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Training Asian Immigrant Parents to Teach Manding to Children with Autism Spectrum Disorder

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Title: Training Asian Immigrant Parents to Teach Manding to Children with Autism Spectrum Disorder
Language: English
Authors: Xiaohan Chen (ORCID 0000-0003-4117-0359), Ann X. Huang
Source: Journal of Behavioral Education. 2025 34(1):184-212.
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: 29
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Adult Education
Descriptors: Verbal Operant Conditioning, Behavior Modification, Communication Skills, Children, Autism Spectrum Disorders, Parent Education, Immigrants, Asians, Program Effectiveness
DOI: 10.1007/s10864-023-09526-4
ISSN: 1053-0819
1573-3513
Abstract: Children with autism spectrum disorder often exhibit difficulties in social communication and interaction. Those who do not acquire functional communication to effectively express wants and needs often are at a higher risk of displaying challenging behaviors. Mand training is recognized as an evidence-based intervention for teaching communication to children with autism spectrum disorder. However, limited research has been conducted to examine the effects of training parents from Asian immigrant backgrounds to teach manding to their children at home. To fill the gap, we trained three Asian parents using behavioral skills training to teach their children with autism spectrum disorder to mand for preferred items. A multiple-baseline across participants design was used to evaluate the effects of parent training on parent participants' implementation of mand training and the effects of the parent-delivered training on mand acquisition of their children. Results showed that all three parents had significant improvement in their mand training implementation, and all three children demonstrated an increase in their use of unprompted mands at different levels. The three parent-child dyads demonstrated various levels of maintenance and generalization of the skills learned. Implications of the findings and recommendations for future research are discussed with specific regard to working with Asian immigrant families.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1485504
Database: ERIC
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  Value: <anid>AN0184231745;41z01mar.25;2025Apr07.04:59;v2.2.500</anid> <title id="AN0184231745-1">Training Asian Immigrant Parents to Teach Manding to Children with Autism Spectrum Disorder </title> <p>Children with autism spectrum disorder often exhibit difficulties in social communication and interaction. Those who do not acquire functional communication to effectively express wants and needs often are at a higher risk of displaying challenging behaviors. Mand training is recognized as an evidence-based intervention for teaching communication to children with autism spectrum disorder. However, limited research has been conducted to examine the effects of training parents from Asian immigrant backgrounds to teach manding to their children at home. To fill the gap, we trained three Asian parents using behavioral skills training to teach their children with autism spectrum disorder to mand for preferred items. A multiple-baseline across participants design was used to evaluate the effects of parent training on parent participants' implementation of mand training and the effects of the parent-delivered training on mand acquisition of their children. Results showed that all three parents had significant improvement in their mand training implementation, and all three children demonstrated an increase in their use of unprompted mands at different levels. The three parent–child dyads demonstrated various levels of maintenance and generalization of the skills learned. Implications of the findings and recommendations for future research are discussed with specific regard to working with Asian immigrant families.</p> <p>Keywords: Autism spectrum disorder; Mand training; Parent training; Behavioral skills training; Asian immigrants; Psychology and Cognitive Sciences Psychology</p> <p>Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10864-023-09526-4.</p> <hd id="AN0184231745-2">Introduction</hd> <p>Communication deficit is one of the core symptom domains of autism spectrum disorder (ASD; APA, [<reflink idref="bib2" id="ref1">2</reflink>]). Although many children with ASD have spoken words, they tend to experience difficulties in using language functionally (Norrelgen et al., [<reflink idref="bib54" id="ref2">54</reflink>]). Limited language repertoire impacts a child's ability to effectively express wants and needs (Nam et al., [<reflink idref="bib52" id="ref3">52</reflink>]; Syriopoulou-Delli & Eleni, [<reflink idref="bib77" id="ref4">77</reflink>]). As a result, children with ASD often exhibit challenging behaviors such as tantrums, aggression, and self-injury (Matson et al., [<reflink idref="bib50" id="ref5">50</reflink>]), as an avenue to obtain preferred things (Beavers et al., [<reflink idref="bib4" id="ref6">4</reflink>]). Such maladaptive behaviors can interfere with the child's learning and daily functioning, thereby hindering their overall improvement (Kanne & Mazurek, [<reflink idref="bib38" id="ref7">38</reflink>]; Taylor & Seltzer, [<reflink idref="bib80" id="ref8">80</reflink>]). Teaching appropriate communication decreases the occurrence of challenging behaviors, as the acquisition of language allows the child to make their needs and desires known to others around them (Sundberg & Michael, [<reflink idref="bib76" id="ref9">76</reflink>]). Rooted in behavior analysis, mand training is an evidence-based intervention for teaching the requesting behaviors and has shown positive effects on improving the communication skills of children with ASD (see Shea et al., [<reflink idref="bib65" id="ref10">65</reflink>]; Tapp et al., [<reflink idref="bib78" id="ref11">78</reflink>]).</p> <p>Mand is defined as, "a verbal operant in which the response is reinforced by a characteristic consequence and is, therefore, under the functional control of relevant conditions of deprivation or aversive stimulation" (Skinner, [<reflink idref="bib69" id="ref12">69</reflink>], pp. 35–36). In other words, a mand is a request for something a person wants in the moment. According to Sundberg and Michael ([<reflink idref="bib76" id="ref13">76</reflink>]), it receives specific reinforcement to the particular mand. For example, the mand "toy" would be reinforced by receiving toy, the mand "juice" would be reinforced by receiving juice, and the mand "tickle" would be reinforced by being tickled. Mands directly benefit the learner by producing access to the reinforcer, thereby giving them control over their environment (Sundberg & Michael, [<reflink idref="bib76" id="ref14">76</reflink>]). Additionally, mands provide the learner with a socially acceptable means of communication (Drasgow et al., [<reflink idref="bib20" id="ref15">20</reflink>]). Therefore, teaching mands is of crucial importance as it equips individuals with ASD with an essential communication skill and is an integral component of their treatment (Sundberg & Michael, [<reflink idref="bib76" id="ref16">76</reflink>]).</p> <p>A mand is under the control of establishing operations (EO) that can serve as an independent variable to evoke behavior (Gutierrez et al., [<reflink idref="bib26" id="ref17">26</reflink>]; Laraway et al., [<reflink idref="bib42" id="ref18">42</reflink>]). Children are not likely to make requests for things they do not want. Therefore, mands should only be trained when the learner indicates a desire to access the relevant consequence (Drasgow et al., [<reflink idref="bib19" id="ref19">19</reflink>]). Mand training is conducted by capturing or contriving EO to evoke a response from the learner (Laraway et al., [<reflink idref="bib42" id="ref20">42</reflink>]). Capturing EO means taking advantage of naturally occurring events (Shafer, [<reflink idref="bib64" id="ref21">64</reflink>]). For example, when an instructor observes that a child attempts to open a bin to access a preferred toy inside, she captures his EO and prompts him to mand by saying "open." Contriving EO involves withholding a desired item by placing it in the child's view but out of reach to increase its value (Jennett et al., [<reflink idref="bib34" id="ref22">34</reflink>]). For example, when a child is building Legos, the instructor holds up a piece in front of the child to contrive EO for the child to mand "Lego."</p> <p>Researchers have manipulated EOs in both ways to facilitate the emergence of mands of learners. For example, Halle et al. ([<reflink idref="bib28" id="ref23">28</reflink>]) taught six children with intellectual disabilities to mand for breakfast items through capturing EOs. The participants typically waited in line to receive their breakfast on trays and during the study, the food tray was given with a 15-s delay. By capturing the naturally occurring EOs for food, the researchers trained the participants to mand for each item prior to the elapsed time delay. Two participants emitted the target mands and the other four required vocal models. Neely et al. ([<reflink idref="bib53" id="ref24">53</reflink>]) trained three interventionists to implement mand training with three children with ASD by contriving EOs which included placing preferred items in sight but out of reach of the child participants, sabotaging their task completion, and engaging in unexpected behaviors during a routine. Results showed that all three children increased their use of target mands following the training.</p> <p>According to the most recent report of <emph>Evidence-Based Practices (EBP) for Children, Youth and Young Adults with Autism</emph>, parent-implemented intervention is an EBP that promotes their child's social communication (Steinbrenner et al., [<reflink idref="bib70" id="ref25">70</reflink>]). Research has shown that parents can be trained to accurately deliver mand training to promote language acquisition of their children with developmental disabilities (Hong et al., [<reflink idref="bib32" id="ref26">32</reflink>]; Togashi et al., [<reflink idref="bib81" id="ref27">81</reflink>]). For example, Loughrey et al. ([<reflink idref="bib48" id="ref28">48</reflink>]) trained two parents to conduct mand training with their children diagnosed with ASD, and fragile X syndrome, respectively. Using a multiple baseline design, the researchers analyzed the effects of the training on the performance of each parent. Results indicated that their performance improved significantly after the parent training and both children emitted more unprompted than prompted mands. More recently, Suberman and Cividini-Motta ([<reflink idref="bib74" id="ref29">74</reflink>]) trained three parents to implement mand training with their children using speech generating devices. A multiple baseline design was used to examine the training effectiveness. Results showed that parents learned to implement mand training with their children and independent mands increased for two out of the three children. Both studies demonstrated the effects of teaching parents to deliver mand training to their children. However, neither included racial and ethnic information of the parents. To evaluate the effectiveness of training Asian immigrant parents, it is necessary to conduct research with this population as they may hold different values and beliefs of child-rearing (Lau et al., [<reflink idref="bib46" id="ref30">46</reflink>]). For instance, they may object to provide tangible rewards to their child for desirable behaviors (Lau et al., [<reflink idref="bib46" id="ref31">46</reflink>]). Given that reinforcer delivery is critical in promoting the emission of mands, withholding reinforcers may hinder the child's acquisition of mands. More research is warranted to examine the effects of training Asian immigrant parents to teach their children manding.</p> <p>One way to train parents is through behavioral skills training (BST). It is an evidence-based protocol to teach new skills and train individuals to implement intervention plans (Schaefer & Andzik, [<reflink idref="bib61" id="ref32">61</reflink>]; Stewart et al., [<reflink idref="bib72" id="ref33">72</reflink>]). The BST package is a multi-component intervention that consists of instructions, modeling, rehearsal, and feedback (Miltenberger, [<reflink idref="bib51" id="ref34">51</reflink>]; Seiverling et al., [<reflink idref="bib63" id="ref35">63</reflink>]). Specifically, it involves (a) clear and explicit instructions (written or verbal) of the target behavior, (b) modeling or demonstration of the target skill or procedure, (c) role-play to practice the target skill or procedure, and (d) feedback on the performance that occurred during rehearsal (Sarokoff & Sturmey, [<reflink idref="bib60" id="ref36">60</reflink>]).</p> <p>BST has been widely used to train parents with limited experience in behavior analysis to effectively implement behavioral procedures with children with ASD. For example, Harriage et al. ([<reflink idref="bib29" id="ref37">29</reflink>]) used BST to train three parents to implement most-to-least prompting procedures to teach their children to use pedestrian safety skills. Results showed that parents implemented the procedures with high levels of accuracy during intervention and all children demonstrated improvement in their pedestrian safety skills. Similarly, Drifke et al. ([<reflink idref="bib21" id="ref38">21</reflink>]) used BST to train two parents to implement three-step prompting and differential reinforcement with alternative behavior with their children with special needs. The authors reported that parents were able to implement the procedures with high levels of fidelity at the conclusion of the study. In these studies, parents were successfully trained using BST to implement different behavioral skills; however, no demographic information related to ethnicities and home languages of the participants were reported. The paucity of this information may lead to a lack of understanding of the effectiveness of BST with culturally diverse populations (Dennison et al., [<reflink idref="bib17" id="ref39">17</reflink>]).</p> <p>A few studies concerning parent training using BST have included parents from Asian backgrounds. However, those parents constituted only a small proportion of the participants. For instance, Hassan et al. ([<reflink idref="bib30" id="ref40">30</reflink>]) evaluated the efficacy of BST for teaching parents to support social skills development of their children with ASD. In this research, they conducted two studies where Study 1 had four parents including one Chinese, one Metis, and two Caucasians, and Study 2 had four parents and all were Caucasians. Out of the eight participants, only one was from Asian background. Similarly, Conklin and Wallace ([<reflink idref="bib14" id="ref41">14</reflink>]) used BST to train parents to use differential reinforcement. In this study, they had six participants including three Chinese. Parents learned to accurately implement the procedures and the authors reported that the Chinese parents provided lower scores on the social validity survey in comparison with other participants. The authors argued that it may have resulted from the fact the Chinese parents needed translation from English to Mandarin and some of the training procedures may have been difficult for them to understand. They recommended that future research should identify the cultures and parenting styles of the participants. In both studies, Asian parents were only included as a small proportion of the participants and were not specifically studied as a minority group.</p> <p>The present study specifically focused on training parents of Asian immigrant background for two main reasons: the lack of research on this population, and the paucity of evaluation and dissemination of evidence-based practices (EBP) with this population. According to the U.S. Census Bureau, the estimated number of Asian Americans in the United States is 19.9 million (U.S. Census Bureau, [<reflink idref="bib9" id="ref42">9</reflink>]). It is the fastest-growing racial or ethnic group in the nation, of which, about 57% were first-generation immigrants born in another country (Pew Research Center, [<reflink idref="bib56" id="ref43">56</reflink>]). Despite being the proportionally fastest-growing ethnic group in the U.S., Asian families with children with disabilities are not well-represented in the literature (Kim et al., [<reflink idref="bib40" id="ref44">40</reflink>]). In fact, most research in applied behavior analysis (ABA) has been conducted with European American samples (Dyches et al., [<reflink idref="bib22" id="ref45">22</reflink>]). Jones et al. ([<reflink idref="bib35" id="ref46">35</reflink>]) reviewed articles published in the Journal of Applied Behavior Analysis between 2013 and 2019 and found that only 7% of the articles reported the race of the participants, and of these articles, 69% of the participants were Caucasian, 20% were African American, and less than 5% were Asian, Hispanic, Native American, Biracial, or "Other." More recently, Steinbrenner et al. ([<reflink idref="bib71" id="ref47">71</reflink>]) examined the reporting of race and ethnicity and the inclusion of participants across racial and ethnic groups in studies included in a large-scale systematic review of autism research (1990–2017) and found that the rate of participation was 64.8% among White, 9.4% among Hispanic/Latino, 7.7% among Black and 6.4% among Asian participants. Given the paucity of research on the Asian minority group, it is argued that data generated from existing research may not be generalizable beyond populations of Anglo origins (Bernal & Scharró-del-Río, [<reflink idref="bib5" id="ref48">5</reflink>]; Hall, [<reflink idref="bib27" id="ref49">27</reflink>]).</p> <p>Moreover, there has been a paucity of evaluation and dissemination of EBPs with minority communities (Lau, [<reflink idref="bib43" id="ref50">43</reflink>]). For example, although BST is recognized as an evidence-based approach to teaching new skills, currently, there is limited research specifically evaluating its effects on training parents from Asian immigrant backgrounds. Therefore, more research is needed to examine its effectiveness across cultural and linguistic contexts. Similarly, parent training is a well-established practice involving children with ASD, but there is a gap in the literature of how this approach works for ethnic minority families (Bjørknes et al., [<reflink idref="bib7" id="ref51">7</reflink>]). According to Lau ([<reflink idref="bib43" id="ref52">43</reflink>]), less involvement of ethnic minority families is the most well-documented disparity in parent training. Comparing to White parents of the host country, ethnic minority parents represent lower recruitment rates and higher dropout rates in parent training programs (Kazdin & Whitley, [<reflink idref="bib39" id="ref53">39</reflink>]) due to various challenges such as cultural and language barriers, shortage of therapists that are bilingual proficient, limited knowledge about services, and reduced social networks (e.g., Rotheram-Fuller et al., [<reflink idref="bib58" id="ref54">58</reflink>]; Vargas Londono et al., [<reflink idref="bib83" id="ref55">83</reflink>]). Since the link between parental involvement and positive child outcome is considered more complex in ethnic minority groups (Dishion & Patterson, [<reflink idref="bib18" id="ref56">18</reflink>]), without enough research evidence, dissemination of parent training is questionable to Asian immigrant families, as they hold different perspectives on family functioning and child-rearing (Lau et al., [<reflink idref="bib46" id="ref57">46</reflink>]). For example, some Asian parents believe that children may stop working hard if they praise them too much (Heine et al., [<reflink idref="bib31" id="ref58">31</reflink>]), so they favor criticism instead (Lau, [<reflink idref="bib44" id="ref59">44</reflink>]). They may disagree to ignore challenging behaviors because of the potential fear of losing face (embarrassed or humiliated; Lau et al., [<reflink idref="bib46" id="ref60">46</reflink>]). Furthermore, disability-related stigma is well-documented in Asian cultures that individuals of Asian backgrounds are more likely to perceive negative attitudes toward disabilities (e.g., Salleh et al., [<reflink idref="bib59" id="ref61">59</reflink>]; Shorey et al., [<reflink idref="bib68" id="ref62">68</reflink>]). Therefore, more research is warranted to build in elements to address cultural incongruence of parent training in Asian immigrant families.</p> <p>Taken together, the purpose of the study was threefold. First, it evaluated how well Asian immigrant parents can be trained to deliver mand training to their children with ASD. Second, it assessed the effectiveness of the parent-delivered mand training on the children's mand acquisition. Third, it evaluated the effectiveness of EBPs such as behavioral skills training and parent training on the Asian immigrant population.</p> <hd id="AN0184231745-3">Method</hd> <p></p> <hd id="AN0184231745-4">Participants</hd> <p>Three parent–child dyads participated. All parents met the following inclusion criteria: (a) are first-generation immigrants from an Asian country, (b) have a child diagnosed with ASD, (c) have no previous experience of mand training, and (d) speak English unless first language is Mandarin Chinese (first author's first language). All children met the following inclusion criteria: (a) have a diagnosis of ASD, (b) have limited mand skills demonstrated by scores at or below level 1 in the mand domain of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP; Sundberg, [<reflink idref="bib75" id="ref63">75</reflink>]), and (c) have some echoic skills demonstrated by scores at or above level 1 in the echoic domain of the VB-MAPP. The VB-MAPP is an assessment tool, curriculum guide, and skill system for children with ASD (Sundberg, [<reflink idref="bib75" id="ref64">75</reflink>]). The VB-MAPP milestones assessment is commonly used to provide a measure of the learner's existing verbal skills. It contains 170 milestones which are sequenced based on typical development and grouped into three levels. Skills at levels 1, 2, and 3 correspond to verbal skills typically acquired between birth and 18 months, 18–30 months, and 30–48 months, respectively.</p> <hd id="AN0184231745-5">Dyad 1: Malai and Neal</hd> <p>Malai and her son Neal were originally from Thailand. Malai obtained her bachelor's degree in Thailand. They came to the United States approximately one year before the study occurred to seek educational and intervention services for Neal. The family spoke Thai at home, and both Malai and Neal could speak basic English. The family had two children, Neal and his younger sister who was typically developing. Neal was a 10-year-old boy and was diagnosed with ASD at three in Thailand. He attended a special education school and received ABA services for 6 h per week at a local clinic. Neal typically manded for desired items by gesturing and making eye contact with an adult. Before participating in the study, he was able to mand with echoic prompts for "candy," "cucumber," and "bubbles." Malai reported he had one unprompted mand which was "bathroom" in Thai when he needed to go to the bathroom. Neal demonstrated low intensity self-injurious behaviors such as head hitting and head pressing where he forcefully hit or pressed his forehead with his right palm.</p> <hd id="AN0184231745-6">Dyad 2: Yan and Julia</hd> <p>Yan was the mom and Julia was her daughter. Yan was originally from China and came to the United States to pursue her master's degree. The primary spoken language of the family was Mandarin Chinese. Yan was the main caregiver of Julia and worked part-time. The family had three children, Julia and her two older brothers who were typically developing. Julia was a 6-year-old girl diagnosed with ASD at age four. She was born in the United States and attended a self-contained classroom in a public school. She received in-home ABA service for 10 h per week. She manded for desired items by grabbing and pointing. She often yelled "mine!" when she attempted to grab something. If desired items were not obtained, Julia would whine. She also had difficulty giving up desired items such as toys in her possession.</p> <hd id="AN0184231745-7">Dyad 3: Ting and Taylor</hd> <p>Ting and her son Taylor were originally from China. Ting obtained her bachelor's degree in China and immigrated to the United States in her adulthood. Mandarin Chinese was the spoken language in the house. Taylor was the only child. He was a 12-year-old boy and was diagnosed with ASD at age three in China. He came to the United States when he was six. He attended a private special school and received in-home ABA service for 10 h per week. Taylor generally had trouble manding for preferred items. When wanting something, he would grab it or yell "truck" or "mommy" repeatedly until the item was provided. His unprompted mands observed before the study were "fish," "truck," and "mommy." Taylor demonstrated a low frequency of aggressive behaviors in the form of scratching and pinching others on their arms and hands.</p> <hd id="AN0184231745-8">Settings, Materials, and Languages</hd> <p>The study took place in a room at least 3 × 3 m in each family's house located in an eastern U.S. state. Specifically, sessions were conducted at the dining table with Dyads 1 and 2 and at the desk in Taylor's room with Dyad 3. Parent and child sat across the table/desk. The researcher (first author) either sat next to the parent or in a chair 1–1.5 m away from them. Toys and edibles were kept away from the instructional area and were not easily accessible to the children. Sessions involving the children were scheduled at the end of the school day or on the weekend to accommodate family schedules.</p> <p>Reinforcing items including edibles and toys were identified through preference assessments and used in all phases. Identified preferred items were brought in by the researcher each time she went to their houses. Parents also limited access to the same items available at their houses. A GoPro camera on a tripod was used to record sessions with the permission of all participants. The task analysis form and flowchart were written in English and Chinese and both versions were provided to the parents. Yan and Ting opted to use the Chinese version.</p> <p>Throughout the study, Mandarin was spoken between the researcher and Yan/Ting. English was spoken between the researcher and Malai. The language used between the parent and their child was a mixture of Mandarin/Thai and English. Mands emitted by the children in either Mandarin or Thai were accepted with the confirmation of the parents.</p> <hd id="AN0184231745-9">Dependent Variables and Data Collection</hd> <p>The primary dependent variable was the percentage of steps completed correctly by the parents on the mand training task analysis form (see Electronic Supplementary Material) in a session. It was created by the first author based on mand training literature including manipulating EO (e.g., Gutierrez et al., [<reflink idref="bib26" id="ref65">26</reflink>]; Shillingsburg et al., [<reflink idref="bib66" id="ref66">66</reflink>]), prompt and prompt fading (e.g., Albert et al., [<reflink idref="bib1" id="ref67">1</reflink>]; Shillingsburg et al., [<reflink idref="bib67" id="ref68">67</reflink>]), and differential reinforcement (e.g., Betz et al., [<reflink idref="bib6" id="ref69">6</reflink>]; van der Meer et al., [<reflink idref="bib82" id="ref70">82</reflink>]). A flowchart (Fig. 1) was created to serve as a companion to the task analysis form.</p> <p>Graph: Fig. 1 Flowchart of mand training task analysis</p> <p>Each session consisted of five trials of implementing the task analysis. The presentation of a preferred item of the child participants marked the onset of each trial. The percentage of correct steps was calculated by dividing the number of correctly completed steps in a trial by the total number of applicable steps within that trial, and then adding the scores of the five trials of the session and dividing it by five and multiplying by 100. Contingent on the child's response, only certain steps of the task analysis were applicable. For example, when the parent initiated a trial by checking for the presence of an EO of an item shown to the child, and under an EO the child manded, then this trial was finished and only steps 1–3A were applicable for data collection. Contingent upon no or wrong response from the child, 3A would be considered a non-applicable step and the parent would continue the task analysis from step 3B. The task analysis form was used to score parents' performance using "Y" for correct step implementation, "N" for incorrect step implementation, and "N/A" for non-applicable steps.</p> <p>The secondary dependent variable was the percentage of unprompted mands emitted by the child participants in a session. The response form was vocal mand and the mand type was mand for present items, meaning given that the item was in sight, the child would vocally request it. Unprompted mands are also called independent mands which were defined as when the child oriented toward the parent and made vocal responses for the preferred item without prompts from the parent. Unprompted mands did not include grabbing, gesturing, or pointing to the item. Adding words or phrases to the name of the item was accepted if the specific item was identified. For example, manding for candy by saying "candy please" or "I want candy" was accepted. Mands emitted in either Mandarin or Thai were accepted with the confirmation of the parents.</p> <p>Data were collected only on the first mand opportunity of each trial, which was step 3A on the task analysis form. For each session consisting of five trials, the child could emit unprompted mands between zero and five times. The mastery criterion is 80% or higher of unprompted mands within a session. That is, when the child independently manded for at least four out of five trials for an item in one session, the mand for that item is considered acquired.</p> <hd id="AN0184231745-10">Experimental Design</hd> <p>A non-concurrent multiple-baseline-across participants design was used to evaluate the effects of parent training on parent participants' implementation of the task analysis and the effects of the parent-delivered mand training on the acquisition of mands of the child participants. This design was selected because it allowed the researcher to demonstrate the effectiveness of the intervention with the three parents who displayed a similar need for behavior change without withdrawing the intervention. By introducing the intervention phases in a staggered fashion, the effects were replicated in a way that demonstrates experimental control (Byiers et al., [<reflink idref="bib8" id="ref71">8</reflink>]).</p> <p>Each parent–child dyad had baseline, post-BST, follow-up and generalization phases. All three dyads were introduced to baseline at the same time. Upon having a visually stable baseline or a baseline with a decreasing trend, the first parent moved from baseline to parent training while the other two parents remained in baseline. Subsequent parents received parent training in a staggered fashion.</p> <hd id="AN0184231745-11">Procedure</hd> <p></p> <hd id="AN0184231745-12">Preference Assessment</hd> <p>A two-step approach was used to conduct preference assessment: parent interview and multiple stimulus without replacement assessment (MSWO; DeLeon & Iwata, [<reflink idref="bib16" id="ref72">16</reflink>]). Parent interviews allowed the researcher to quickly narrow down categories of items to be used in the subsequent MSWO assessment. Parents observed the MSWO process while the researcher completed the assessment in the following steps.</p> <p></p> <ulist> <item> Have eight items ready and make sure edibles and toys are not mixed in one round.</item> <p></p> <item> Present each item in isolation and state its name.</item> <p></p> <item> Present the items on a tray and instruct the child to pick one.</item> <p></p> <item> Record the item selected.</item> <p></p> <item> Allow a few seconds for the child to interact with the toy or consume the edible.</item> <p></p> <item> Remove the selected item and place it in an empty bin and rearrange the positions of the remaining items.</item> <p></p> <item> Repeat steps 3–6 until all items are selected or the child shows no interest in the remaining items.</item> </ulist> <p>The first three selected from the eight items were considered items of high preference. Steps 1–7 were repeated four more times using eight different items each time for every child participant. The rationale for doing five rounds was to identify a plenty of preferred items, so if the child participants had no or a weak EO for some of them during a session, there were other items to use. Among the 40 items presented in the five rounds of the preference assessment, a total of 15 items were identified for each child participant and were used throughout the study as mand targets and reinforcers. To create deprivation of EO, the children were only allowed access to the identified items during research sessions of the study.</p> <hd id="AN0184231745-13">Baseline</hd> <p>The task analysis form, flowchart and identified preferred items were provided to the parents. The researcher instructed the parents to follow the steps to the best of their abilities to teach their children to ask for a preferred item. A trial started with the parent holding up one item and checking for their child's EO for the item. Several items were used alternately until five trials had been run for each one. During baseline, the researcher did not participate in the activity nor provided any feedback.</p> <hd id="AN0184231745-14">BST</hd> <p>Following baseline, the researcher provided mand training to parents using the four steps of BST, which were instruction, modeling, rehearsal, and feedback.</p> <hd id="AN0184231745-15">Instruction</hd> <p>A PowerPoint presentation was used at the beginning. Handouts of the slides were provided, so that parents could refer to them as written instructions. The presentation and handouts were created in English and Chinese. Yan and Ting chose to use the Chinese version and the English version was used with Malai as the researcher does not know Thai (Malai's first language). Topics of the presentation included definition of mand, definition of reinforcers, importance of mand training for children with ASD, and five mand training components which were integrated into the task analysis. The researcher explained and modeled the task analysis steps in detail.</p> <p>All five components of the mand training were specifically taught, which were check for motivation, echoic prompt, differential reinforcement, prompt fading using time delay, and error correction. First, parents were trained to check for child's motivation at the onset of each trial. To check for the presence of EOs, parents would hold up a preferred item within the child's view but out of reach and observe if the child approached the item by looking at, pointing to, or reaching for it or made sounds to ask for it. They were instructed to have multiple preferred items ready and rotate them among trials to prevent satiation of one particular item. They were then taught to provide echoic prompts to facilitate manding by the child. Specifically, if the child showed interest in an item and did not emit the correct mand after 2 s, the parent would provide an echoic prompt by saying the name of the item. They were also taught to use differential reinforcement and to reinforce unprompted responses more than prompted responses (Vollmer et al., [<reflink idref="bib84" id="ref73">84</reflink>]). Specifically, the parent would give the child the requested item more in quantity or longer in duration for an unprompted mand (i.e., steps 3A and 6A), and less in quantity or shorter in duration for a prompted mand (i.e., steps 4A, 5A, and 7A). Additionally, parents were trained to use time delay to fade prompt and promote unprompted manding. After presenting the preferred item, parents waited for 2 s before providing a prompt. In the task analysis, step 5 served as the prompt fading step. That is, after parent delivered reinforcer for the prompted mand in step 4A, they then presented the desired time again and used time delay to fade the prompt. Lastly, parents learned to conduct error correction which had two steps: removing the preferred item and attention (i.e., not providing eye contact) for 2 s and re-presenting the item with an immediate echoic prompt. Error correction could be run two times at most within one trial (i.e., steps 3B and 4B or steps 3B and 6B), and if the child gave no or wrong responses after the second error correction, parents would end that trial.</p> <hd id="AN0184231745-16">Modeling</hd> <p>After teaching the components of the task analysis, the researcher played pre-recorded videos of herself and an assistant performing the task analysis steps. English was spoken in the videos and both English subtitles and Chinese subtitles were shown on the screen. The duration of the video was 1 min and 45 s, and it was played several times upon the parents' request. Following the video modeling, the researcher modeled the steps in person with the parent acting as the "target child." As the researcher modeled the implementation of the task analysis, she explained each step again and answered questions. The entire task analysis was run multiple times until parents reported having no questions and feeling ready to switch roles.</p> <hd id="AN0184231745-17">Rehearsal and Feedback</hd> <p>The parent then rehearsed the steps with the researcher where parent implemented the steps and the researcher acted as the child. The researcher purposefully gave no or wrong responses at different steps so that parents were trained to correct various errors by closely following the steps listed in the task analysis. For example, the researcher gave a wrong response after the parent completed step 2 and assessed if the parent did step 3B instead of 3A. The entire task analysis was run multiple times to ensure every step was practiced.</p> <p>Questions and concerns were addressed, and immediate verbal feedback and praise were given throughout the training. In order to move from the parent training phase to the intervention phase, parents were required to meet the mastery criterion which was 100% accuracy of implementation of the task analysis for three consecutive sessions. Table 1 depicts the duration of training for each parent.</p> <p>Table 1 Duration of BST for each parent participant</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Parent participants</p></th><th align="left"><p>Instruction</p></th><th align="left"><p>Modeling</p></th><th align="left"><p>Rehearsal and feedback</p></th><th align="left"><p>Booster</p><p>training</p></th><th align="left"><p>Total</p></th></tr></thead><tbody><tr><td align="left"><p>Malai</p></td><td char="." align="char"><p>42</p></td><td char="." align="char"><p>30</p></td><td char="." align="char"><p>34</p></td><td align="left"><p>N/A</p></td><td char="." align="char"><p>106</p></td></tr><tr><td align="left"><p>Yan</p></td><td char="." align="char"><p>20</p></td><td char="." align="char"><p>25</p></td><td char="." align="char"><p>40</p></td><td align="left"><p>N/A</p></td><td char="." align="char"><p>85</p></td></tr><tr><td align="left"><p>Ting</p></td><td char="." align="char"><p>39</p></td><td char="." align="char"><p>20</p></td><td char="." align="char"><p>40</p></td><td align="left"><p>80</p></td><td char="." align="char"><p>179</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph>: Duration is shown in min. Booster training consisted of modeling, rehearsal, and feedback of the BST</p> <hd id="AN0184231745-18">Booster Training for Ting</hd> <p>During intervention, parents' fidelity of implementation was closely monitored and when it dropped below 80% for two consecutive sessions, intervention was paused, and BST booster sessions were provided. Ting-and-Taylor was the only dyad that required booster training. It differed from the previous BST in two areas. First, the booster training only involved modeling, rehearsal, and feedback of the BST and the instruction step was omitted. Second, the child was engaged in the booster training. Instead of modeling and rehearsing between the researcher and parent, the researcher modeled the steps with Taylor for Ting and then she rehearsed the steps with Taylor while the researcher provided feedback.</p> <hd id="AN0184231745-19">Post-BST</hd> <p>Upon completing parent training and meeting the mastery criterion which was 100% accuracy of task analysis implementation for three consecutive sessions, parents delivered mand training to their children. This process was the same as that was described in baseline. The post-BST phase for Ting and Taylor resumed after Ting re-met the mastery criterion. This phase ended when the parent had at least 7 sessions above 80% and her child acquired at least 2 mand targets. If the child did not acquire any target after 8 sessions, this phase also stopped.</p> <hd id="AN0184231745-20">Follow-Up</hd> <p>Two follow-up sessions were conducted two weeks after the completion of the post-BST phase to assess if the skills of the parents and children had been maintained. All procedures in this phase were the same as those implemented in the post-BST phase. Due to holidays and family schedules, Ting-and-Taylor's follow-up sessions were conducted four weeks after the completion of their post-BST phase.</p> <hd id="AN0184231745-21">Generalization (Mand for Actions)</hd> <p>The generalization phase was implemented following the completion of the follow-up. The mand type was changed from manding for present items in the post-BST phase to manding for actions to assess if the parents could use the task analysis to teach their children to request preferred actions and if the children could emit unprompted mands for preferred actions. For example, when the child shows an EO to be picked up, he or she would say "pick up." All procedures in this phase were the same as those described in the post-BST phase. Depending on each child's EO, one to three sessions were conducted. Target actions were selected based on parents' suggestions and children's motivation. For Neal, the target was to vocally say "play" for Malai to play the "Finger Family" song on the iPad. For Julia, the target was to say "throw" when playing catch with Yan using a small, inflated vinyl ball. For Taylor, the target was also "throw" when playing catch with Ting using a small cloth bean bag.</p> <hd id="AN0184231745-22">Interobserver Agreement</hd> <p>A second observer was trained to collect interobserver agreement (IOA) and treatment integrity data for this study. She was a doctoral student in a Special Education program and a Board Certified Behavior Analyst and had experience in mand training and data collection. The researcher introduced the study to her, explained each step of the task analysis, and reviewed the data collection process and datasheets. They then reviewed and coded two randomly selected video clips of the study together and addressed disagreements on scoring until achieving 100% agreement on both training videos. Thirty-five percent, 33% and 30% of sessions across all phases were randomly selected and calculated for Dyads 1, 2, and 3, respectively. Video recordings of the sessions were used to score both parent and child participant dependent variables. The second observer scored each applicable task analysis step in a trial and compared them with the scorings of the researcher. Then a step-by-step method was used to calculate IOA by dividing the number of agreements by the total number of agreements and disagreements and multiplying by 100. The mean of each investigation phase was then calculated. To calculate IOA for the child participants, the second observer scored step 3A on the task analysis in a trial and compared it with that of the researcher. All five trials were compared individually, and a trial-by-trial method was used to calculate IOA for the session by dividing the number of agreements by the total number of agreements and disagreements and multiplying by 100. The average IOA was 99% for Malai, 99% for Yan, and 100% for Ting. The IOA was 100% for all three child participants.</p> <hd id="AN0184231745-23">Treatment Integrity</hd> <p>Treatment integrity refers to the extent to which treatment is carried out as intended (Gresham, [<reflink idref="bib25" id="ref74">25</reflink>]). A treatment integrity checklist (Table 2) was developed to measure the researcher's implementation of each phase of the study. The same video recordings as the IOA were used. The second observer coded each checklist item as "Y" for observed, "N" for not observed, and "N/A" for non-applicable. Score was calculated by adding the number of steps performed correctly, dividing it by the total number of applicable steps, and multiplying by 100. The researcher's treatment integrity score was 99% for Dyads 1 and 2 and, 100% for Dyad 3.</p> <p>Table 2 Treatment integrity checklist</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Baseline</p></th><th align="left" colspan="3"><p>Score</p></th></tr></thead><tbody><tr><td align="left"><p>1. Provide preferred items, task analysis form, and flowchart to the parents</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>2. Briefly go over the task analysis and flowchart</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>3. Instruct the parents to follow the steps and teach their child to request</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>4. Do not provide verbal interactions to the participants</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr></tbody></table> </ephtml> </p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>BST</p></th><th align="left" colspan="3"><p>Score</p></th></tr></thead><tbody><tr><td align="left"><p>1. Provide PowerPoint presentation and handout</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>2. Explain each step of the task analysis in detail</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>3. Show video models</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>4. Model the steps with the parents as the "target child"</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>5. Rehearse steps with the parents</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>6. Provide immediate verbal feedback on performance</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>7. Allow enough time to practice as needed and provide feedback</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr></tbody></table> </ephtml> </p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Post-BST</p></th><th align="left" colspan="3"><p>Score</p></th></tr></thead><tbody><tr><td align="left"><p>1. Provide preferred items, task analysis form, and flowchart to the parents</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>2. Do not provide verbal interactions to the participants</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr></tbody></table> </ephtml> </p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Booster Training</p></th><th align="left" colspan="3"><p>Score</p></th></tr></thead><tbody><tr><td align="left"><p>1. Show video models</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>2. Model the steps directly with the child participants</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>3. Instruct parents to rehearse with the child participants</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>4. Provide immediate verbal feedback on performance</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>5. Allow enough time to practice as needed and provide feedback</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr></tbody></table> </ephtml> </p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Follow-up</p></th><th align="left" colspan="3"><p>Score</p></th></tr></thead><tbody><tr><td align="left"><p>1. Provide preferred items, task analysis form, and flowchart to the parents</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>2. Do not provide verbal interactions to the participants</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr></tbody></table> </ephtml> </p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Generalization (Mand for Actions)</p></th><th align="left" colspan="3"><p>Score</p></th></tr></thead><tbody><tr><td align="left"><p>1. Provide preferred items, task analysis form, and flowchart to the parents</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p>2. Do not provide verbal interactions to the participants</p></td><td align="left"><p>Y</p></td><td align="left"><p>N</p></td><td align="left"><p>N/A</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0184231745-24">Social Validity</hd> <p>Social validity is used to evaluate the social significance and appropriateness of research goals, procedures, and effects of the treatment (Wolf, [<reflink idref="bib87" id="ref75">87</reflink>]). A social validity questionnaire containing five 5-point Likert Scale questions was developed by the researcher to evaluate parents' perspectives on the parent training process, the mand training procedures, and their children's outcomes. Parents answered each question anonymously by selecting a number between 1 = <emph>strongly disagree</emph> and 5 = <emph>strongly agree</emph>. The questionnaire was uploaded to SurveyMonkey.com and the link was sent to each parent following their completion of the study. The questionnaire was written in both English and Chinese and then translated to Thai using Google Translate. To ensure anonymity, only the English version was uploaded to SurveyMonkey.com for parents to complete. However, the Chinese and Thai translations were also provided to parents as hard copies for reference purposes. All three parents selected "5" for all five questions, showing a high level of social validity of the present study (Table 3). Another indication of the high social validity was the unsolicited verbal report from the parents. Specifically, Malai reported that she continued using the procedures to teach Neal manding after the study was completed and found it helpful. Ting expressed a strong interest throughout the study in having Taylor's in-home therapist trained by the researcher to use the procedures with him.</p> <p>Table 3 Results of the social validity questionnaire</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" colspan="2"><p>Question</p></th><th align="left"><p>Mean</p></th></tr></thead><tbody><tr><td align="left"><p>1.</p></td><td align="left"><p>I think manding is an important communication skill for my child to learn.</p></td><td align="left"><p>5</p></td></tr><tr><td align="left"><p>2.</p></td><td align="left"><p>I thought the parent training was enjoyable and valuable.</p></td><td align="left"><p>5</p></td></tr><tr><td align="left"><p>3.</p></td><td align="left"><p>I will continue to use the mand training procedures with my child.</p></td><td align="left"><p>5</p></td></tr><tr><td align="left"><p>4.</p></td><td align="left"><p>I would recommend the mand training procedures to other parents who seek to increase their child's manding skills.</p></td><td align="left"><p>5</p></td></tr><tr><td align="left"><p>5.</p></td><td align="left"><p>I am satisfied with my child's outcomes.</p></td><td align="left"><p>5</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0184231745-25">Results</hd> <p>Figure 2 depicts the percentage of steps implemented correctly per session across phases by the parents. Malai's baseline performance had a low to medium level and a flat trend (decreasing toward the end). She correctly implemented an average of 37% of the steps with a range of 23–46%. There was an immediate change in level from baseline to post-BST, and no overlapping data points between these two phases. She correctly implemented an average of 97% of the steps with a range of 94–100%, showing a consistent performance of low variability. In addition, Malai correctly implemented an average of 85.5% of the steps during follow-up and 83% during generalization.</p> <p>Graph: Fig. 2 Percentage of steps implemented correctly by parent participants</p> <p>Yan did not implement any of the steps correctly during her baseline phase. Post-BST, her performance showed an immediate increase in level with an increasing trend and little variability. She correctly implemented an average of 89% (range, 74–100%) of the steps and there were no overlapping data points between baseline and post-BST. In addition, she correctly implemented an average of 70.5% of the steps during the follow-up phase. She was in the generalization phase for two sessions and completed an average of 72% of the steps correctly.</p> <p>Ting did not implement any of the steps correctly during baseline. After BST, her performance showed an immediate increase in level. However, since her fidelity of implementation was below 80% for two consecutive sessions (70% and 74%), she required booster training. Upon meeting the mastery criterion in the booster training, she returned to intervention and her correct implementation increased to 83% (range, 80–93%). In addition, Ting correctly implemented an average of 56% of the steps during follow-up and 36% during generalization, suggesting a low level of generalization.</p> <p>Figure 3 depicts the percentage of unprompted mands emitted per session across phases by the children. The mastery criterion was 80% of unprompted mands in one session. That is, if the child independently manded four times or more for one item within a session, the mand for that item was considered acquired. In baseline, Neal emitted an average of 37% of unprompted mands with a range of 0%-60%. Upon receiving mand training delivered by Malai, his unprompted mands increased to 71% with a range of 20–100%. There was a high variability with a 43% overlap. In addition, he met mastery criterion in four sessions and acquired two mands: Frito and Smarties (candy). Frito was subsequently used in the follow-up phase as a mand target, and he emitted unprompted mands for it in an average of 50% of opportunities. In generalization, he independently manded in 60% of the opportunities and demonstrated criterion performance in two out of the three sessions. These data suggested that he could generalize his manding skills from manding for present items to manding for actions (i.e., play).</p> <p>Graph: Fig. 3 Percentage of unprompted mands emitted by child participants</p> <p>Throughout baseline, Julia did not emit any unprompted mands. When introduced to intervention, her performance had an immediate jump from 0% in baseline to an average of 82% in post-BST. The range of her datapoints in this phase was 40–100%, which showed a high variability. In addition, she met mastery criterion in seven out of the nine sessions and acquired four mands: mochi, flute, guitar, and cracker. She emitted unprompted mands in 60% of opportunities in follow-up and had criterion performance in one session. She emitted unprompted mands in 80% of opportunities in generalization and demonstrated criterion performance in both sessions, suggesting skill generalization from manding for present items to manding for actions (i.e., throw).</p> <p>During baseline, Taylor did not emit any unprompted mands. Post-BST, there was an immediate increase in level and his unprompted mands increased to an average of 40% of the opportunities. Following the booster parent training, the percentage of unprompted mands increased from 40% to 50% (range, 40–60%). However, he never met the mastery criterion during the post-BST phase. In addition, he emitted unprompted mands in 40% of opportunities in the follow-up and 0% in generalization. Data showed no evidence of generalization of his manding skills from manding for present items to manding for actions.</p> <hd id="AN0184231745-26">Discussion</hd> <p>To our knowledge, the present study was the first to explore the effectiveness of parent training for Asian immigrants on mand training for children with ASD. The overall results of the study indicated that BST was effective in teaching Asian immigrant parents the mand training procedures, which supports its effectiveness across cultural contexts and the transportability of parent training with Asian families. In addition, the parent-delivered mand training was effective in increasing the percentage of unprompted mands emitted by their children with ASD.</p> <p>It is worth noting that Malai's accuracy of implementation in baseline was higher than that of the other two parents. One possible explanation is that Malai thoroughly studied the task analysis and practiced the steps with her husband outside of the research sessions. This additional practice may have allowed her to become more familiar with and fluent in implementing the steps. In addition, it was observed that she adhered to the task analysis steps. When she missed a step or completed a step incorrectly, she still attempted to follow the steps, which led to a higher fidelity of implementing the task analysis.</p> <p>On the contrary, Yan's low fidelity in baseline was a result of her nonadherence to the task analysis. When Julia attempted to reach for a desired item, Yan kept saying "what is it, say its name," and when Julia failed to give a response, Yan repeated "tell me what this is called" without providing any prompt. A trial often ended with Julia being frustrated and losing interest in the item. When Julia did emit a correct mand for the desired item, instead of providing the item as a reinforcer, Yan often required Julia to ask for the item again, which caused a delay in reinforcer delivery. In addition, she sometimes increased the response effort for Julia. For example, when Julia manded for a bite of ice cream in a bowl, instead of delivering the bite, Yan added a follow-up question "tell mommy what color this ice cream is." This ended with Julia trying to grab the bowl without responding to the question.</p> <p>Similar to Yan, Ting's low fidelity in baseline resulted from her failing to follow the task analysis. Specifically, when Taylor emitted an incorrect mand for an item, instead of providing an echoic prompt, Ting switched to a different item. Another common error observed was that when Taylor emitted a prompted mand, Ting did not provide another opportunity for him to mand independently, which was listed as a step in the task analysis. The researcher brought these issues to Yan's and Ting's attention and addressed them in their parent training sessions. They then started following the steps and became better at providing prompts and delivering reinforcers. As a result, their performance increased immediately upon entering their post-BST phases.</p> <p>It was interesting to find that not only was the children's performance positively impacted by the parent-delivered training, but the level of their responding generally aligned with the level of procedural fidelity of their parents. This finding supports previous research indicating that higher procedural fidelity by parents was correlated with better treatment outcomes (Arkoosh et al., [<reflink idref="bib3" id="ref76">3</reflink>]; Strauss et al., [<reflink idref="bib73" id="ref77">73</reflink>]). Similar results were reported by Kaiser et al. ([<reflink idref="bib36" id="ref78">36</reflink>]) that as parents increased their fidelity in implementing mand procedures, their children's manding abilities also improved. This finding is not surprising because when the parents can implement the procedures with high fidelity, it means that they can administer mand training steps accurately, provide reinforcement accordingly, and use error correction procedures as needed. Consequently, their children receiving the high quality mand training are more likely to learn the skills successfully.</p> <p>When children make quick progress following training from their parents, it reinforces and motivates parents to provide better training. On the contrary, when children do not make sufficient progress, parents may feel discouraged and have less confidence in their teaching abilities (Schertz & Odom, [<reflink idref="bib62" id="ref79">62</reflink>]). In the case of Taylor, he had an overall low level of responding to Ting's teaching and Ting appeared to struggle with implementing the procedures as described. Deviating from the task analysis steps often led to lower fidelity in prompt provision and reinforcer delivery. As a result, Taylor showed a lower level of performance, compared to the other two children. This aligns with findings of previous research that parents' fidelity and child performance influence each other in a reciprocal manner (Strauss et al., [<reflink idref="bib73" id="ref80">73</reflink>]).</p> <p>There were a few post-BST sessions where Neal and Julia emitted a low level of mands (Fig. 3). One possible explanation is that their EOs for the preferred items used in trials were not closely monitored and followed by their parents. Parents were trained to keep the preferred items novel and of high value by rotating them frequently. However, sometimes an item may have been used repeatedly for several trials, resulting in the children losing interest in the items and hence not emitting mands to obtain them, which may have contributed to the drops of scores in this phase of both children.</p> <p>It was constantly noted in previous literature that Asian parents of children with disabilities hold negative perceptions of disabilities (Chan et al., [<reflink idref="bib10" id="ref81">10</reflink>]; Chan & Lee, [<reflink idref="bib12" id="ref82">12</reflink>]), experience a sense of guilt and shame (Chan, [<reflink idref="bib11" id="ref83">11</reflink>]; Chiang & Hadadian, [<reflink idref="bib13" id="ref84">13</reflink>]; Shorey et al., [<reflink idref="bib68" id="ref85">68</reflink>]), and often view their children's challenging behavior as a "loss of face" (Kramer et al., [<reflink idref="bib41" id="ref86">41</reflink>]; Yang & Kleinman, [<reflink idref="bib88" id="ref87">88</reflink>]). Therefore, they tend to remain private about their children's diagnoses (Kang-Yi et al., [<reflink idref="bib37" id="ref88">37</reflink>]). However, these tendencies were not observed in the three Asian parents in the present study. Throughout this investigation, all three parents demonstrated positive attitudes toward their children and were open to discussing disability-related issues. Parette et al. ([<reflink idref="bib55" id="ref89">55</reflink>]) reported that Asian Americans who hold higher education degrees and lived in the U.S. for over 10 years tend to have objective perceptions toward disabilities and do not see disability as a source of shame. This finding may be due to the fact that the three parents all obtained their higher education degrees, and Yan and Ting have lived in the United States for many years. This suggests that parents who are well educated and immigrated to the U.S. for a long period of time may be more acculturated to the Western culture (Kim et al., [<reflink idref="bib40" id="ref90">40</reflink>]), and thus less influenced by traditional perceptions of ASD prevalent in their home countries. Future research could further investigate the relationship between parental attitude toward ASD and their educational level and immigration history using a larger sample of Asian immigrant parents.</p> <hd id="AN0184231745-27">Implications for Practice</hd> <p>The findings of the study may be helpful in developing culturally responsive strategies for practitioners to train Asian immigrant families with children with ASD. The three parents did not demonstrate negative attitudes toward their children; however, findings of the study showed that the two Chinese parents, Yan and Ting, were slow and somewhat reluctant to frequently deliver reinforcers. It was observed that they tend to delay and sometimes cancel the delivery of reinforcers for a correct response of their children despite providing reinforcement being a step outlined in the task analysis. This finding is consistent with previous research that Chinese American parents may object to positive reinforcement systems that require them to provide tangible rewards to their children for performing certain behaviors (Lau et al., [<reflink idref="bib46" id="ref91">46</reflink>]). One possible explanation is that after hearing a correct mand emitted by their children, the two parents attempted to motivate them to mand again before providing reinforcement so that the children could practice the skill one more time. This phenomenon has been documented in previous research that Chinese immigrant parents believed demanding parenting would ultimately yield positive outcomes (Li, [<reflink idref="bib47" id="ref92">47</reflink>]). Given that the immediacy of reinforcer delivery following a correct response is critical in promoting the future occurrence of the response (Marlott & Shane, [<reflink idref="bib49" id="ref93">49</reflink>]), this finding suggests that when conducting parent training, emphasizing timely reinforcer delivery may be necessary for Chinese parents.</p> <p>A practical suggestion is to include a step in the task analysis that reads, "a reinforcer must be delivered within 3 s of the occurrence of a correct response." This step may serve to improve the immediacy of reinforcement provision. Relatedly, another suggestion is to provide extra opportunities to practice the abovementioned step in the rehearsal stage of BST. The need for an increased dosage of rehearsing and support was suggested in previous research on parent training with Chinese-origin families. For example, Crisante and Ng ([<reflink idref="bib15" id="ref94">15</reflink>]) reported that Chinese-origin immigrants needed substantial practice to bolster their behaviors of delivering praise. Likewise, Lau et al. ([<reflink idref="bib45" id="ref95">45</reflink>]) suggested that extra support to rehearse behavior changes is necessary in training Chinese parents. The additional practice will likely improve their performance of reinforcer delivery. Our suggestion of providing extra practice was also supported by Ting's outcomes. Her performance improved through receiving extra practice and feedback in the booster sessions. Future research could investigate additional practice as a variable of parent training outcomes.</p> <p>Based on observations and parent reports throughout the study, practitioners might also consider these cultural adaptations when working with immigrant families. First, offer translated materials to the families. It was observed that when both English and Chinese materials were available, Yan and Ting consistently opted to use the Chinese version. Ting reported her English is at the beginner level and Yan reported it at the advanced level. Even though English is their second language, they chose to use their first language whenever it was available. It is therefore recommended for practitioners to translate materials to parents' first language and offer them as an option, even when they can use English as a second language. If no practitioner in the workplace speaks the same language as the parents, efforts should be made to find a competent translator in advance for the development of materials.</p> <p>In addition, schedule a few sessions prior to the start of the training to build rapport with the families and continue to do so throughout the training. The researcher met with each dyad prior to the study to introduce herself, explain the study, answer their questions, and obtain consent and assent. She also communicated with the parents in person and via text messages about their children's strengths, desired items and activities, school schedules, parent–child interactions, and challenging behaviors. This allowed her to gain insights into their family cultures, values, and expectations of the training. Proactively engaging parents in conversations conveys an understanding and appreciation of their opinion and concerns, which may increase their overall trust (Taylor et al., [<reflink idref="bib79" id="ref96">79</reflink>]) and help build a collaborative relationship with the researcher. Furthermore, the researcher shared with the parents many similar obstacles she faced and overcame as an immigrant. Tacting her own personal experience and identifying their struggles through the process of perspective taking may strengthen parents' investment in the treatment and training (Taylor et al., [<reflink idref="bib79" id="ref97">79</reflink>]). Malai shared with the researcher that she greatly appreciated the rapport building efforts and felt safe to express feelings and ask questions. Fostering a trusting relationship would help immigrant parents feel more supported, which may increase their openness and willingness to fully engage in the training sessions.</p> <hd id="AN0184231745-28">Limitations and Future Research</hd> <p>Study limitations should be noted. First, the child participants' progress might be partly attributed to learning from outside of the parent training of this study. This investigation happened 1–2 times a week for 3–4 months during the school year. It is possible that the children have practiced manding skills in their schools and/or other interventional settings, which may have impacted the results of the study. Second, Malai's fidelity in baseline was higher compared to data of the other two parents. This might be because that she and her husband studied and practiced the steps outside of the research sessions. Malai became familiar with the steps shortly after entering baseline. This might have contributed to her higher scores in baseline. Third, we did not collect generalization data in baseline prior to intervention. Although we believe our generalization data at the end of the study provided valuable information of the performance of the participants, collecting such data in baseline would be beneficial in drawing valid and trustworthy conclusions regarding the generalization of the acquired skills.</p> <p>The fourth limitation is regarding the language use in the study. We included participants who spoke English and/or Mandarin Chinese. This language criteria may have excluded other Chinese immigrants who only spoke Cantonese. Malai did not have the option to receive the training in her first language (Thai) and had to be trained in English, while the other two parents selected to be trained in Mandarin. When asked, Malai expressed a preference for training in Thai if given the choice. Since providing training in the parent's native language tends to increase participation and adherence (Forehand & Kotchick, [<reflink idref="bib24" id="ref98">24</reflink>]), training Malai in English may have limited the effectiveness of the intervention and its outcomes for her. Another point related to language is that we did not check with a Thai speaker about the Thai translation of the social validity questionnaire due to the lack of access to native Thai speakers. Without checking by a native speaker, we do not know whether the translated information lacks accuracy. However, the Thai translation was provided as a hard copy for reference purposes only, as parents were required to complete the English questionnaire on SurveyMonkey.com to ensure anonymity. Furthermore, we did not include questions regarding language or cultural aspects of the intervention in the social validity questionnaire. Such a measure would have allowed parents to provide feedback on the language adaptations of the intervention. As suggested by Taylor et al. ([<reflink idref="bib79" id="ref99">79</reflink>]), social validity measures should enable parents to evaluate the degree to which culturally and linguistically appropriate treatment was implemented. Future research could include social validity questions to evaluate parents' opinions on language adaptations and cultural aspects of the intervention.</p> <p>We recommend several directions for future research. The increasing Asian immigrant population and their growing needs for culturally and linguistically responsive services for their children with ASD urge researchers to conduct more research with this minority group. A valuable aspect of the present study is its focus on Asian immigrant parents and their linguistic challenges. The majority of special education research has predominantly involved Anglo populations (Dyches et al., [<reflink idref="bib22" id="ref100">22</reflink>]; Jones et al., [<reflink idref="bib35" id="ref101">35</reflink>]; Steinbrenner et al., [<reflink idref="bib71" id="ref102">71</reflink>]) and Asian Americans are nearly excluded from treatment outcome literature (Huey & Polo, [<reflink idref="bib33" id="ref103">33</reflink>]). Therefore, it is crucial to recruit participants from Asian backgrounds in research to develop culturally and linguistically adapted interventions.</p> <p>In addition, future research is recommended to examine the effects of mand training implemented by fathers. The present study had three mothers as the parent participants, and the training effect with fathers was unknown. Research indicates that fathers of children with ASD are less likely to participate in parent training programs compared to mothers (Rankin et al., [<reflink idref="bib57" id="ref104">57</reflink>]). In a systematic review conducted by Flippin and Crais ([<reflink idref="bib23" id="ref105">23</reflink>]) on parent-implemented interventions for children with ASD, only three out of the 26 reviewed articles reported the involvement of fathers in parent training. These findings underscore the necessity for increased father involvement in research on children with ASD. Additionally, within many Asian cultures, there are distinct differences in how fathers and mothers perceive their roles in child-rearing and their expectations for their children (Lau et al., [<reflink idref="bib46" id="ref106">46</reflink>]). Mothers in Asian cultures tend to prioritize family goals over personal achievements (Wang & Casillas, [<reflink idref="bib85" id="ref107">85</reflink>]), while fathers view themselves as role model for their children (Wang & West, [<reflink idref="bib86" id="ref108">86</reflink>]). Mothers often lower their expectations for their children after they receive a diagnosis of ASD, whereas fathers maintain higher expectations compared to mothers (Wang & West, [<reflink idref="bib86" id="ref109">86</reflink>]). Thus, it would be beneficial to assess the effects of father-delivered training on skill acquisition of children with ASD.</p> <hd id="AN0184231745-29">Conclusion</hd> <p>The present study is the first to investigate the effectiveness of using BST to train Asian immigrant parents in teaching manding to children with ASD. Although many well-supported practices involving individuals with ASD, such as BST and parent training, have a robust body of evidence, a major limitation is their lack of representation of cultural minority families (Hall, [<reflink idref="bib27" id="ref110">27</reflink>]; Lau, [<reflink idref="bib43" id="ref111">43</reflink>]). The present study fills this gap by examining the effects of these practices with a less-researched minority population and addressing their language barriers. Specifically, findings of this study demonstrate the effectiveness of BST on training Asian immigrant parents, supporting its effectiveness across cultural and linguistic contexts. It also shows that Asian immigrant parents can be trained to implement mand training to their children with a high level of fidelity, indicating the transportability of parent training to Asian families. Furthermore, this study sheds light on the development of culturally sensitive parent training and highlights the importance of conducting research with Asian populations to meet the increasing needs of this growing culturally and linguistically diverse community in this country.</p> <hd id="AN0184231745-30">Declarations</hd> <p></p> <hd id="AN0184231745-31">Conflict of interest</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0184231745-32">Ethical Approval</hd> <p>Institutional Review Board approval was obtained prior to the commencement of recruitment.</p> <hd id="AN0184231745-33">Human and Animal Rights</hd> <p>All procedures performed in the current study were in accordance with the ethical standards of the institutional review board.</p> <hd id="AN0184231745-34">Supplementary Information</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary file1 (DOCX 110 kb)</p> <hd id="AN0184231745-35">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0184231745-36"> <title> References </title> <blist> <bibl id="bib1" idref="ref67" type="bt">1</bibl> <bibtext> Albert KM, Carbone VJ, Murray DD, Hagerty M, Sweeney-Kerwin EJ. 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  Group: Ti
  Data: Training Asian Immigrant Parents to Teach Manding to Children with Autism Spectrum Disorder
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Xiaohan+Chen%22">Xiaohan Chen</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-4117-0359">0000-0003-4117-0359</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ann+X%2E+Huang%22">Ann X. Huang</searchLink>
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  Label: Source
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Behavioral+Education%22"><i>Journal of Behavioral Education</i></searchLink>. 2025 34(1):184-212.
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  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/
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 29
– 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="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Verbal+Operant+Conditioning%22">Verbal Operant Conditioning</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Skills%22">Communication Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Education%22">Parent Education</searchLink><br /><searchLink fieldCode="DE" term="%22Immigrants%22">Immigrants</searchLink><br /><searchLink fieldCode="DE" term="%22Asians%22">Asians</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink>
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  Label: DOI
  Group: ID
  Data: 10.1007/s10864-023-09526-4
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  Label: ISSN
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  Data: 1053-0819<br />1573-3513
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Children with autism spectrum disorder often exhibit difficulties in social communication and interaction. Those who do not acquire functional communication to effectively express wants and needs often are at a higher risk of displaying challenging behaviors. Mand training is recognized as an evidence-based intervention for teaching communication to children with autism spectrum disorder. However, limited research has been conducted to examine the effects of training parents from Asian immigrant backgrounds to teach manding to their children at home. To fill the gap, we trained three Asian parents using behavioral skills training to teach their children with autism spectrum disorder to mand for preferred items. A multiple-baseline across participants design was used to evaluate the effects of parent training on parent participants' implementation of mand training and the effects of the parent-delivered training on mand acquisition of their children. Results showed that all three parents had significant improvement in their mand training implementation, and all three children demonstrated an increase in their use of unprompted mands at different levels. The three parent-child dyads demonstrated various levels of maintenance and generalization of the skills learned. Implications of the findings and recommendations for future research are discussed with specific regard to working with Asian immigrant families.
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  Data: 2025
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 29
        StartPage: 184
    Subjects:
      – SubjectFull: Verbal Operant Conditioning
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Communication Skills
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Parent Education
        Type: general
      – SubjectFull: Immigrants
        Type: general
      – SubjectFull: Asians
        Type: general
      – SubjectFull: Program Effectiveness
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    Titles:
      – TitleFull: Training Asian Immigrant Parents to Teach Manding to Children with Autism Spectrum Disorder
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            NameFull: Xiaohan Chen
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            NameFull: Ann X. Huang
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              Y: 2025
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