention took place 1–2 times per week. On average, these sessions lasted for 24.5 min (range 10.5–39.5 min). EPs implemented PRT with a focus on providing opportunities for students to ask the three types of target questions. Video/audio recordings of the first 15 min of PRT implementation were coded for dependent variables and monitored for fidelity of implementation. If fidelity fell below 80%, the PI provided performance feedback. At the completion of this phase, EPs completed a social validity survey. The intervention phase for Pair C was cut short (i.e., four sessions rather than five; Kratochwill, 2010) because of the end of the school year.</p> <hd id="AN0187434587-16">Data Analysis</hd> <p>We used visual analysis to analyze the data collected on student behaviors and fidelity of implementation with the purpose of determining a functional relation (Cooper et al., [<reflink idref="bib6" id="ref54">6</reflink>]; Kazdin, [<reflink idref="bib15" id="ref55">15</reflink>]). Specifically, visual analysis within conditions involved examination of the variability, level, and trend of the data, as well as the total number of data points. Visual analysis between conditions involved comparisons of the data's level, trend, and variability between different conditions and across participants. We conducted Tau-U analysis for targeted question initiations (i.e., the primary dependent variable only) using the Single Case Research™ web-based calculator (Vannest et al., [<reflink idref="bib40" id="ref56">40</reflink>]). Tau-U analysis takes into account non-overlap between phases as well as trend from within the intervention phase and controls for positive trend in the baseline data (Parker et al., [<reflink idref="bib31" id="ref57">31</reflink>]). Tau-U trend analysis was conducted for baseline before conducting Tau-U contrast analysis (Vannest &amp; Ninci, [<reflink idref="bib39" id="ref58">39</reflink>]). Finally, social validity was summarized using descriptive statistics and explicated with participants' qualitative feedback.</p> <hd id="AN0187434587-17">Results</hd> <p></p> <hd id="AN0187434587-18">Research Question 1: What is the Effect of School-Implemented PRT on Target Social Communicat...</hd> <p>Each observation session was coded for two student dependent variables: targeted question initiations and untargeted question initiations. Two rates were calculated based on the number of targeted and untargeted question initiations posed by the student per minutes of coded observation. The results for targeted question initiations are presented in Fig. 1 alongside the data for EP percentage of opportunities with PRT fidelity, to allow for examination of the primary dependent variable in the context of the fidelity of the independent variable. Figure 2 presents the data for untargeted question initiations.</p> <p>Graph: Fig. 1 Rate of student targeted question initiations and education provider percentage of opportunities with fidelity by session. Note. For Pair B, baseline data for student and EP overlaps at zero for all sessions</p> <p>Graph: Fig. 2 Rate of student untargeted question initiations by session</p> <hd id="AN0187434587-19">Targeted Question Initiations</hd> <p>The total number of targeted question initiations was divided by the total number of minutes coded to generate a rate of targeted question initiations (see Table 2). For all students, baseline targeted question initiation rate was low and stable, but increased in variability and level during intervention. Table 3 reports the individual and aggregate Tau-U trend and phase contrast analyses for targeted question initiations. Visual analysis of the baseline data for Student A suggested a slight positive trend, confirmed by Tau-U calculations (Tau-U = 0.10). We did not adjust for this because it was under 0.20 (Vannest &amp; Ninci, [<reflink idref="bib39" id="ref59">39</reflink>]). The weighted value for the Tau-U phase contrast between aggregated baseline and intervention phases was 0.80 and statistically significant (<emph>p</emph> &lt;.0001), indicating an 80% overall improvement between phases and during treatment (Parker et al., [<reflink idref="bib31" id="ref60">31</reflink>]).</p> <p>Table 2 Number of sessions, medians, and ranges for rate of targeted question initiations</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;p&gt;Number of sessions&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Median rate of targeted&lt;/p&gt;&lt;p&gt;question initiations&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Range&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;&lt;italic&gt;Baseline&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00-0.20&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.03&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00-0.20&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00-0.20&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;&lt;italic&gt;Video Feedback Training Phase&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.93-2.33&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.27&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.20-0.40&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.13&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07-0.60&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.40&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07-2.33&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;&lt;italic&gt;Intervention&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.20-2.27&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.73&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.33-0.93&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00-0.40&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.70&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00-2.27&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>Table 3 Tau-U trend and phase contrast results for student targeted question initiations</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Participant&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Baseline Trend&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;Baseline vs. Intervention Contrast&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Tau-U&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Tau-U&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;&lt;italic&gt;p&lt;/italic&gt;-value&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.94&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.007&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.45&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.163&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Weighted Aggregate&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.80&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Note</emph> "*" denotes Tau-U phase contrast analysis conducted with corrected video feedback trend due to high positive Tau results during initial trend analysis, as reported in column three</p> <hd id="AN0187434587-20">Untargeted Question Initiations</hd> <p>Video coders recorded the total number of untargeted questions posed by the student to evaluate general improvements in the skill of question-asking. Table 4 reports descriptive statistics for untargeted question initiations. Across participants, the median rate of untargeted question initiations was zero at baseline (Range 0.00–1.00). The overall median rate increased during the intervention phase (<emph>Mdn</emph> = 0.53, Range 0.00–1.82).</p> <p>Table 4 Number of sessions, medians, and ranges for untargeted question initiations</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;p&gt;Number of sessions&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Median&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Range&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;&lt;italic&gt;Baseline&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.27&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;1.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;0.40&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;1.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;&lt;italic&gt;Video Feedback Training Phase&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.62&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.60&amp;#8211;1.07&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;1.13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;0.13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.13&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;1.13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;&lt;italic&gt;Intervention&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.07&amp;#8211;1.82&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.53&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;1.73&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Student C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.17&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.07&amp;#8211;0.47&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.53&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&amp;#8211;1.82&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <hd id="AN0187434587-21">Research Question 2: Can Education Providers at the Secondary Level be Trained to Implement P...</hd> <p>Percentage of opportunities with fidelity was calculated as the number of opportunities implemented with fidelity divided by the total number of opportunities in the session. Figure 1 shows the results alongside the corresponding rate of targeted question initiations. Table 5 presents descriptive statistics by individual EP, as well as aggregated results. All EPs exhibited low levels of fidelity of PRT implementation at baseline. Overall, the median percentage of opportunities with fidelity increased from baseline (<emph>Mdn =</emph> 7.83%, Range 0.00 − 33.33%) to intervention (<emph>Mdn</emph> = 59.16%, Range 24.71 − 89.36%). However, the overall median score never reached the 80% criterion for fidelity (i.e., 80% of opportunities in utilizing all seven PRT strategies). During the intervention phase, only EP B implemented with fidelity, reaching the target criterion four out of seven times. While the remaining EPs never achieved the 80% criterion, their levels of fidelity increased during video feedback training, and for EP C, continued to increase in the intervention phase (<emph>Mdn</emph> = 52.33%, Range 40.96 – 60.42%). Due to their low levels of fidelity, EP A and EP C received performance feedback before each session in the intervention phase. While EP A participated in seven baseline sessions, upon review, one of the video/audio recordings was inaudible for the EP (Student A was audible). As such, this video was not coded for PRT fidelity and only six baseline sessions were considered in the visual and statistical analyses.</p> <p>Table 5 Number of sessions, medians, minimum, and maximum values for percentage of opportunities with education provider prt fidelity of implementation</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;p&gt;Number of Sessions&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Median&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Minimum&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Maximum&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;&lt;italic&gt;Baseline&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6.89&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27.59&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.05&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;33.33&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7.83&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;33.33&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;&lt;italic&gt;Video Feedback Training&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;45.57&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;33.33&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;51.43&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27.42&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;73.21&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38.10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29.31&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;50.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38.10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;73.21&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;&lt;italic&gt;Intervention&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28.57&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.71&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;57.89&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider B&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;81.82&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;64.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;89.36&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Education Provider C&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;52.33&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;40.96&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;60.42&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;59.16&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.71&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;89.36&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <hd id="AN0187434587-22">Social Validity</hd> <p>At the end of the study, EPs anonymously completed the "<emph>Implementer Satisfaction Questionnaire</emph>;" Table 6 presents the results from the Likert-style questions. In responding to the open-ended questions, all EPs reported that modeling was the most useful part of training and that no aspects of the training were unhelpful. When asked for suggestions to improve training, one EP said they wanted more modeling; two EPs did not have suggestions. EPs were asked to report their concerns regarding the techniques they had learned: one wanted more time to master PRT and another expressed concern about how PRT would work in settings with multiple students. EPs were invited to share any other thoughts. One wrote:I am thrilled that I had an opportunity to be introduced to PRT. I also feel the training I received was conducive to an engaging, comfortable, and informative experience. I was in a position where I felt very comfortable to ask questions and make mistakes</p> <p>Table 6 Implementer satisfaction questionnaire means and standard deviations</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;p&gt;Mean&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Standard Deviation&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I feel satisfied with the training I received as part of this study.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.67&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.58&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;The strategies I learned benefited my assigned student.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.67&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.58&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I enjoyed using these strategies with my student.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.67&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.58&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I will continue to use these strategies with my student.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.67&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.58&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I will use these strategies in the future with other students.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I felt comfortable being video recorded as part of the study.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I felt comfortable receiving feedback on my use of the strategies.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;I would recommend this training to others.&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.00&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <hd id="AN0187434587-23">Discussion</hd> <p>Evidence-based practices to teach social skills to students with ASD, such as PRT, often take place in clinical settings and are targeted towards elementary-age children (e.g., Suhreinrich et al., 2013). This presents two opportunities for expanding their use. First, access to evidence-based practices is limited when they are available only through clinics; only people who live near or have access to clinical resources are able to participate. When practices are made available through public schools, more people can receive their potential benefits. This is particularly true in rural areas, in which families are less able to access services due to geographic barriers and thus rely on school-based social skills interventions for youth with ASD (Antezana et al., [<reflink idref="bib2" id="ref61">2</reflink>]). Additionally, research consistently demonstrates advantages that come with intervention taking place in natural environments, which increases the likelihood of generalization and maintenance (Forgan &amp; Jones, [<reflink idref="bib9" id="ref62">9</reflink>]). As such, it is important to bring effective practices into schools where they can be accessed by more people. PRT is a practice with an established evidence base in clinics, which has not been sufficiently tested in secondary schools. The efficacy of evidence-based practices must be tested across different conditions, including setting, target audience, and implementer (Horner et al., [<reflink idref="bib11" id="ref63">11</reflink>]; Schmidt, [<reflink idref="bib33" id="ref64">33</reflink>]). This study expanded the use of PRT by both bringing it to the secondary setting and training educators already in schools to implement PRT. While only one EP was able to reach the requisite level of fidelity of implementation, all educators responded to the training and increased their use of key strategies to support the development of question-asking in their students. This study shows that EPs can improve in their ability to implement PRT after a brief training package conducted in the school setting, but may need more support, particularly if this is their first exposure to behavioral methodologies. In their examination of classroom-based PRT, Suhrheinrich and Chan ([<reflink idref="bib36" id="ref65">36</reflink>]) found that teachers had higher fidelity of implementation than paraprofessionals. They noted it makes sense that EPs with more education and prior training would find it easier to learn a new related skill; in this study, we found similar patterns suggesting paraprofessionals may need more intensive training to implement PRT with fidelity. The variation in fidelity found in this study is consistent with prior research on teacher-implemented PRT, which found teachers skilled at using some PRT components but struggling to implement others (Suhrheinrich et al., [<reflink idref="bib37" id="ref66">37</reflink>]). Through the "<emph>Implementer Satisfaction Questionnaire</emph>," EPs indicated that modelling would be helpful and this should be incorporated into future studies to test a more rigorous training package. Visual analysis and descriptive statistics suggest that EPs improved in their ability to implement PRT as a result of the training they received; there was a clear pattern between the staggered introduction of training and improvement in PRT fidelity. Analysis further suggests that most change took place after the didactic training, although the in-vivo video feedback training contributed to improvements in fidelity; all three EPs achieved their high score after video feedback training suggesting that both components of the training contributed to the observed effects. All participant educators reported that they found the training useful and informative.</p> <p>Second, children with ASD grow into adolescents and young adults with ASD who need support navigating new experiences associated with this unique time in life. College and career readiness, success in the workplace and postsecondary education, and community inclusion hinge on the ability to navigate social arenas. Unfortunately, many adolescents and young adults experience a decrease in supports and services just as they are entering this complex phase (Laxman et al., [<reflink idref="bib23" id="ref67">23</reflink>]). As such, there is an immediate need to develop and test ways to teach social skills to adolescents with ASD in the public-school setting. We must continue to provide adolescents and young adults with ASD opportunities to build their social skills, but cannot assume that evidence-based practices that were effective in younger years will be effective later in life (Freeman et al., [<reflink idref="bib10" id="ref68">10</reflink>]). This study demonstrated that educator-implemented PRT can increase question-asking behavior in secondary students with ASD. Even though EPs struggled to implement PRT with fidelity, their use of some component strategies resulted in an increase in question-asking behavior across all students. The large effect size (TAU-U = 0.80, <emph>p</emph> &lt;.001) indicates the potential for PRT to result in statistically significant and practically meaningful increases in students' use of targeted question initiations. Similarly, changes in untargeted question initiations in two of the three students suggests the potential for students to generalize question-asking skills learned through PRT to a broader of set of questions.</p> <p>Student behavior must be interpreted through the lens of variability in the independent variable during the intervention phase (i.e., EPs did not always implement PRT with fidelity). Across pairs, as EP behavior changed, so did student behavior. The patterns of behavior change differed across pairs. For Pair A, student variability matched variability in fidelity. In Pair C, student behavior did not mirror that of PRT fidelity. However, as EP C slowly started to implement PRT, there was an indication of change in Student C's behavior. When EP B implemented PRT with fidelity, Student B exhibited a correspondingly stable, higher level of target question initiations per minute. These individual patterns show promise for the use of PRT in the secondary setting with students with ASD; each relationship demonstrates impact on an important student behavior, even when EPs implemented only some PRT strategies. These relationships demonstrate the need for more research into school-based PRT for secondary students with ASD.</p> <hd id="AN0187434587-24">Limitations</hd> <p>An important limitation of this study has to do with the collection of social validity data; we only collected this data from EPs and future studies should explore the acceptability of the intervention from the perspective of student participants. The decision to use a range of implementers was deliberately made to accommodate the structures of real school settings and reflects a primary goal of the study: to bring PRT into schools in a way that is useful to teachers, and realistic for the unique structure of secondary school environments. However, the heterogeneity of EPs is also a limitation and impacts interpretation of the results. The diversity of professional roles and educational backgrounds presents a threat to internal validity (Shadish et al., [<reflink idref="bib34" id="ref69">34</reflink>]), making it challenging to draw conclusions about why they responded differently to training. Specifically, only EP B entered the study with experience with ABA and was the only educator to achieve the 80% criterion for fidelity. Several challenges also centered around the setting. Extraneous variance in the experimental setting is a reality in schools and this threat to statistical conclusion validity must be considered when interpreting results (Shadish et al., [<reflink idref="bib34" id="ref70">34</reflink>]). Missed data collections and session interruptions due to school breaks, absences, students having challenging days, and snow days interfered with continuous assessment, which is an important requirement for single-case designs (Kazdin, [<reflink idref="bib15" id="ref71">15</reflink>]). The study concluded with the end of the school year; Pair C was only able to complete four intervention sessions by this time. Importantly, implementation in the classroom setting should be considered a strength of this study. While descriptive statistics indicate an increase in Student C's use of questions, these gains were not statistically significant; additional sessions during the intervention phase for Pair C may have clarified the positive trend. Finally, only one EP was able to implement PRT at the 80% criterion necessary for fidelity and therefore the independent variable was not consistently implemented with fidelity. This impacts the ability to draw conclusions about the effect of the independent variable and leaves the door open for future research.</p> <hd id="AN0187434587-25">Implications for Practice and Research</hd> <p>Schools are federally mandated to use evidence-based practices to the greatest extent possible (Individuals with Disabilities Education Improvement Act, 2004). Unfortunately, options are limited for educators seeking evidence-based practices to teach social skills to secondary students with ASD. The results of this study suggest that when implemented in secondary schools, PRT may help adolescents with ASD develop a critical social skill (i.e., question asking). Additionally, this study suggests that secondary EPs who participate in a brief training package can improve their use of PRT strategies. This training can be implemented in a range of secondary settings (i.e., a typical high school, an external transition program) in a way that accommodates the complex scheduling needs of schooling at this level. Importantly, the results further suggest that 80% fidelity is not necessary for measurable changes to occur with student outcomes.</p> <p>Little research on PRT has included older students in its sample. This study contributes to the literature by testing the intervention with adolescents with ASD. The results suggest that adolescent students with ASD may respond positively to PRT. This study further contributes to a line of research that has highlighted the challenges of bringing evidence-based practices from elementary and middle school settings into high schools (e.g., Freeman et al., [<reflink idref="bib10" id="ref72">10</reflink>]). Future research should narrow the sample by including only paraprofessionals or only special education teachers, for example, potentially clarifying why training may be effective for some EPs and not for others. Future research should also consider additional supports for EPs who struggle to achieve the criterion for fidelity. EP B's success indicates that some deeper knowledge of ABA may contribute to fidelity and studies should explore incorporating instruction in this area in the training package. EPs reported their preference for modelling and future studies should also incorporate more opportunities for modelling in the training. In addition, examination of which PRT strategies are most likely to be implemented correctly by EPs might illuminate which components require more targeted training and which might be more integral in increasing question asking in students. Finally, the present study ended with the conclusion of the academic year; future research should examine maintenance and generalization.</p> <hd id="AN0187434587-26">Conclusion</hd> <p>Individuals with ASD struggle with social communication and interaction, one element of which is question asking. In addition, adults with ASD have poor outcomes in critical areas such as independent living, postsecondary education, and employment, all of which require social interaction for success. PRT is an evidence-based practice that has been found to effectively increase question-asking behavior but has most often been tested in clinical settings and with young children with ASD. This study suggests promise in the use of PRT with adolescents in secondary schools when implemented by education providers. Continued research in this area should be a matter of priority in order to better understand how to improve social interaction and communication in adolescents with ASD with the hope of ultimately improving adult outcomes.</p> <hd id="AN0187434587-27">Funding</hd> <p>This work was supported by a Doctoral Dissertation Fellowship from the Graduate School, University of Connecticut, Storrs, CT.</p> <hd id="AN0187434587-28">Declarations</hd> <p></p> <hd id="AN0187434587-29">Ethical Approval</hd> <p>All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Institutional Review Board at a large Northeastern public university.</p> <hd id="AN0187434587-30">Consent to Participate and Publish</hd> <p>Informed consent was obtained from education providers and the legal guardians of students who participated in the study; the signed consent form informed participants and legal guardians that researchers may publish findings after completing the study. Verbal assent to participate was obtained from student participants.</p> <hd id="AN0187434587-31">Competing Interest</hd> <p>The authors have no financial or proprietary interests in any material discussed in this article.</p> <hd id="AN0187434587-32">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0187434587-33"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). American Psychiatric Association Publishing.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref61" type="bt">2</bibl> <bibtext> Antezana L, Scarpa A, Valdespino A, Albright J, Richey JA. Rural trends in diagnosis and services for Autism Spectrum Disorder. Frontiers in Psychology. 2017; 8: 590. 10.3389/fpsyg.2017.00590. 28473784. 5397491</bibtext> </blist> <blist> <bibl id="bib3" idref="ref27" type="bt">3</bibl> <bibtext> Brock, M. E, Dueker, S. A, &amp; Barczak, M. A. (2017). Brief report: Improving social outcomes for students with autism at recess through peer-mediated pivotal response training. Journal of Autism and Developmental Disorders. Advance online publication. https://doi.org/10.1007/s10803-017-3435-3.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref7" type="bt">4</bibl> <bibtext> Camargo S, Rispoli M, Ganz J, Hong E, Davis H, Mason R. Behaviorally based interventions for teaching social interaction skills to children with ASD in inclusive settings: A meta-analysis. Journal of Behavioral Education. 2016; 25: 223-248. 10.1007/s10864-015-9240-1</bibtext> </blist> <blist> <bibl id="bib5" idref="ref33" type="bt">5</bibl> <bibtext> Carrow-Woolfolk, E. (1999). CASL: Comprehensive Assessment of Spoken Language. American Guidance Services.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref17" type="bt">6</bibl> <bibtext> Cooper, J. O, Heron, T. E, &amp; Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Pearson/Merrill-Prentice Hall.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref3" type="bt">7</bibl> <bibtext> Doggett RA, Krasno AM, Koegel LK, Koegel RL. Acquisition of multiple questions in the context of social conversation in children with autism. Journal of Autism and Developmental Disorders. 2013; 43: 2015-2025. 10.1007/s10803-012-1749-8. 23292139. 3631576</bibtext> </blist> <blist> <bibl id="bib8" idref="ref26" type="bt">8</bibl> <bibtext> Feldman E, Matos R. Training paraprofessionals to facilitate social interactions between children with autism and their typically developing peers. Journal of Positive Behavior Interventions. 2013; 15: 169-179</bibtext> </blist> <blist> <bibl id="bib9" idref="ref62" type="bt">9</bibl> <bibtext> Forgan JW, Jones CD. How experiential activities can improve children's social skills. TEACHING Exceptional Children. 2002; 34: 52-58</bibtext> </blist> <blist> <bibtext> Freeman, J, Kowitt, J, Simonsen, B, Yan, W, Dooley, K, Gordon, L, &amp; Maddock, E. (2018). A high school replication of targeted professional development for classroom management. Remedial and Special Education, 39, 144–157. https://doi.org/10.1177/0741932517719547</bibtext> </blist> <blist> <bibtext> Horner RH, Carr EG, Halle J, McGee G, Odom S, Wolery M. The use of single-subject research to identify evidence-based practice in special education. Exceptional Children. 2005; 71: 165-179</bibtext> </blist> <blist> <bibtext> Howlin P, Moss P, Savage S, Rutter M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. Journal of the American Academy of Child and Adolescent Psychiatry. 2013; 52: 572-581. 10.1016/j.jaac.2013.02.017. 23702446</bibtext> </blist> <blist> <bibtext> Individuals with Disabilities Education Act of (2004). 20 U.S.C, § 1400 et seq</bibtext> </blist> <blist> <bibtext> Jerald, C. (2009). Defining a 21st century education The Center for Public Education. Retrieved from <ulink href="http://www.centerforpubliceducation.org/Main-Menu/Policies/21st-Century/Defining-a-21st-Century-Education-Full-report-PDF.pdf">http://www.centerforpubliceducation.org/Main-Menu/Policies/21st-Century/Defining-a-21st-Century-Education-Full-report-PDF.pdf</ulink>.</bibtext> </blist> <blist> <bibtext> Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). Oxford University Press.</bibtext> </blist> <blist> <bibtext> Kearsley GP. Questions and question asking in verbal discourse: A cross-disciplinary review. Journal of Psycholinguistic Research. 1976; 5: 355-375</bibtext> </blist> <blist> <bibtext> Koegel, R. L, &amp; Koegel, L. K. (2006). Pivotal response treatments for Autism: Communication, social and academic development. Paul H. Brookes Publishing Co.</bibtext> </blist> <blist> <bibtext> Koegel, R. L, &amp; Koegel, L. K. (2012). The PRT pocket guide: Pivotal response treatment for Autism Spectrum Disorder. Paul H. Brookes Publishing Co.</bibtext> </blist> <blist> <bibtext> Koegel RL, O'Dell MC, Koegel LK. A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders. 1987; 17: 187-200. 3610995</bibtext> </blist> <blist> <bibtext> Koegel, R. L, Schreibman, L, Good, A, Cerniglia, L, Murphy, C, &amp; Koegel, L. (1989). How to teach pivotal behaviors to children with autism: A training manual. University of California.</bibtext> </blist> <blist> <bibtext> Koegel RL, Bradshaw JL, Ashbaugh K, Koegel LK. Improving question-asking initiations in young children with autism using Pivotal Response Treatment. Journal of Autism and Developmental Disorders. 2014; 44: 816-827. 10.1007/s10803-013-1932-6. 24014174. 3949143</bibtext> </blist> <blist> <bibtext> Kratochwill, T. R, Hitchcock, J, Horner, R. H, Levin, J. R, Odom, S. L, Rindskopf, D. M, &amp; Shadish, W. R. (2010). Single-case designs technical documentation. Retrieved from What Works Clearinghouse website: https://ies.ed.gov/ncee/WWC/Docs/ReferenceResources/wwc_scd.pdf.</bibtext> </blist> <blist> <bibtext> Laxman DJ, Taylor JL, DaWalt LS, Greenberg JS, Mailick MR. Loss in services precedes high school exit for teens with autism spectrum disorder: A longitudinal study. Autism Research. 2019; 12: 911-921. 31033222. 6546537</bibtext> </blist> <blist> <bibtext> Locke J, Ishijima EH, Kasari C, London N. Loneliness, friendship quality and the social networks of adolescents with high-functioning autism in an inclusive school setting. Journal of Research in Special Educational Needs. 2010; 10: 74-81. 10.1111/j.1471-3802.2010.01148.x</bibtext> </blist> <blist> <bibtext> Mason RA, Rispoli M, Ganz JB, Boles MB, Orr K. Effects of video modeling on communicative social skills of college students with Asperger Syndrome. Developmental Neurorehabilitation. 2012; 15: 425-434. 10.3109/17518423.2012.704530. 23030681</bibtext> </blist> <blist> <bibtext> Mohammadzaheri F, Koegel LK, Rezaee M, Rafiee SM. A randomized clinical trial comparison between pivotal response treatment (PRT) and structured Applied Behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders. 2014; 44: 2769-2777. 10.1007/s10803-014-2137-3. 24840596. 4194254</bibtext> </blist> <blist> <bibtext> National Autism Center (2015). Findings and conclusions: National standards project, phase 2. Retrieved from <ulink href="http://www.nationalautismcenter.org">http://www.nationalautismcenter.org</ulink>.</bibtext> </blist> <blist> <bibtext> Newman, L, Wagner, M, Knokey, A. M, Marder, C, Nagle, K, Shaver, D, Wei, X, with, Cameto, R, Contreras, E, Ferguson, K, Greene, S, &amp; Schwarting, M. (2011). The post-high school outcomes of young adults with disabilities up to 8 Years after high school. A Report from the National Longitudinal Transition Study-2 (NLTS2) (NCSER 2011–3005). SRI International.</bibtext> </blist> <blist> <bibtext> Odom SL, Duda MA, Kucharczyk S, Cox AW, Stabel A. Applying an implementation science framework for adoption of a comprehensive program for high school students with Autism Spectrum Disorder. Remedial and Special Education. 2014; 35: 123-132</bibtext> </blist> <blist> <bibtext> Parker, J. G, Rubin, K. H, Erath, S. A, Wojslawowicz, J. C, &amp; Buskirk, A. A. (2006). Peer relationships, child development, and adjustment: A developmental psychopathology perspective. In D. Cicchetti, &amp; D. J. Cohen (Eds.), Developmental psychopathology, Vol. 1: Theory and method (2nd ed, pp. 419–493). John Wiley.</bibtext> </blist> <blist> <bibtext> Parker RI, Vannest KJ, Davis JL, Sauber SB. Combining nonoverlap and trend for single-case research: Tau-U. Behavior Therapy. 2011; 42: 284-299. 10.1016/j.beth.2010.08.006. 21496513</bibtext> </blist> <blist> <bibtext> Robinson S. Teaching paraprofessionals of students with autism to implement Pivotal Response Treatment in inclusive school settings using a brief video feedback training package. Focus on Autism and Other Developmental Disabilities. 2011; 26: 105-118</bibtext> </blist> <blist> <bibtext> Schmidt S. Shall we really do it again? The powerful concept of replication is neglected in the social sciences. Review of General Psychology. 2009; 13: 90-100</bibtext> </blist> <blist> <bibtext> Shadish, W. R, Cook, T. D, &amp; Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Wadsworth Cengage Learning.</bibtext> </blist> <blist> <bibtext> Sparrow, S. S, Cicchetti, D. V, &amp; Balla, D. A. (2005). Vineland Adaptive Behavior scales (2nd ed). American Guidance Service.</bibtext> </blist> <blist> <bibtext> Suhrheinrich J, Chan J. Exploring the Effect of Immediate Video Feedback on Coaching. Journal of Special Education Technology. 2017; 32; 1: 47-53. 10.1177/0162643416681163</bibtext> </blist> <blist> <bibtext> Suhrheinrich J, Stahmer AC, Reed S, Schreibman L, Reisinger E, Mandell D. Implementation challenges in translating pivotal response training into community settings. Journal of Autism and Developmental Disorders. 2013; 43: 2970-2976. 23619949</bibtext> </blist> <blist> <bibtext> Taylor BA, Harris SL. Teaching children with autism to seek information: Acquisition of novel information and generalization of responding. Journal of Applied Behavior Analysis. 1995; 28: 3-14. 7706148. 1279781</bibtext> </blist> <blist> <bibtext> Vannest K, Ninci J. Evaluating intervention effects in single-case research designs. Journal of Counseling and Development. 2015; 93: 403-411</bibtext> </blist> <blist> <bibtext> Vannest, K. J, Parker, R. I, Gonen, O, &amp; Adiguzel, T. (2016). Single case research: Web based calculators for SCR analysis. (Version 2.0) [Web-based application]. Texas A&amp;M University. Retrieved from singlecaseresearch.org.</bibtext> </blist> <blist> <bibtext> Wechsler, D. (2003). Wechsler Intelligence Scale for Children – Fourth Edition. Pearson Education Inc.</bibtext> </blist> <blist> <bibtext> Wechsler, D. (2008). Wechsler Adult Intelligence Scale– Fourth Edition (WAIS–IV). NCS Pearson.</bibtext> </blist> <blist> <bibtext> Williams, K. T. (2007). Expressive vocabulary test (2nd ed.). Pearson.</bibtext> </blist> <blist> <bibtext> Wong, C, Odom, S. L, Hume, K, Cox, A. W, Fettig, A, Kucharczyk, S, &amp; Schultz, T. R. (2014). Evidence-based practices for children, youth, and young adults with Autism Spectrum Disorder The University of North Carolina, Frank Porter Graham Child Development Institute, Autism Evidence-Based Practice Review Group. Retrieved from <ulink href="http://autismpdc.fpg.unc.edu">http://autismpdc.fpg.unc.edu</ulink>.</bibtext> </blist> <blist> <bibtext> Woodcock, R. W, McGrew, K. S, &amp; Mather, N. (2001). Woodcock– Johnson III tests of cognitive abilities. Riverside.</bibtext> </blist> </ref> <aug> <p>By Jennifer S. Kowitt; Joseph Madaus; Brandi Simonsen; Jennifer Freeman; Allison Lombardi and Pamela Ventola</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib16" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib18" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib38" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib27" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib30" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib29" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib24" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib28" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib25" firstref="ref13"></nolink> <nolink nlid="nl11" bibid="bib12" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib17" firstref="ref15"></nolink> <nolink nlid="nl13" bibid="bib44" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib21" firstref="ref21"></nolink> <nolink nlid="nl15" bibid="bib10" firstref="ref23"></nolink> <nolink nlid="nl16" bibid="bib11" firstref="ref24"></nolink> <nolink nlid="nl17" bibid="bib33" firstref="ref25"></nolink> <nolink nlid="nl18" bibid="bib26" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib22" firstref="ref30"></nolink> <nolink nlid="nl20" bibid="bib41" firstref="ref31"></nolink> <nolink nlid="nl21" bibid="bib42" firstref="ref32"></nolink> <nolink nlid="nl22" bibid="bib45" firstref="ref34"></nolink> <nolink nlid="nl23" bibid="bib35" firstref="ref36"></nolink> <nolink nlid="nl24" bibid="bib43" firstref="ref37"></nolink> <nolink nlid="nl25" bibid="bib19" firstref="ref39"></nolink> <nolink nlid="nl26" bibid="bib36" firstref="ref43"></nolink> <nolink nlid="nl27" bibid="bib32" firstref="ref46"></nolink> <nolink nlid="nl28" bibid="bib15" firstref="ref48"></nolink> <nolink nlid="nl29" bibid="bib20" firstref="ref52"></nolink> <nolink nlid="nl30" bibid="bib40" firstref="ref56"></nolink> <nolink nlid="nl31" bibid="bib31" firstref="ref57"></nolink> <nolink nlid="nl32" bibid="bib39" firstref="ref58"></nolink> <nolink nlid="nl33" bibid="bib37" firstref="ref66"></nolink> <nolink nlid="nl34" bibid="bib23" firstref="ref67"></nolink> <nolink nlid="nl35" bibid="bib34" firstref="ref69"></nolink> |
|---|---|
| Header | DbId: eric DbLabel: ERIC An: EJ1481032 AccessLevel: 3 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
| IllustrationInfo | |
| Items | – Name: Title Label: Title Group: Ti Data: Implementing Pivotal Response Treatment to Teach Question Asking to High School Students with Autism Spectrum Disorder – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Jennifer+S%2E+Kowitt%22">Jennifer S. Kowitt</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-8460-7237">0000-0001-8460-7237</externalLink>)<br /><searchLink fieldCode="AR" term="%22Joseph+Madaus%22">Joseph Madaus</searchLink><br /><searchLink fieldCode="AR" term="%22Brandi+Simonsen%22">Brandi Simonsen</searchLink><br /><searchLink fieldCode="AR" term="%22Jennifer+Freeman%22">Jennifer Freeman</searchLink><br /><searchLink fieldCode="AR" term="%22Allison+Lombardi%22">Allison Lombardi</searchLink><br /><searchLink fieldCode="AR" term="%22Pamela+Ventola%22">Pamela Ventola</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(9):3065-3077. – Name: Avail Label: Availability Group: Avail Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 13 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Audience Label: Education Level Group: Audnce Data: <searchLink fieldCode="EL" term="%22High+Schools%22">High Schools</searchLink><br /><searchLink fieldCode="EL" term="%22Secondary+Education%22">Secondary Education</searchLink> – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Teaching+Methods%22">Teaching Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Questioning+Techniques%22">Questioning Techniques</searchLink><br /><searchLink fieldCode="DE" term="%22High+School+Students%22">High School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Fidelity%22">Fidelity</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s10803-024-06405-3 – Name: ISSN Label: ISSN Group: ISSN Data: 0162-3257<br />1573-3432 – Name: Abstract Label: Abstract Group: Ab Data: The purpose of this study was to test the use of Pivotal Response Treatment (PRT) in the secondary school setting. There were two main goals: (a) to evaluate secondary education providers' ability to implement PRT with fidelity following a PRT training program; and (b) to evaluate the effects of school-implemented PRT on the social communication skills of adolescents and young adults with ASD, specifically, question-asking behavior. This concurrent multiple baseline design study across dyads investigated the use of PRT in the secondary school setting with adolescents with ASD. Specifically, it examined the impact of PRT on question-asking behavior. Education providers (n = 3) were trained to implement PRT with a secondary student with ASD. All education providers improved in their ability to use PRT strategies, though struggled with fidelity. Two students exhibited clear effects with noteworthy improvement in their use of targeted question initiations. For targeted question initiations, the weighted value for the Tau-U phase contrast between aggregated baseline and intervention phases was 0.80 and statistically significant (p < 0.0001). PRT is a promising approach to increasing question-asking behavior in secondary students with ASD when implemented by a trained education provider. Continued research should be a matter of priority in order to expand social skills instruction for adolescents with ASD with the hope of ultimately making a positive difference in adult outcomes. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2025 – Name: AN Label: Accession Number Group: ID Data: EJ1481032 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1481032 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10803-024-06405-3 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 13 StartPage: 3065 Subjects: – SubjectFull: Teaching Methods Type: general – SubjectFull: Questioning Techniques Type: general – SubjectFull: High School Students Type: general – SubjectFull: Autism Spectrum Disorders Type: general – SubjectFull: Behavior Modification Type: general – SubjectFull: Program Implementation Type: general – SubjectFull: Fidelity Type: general – SubjectFull: Interpersonal Communication Type: general – SubjectFull: Adolescents Type: general – SubjectFull: Outcomes of Treatment Type: general Titles: – TitleFull: Implementing Pivotal Response Treatment to Teach Question Asking to High School Students with Autism Spectrum Disorder Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Jennifer S. Kowitt – PersonEntity: Name: NameFull: Joseph Madaus – PersonEntity: Name: NameFull: Brandi Simonsen – PersonEntity: Name: NameFull: Jennifer Freeman – PersonEntity: Name: NameFull: Allison Lombardi – PersonEntity: Name: NameFull: Pamela Ventola IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 09 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 0162-3257 – Type: issn-electronic Value: 1573-3432 Numbering: – Type: volume Value: 55 – Type: issue Value: 9 Titles: – TitleFull: Journal of Autism and Developmental Disorders Type: main |
| ResultId | 1 |
