Using the high-probability instructional sequence to improve initiation and completion of low-probability instructions in young autistic children (2024)

The high-p instructional sequence is an antecedent-based intervention found to be effective in increasing academic task completion for autistic children in the school environment (Banda and Kubina, 2006, Jung et al., 2008). The high-p instructional sequence involves presenting an individual with a sequence of high-p tasks, which the individual is highly likely to perform, prior to presenting a low-probability (low-p) instruction or task that is more difficult and less likely to be performed by the individual (Mace et al., 1988). The high-p instructional sequence was developed based on the behavioral momentum theory (see Nevin et al., 1983). The theory suggests that when an increased rate of reinforcement is established in the presence of a specific discriminative stimulus, response strength will enhance due to a greater resistance to change (Lipschultz and Wilder, 2017, Nevin and Grace, 2000). Therefore, when reinforcement is delivered contingent on completion of a high-p instruction, which directly precedes a low-p instruction, completion of the low-p instruction may increase (Lipschultz & Wilder, 2017).

Prior to discussing published literature on evaluating the use of high-p instructional sequences, it should be noted that historically, researchers have primarily targeted behavior labeled as ‘compliance’. The use of this term within autism research and intervention may not reflect the values of the autism community and no longer be appropriate within this context of research and practice (Bottema-Beutel et al., 2021). Compliance as a label for target behavior may perpetuate the use of ableist language and ideology. Autism researchers and practitioners alike have made strides towards acknowledging, understanding, and advocating for centralization of the autistic perspective and autistic-preferred language (Monk et al., 2022). However, ableist language within autism research persists, thus fostering the assumption that autistic individuals require interventions to be ‘fixed’ (Bottema-Beutel et al., 2021). Therefore, in this manuscript, we instead use the terms ‘initiation and completion’ to label the targeted behaviors of starting and completing pre-academic or academic tasks in the classroom setting.

Using the antecedent-based interventions, such as the high-p instructional sequence, that are non-aversive and promote task engagement and completion in autistic children are beneficial for academic success (Killu et al., 1998). Researchers have recognized that high-p instructional sequence can be applicable to teaching autistic children within the context of a classroom (e.g., Belfiore et al., 2002; Planer et al., 2018). In the school setting, the high-p instructional sequence has been used to increase engagement in academic and social instructions, skill mastery of communication, and social and functional skills (Belfiore et al., 2002; Borgen et al., 2017; Jung et al., 2008). For instance, Jung et al. (2008) evaluated the high-p instructional sequence with embedded peer modeling to facilitate social interactions for six preschool-aged autistic children in a preschool-kindergarten classroom. Social interaction initiations to peers increased for all children following intervention and were maintained and generalized with novel settings and peers.

Belfiore et al. (2002) examined the effect of the high-p instructional sequence on math task completion for two students with disabilities. The students were instructed to complete a stack of math problem cards, in which three high-p problem cards preceded every low-p problem card. They found that the intervention was effective in both decreasing latency of initiation and total duration of math task completion. Additionally, Banda & Kubina, (2006) examined teacher implemented high-p request sequences during morning school transitions for a middle school autistic student. They found that high-p requests, such as general conversation questions, decreased the total duration of low-p transition tasks and the number of verbal prompts required. Inferred by the outcomes, the use of the high-p request sequence in Banda & Kubina, (2006) promoted both preferred social interactions and independence during transition for the student. This demonstrates the positive collateral effects the high-p sequence may have on independence and autonomy for autistic students.

Although researchers have demonstrated benefits of using the high-p instructional sequence for autistic students, significant methodological limitations exist across studies (Common et al., 2019). In a systematic review of the high-p instructional sequence intervention in K-12 settings, Common et al. (2019) examined whether the intervention could be classified as an evidence-based practice (EBP). The researchers found that of the 22 reviewed studies, only two studies met all quality indicators of the Council for Exceptional Children’s Standards for EBPs in Special Education (CEC, 2014). This indicates the need to replicate and systematically extend methodologically sound studies to identify the overall effectiveness of the high-p instructional sequence as an antecedent-based intervention.

One concern for using the high-p instructional sequence for autistic children is inconsistent outcomes across studies, which may indicate insufficient evidence for the efficacy of the intervention. Researchers have recognized occasions in which the high-p sequence is ineffective as a stand-alone strategy and only effective when an additional component (e.g., escape extinction, punishment) is added (Dawson et al., 2003, Rortvedt and Miltenberger, 1994). Other findings have shown that the high-p instructional sequence alone is effective; however, when combined with another intervention strategy, such as demand fading or differential reinforcement, effectiveness often increases (Patel et al., 2007; Penrod et al., 2012). Researchers have also suggested the high-p instructional sequence to be equally as effective both as a stand-alone strategy and when an additional component is added (Belfiore et al., 2002). Although a large pool of literature evaluating the high-p instructional sequence has been established, more data indicating the effectiveness or ineffectiveness of specific procedural variations are necessary. In addition, few studies examined the maintenance effects on task completion for autistic children when high-p instructions in the sequence are faded. Researchers found completion of transitioning tasks maintained when the high-p instructional sequence was faded during classroom transitions for typically developing children but not for this population. Levels of completed transitioning tasks varied for autistic children (Ardoin et al., 1999, Axelrod and Zank, 2012). This indicates the need to further examine the potential long-term benefits of high-p intervention for these children. When maintenance is assessed, further evaluation of effective fading procedures is warranted to increase the likelihood of sustained positive outcomes for this population.

Moreover, researchers have primarily focused on evaluating dependent measures of initiation of the low-p instruction and compliance to the low-p instruction within high-p research. However, task initiation and task completion have not yet been evaluated as separate dependent variables within a given study. Given that autistic children may be less likely to self-initiate compared to their typically developing peers, the effects of the high-p instructional sequence may not be clear when initiation and completion are not measured separately (Bauminger et al., 2003, Sutton et al., 2022). That is, while completion of a task is dependent on initiation, initiation is not dependent on completion. Self-initiation in autism research has often been defined in the context of social interactions (Koegel et al., 2014); however, in the context of academic tasks, self-initiation can be defined as the ability to spontaneously and independently initiate or begin a task (De Korte et al., 2020, Koegel et al., 2003). Conversely, the definition of task completion differs in that the requirement of completing or finishing the entirety of the task is included. When low-p instructions require a child to engage in a quick, single-step skill (e.g., touching a picture card), differentiation between initiation and completion may not be necessary or even possible. On the other hand, when the low-p instructions consist of a lengthier, multi-step skill such as writing a sentence, initiation and completion of the task can be differentiated. This can provide further insight to whether the unlikelihood of responding is derived from a lack of initiation or lack of maintained engagement in the task at hand.

Independently initiating and maintaining engagement in academic activities until completion can impede on the academic success of autistic children (Hume et al., 2021, Milley and Machalicek, 2012). Difficulties in independent initiation and completion of academic tasks for these children often result in the delivery of frequent and repetitive prompting by teachers (Milley & Machalicek, 2012). When the skill is previously trained and is within the child’s behavioral repertoire, independent initiation of the skill may still be infrequent in the absence of adult prompting (MacDuff et al., 1993). Prompting a child to initiate or continue engaging in a task is common practice during initial training of a skill. Yet, continual long-term adult prompting can have negative implications for autistic children such that the development of prompt dependency is likely, ultimately impeding on the development of independence and self-initiation skills (Hume et al., 2009; Milley & Machalicek, 2012). Identifying whether a student has difficulties completing a task once initiated, or initiating the task at all can be beneficial to inform the use of the high-p intervention for autistic students. Once identified, high-p procedures can be tailored to produce the most beneficial outcomes for this population and maximize instructional time in the classroom (Lindsay, Proulx, Thomson, & Scott, 2013).

Additionally, researchers have commonly used latency to initiation of low-p instruction or latency to compliance as a measure (e.g., Banda & Kubina, 2006; Belfiore et al., 2002; Wehby & Hollahan, 2000). Latency has been established as an adequate measure of response strength (Ardoin et al., 1999; Belfiore et al., 1997) and is a helpful measure in high-p research given that response strength should enhance once the high-p sequence is implemented. However, in the school setting, latency as a measure may be difficult for teachers because it requires continuous observation until the behavior occurs. Despite the value of measuring percentages of change, to our knowledge, no studies on high-p instructional sequences have to date measured the proportional changes in initiation and completion of low-p instructions separately, within an experimental study.

The present literature differentiating between initiation and completion of low-p instructions within the academic context is limited. Therefore, the current study aimed to explore the separate effects of the high-p instructional sequence on initiation and completion of low-p pre-academic or academic instructions. Specifically, we trained two early childhood teachers and one elementary special education teacher to implement the high-p instructional sequence during typical classroom routines for three young autistic children in the public school setting. Percentage of initiation and completion were measured in comparison to latency, to provide a measurement system that may be more feasible for the school setting.

Although the current study provides preliminary data on differential effects of high-p instructional sequence on initiation and completion of low-p instructions when typical high-p instructional procedures are used, the ultimate goal was to increase students’ completion. Therefore, when the high-p instructional sequence alone was ineffective at increasing sustained completion to criterion levels, a programmed reinforcement procedure, differential reinforcement of alternative behavior (DRA), was added. In doing this, we could examine whether differences between initiation and completion levels were present while still aiming to achieve our goal. The study addressed the following research questions: (a) will the high-p instructional sequence implemented by teachers increase initiation of low-p pre-academic or academic instructions for young autistic children, (b) will the high-p instructional sequence increase completion of low-p pre-academic or academic instructions for these children, and (c) will adding the delivery of a highly preferred item (DRA) to the high-p procedure increase completion of low-p instruction to criterion levels for children who do not demonstrate sustained levels of completion with the high-p instructional sequence alone?

Discussion

The current study aimed to explore the separate effects of the high-p instructional sequence on initiation and completion of low-p pre-academic and academic instructions for autistic children when implemented by teachers in the classroom setting. The results showed that the high-p instructional sequence increased levels of initiation for low-p instructions for all children; however, increases in levels of completion did not sustain for two of three children. For one child, Lucas, the high-p

Conclusion

Despite the limitations, this study contributes to the existing literature on the use of the high-p instructional sequence as a low intrusive antecedent-based intervention for autistic children in the school setting. Overall, the high-p instructional sequence can be a feasible strategy that requires minimal time for training and implementation, utilizes resources that exist within the typical classroom environment, and can promote prosocial and academic skills within the school setting for

What this paper adds?

This paper provides data on child initiation and completion to low-probability instructions when teachers implement a high-probability instructional sequence as an antecedent strategy. Measurement of the percentage of initiation and completion separately in this study allowed for the evaluation of differentiated effects high-probability sequences have on initiation and completion with low-probability instructions, which has not been reported in previous research. This study highlights the

CRediT authorship contribution statement

Danielle Russo: Conceptualization, Methodology, Writing – original draft. Kwang-Sun Cho Blair: Conceptualization, Methodology, Writing – review & editing, Supervision.