Verbal Mand Interventions for Preschool Children with Autism: A Review of the Literature...

Verbal Mand Interventions for Preschool Children with Autism:

A Review of the Literature

Presentation for the Chinese American Educational Research & Development Association Annual Conference 2015

Heather M. ColemanVirginia Commonwealth University

What is Verbal Mand Training?

• Mands are requests. • Example: a child says “apple” because he wants the apple. • Initial focus of language training (Skinner, 1957).

• Verbal Mand Training- teaching a child to verbally request.• Target interventions: 1. Echoic to mand training, 2. Sign language, and 3. Picture communication.

Heather Coleman CAERDA April 15th, 2015

Purpose and Significance

Autism defined: a disability with deficits in social communication, social interaction, and restricted, repetitive patterns of behaviors (APA, 2013, p. 50-51).

• Verbal communication is the least burdensome and most widely understood (Yoder & Stone, 2006).

• For children with autism, if they acquires useful speech by 5 years:• Increase in positive social and occupational outcomes (Yoder & Stone,

2006). • Function more adaptively when compared to children who do not acquire

verbal speech (Carr, 1979).


Research Questions

1. Which intervention is effective for teaching verbal mands to preschool students with autism?

2. Are the verbal mands maintained after intervention ceases and generalized under differing conditions?


Methods of Inquiry


Interventions: -echoic to mand training -sign language -picture exchange

Participants: -diagnosed with autism -age 2-6 years

Behavior: -verbal mands

Date range: -Originally: 2010 to current -Revised: 2005 to current -Revised: 1977 to current (sign language only)

Echoic to Mand Training

• Defined: Utilizes echoics (imitations) to train mands• Example: adult verbally models “apple,” for the child to echo.

• 5 studies met criteria for review, 17 participants(Christensen-Sandfort & Whinnery, 2011; Ganz, Flores, & Lashley, 2011; Jennett, Harris, & Delmolino, 2008; Kodak & Clement, 2009; Nigro-Bruzzi & Sturmey, 2010)

• Important Findings:• Effective for all participants (exception: 1 participant in Jennett et al., 2008). • Intervention differed slightly in several articles. • Effective when utilizing discrete trail instruction and a child-directed method of instruction. • Maintained following 2-3 weeks of intervention (Christensen-Sandfort & Whinnery, 2011; Ganz et

al., 2011).• Generalized in differing natural environments (Christensen-Sandfort & Whinnery, 2011) and with a

novel instructor (Ganz et al., 2011) • Can be effectively implemented by speech pathologists and special education teachers (Nigro-

Bruzzi & Sturmey, 2010).


Sign Language

• Defined: Utilizes sign language and verbal models to train mands.• Example: adult simultaneously signs the name of an object while saying the name of the object: i.e.,

sign apple and say ”apple”

• 3 studies met criteria for review, 66 participants(Yoder & Layton, 1988; Carbone & Sweeny-Kerwin, 2010; Schaeffer, Kollinzas, Musil, & McDowell, 1977).

• Important Findings• Effective for all participants.• Intervention differed slightly in several articles. • Verbal prompting only may have produced the same effect with or without sign language (Yoder &

Layton, 1988; Carbone & Sweeny-Kerwin, 2010). • 2 articles reviewed utilized differing environments or communicative partners.


Picture Exchange Communication System

• Defined: Utilizes picture symbols to train mands.• PECS contains 6 phases; the studies reviewed examined phases 1 - 4. • Designed to teach functional communication (Bondy & Frost, 2002).• Example: child hands a picture of an apple to an adult to request.

• 6 studies met criteria for review, 15 participants.(Ganz et al., 2008; Jurgens, Anderson, & Moore, 2009; Carré, Grice, Blampied, & Walker, 2009; Park, Alber-Morgan, & Cannella-Malone, 2011; Ganz, Parker, & Benson, 2009; Ganz, Lashley, & Rispoli, 2010).

• Important Findings• Effective for 7 of the 15 participants.• No substantially differences in participants prior verbal abilities.• Location did not affect the participants’ ability.


Comparative Study by Tincani (2004)

• Comparing sign language training and PECS.

• Important Findings• Participant 1: more vocalizations in the best-treatment phase of sign language training. • Participant 2: more vocalizations were emitted in the sign language trials during intervention. • Observational data revealed both participants vocalized immediately after signing.

• PECS training: participants waited for a model before they vocalized.


Conclusions and Future Research

Echoic to mand training is effective for increasing verbal mands.• Utilizing a child-directed method of instruction or a discrete trail method of instruction.• Skills were maintained and generalized in differing natural environments, among novel instructors, and can

be effectively implemented by speech pathologists and special education teachers.• Future research need:

• Involve parents and families in the intervention.

Sign language, when paired with vocal prompting, is effective for increasing verbal mands.• Skills were generalized in differing natural environments and with differing instructors.• Future research needed:

• Current research.• Data on maintenance or generalization.• Involve parents and families in the intervention.


Conclusions and Future Research

Picture Communication may or may not be effective for increasing verbal mands.• Effective for less than half of the participants. • Effective for increasing functional communication.• Further research needed:

• Modifying the PECS protocol to add additional verbal modeling into the intervention.

Future Research Methods• Comparative designs.

• Single Subject Research: Alternating Treatment Design• Large Groups Research: Control and Comparison Group Design


ReferencesAmerican Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Bondy, A., & Frost, L. (2002). The picture exchange communication system: Training manual. Newark, DE: Pyramid Educational Consultants, Inc.*Carbone, V. J., & Sweeney-Kerwin, E. J. (2010). Increasing the vocal responses of children with autism and developmental disabilities using manual sign mand training and prompt delay. Journal of Applied Behavior Analysis, 43(4), 705-709.Carr, E. G. (1979). Teaching autistic children to use sign language: Some research issues. Journal of Autism and Developmental Disorders, 9(4), 345- 359.*Carré, A. J. M., Grice, B. L., Blampied, N. M., & Walker, D. (2009). Picture exchange communication (PECS) training for young children: Does training transfer at school and to home? Behaviour Change, 26(1), 54–65.*Christensen-Sandfort, R. J., & Whinnery, S. B. (2011). Impact of milieu teaching on communication skills of young children with autism spectrum disorders. Topics in Early Childhood Special Education, 32(4), 211-22.*Ganz, J. B., Flores, M. M., & Lashley, E. E. (2011). Effects of a treatment package on imitated and spontaneous verbal request in children with autism. Education and Training in Autism and Developmental Disabilities, 46(4), 596-606.*Ganz, J. B., Lashley, E., & Rispoli, M. J. (2010). Non-responsiveness to intervention: Children with autism spectrum disorders who do not rapidly respond to communication interventions. Developmental Neurorehabilitation, 13(6), 399-407. *Ganz, J. B., Parker, R., & Benson, J. (2009). Impact of the picture exchange communication system: Effects on communication and collateral effects on maladaptive behaviors. Augmentative and Alternative Communication, 25(4), 250–261.*Ganz, J. B., Simpson, R. L., & Corbin-Newsome, J. (2008). The impact of the picture exchange communication system on requesting and speech development in preschoolers with autism spectrum disorders and similar characteristics. Research in Autism Spectrum Disorders, 2, 157-169.Greenberg, A. L., Tomaino, M. E., & Charlop, M. H. (2013). Adapting the picture exchange communication system to elicit vocalizations in children with autism. Journal of Developmental and Physical Disabilities, 26(1), 35-51.


References*Jennett, H. K., Harris, S. L., & Delmonico, L. (2008). Discrete trial instruction vs. mand training for teaching children with autism to make request. The Analysis of Verbal Behavior, 24, 69-85.*Jurgens, A., Anderson, A., & Moore, D. W. (2009). The effect of teaching PECS to a child with autism on verbal behaviour, play, and social functioning. Behaviour Change, 26(1), 66-81. *Kodak, T., & Clements, A. (2009). Acquisition of mands and tacts and concurrent echoic training. Journal of Applied Behavior Analysis, 42, 839-843.*Nigro-Bruzzi, D., & Sturmey, P. (2010). The effects of behavioral skills training on mand training by staff and unprompted vocal mands in children. Journal of Applied Behavior Analysis, 43(4), 757-761.*Park, J. H., Alber-Morgan, S. R., & Cannella-Malone, H. (2011). Effects of mother implemented picture exchange communication system (PECS) training on independent communicative behaviors of young children with autism spectrum disorders. Topics in Early Childhood Special Education, 31(1), 37-47.*Schaeffer, B., Kollinzas, G., Musil, A., & McDowell, P. (1977). Spontaneous verbal language for autistic children through signed speech. Sign Language Studies, 17, 287-328.Skinner, B. F. (1957). Verbal behavior. New York, NY: Appleton-Century-Crofts, Inc.*Tincani, M. (2004). Comparing the picture exchange communication system and sign language training for children with autism. Focus on autism and other developmental disabilities, 19(3), 152-163. *Yoder, P. J., & Layton, T. L. (1988). Speech following sign language training in autistic children with minimal verbal language. Journal of Autism and Developmental Disorders, 18(2), 217-229.Yoder, P. & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49, 698–711.

*Articles Reviewed


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