افزایش فرصت ها برای پرسیدن سوال در مدارس کودکان با اختلال طیف اوتیسم: اثربخشی آموزش کارکنان در درمان پاسخ محوری Increasing Opportunities for Question-Asking in School-Aged Children with Autism Spectrum Disorder: Efectiveness of Staf Training in Pivotal Response Treatment

Introduction Autism spectrum disorder (ASD) is characterized by restricted, repetitive, and stereotyped behaviors and impairments in social communication and social interaction, (American Psychiatric Association 2013), including deicits in self-initiations and question-asking. Compared with typically developing children, children with ASD ask fewer questions and their questions serve fewer functions (Hauck et al. 1995; Stone and Caro-Martinez 1990; Stone et al. 1997; Wetherby and Prutting 1984). This results in reduced opportunities for learning a variety of skills as they elicit fewer teaching interactions from their environment (Koegel et al. 2003; McDuf et al. 2001). Furthermore, deicits in question-asking often lead to directive behavior of children’s environment, thereby further reducing their opportunities to self-initiate questions (Hudry et al. 2013). Deicits in question-asking are associated with poorer long-term outcomes on pragmatic and adaptive skills and school and community functioning (Koegel et al. 1999). For these and other reasons, it is important to teach children with ASD to initiate questions. Numerous studies have reported on interventions aimed at teaching question-asking skills to children with ASD. Targeted questions had various communicative functions, including requesting objects (e.g., Wert and Neisworth 2003), help (e.g., Dotto-Fojut et al. 2011), information (e.g., Betz et al. 2010), and social information (e.g., Dogget et al. 2013). These studies encompassed multicomponent behavioral interventions to increase question-asking, for example discrete trial teaching (DTT; e.g., Ingvarsson and Hollobaugh 2010), pivotal response treatment (PRT) (e.g., Koegel et al. 2014), self-management (e.g., Koegel et al. 2014), and video modeling (e.g., Charlop and Millstein 1989). Common components included contrived establishing operations, systematic prompting (e.g., echoic prompts) and prompt fading procedures (e.g., time delay) and natural reinforcement (Raulston et al. 2013). A systematic review reported positive results of these components with regard to the acquisition of targeted questions, suggesting that these components are efective in teaching question-asking skills to children with ASD (Raulston et al. 2013). However, the efectiveness of these components has not yet been investigated during intervention sessions in the context of natural everyday activities, conducted by children’s natural conversational partners, and targeting questions with various communicative functions. Moreover, generalization efects of question-asking interventions to natural situations were rather limited (e.g., Betz et al. 2010). Deicits in question-asking in natural situations may thus relect a performance deicit rather than a skill deicit (Koegel et al. 2012, 2014; Palmen et al. 2008). To bring question-asking under control of natural stimuli, children with ASD should preferably be taught question-asking skills directly in natural situations by natural conversational partners who need training to implement interventions with adequate treatment idelity (e.g., Reid and Fitch 2011).