Clinical Research Reports

Beacon is proud to contribute to the latest evidence based strategies in the field of ABA therapy. We regularly analyze clinical research reports to support our core value of utilizing evidence-based strategies that lead to functional treatment outcomes for clients, children and families.

February 2025

For families of children with developmental delays, caregiver training is an important part of intervention. Caregiver training can support the learning of new skills that are specific to the home setting and may also encourage generalization of skills learned in other settings. Many caregivers benefit from training as part of a comprehensive treatment program such as that provided in ABA intervention.

During the COVID pandemic, many intervention providers were forced to shift to a telehealth model to train and support caregivers. One limitation with telehealth, however, is that the practitioner is not present to model or demonstrate skills for caregivers. Video modeling is one empirically validated method for training new skills that may address this limitation. It also has the potential to save time and resources, particularly when the practitioner cannot be present with the caregiver.

Yarzebski & Dickson (2024) evaluated the effects of a video modeling training to teach three caregivers how to use graduated guidance, a type of prompting procedure using physical prompts and gradual fading of those prompts. Their results indicated that video modeling with a voiceover was effective at teaching caregivers to use graduated guidance with their young children with autism spectrum disorder. Moreover, all caregivers learned the skills in under 30 minutes and reported the video modeling was a helpful approach that they would recommend to others.

To read the full report:

Yarzebski, V. & Dickson, C. (2024). Teaching caregivers to use graduated guidance using video modeling. Behavior Analysis in Practice, 17, 1198-1203.

December 2024

Toilet training is often a concern for families who have children with developmental delays, as some children may not experience successful toilet training until later in life. Incontinence may lead to health and social issues and may be a source of frustration and anxiety for parents and caregivers. Although some regression in toilet training may be expected for young children under the age of three, common barriers to urinary continence for older children may include problem behavior, urine retention, recurrent accidents, and repeated or limited requests to use the toilet.

There are several empirically validated toileting training methods founded in Applied Behavior Analysis (ABA). Donnelly and Karsten (2024) outlined a series of research-based solutions that clinicians can use when they encounter barriers to toilet training. The authors also encouraged clinicians to consider when problems with toilet training might indicate a child has withdrawn assent, and to consider cultural aspects of toilet training that may not be well-researched.

To read the full report:

Donnelly, M. G., & Karsten, A. M. (2024). Resolving barriers to continence for children with disabilities: Steps toward evidence-based practice. Behavior Analysis in Practice, 17, 157-175. https://doi.org/10.1007/s40617-023-00891-0

November 2024

Many individuals with autism present with feeding issues such as eating a limited number of foods and refusing to try or consume novel foods. Rigid eating patterns may include refusal to try new foods based on texture, brand, smell, or appearance (Hubbard et al., 2014). These restricted diets may lead to nutritional deficiencies, health concerns, and increased mealtime stress for families and caregivers.

There are several evidence-based interventions based on Applied Behavior Analysis (ABA), but these are often implemented in clinical settings and may be difficult for parents to implement. Two relatively simple interventions involve the simultaneous or sequential presentation of foods. The simultaneous presentation involves presenting the child with a preferred food along with a non-preferred food, either side by side or with one food in another (e.g., bite of vegetable topped with a condiment). In the sequential presentation, the bite of preferred food is provided after the bite of nonpreferred food has been eaten.

Davis et al. (2023) compared the use of the simultaneous vs. the sequential food presentation to determine which was more effective for three young children with autism. Their results indicated that two of the children’s consumption of novel foods increased with the sequential presentation, suggesting this may be an easy to use and effective intervention for caregivers. The authors noted that behavior analysts should consult with medical professionals to rule out medical causes (e.g., difficulty swallowing, acid reflux, etc.) of restricted eating prior to intervening.

To read the full report:

Davis, M., Slaton, J., MacDonald, J., & Parry-Cruwys, D. (2023). Comparing simultaneous and sequential food presentation to increase consumption of novel target foods. Behavior Analysis in Practice, 16, 1124-1137.

Hubbard, K. L., Anderson, S. E., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. Journal of the Academy Nutrition & Dietetics, 114(12), 1981–1987.

October 2024

Imitation is a critical skill for young children as it facilitates the acquisition of social and communicative behaviors and helps children learn from their environment. Many children with autism spectrum disorders (ASD) struggle to learn imitation skills, and these skills are often targeted as part of ABA therapy. When teaching imitation skills, a therapist might use a fixed model that involves modeling the movement one time and leaving a visible outcome (e.g., covering a doll with a blanket). Alternatively, a therapist might use a repetitive model, where the target movement occurs several times and returns an item to its original position, without a visible outcome (e.g., pushing a car back and forth four times).

A recent study by Halbur et al. (2023) compared the use of fixed and repetitive models during object imitation training to determine if one led to faster acquisition of imitation skills. Their results demonstrated that the fixed models led to quicker learning and that repetitive models were more likely to be effective following learning with the fixed models. Currently, there are limited guidelines on best practices for teaching object imitation skills to young children with ASD, but these results suggest that the fixed model may be more efficient for some learners.

For additional information, see:

https://onlinelibrary.wiley.com/doi/full/10.1002/jaba.993

Halbur, M., Preas, E., Carroll, R., Judkins, M., Rey, C., & Crawford, M. (2023). A comparison of fixed and repetitive models to teach object imitation to children with autism. Journal of Applied Behavior Analysis, 56, 674-686. DOI: 10.1002/jaba.993

July 2024

When delivering clinical supports, it’s important to listen, reflect, and reconsider approaches to service delivery to ensure the most effective treatments for those within the autistic and neurodivergent communities and beyond.

Labeling (or tacting) describes the act of identifying or naming items or objects around us. For example, when a child picks up a block, their ability to verbally identify the item and say “block” would be a demonstration of labeling. For young children, learning to label objects is an essential communication skill. In this study by Yang, Wilder, Fernand, and McChristie, the authors investigated if the amount of time between when a child labels/tacts an item and when they are rewarded for this action impacts learning. They discovered that a reward or immediate praise by the parent, caretaker, or therapist was an effective contributor when teaching children new labels.

To read the full report:

Yang, Y.-C., Wilder, D.A., Fernand, J. K., & McChristie, A. (2024). The effect of variable delays to reinforce on the acquisition of tacts in children with autism. Behavioral Interventions, e2025.

June 2024

When teaching a child how to use Augmentative and Alternative Communication (AAC), it’s important for Beacon Speech-Language Pathologists (SLPs) to develop a professional partnership with the child’s family. In this study by Biggs, Therrien, Abarca, Romano, Barton-Hulsey, and Collins, they examined the family-oriented beliefs and practices of SLPs who were working with preschool and school-aged children learning to use aided AAC.

The researchers interviewed 25 SLPs to get an understanding of the similarities and differences in their beliefs and practices when working with families. Based off their responses, the SLPs were separated into three groups; Professionally Centered, Family-Allied, and Family Focused. The researchers discovered that there is a need for an increase in family-centered practices, which in turn, could increase family empowerment. By fostering a strong partnership with families, SLPs could see improved outcomes for children who use AAC.

To read the entire report:

Biggs, E. E., Therrien, M. C. S., Abarca, D., Romano, M., Barton-Hulsey, A., & Collins, S. C. (2024). Examining the Family-Centeredness of Speech-Language Pathologists Working With Children Who Use Augmentative and Alternative Communication. American Journal of Speech-Language Pathology, 33(2), 1021–1039

May 2024

When delivering ABA therapy, it’s important to listen, reflect, and reconsider approaches to service delivery to ensure the most effective treatments for those within the autistic and neurodivergent communities and beyond.

In this study by Allen, Mellon, Syed, Johnson, and Bernal, they reflected on an ongoing trend in the field of ABA that focuses on how to best listen and collaborate with autistic clients and their stakeholders. In the report, the researchers provided an overview of this trend as well as suggestions for best practice. At Beacon, our goal is to respect neurodiversity while working with each child and their family to identify and teach new skills that increase independence and autonomy.

To read the full report:

Allen, L.L., Mellon, L.S., Syed, N. et al. Neurodiversity-Affirming Applied Behavior Analysis. Behav Analysis Practice (2024).

April 2024

We’re passionate about delivering ABA services that are supported by evidence-based peer-review research to young children with autism.

A characteristic of autism is repetitive behavior, and this often manifests itself in children by them lining up and ordering items such as toy cars, blocks, animals, or any household items. For some children, if an arrangement of items is disrupted, this results in problem behavior.

In this study, Anderson and Kenaston-Manasseh identified if the function of the participants problem behavior was environmental restoration, such as fixing an item out of sequence. In identifying the function, this demonstrated that children with this profile could be taught to request the items to be restored to their original locations without exhibiting problem behavior.

To read the entire report:

Anderson, J., & Kenaston-Manasseh, L. (2024). Environmental restoration as a reinforcer in ritualistic contexts. Behavioral Interventions, e2001.

March 2024

We’re passionate about delivering ABA services that are supported by evidence-based peer-review research to young children with autism.

Teaching children with autism to request items that they want is a critically important skill. In this study by Chezan, Bauer, Drasgow, Garcia, and Warman, they researched if constant time delay prompting and the delivery of rewards could be used to teach children this skill.

This study included 3 children with autism, ranging in age from 3-6 years who had limited communication skills, either vocally or through gestures. Each child was given a preference assessment to identify a highly preferred object that the child was taught to request, such as bubbles, a laptop, and a tablet. The researchers then taught the children individualized requests which included pointing, reaching, or leading. Next, when the child showed interest in the highly preferred item, they were prompted to physically request the item and then were given the item as a reward for 30 seconds. Results found that all 3 children learned to request the preferred item after training. This training also highlighted the importance of determining the child’s interest prior to teaching. It’s important to ensure that the child is interested in the item before beginning instruction.

To read the full report:

Chezan, L. C., Bauer, A., Drasgow, E., Garcia, H., & Warman, A. (2024). Generalization and Discrimination of Positively Reinforced Explicit Mands in Young Children with Autism Spectrum Disorder. Behavior Modification, 0(0).

February 2024

A study by Pálsdóttir, Magnússon, and Sveinbjörnsdóttir conducted an experimental analysis of academic task refusal for a child with a developmental disability. Task refusal was analyzed in two experimental analyses. The first experimental analysis was to see if the child’s behavior was maintained by negative reinforcement, and the second was to see if the behavior exhibited by the child was the result of transitioning between academic tasks differing in preference. They discovered that task refusal did not occur in the demand condition of the functional analysis, indicating that the behavior was not maintained by escape from demands. Furthermore, task refusal occurred solely in the second experimental analysis when transitioning from a task that was highly preferred to one that was not preferred. It was determined that it wasn’t the less preferred academic task itself that was aversive, but rather transitioning from a preferred academic task to one that was not.

Often, sessions with your child’s therapist involve a cycle of learning trials followed by a break with a reinforcer. When children display challenging behaviors when learning tasks are presented, we often conclude that this behavior functions to avoid or escape the task. This study suggests that this sequence has multiple components: ending a task, transitioning to a reinforcer, ending a reinforcer, and possibly transitioning to a new task that is less preferrable than the preceding task. This study highlights the importance of considering all the possible reasons for challenging behavior. A careful assessment of any task refusal helps your Beacon clinical team provide a learning environment that will be successful for your child. The goal is keeping your child happy, relaxed, and engaged throughout sessions!

To read the entire report:

Pálsdóttir, E. D., Magnússon, A. F., & Sveinbjörnsdóttir, B. (2023). An experimental analysis of task refusal: A comparison of negative reinforcement contingencies and transitions between academic tasks. Behavioral Interventions, e1993.

January 2024

Behavioral treatment involves teaching the child an adaptive behavior to replace their challenging behavior. The ABA approach to treatment starts with assessing why a child is engaging in challenging behavior. In other words, a Beacon therapist wants to identify what a child is achieving by using challenging behaviors.

For example, if a child cannot yet ask for juice, they may repeatedly hit the refrigerator and cry until someone notices and offers them juice. Behavioral treatment involves teaching the child an adaptive behavior that can replace the challenging behavior. In this example, the behavioral therapist might teach the child to give a caregiver a picture of juice instead of crying and hitting.

In this study by Nuhu, Muething, Gillespie, Mevers, and Scheithauer, therapists coached parents on how to implement functional analyses and individualized function-based treatment packages to help alleviate challenging behavior. Forty-one families of children and young adults with neurodevelopmental disorders participated. Most clients (75.6%) met all admission treatment goals and parents reported significant decreases in frequency and severity of challenging behaviors at discharge. The results of the study suggest this parent-mediated treatment model is a viable option to treating moderate challenging behavior in children and young adults with intellectual and developmental disorders. While behavioral treatment is often conducted by BCBAs and BTs, parent involvement can result in positive outcomes that will maintain over time.

To read the full report:

Nuhu, N. N., Muething, C., Gillespie, S. E., Mevers, J. L., & Scheithauer, M. (2023). Individualized Parent-Mediated Behavioral Treatment for Challenging Behavior: A Program Description. Behavior Modification, 0(0).

December 2023

As a provider of services to young children with Autism, we’re passionate about delivering developmental, behavioral, and treatment services that are supported by evidence-based peer-reviewed research.

Identifying how someone feels and why they feel that way is an important social skill. These skills are considered “Theory of Mind” or “Perspective Taking” skills. Many children with autism have difficulties answering these questions. In this study by Persicke, Najdowski, and Tarbox, children with autism were taught how to predict emotions and infer why they felt this way. Every child who participated in the study was able to communicate in full sentences prior to the training.

As an example, the children in the study were given the following scenario: “Sara loves Halloween and loves to eat Skittles. After trick-or-treating at two houses, Sara did not get any Skittles.” The children were then asked the following: “If she doesn’t get Skittles, how will Sara feel” and ”Why does she feel this way?” (answer: Sad, because she wanted Skittles and didn’t get any). Training included providing multiple examples of correct answers, modeling, prompting and reinforcement. All the participants learned how to predict emotions as well as their causes and were able to utilize these skills in new situations.

If you would like to read the full report:

Persicke, A., Najdowski, A.C., Tarbox, J. et al. Teaching Children with Autism Spectrum Disorder Desire-Based Emotion Prediction and Cause. Behavior Analysis in Practice 16, 826–836 (2023).

November 2023

Many parents and caregivers would like their children to be better “listeners” and follow requests without protest and refusals. In this study by Baida, Azizi, and Jessel, they investigated if an evidence-based strategy could increase the likelihood of instruction following.

Five children, ranging in age from 2-8 years old, participated in the research, with each child in the study having developmental disabilities, such as Autism and ADHD. The researchers opted to use a high-probability request sequence, which is also referred to as behavioral momentum. Low probability and high probability requests were identified for each participant. Low probability requests were those that the child was less likely to do, such as giving up something they were enjoying (“give me the iPad”) or something that was challenging, such as identifying an object’s color or reading a word. High probability requests were those that the child did without refusals, such as, “give me a high five” or “stand up.” The children who followed each instruction without protest or refusal received a reward. The study found that when a high probability request was immediately followed with a low probability request (“give me a high five, give me the iPad”), the participants were far more likely to do them compared to if they were just asked to do the low probability request. The study also assessed which method the participants and caregivers preferred, and it was discovered that the high probability request sequence was the favorite.

It’s possible that if you do something easy and get a reward, it increases the likelihood that you’ll follow the next instruction, even if it’s more challenging. It’s similar for us as adults when we do easier tasks first before tackling the bigger or more complex tasks. So, if you find yourself needing to ask your child to do something challenging, consider having them do 1-3 easy tasks first.

If you’d like to read the report:

Baida, A. N., Azizi, S., & Jessel, J. (2023). A Parametric Single-Case Analysis and Social Validation of the High-Probability Request Sequence. Journal of Positive Behavior Interventions, 25(1), 41-52.

October 2023

A major barrier that families and caregivers face is the potential to misunderstand the technical terminology that behavior analysis professionals use when trying to effectively communicate their valuable expertise.

In this study by Marshall, Weiss, and Critchfield, they evaluated the effect that technical terms have during parent training. Seventeen parents of individuals with disabilities were taught to implement discrete trial teaching via individualized instructions that contained high or low percentages of jargon. The jargon that was utilized was individually determined for each participant based on a pre-evaluation. It was discovered that parents who encountered more jargon benefitted significantly less from the training, and the jargon damaged the professional-stakeholder relationship in several ways. These findings support the idea that technical terminology has a negative impact on the effective sharing of evidence-based practices. Professionals should limit jargon whenever possible and discuss with parents and caregivers which technical terms (such as “reinforcer” or “stimulus”) are understood at the outset of services.

At Beacon, we recognize the importance of having constructive and collaborative discussions with families and stakeholders to provide the best services for children with Autism. Skills instruction and coaching must be easy to understand and implement. Be sure to ask your BCBA or behavior therapist to explain any terminology that is unfamiliar to you.

If you would like to read the report:

Marshall, K.B., Weiss, M.J., Critchfield, T.S. et al. (2023). Effects of Jargon on Parent Implementation of Discrete Trial Teaching. Journal of Behavioral Education.

September 2023

As a provider of services to young children with Autism, Beacon uses compassionate interventions and state-of-the-art services to improve and support the development of children.

Many children with Autism Spectrum Disorder (ASD) have restrictive eating patterns, which is why it’s important that we teach them to eat a variety of healthy foods. Identifying successful methods that don’t involve restrictive procedures, such as not removing a new food, is a demonstration of using compassionate interventions.

In this study by Gover, Hanley, Ruppel, Landa, and Marcus, it was discovered that rewarding a child for eating small bites of food could be successful when using an individualized approach and providing frequent choice making opportunities. Standard feeding programs can be unpleasant for the child (and caregivers), so this type of intervention can be more reinforcing, enhancing effectiveness.

If you’d like to read the report:

Gover, H.C., Hanley, G.P., Ruppel, K.W., Landa, R.K., & Marcus, J. (2023) Prioritizing choice and assent in the assessment and treatment of food selectivity, International Journal of Developmental Disabilities, 69:1, 53-65.

August 2023

When your child is expressing challenging behavior, the goal is to replace that behavior with communication skills that meet the same purpose. For example, a child who wants their parent’s attention may scream or hit because that “works” to get their attention. By teaching the child to ask for attention vocally or by handing over a picture, screaming and hitting should decrease.

As a part of this process, parents may be asked to ignore challenging behavior and only react to appropriate attempts to communicate. This article by Lloveras and McKeown caution that we should be careful in how we interpret “ignoring.” Ignoring challenging behavior shouldn’t mean not providing care to the child or standing by when unsafe behavior is occurring. When ignoring challenging behavior is recommended, it is important to ask your Beacon BCBA, “what specifically should I do?”. It might be that just limiting highly emotional responses to your child such as “WHAT DID YOU DO?” is what is necessary while continuing to provide calm care and attention. During parent training, work with your Beacon BCBA to determine how best to limit attention while being responsive to all attempts to communicate.

If you would like to read the report:

Lloveras, L.A., McKeown, C.A., Lichtenberger, S.N. et al. (2023). Recommendations Regarding Use of the Term “Ignore” in Applied Behavior Analysis. Perspectives on Behavioral Science.

July 2023

For parents and caregivers of children with autism, pica, the ingestion of non-food items, can be an especially dangerous behavior. Sources (CDC, 2019) report that while pica only occurs in about 4% of preschool children without disabilities, it occurs in 14% of autistic preschool aged children without intellectual disabilities and in 28% of those with autism and intellectual disabilities. While there are many different treatments for pica, prevention is the most important. This article by Thomas and O’Connor demonstrates the successful use of a safety checklist as a tool to remind caregivers to remove unsafe items that could be ingested.

If your child engages in pica, it’s important to speak to your Beacon BCBA to identify what items are most likely to be ingested, as well as the settings and activities that may trigger the behavior. Identifying the function or the “why” of the behavior is important, as some children ingest items because of the way they taste while others may do so to get your attention. Different functions require different strategies to treat the behavior. In this study, it’s suggested that if you and your BCBA develop a safety checklist, you’ll be less likely to leave unsafe items accessible to your child.

If you’d like to read the report:

Thomas, B.R., O’Connor, J.T. (2023). Parent Use of a Safety Checklist to Prevent Their Child’s Pica. Behavior Analysis in Practice.

June 2023

For some children with Autism Spectrum Disorder (ASD), it can be a struggle to know when they are feeling happy or sad. Communication challenges lead to children that can’t verbally report their feelings, which can add to parents’ frustration. In this study done by Ramey, Healy and McEnaney, they found that for children with ASD, happiness and unhappiness could be best identified by unique behaviors that they engaged in during enjoyable and unenjoyable conditions. For example, if the child flaps their hands and jumps when playing with bubbles, those behaviors may be their indicators of happiness. In these conditions, they also found that the children were not able to accurately self-report their feelings.

It’s important to understand what contributes to a child’s happiness. This study shows that for children with ASD, we may need to look for unique things that they do as signs of happiness. For Beacon parents and caregivers, this requires working closely with your BCBA to identify and measure these behaviors. While many preschools use emojis, emotional thermometers, or other visuals to identify emotions; children with autism may need explicit instruction to learn how to express these feelings and answer these questions.

If you’d like to read the report:

Ramey, D., Healy, O. & McEnaney, E. Defining and Measuring Indices of Happiness and Unhappiness in Children Diagnosed with Autism Spectrum Disorder. Behavior Analysis in Practice 16,194–209 (2023).

March 2023

Providing clients with a choice of behavioral intervention is an important component of administering compassionate, trauma-informed care. In this study by Huntington and Schwartz, it was found that participants with Autism/ADHD all had clear preferences for a specific intervention package, and that the intervention package was successful in reducing target behaviors and in increasing on-task behavior.

There may be more than one treatment option for a particular behavior. If that is the case, your BCBA could ask you to choose the intervention that is preferred. When working with younger clients, choice can be inferred from assent, defined as willing participation, or the absence of challenging behavior when an intervention is applied.

If you’d like to read the report:

Huntington, R. N., & Schwartz, I. S. (2022). The Use of Stimulus Preference Assessments to Determine Procedural Acceptability for Participants. Journal of Positive Behavior Interventions, 24(4), 325–336.

February 2023

Beacon’s Clinical Services department is constantly reviewing current publications to identify state-of-the-art services. This month focused on Mckeown, Vollmer, Cameron, Kinsella, and Shaibani’s (2022) research report that detailed the impact of considering the needs of the whole client – including the input of the client’s family as well as other professionals.

In their report, they recognized the importance of when working with clients, especially those that are children, always considering the possibility that they are experiencing pain, which may factor into their clinical profile.

Best practice involves collaborating with medical personnel and the client’s family to investigate if pain plays a role in the causes of challenging behavior. As a compassionate caregiver, Beacon’s BCBAs will consider the impact of your child’s communication challenges, especially regarding the possibility of your child experiencing pain. By defining and measuring behaviors, your BCBA plays an essential role in identifying signs of pain that your child may be unable to communicate vocally.

An early and comprehensive response to pain by caregivers enhances your child’s health and happiness. If you’d like more information, ask your BCBA.

If you’d like to read the report:

McKeown, C.A., Vollmer, T.R., Cameron, M.J. et al. Pediatric Pain and Neurodevelopmental Disorders: Implications for Research and Practice in Behavior Analysis. Perspectives on Behavioral Science, 45, 597–617 (2022).