While some require tactile prompts to facilitate their oral motor imitation in Discrete Trials, other EBIs should be more naturalistic and play-based.
B.F. Skinner first outlined four basic verbal operants: mands, tacts, echoics, and intraverbals. His model to Verbal Behavior is highly effective when used to teach children with autism how to speak. While Mand Training serves as the basis behind Pivotal Response Treatment (PRT)—the naturalistic form of Early Behavioral Intervention (EBI), which is very beneficial to the children with higher receptive language skills—those who do not get distracted from their natural environment, or as a way for them to generalize, some undergoing Discrete Trial Teaching (DTT)—also called structured EBI—do not respond correctly to Echoic Training alone (i.e., see Ferraioli, Hughes, and Smith, 2005).
In these scenarios, it is crucial to initially incorporate oral motor/tactile prompts into the Discrete Trials so the child can properly facilitate the sounds that make up the word before having them tact—or label—the item in the environment (i.e., see Lovaas, 1977; Maurice, Green, and Luce, 1996; Leaf and McEachin, 1999; Maurice, Green, and Foxx, 2001; Granpeesheh, Tarabox, Najdowski, and Kornack, 2014).
To pronounce the oral motor sounds correctly, it will typically involve breaking down the word systematically into a series of chains that are modeled out for the child. These trials should be repeated multiple times through the use of shaping—the process in which positive reinforcement is provided each time after the child pronounces the target verbal response more clearly until it is fully mastered.
Before getting into the speech, however, the behavior analyst should initially deliver eye contact trials performed through instructional cues, visual prompts, and shaping, as well as having the child imitate a series of fine and gross motor imitation exercises, so he or she is more alert and attentive to you.
There is also a growing need for research on incorporating oral motor prompts into the Discrete Trials and to establish dual degree graduate school programs in both Speech Pathology and Behavior Analysis.
*Note: The Assistant Behavior Analyst (BCaBA) or Registered Behavior Technician (RBT) should collaborate with a Speech Pathologist on these complex manual prompt procedures:
To say "ball," it will consist of the following set of techniques:
1. Model molding your lips together to say "buh." Next, provide a tactile prompt on his or her own lips before using prompt fading. Following the child's echoic response, practice pronouncing this multiple times through shaping.
2. Give the instructional cue (Sd), "Open your mouth." Next, use a tongue dispenser and place it underneath the child's tongue while telling him or her, "say lah." Once the child responds with the correct response, fade the manual prompt tool and practice saying "lah" with the child multiple times through shaping.
3. After the child has pronounced each sound separately, provide the child with the following instructional cue (or Sd), "Say 'ball' " while holding a small ball (or showing a picture of it will be just as useful). After the child responds correctly, ask the child, "What is this?" The child's correct response should be followed by praise and giving he or she the ball.
The instance given is how to say the word "frog":
1. Model saying "fuh" by placing your top teeth over the bottom lip. Next, say "fuh" while manually moving the child's top teeth over their bottom lip before practicing that sound with the child multiple times through shaping.
2. Say "ruh" with a gestural prompt before manually puckering the child's lips while saying that sound with the child. Then, practice pronouncing it multiple times through shaping.
3. Give the child the Sd (or instructional cue) by saying, "Touch my neck." Next, provide the child with a touch cue by having him or her feel the vibration of your neck while saying "guh" before redirecting the child to perform that same touch cue on their own neck. Then, practice saying "guh" with the child multiple times through shaping.
4. Tell the child (the Sd or instructional cue) "say frog" while holding a picture of a frog. He or she should respond with that same tact. Then, ask the child (the Sd or instructional cue), "What is this?" After the child responds with the correct intraverbal, simply praise him or her.
The following set of procedures on how to say "hi" are provided below:
1. First have the child imitate waving your hand up and down.
2. Tell the child, "Feel my breath" (the Sd or instructional cue) before manually prompting his or her hand in front of your mouth to feel a blow of air release from your mouth while saying "huh." Next, give the child the instructional cue (or Sd), "You do" before manually moving the child's hands in front of his or her mouth to say "huh" as the child simultaneously feels the pressure of their own breath. Then, practice pronouncing this with the child multiple times through shaping.
3. Give the child the instructional cue (or Sd), "Say, 'Hi.' " After the child responds, say "Do this" before modeling waving your hand up and down while saying "Hi." If the child responds with the echoic, but does not wave, provide him or her with a manual prompt. This, of course, should be followed by praise.
In the instance of teaching the child how to say "mom," it will consist of the following set of trials (see Lovaas, 1977 or Maurice, Green, and Foxx, 2001):
1. Model puckering your lips while saying "muh." Next, manually pucker the child's lips together and then say "muh" with him or her multiple times through shaping (also see Maurice, Green, and Foxx, 2001).
2. Either have the child's mother present or hold a picture of her while telling the child, "Say, 'mom'." After the child responds, ask him or her the following question (or Sd), "Who is this?" The child's correct response to this question is both a tact and intraverbal, and should be followed by praise.
To teach the child how to say "lollipop," it will consist of the following set of trials (see Maurice, Green, and Luce, 1996):
1. Take a lollipop and place it underneath your tongue while modeling with a gestural prompt in conjunction with a tact by saying "lah" three times.
2. Then, give the child another lollipop and place it underneath his or her tongue while saying "lah" with the child multiple times through shaping.
3. Give a gestural prompt in conjunction with an echoic cue (also called vocal imitation) by modeling a tactile prompt on the corner of your own lips while saying "eeh." Next, provide the child with that tactile prompt on the corner of his or her lips while saying "eeh." This should be followed by prompt-fading (for more information on fading tactile prompts, see Lovaas, 1977 or Maurice, Green, and Luce, 1996) and practice this multiple times through shaping.
4. Tell the child the following instruction (or Sd): "Feel my lips," and have the child press their pointer and middle finger together, slanting those fingers sideways with the child's middle finger on your bottom lip. Next, slide them off the lip while having the child feel the pressure of your breath that comes along with you saying "puh" three times. Once the child responds, have him or her imitate that action on their own lips. Then, practice saying "puh" with the child multiple times through shaping.
5. Hold your own lollipop while telling the child, "Say 'lolli.' " After the child responds, provide him or her with another instruction (or Sd), "Say 'lollipop.' " The child should respond with that tact and intraverbal. Then ask, "What is this?" Following the child's correct response, reinforce the child by providing the lollipop and praise.
When having the child say "cup," it will consist of the following set of trials:
1. Give the child an instruction (or Sd) by saying, "Touch my neck." Then, provide the child with a tactile prompt (or touch cue) by having him or her feel the vibration of your neck while saying "cuh" before redirecting the child to imitate that tactile prompt on their own neck. Once the child responds, practice saying "cuh" with the child multiple times through shaping.
2. After the child has mastered pronouncing the sound separately, provide a tact by telling him or her "say cup" while holding a cup (or saying it with a picture card can be beneficial, as well). Following the child’s response, ask the following question: "What is this?" Once the child responds with the tact and intraverbal, "cup," simply praise him or her.
The finale example provided involves having the child say "juice":
1. Model saying "juh" by placing your thumb and pointer finger on the opposite set of your cheeks. Next, give the child those same tactile prompts on his or her own cheeks while saying "juh" before fading out those tactile prompts. Then, practice that multiple times through shaping.
2. Provide the child with the instruction (or Sd), "Say 'sss' " before practicing that echoic response multiple times through shaping.
3. Give the child the instruction (or Sd), "Say 'juice' " while holding a juice box. After the child responds, ask him or her the following question (or Sd): "What is this?" Following the child's correct mand and intraverbal, simply praise him or her before giving the child the juice box.
When instructing the child to say "thumb," the therapist will model sticking out the tongue underneath their top teeth while pronouncing "thuh" before manually assisting the child to do the same with his or her own mouth. Then, practice saying this with the child multiple times through shaping. Finally, have the child tact "thumb" while holding a picture of a thumb. Following the child's correct response, ask him or her, "What is this?" After responding with the correct tact and intraverbal, the therapist should provide the child with praise.
Leaf and McEachin (1999) also gave the example of hand-clapping the mouth as a way to promote vocalization. Other imitative modeling techniques that can be used to facilitate oral motor sounds within a Early Intensive Behavioral Intervention (EIBI)—or structured Early Behavioral Intervention (EBI)—program include gestural prompts in conjunction with echoic training—also called vocal imitation, and even hand gestures, such as signing.
Naturalistic EBI programs, including such procedures as Pivotal Response Treatment (or PRT; sometimes branded Incidental Teaching or Natural Environment Teaching), are also highly effective in enhancing the child's functional communication skills by motivating them to talk and make requests within their natural environment.
PRT—first coined by Drs. Robert and Lynn Koegel—is a broad encompassing term that involves incorporating operant contingency management for managing challenging and self-injurious behaviors, and using their interests and lead into play as natural reinforcers for relationship-building. The Natural Language Paradigm (NLP) form of PRT is also essential for teaching children speech in the natural environment, which relies heavily on mand training procedures.
For instance, when the child is ready to go down the slide, you may want to hold them and say "Ready, set, go", "Ready, set, go", "Ready, set..." before pausing with a time-delay to wait for the child to respond "guh" or "go." Then, releasing them down the slide is the natural reinforcer.
Another example of this by holding a desirable item (i.e., toy, food, or drink) out of the child's reach and cueing him or her through visual and auditory prompts how to say the word. After the child mands for the item, the therapist or teacher will give the item to the child (which is the natural reinforcer).
Ferraioli, S., Hughes, C., and Smith, T. (2005). A model for problem solving in discrete trial training for children with autism. Journal of Early and Intensive Behavior Intervention, 2(4), 224-246.
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