Using TAGteachTM Methods to Increase Eye Contact Behavior

in Children with Autism

Regina Maendler, John W. Eshleman, Traci M. Cihon

The Chicago School of Professional Psychology

Paper presented at the Meeting of the Association for Behavior Analysis International, May 2009

Introduction• Eye Contact

– Many children with autism demonstrate limited eye contact with others (American Psychiatric Association [DSM-IV-TR], 2000).

– Eye contact may be an important prerequisite for the development of other behavioral repertoires including mands, imitation, compliance with instructions (Hamlet, Axelrod, & Kuerschner, 1984), as well as social interaction (e.g., gaining and maintaining attention, conversational skills, social initiations and reciprocations, etc.).

– Eye contact can be shaped and strengthened using the operant paradigm (Schroder & Holland, 1968; Duran & Holland, 1971)

– Eye contact developed under contingencies that require a response to antecedent stimuli (e.g., “look”) or aversive physical prompting procedures may produce a conditioned avoidance response which is not naturally maintained in the natural environment (Foxx, 1977; Hamlet, Axelrod, & Kuerschner, 1984). Positively reinforcing free operant occurrences of eye contact may be more effective.

Introduction• Immediacy of Reinforcement

– The eye contact movement cycle can be quite brief and it is not always possible to provide immediate reinforcement contingent upon the behavior. Precise reinforcement is essential for more effective behavior change. (Grice, 1948; Ramey & Ourth, 1971; Lattal, 1978; Fowler & Baer, 1981; Lattal, 1984; Reeve, Reeve, Brown, Brown, & Poulson, 1992; Grace, Schwendiman & Nevin, 1998; William, 1999; Doughty & Lattal, 2003; Reilly & Lattal, 2004; Odum, Ward, Barnes, & Burke, 2006; Podleskik, Jimenez-Gomez, Ward, & Shahan, 2006; Podlesnik & Shahan, 2007).

• Clicker Training– Clicker training is an effective reinforcement method for a wide array of

behaviors in animal species (Pryor, Hagg, & O’Reilly, 1969; Ferguson & Rosales-Ruiz, 2001; Pryor, 1999, 2005; Fjellanger, Andersen, & McLean, 2002).

• TAGteach– Although there is limited research, Teaching by Acoustical Guidance (TAG)

has been shown to be a successful teaching tool for developing a variety of behaviors in humans (Madden & Hanson, 2006; Gutierrez, 2007; Libby, Weiss, & Lipcon, 2007; Rosenblum, 2007; Wasano, 2008; Weiss & Libby, 2008; Ueda, 2006).

– The majority of available research on TAG is comprised of treatment designs which are favorable in clinical settings; although, fail to demonstrate a functional relation between the implementation of TAG and behavior change. However, more sound research regarding the effectiveness of TAG is emerging.

Method• Participants:

– A: 3 year old male with autism diagnosis.– B: 4 year old female with autism diagnosis.– C: 11 year old male with autism and obsessive compulsive disorder.

• Setting:– Home or school environment.

• Materials:– Clicker+TM, digital timers, manual counters,

data sheets, 3 colored shirts, and various preferred items and activities.

• Procedure:– The experimenter engaged each student in a variety of play activities

while actively contriving opportunities for the student and the therapist to make eye contact (e.g., contriving mands, social interactions, etc.) and thus providing reinforcement characteristically of each experimental condition.

– 10 minute sessions (originally 20 minutes)

Method• Dependent Variable

– Target Definition:

• 1) The student’s face was oriented toward the therapist, 2) the student and therapist’s line of vision met forming a straight line (Hamlet, Axelrod, & Kuerschner, 1984), and 3) eye gaze between student and therapist was held for a minimum of 1 s.

• Experimental Design: Mulitelement Design– Conditions:

• TAG: All occurrences of the target behavior were tagged with an acoustical marker (i.e., a “ping” sound). All tagged occurrences of eye contact were immediately followed by descriptive praise statements and contingent access to a back up reinforcer (e.g., tangible items or activities).

• Contingent Reinforcement (CR): Descriptive praise statements as well as access to preferred items and activities were made contingent upon any occurrence of eye contact behavior with the therapist.

• Baseline - Non Contingent Reinforcement (NCR): General praise statements and access to desired items and activities were provided on a fixed-interval schedule of 30 seconds

Results• Data Collection:

– Daily Standard Celeration Charts (overall frequency per session)– Successive Minutes Standard Celeration Charts (per minute frequencies within

each session)– Cumulative records (cumulative responses per minute for each session)

• Interobserver Agreement & Treatment Integrity: 33% of all conditions

• Social Validity:– Questionnaire (In progress)

Participant A: Daily SCC

Participant B: Daily SCC

Participant C: Daily SCC

Participant A: Within Session

Participant B: Within Session

Participant C: Within Session

Participant A: Cumulative Records

Participant A

0

10

20

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60

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90

100

1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 280 289 298 307 316 325 334 343 352 361 370 379 388 397

Successive Minutes per Session

Cum

ulat

ive

Num

ber

of R

espo

nses

Participant B: Cumulative Records

Participant B

0

20

40

60

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160

1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262

Successive Minutes per Session

Cum

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f Res

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es

Participant C: Cumulative Records

Participant C

0

5

10

15

20

25

30

1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 280 289 298 307 316 325 334

Successive Minutes per Session

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Results• Average Rates of Responding per Condition:

• Responding reached its highest per min rate first under TAG conditions:– Participant A: 13 responses in 1 min.

– Participant B: 11 responses in 1 min.

– Participant C: 5 responses in 1 min.

Discussion & Implications• Results suggest that Teaching by Acoustical Guidance (TAG) is

an effective technique for increasing eye contact behavior in children with autism.

• TAG may be a more effective and immediate reinforcement method than contingent reinforcement alone, especially for responses that can have a relatively short duration and may be difficult to capture using traditional reinforcement methods.

• TAG sessions not only produced higher rates of responding than CR and NCR sessions, but also evoked more stable rates of responding within sessions.

Limitations• Sequence effects

• Lack of discrimination between conditions

• Length of sessions

• Characteristic Consequences

• Motivating Operations

• Role of the experimenter

• IOA and possible Reactivity

Future Research• Expand target definition of eye contact (e.g., duration, context, in

response to antecedent stimuli, etc.).

• Shaping eye contact in those who do not currently display this behavior.

• Effectiveness of TAG with new populations, target behaviors, settings, etc.

• How experience with TAG might facilitate the development of other behavioral repertoires.

• Most effective method for fading an acoustical marker (e.g., thinning a variable ratio schedule, fading the volume of the auditory stimulus, etc.).

• Which acoustical stimuli serve as the most salient and effective conditioned reinforcers (e.g., click, ping, etc.).

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