Just Tell Me What You Really Want: Teaching Children with Autism to Infer What People Want When they Don’t Say it Adel Najdowski, Ryan Bergstrom, Jonathan Tarbox, and Megan St. Clair

Introduction Children with ASD present with deficits in understanding nonliteral language Humor (Emerich, Creaghead, Grether, Murray, & Grasha, 2003) Sarcasm (Pexman et al., 2011) Deception (Happe, 1995) Indirect requests (Paul & Cohen, 1985)

Introduction ABA effective in teaching basic language (National Autism Center, 2009) RFT approach can be used teach children with ASD to identify and respond to nonliteral language RFT – a generalized operant ability to make relations among untrained stimuli is trainable via multiple exemplar training

Introduction Metaphors (Persicke, Tarbox, Ranick, & St. Clair, 2012) Sarcasm (Persicke, Tarbox, Ranick, & St. Clair, 2013) Deception (Ranick, Persicke, Tarbox, & Kornack, 2014)

Introduction Indirect requests -- AKA disguised mands (Skinner, 1957) Hint that someone wants something without directly asking for it

Introduction Successful communication requires understanding of indirect requests (MacKay & Shaw, 2004) Responding to indirect requests Requires inference about the relation between one’s overt behavior (what one says) and covert behavior (what one thinks)

Introduction Theory of Mind (ToM) research ASD – difficulties understanding and interpreting others’ covert behavior (emotions, belies, intentions, desires; Baron-Cohen, 1993) Typical child development mos: respond to palm-up request (Ma sur, 1983) 18 mos: identify desires based on facial expression (Repacholi & Gopnik, 1997) 4 yrs and up: respond appropriately to indirect requests (Dewart & Summers, 1995)

Introduction RFT perspective - Listener relates the speaker’s indirect request to what the speaker actually means – Relation of distinction (“mmm, those cookies look good” is not what he really meant) – Relation of coordination (“mmm, those cookies look good” is a hint that he might want to try one)

Purpose Can RFT approach be used to teach children with ASD to respond to indirect requests? Multiple exemplar training package – Rules – Role-play – Feedback

Participants 3 boys with ASD: Nick (10), Musa (12), & Drew (9) Nick and Drew were receiving behavioral intervention which addressed all major skill deficits hours per week Musa was receiving 2 hours a week of follow- up services

Participants cont. All failed to respond to indirect requests Prerequisites – Vocal – Well-developed language skills – Repertoire of following rules and multi-step instructions – History of learning via role-play – No significant compliance issues

Setting min sessions conducted one time per day 1-2 days per week In home during regularly scheduled therapy hours For Musa only, one baseline and post-training at an amusement park

Data Collection Percentage correct Correct response to an indirect request: – Asking the speaker a question related to the request (optional) – Engaging in a behavior to give the person what they were requesting Interobserver Agreement (IOA) – Trial-by-trial – 55%-70% sessions; 98%-100% agreement

Experimental Design Nonconcurrent multiple baseline across participants Phases Baseline Training Post-Training

Baseline 5 indirect requests semi-randomly selected from a list of 20 The same indirect request could not be repeated until all 20 had been presented once – Examples: “I’m thirsty”, “I’m bored”, “I’ve always wanted to try that” Indirect requests issued approximately every 5-10 minutes 3-5 different people issued indirect requests

Training Various locations at the child’s house 3 Phases – Phase 1: Explanation, rules, example, role-play Sometimes people use hints You need to respond Pillow example Role-play test Mastery Criteria – Respond within 3 s during role-play test twice consecutively

Training cont. Phase 2: Rule reminder and feedback – At the beginning of the session: “During the rest of the time we are together today, people are going to be making hints about things they want and you will have to ask if they want it and get it for them.” – 10 trials using different but functionally similar indirect requests used in baseline – 2-4 different people issued indirect requests

Training cont. – Praise delivered for correct responses and feedback given on incorrect responses “Hey, did you hear what Sara said? What do you think she was really saying? So what should you do?” – 2 incorrects in a row: priming statement repeated – Mastery Criterion 80%-100% across 2 consecutive sessions

Training cont. Phase 3: Feedback only – No more rules – 3-second prompt delay – Mastery Criterion 80%-100% on training targets and 100% generalization to first trial probes with novel targets across 3 consecutive sessions 80%-100% on test for generalization to a novel person – Trainer not present during this test

Training cont. Targets presented during phases 2 and 3: 1.Targets randomly rotated across 10 trials 2.Started with only 2 targets in the rotation 3.Once at or above 70%, 2 more targets added to the rotation. Repeat. 4.Each time 2 new targets were added to the rotation, as well as being calculated into the total percentage, the first time they were presented was graphed as a “first trial probe”

Post-Training Identical to baseline – Same targets (all absent during training) – Same people (2-3 absent during training)

Summary of Results Data support the use of rules, role-play, and feedback to teach children with ASD to respond appropriately to indirect requests – Generalization was observed across people and indirect requests – Generalization to one community location was observed for one participant (Musa) Relatively efficient procedure – Less than 10 hours of training – Easily incorporated into regular therapy session

Discussion RFT approach that uses rules to teach participants to make relations amongst stimuli across multiple exemplars was used Participants taught via rules to attend to relations between what is said and actually meant in terms of distinction (he said X, but meant Y) and coordination (he said X, which is the same as Y) Multiple exemplar training resulted in a generalized operant ability to respond to novel indirect requests and people

Limitations Limited test for generalization across environments Did not test w/ peers No tests for maintenance Treatment package Lack of social validity measures Lack of training in when it’s okay to ignore and not respond to indirect requests

Thank you Angela Persicke Sara Sharaf Shanee Aziz Stephanie Neri