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Research in Autism Spectrum Disorders 5 (2011) 629632

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Research in Autism Spectrum Disorders


Journal homepage: http://ees.elsevier.com/RASD/default.asp

Teaching two household safety skills to children with autism


Jay Summers a,b, Jonathan Tarbox b,*, Rachel S. Findel-Pyles c, Arthur E. Wilke b,
Ryan Bergstrom b, W. Larry Williams a
a
b
c

University of Nevada, Reno, United States


Center for Autism and Related Disorders, United States
The Chicago School for Professional Psychology, Los Angeles, United States

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 16 July 2010
Accepted 26 July 2010

Appropriate reactions to potentially hazardous situations may help prevent children from
incurring injury or abduction. However, children with autism and other developmental
disorders may not develop safety skills without explicit intervention. This study used a
simple behavioral skills training package for teaching children with autism to respond in a
safe manner to doorbells and to the presence of household cleaning chemicals.
! 2011 Elsevier Ltd. All rights reserved.

Keywords:
Safety skill
Behavioral skills training
Doorbell
Cleaning chemicals

Appropriate reactions to potentially hazardous situations may help prevent children from incurring injury or abduction.
However, children with autism and other developmental disorders may not develop safety skills without explicit
intervention. A significant number of studies have evaluated behavioral intervention procedures for establishing safety skills
in individuals with developmental disabilities. Commonly addressed skills include fire alarm evacuation, pedestrian streetcrossing skills, and sexual abuse prevention (for a recent review, see Dixon, Bergstrom, Smith, & Tarbox, 2010). Most previous
studies have addressed a relatively small number of hazardous situations and safety behaviors. Furthermore, most previous
research on teaching safety skills to individuals with developmental disabilities has involved adolescents and adults, as
opposed to children, and little previous research has evaluated methods for teaching children with developmental
disabilities to respond safely to common household hazards.
In particular, two potential household hazards which have not been addressed in previous research are the presence of
cleaning chemicals and the ringing of the doorbell (and the accompanying presence of someone at the door). If the doorbell
rings and a child opens the front door, without first recruiting the attention of a caregiver, the child is exposing themselves to
an opportunity to be abducted. Previous research has taught children to avoid the advances of strangers in public (Gast,
Collins, Wolery, & Jones, 1993) and at school (Gunby, Carr, & LeBlanc, 2010), but no previous research, of which we are aware,
has taught children to respond appropriately to the doorbell when they are at home.
It is also important that a child respond appropriately to the presence of cleaning chemicals in the home, as these too are a
potential source of harm. If a child plays with chemicals or interacts with them in any other way, it is possible that they could
ingest them or expose his or her eyes to them, thereby resulting in injury or death. Indeed, cleaning chemicals were found to

This study was conducted in partial fulfillment of Jay Summers masters thesis in behavior analysis at the University of Nevada, Reno. Rachel FindelPyles was affiliated with the Center for Autism and Related Disorders when this study was conducted and Jay Summers is currently affiliated with
Wellspring.
* Corresponding author at: Center for Autism and Related Disorders, Research and Development, 19019 Ventura Blvd, 3rd Floor, Tarzana, CA 91356,
United States. Tel.: +1 818 345 2345.
E-mail address: j.tarbox@centerforautism.com (J. Tarbox).

1750-9467/$ see front matter ! 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.rasd.2010.07.008

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J. Summers et al. / Research in Autism Spectrum Disorders 5 (2011) 629632

be the third most common substance involved in accidental poisonings in 2008, for both children under 6 years of age, and
for humans in general (Bronstein et al., 2009). Few previous investigations have attempted to train children to respond
safely to cleaning chemicals and existing studies have largely focused on keeping potential poisons out of the reach of
children (Coyne-Beasley, Runyan, Baccaglini, Perkis, & Johnson, 2005).
Existing research on behavioral skills training packages suggest that this may be an effective approach to training a
variety of safety skills (Miltenberger & Thiesse-Duffy, 1988). Behavioral skills training packages vary, but typically involve
instructions, modeling, rehearsal or role-playing, and feedback. This study consists of two experiments that sought to
evaluate a simplified behavioral skills training package, consisting of rules, partial physical prompting, and verbal feedback,
for teaching children with autism to respond in a safe manner to the doorbell and to the presence of household cleaning
chemicals. Specifically, children with autism were taught to recruit the attention of a caregiver when the doorbell rang and
when they came across the presence of cleaning chemicals.
1. Method
1.1. Participants and setting
Six children with autism participated in the study. Rex, Kip, and Rico were taught safety skills related to the doorbell. Their
ages were four, six, and eight, respectively. Hal, Marco, and Quin were taught to respond safely to cleaning chemicals. Their ages
were four, seven, and eight, respectively. All participants demonstrated the ability to respond to simple instructions and all
reportedly responded well to social praise. All participants were clients of a community-based provider of home-based
behavioral intervention services. None had any prior training on responding to doorbells or cleaning chemicals. All sessions
were conducted as a regular part of participants ongoing behavioral intervention sessions in their homes.
1.2. Response measurement and interobserver agreement
For training in responding to the doorbell, a participants response was coded according to the following classification, in
ascending order of safety: (0) if the child opened the door, regardless of what other behaviors the child emitted subsequently,
(1) walking in the direction of a parent, (2) entering the room occupied by the parent, (3) obtaining the attention of the
parent, and (4) communicating to the parent that someone was at the door. For training in responding to the presence of
chemicals, for each trial, the participants response was coded according to the following classification, in ascending order of
safety: (0) if the child physically touched the dangerous chemicals regardless of any subsequent responses, (1) if the child did
not touch the chemicals but did not leave the room within 10 s, (2) if the child did not touch the chemicals, left the room, but
did not tell an adult, and (3) if the child did not touch the chemicals, left the room and told an adult.
Interobserver agreement (IOA) was assessed by having a second, independent observer collect data. Agreement occurred
when both observers coded exactly the same data for a trial. IOA was calculated by dividing the number of agreements by the
total number of agreements plus disagreements and multiplying the resulting decimal by 100, thereby converting it to a
percentage. For responding to the doorbell, IOA was assessed during 30%, 43%, and 50% of sessions for Rex, Rico, and Kip,
respectively. Mean agreement was 92% (range = 75100%), 96% (range = 75100%), and 94% (range = 50100%), for Rex, Rico,
and Kip, respectively. For training on responding to cleaning chemicals, IOA was assessed on 33%, 42%, and 38% of sessions,
for Hal, Marco, and Quinn, respectively. Mean IOA was 89% (range = 67100%), 92% (range = 67100%), and 95% (range = 67
100%), for Hal, Marco, and Quinn, respectively.
1.3. Procedures
1.3.1. Doorbell
During baseline, participants were told that they were on a break from the therapy session. Without alerting the
participant, the therapist informed the parent that the session was about to begin. The parent went to another room and
waited for the childs response. The therapist then pretended to complete paperwork, in a room adjacent to the room that the
participant was in. A confederate then rang the doorbell. No consequences were provided to the participant, regardless of his
response or lack of response to the doorbell. Baseline sessions consisted of one trial and sessions occurred approximately
twice per day, two-to-three days per week. No more than four trials were conducted per day.
Training sessions were identical to baseline, with the following exceptions: (1) five trials were conducted per day, (2)
participants were provided with clear rules (e.g., when the doorbell rings, do not open the door, you need to go tell mom),
(3) immediate and enthusiastic praise was delivered contingent on correct responding, and (4) a two-step least-to-most
prompting procedure was implemented. Specifically, if the participant did not respond appropriately to the doorbell within
5-s, the therapist gave a verbal prompt for what they should do (e.g., go tell mom the doorbell rang). If the participant did
not respond correctly to the verbal prompt within 5-s, a partial physical prompt was implemented, wherein the therapist
used partial physical guidance to prompt the child to go into the room which his parent was in. Training was completed
when the participant displayed the entire sequence of safe behavior (i.e., walking into the room where his parent was and
telling them someone was at the door), without prompting, for three consecutive sessions over three separate days. After
training was complete, post-training sessions were implemented, which were identical to baseline.

J. Summers et al. / Research in Autism Spectrum Disorders 5 (2011) 629632

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1.3.2. Cleaning chemicals


During baseline, the participant was told that he was on a break from his therapy session and was allowed to sit at the
kitchen table. The parent was surreptitiously informed that the session was about to begin. A therapist then pretended to
clean something in the kitchen (e.g., spray and wipe the kitchen counter), leave the cleaning chemical (which was a chemical
container actually filled with water, devoid of any hazardous chemicals) within reach of the participant, and then leave the
room. No consequences were delivered contingent on any response of the participant.
During training, the procedure was similar to that used for training appropriate responses to the doorbell. That is, rules,
least-to-most two-step prompting, and contingent social praise were implemented during each session, until participants
emitted the entire sequence of safe behaviors (not touching the chemicals, leaving the room, and telling a parent that there
were chemicals) across three consecutive sessions, over three separate days. After training was complete, post-training
sessions were conducted, which were identical to baseline.
2. Results
Fig. 1 depicts the data from the doorbell experiment (top multiple baseline) and cleaning chemicals experiment (bottom
multiple baseline), during baseline and post-training conditions. All participants demonstrated unsafe behavior (a score of 0
[(Fig._1)TD$IG]or 1) during most or all baseline sessions. Training was relatively rapid for all participants, achieving mastery criteria in 926

Fig. 1. The degree of safety of responses to the doorbell (top multiple baseline) and to the presence of cleaning chemicals (bottom multiple baseline), for all
participants, during baseline and post-training phases of the study.

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J. Summers et al. / Research in Autism Spectrum Disorders 5 (2011) 629632

trials (data available from authors, upon request). Post-training data for the participants who were trained to respond to the
doorbell demonstrated consistent increases in safe behavior. Rexs post-training data indicated a large increase in safe
behavior (i.e., omitting opening the door, entering the room of the parent, but not telling the parent the doorbell was ringing)
(mean = 3.1). Ricos post-training data also indicated a large increase in safe behavior, relative to baseline, varying between a
classification of 3 and 4 (mean = 3.63). Kips post-training data indicated a large increase in safe behavior from baseline,
stabilizing at 4 (mean = 3.1).
Post-training data for the participants who were trained to respond to cleaning chemicals demonstrated similar results.
Marcos post-training data increased to a classification of 2 (i.e., omitting touching the chemicals, entering the room of the
parent but not telling him/her that there were chemicals left out) (mean = 2), and Hal and Quins post-training data stabilized
at 3, the maximum possible score. Their mean scores post-training were 2.6 and 2.4, respectively.
3. Discussion
The results of this study indicate that a simplified behavioral skills training package was effective in teaching children
with autism to respond appropriately to a doorbell as well as the presence of household cleaning chemicals. Safe responding
continued to occur after training was discontinued and no programmed prompting or reinforcement occurred for correct
responding. Furthermore, training was efficient, requiring only 926 trials, across the two experiments. The simplicity of the
procedures used in this study is encouraging because the procedures may be manageable for caregivers. Future research
should examine this possibility directly by training caregivers to implement the training procedures.
However, some limitations of the current study warrant discussion. First, this study only included three participants per
experiment. These participants were close in age, were all male, and all possessed relatively well-developed verbal
repertoires. Future studies should include children with autism with a wider variety of verbal repertoires and functioning
levels. It is possible that the verbal instructions component of the training package may be less effective with individuals
whose receptive language repertoires are less developed, and additional training components may be needed for this
population. Perhaps the most significant limitation to the current study is that generalization to situations in which no
behavioral therapist was present was not tested. It is therefore unknown whether the participants would have continued to
respond safely in other homes or when their therapists were not present in the house. Therapists were never present in the
same room as participants during the baseline or post-test sessions, but it is still possible that some degree of reactivity
occurred, simply due to the presence of therapists in the home. Future research should utilize methods for assessing for the
maintenance of the behavior when therapists are absent, such as employing hidden video cameras for surreptitious
observation.
Learning to respond appropriately to a doorbell and to the presence of cleaning chemicals are likely important safety skills
for children with or without disabilities, because they have the potential to prevent abduction and/or injury. This study
demonstrated the effectiveness of a simple behavioral skills training package, consisting of rules, partial physical prompts,
and contingent praise. The procedure was simple, effective, and resulted in relatively rapid acquisition. Further research is
needed to examine the full range of safety skills, as well as further assessing for maintenance and generalization.
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