Behavior Analysis in Practice (2021) 14:513-522 A I B I A I I
https://doi.org/10.1007/s40617-020-00525-9 AssoCMioniDrB«i.,io,«nai,Bi,int.mat™i
DISCUSSION AND REVIEW PAPER
A Review of Effective Strategies for Parent-Delivered Instruction
Cody Morris^ • Alissa A. Conway2   • Dana B. Goetz3
®
Accepted: 6 October 2020 / Published online:4 January 2021 © Association for Behavior Analysis International 2021
Abstract
Parent involvement in treatment is an important component of effective behavior-analytic services. Whether parents are expected to act as the primary behavior change agent or support treatment in other ways, behavior analysts must provide them with the resources necessary to encourage lasting behavior change. A critical component of supporting lasting behavior change is the foundational skills related to instruction delivery. Without these skills, parents will not likely benefit from more advanced programs and interventions recommended by behavior analysts. Therefore, the purpose of this article is to describe the foundational skills necessary for parents to successfully establish an instructional environment for further program and intervention delivery. To aid practitioners, a parent-friendly handout is included and discussed.
Keywords Parent coaching ■ Parenting ■ Service delivery ■ Parent-child interactions
Parental involvement has been identified as a key component in improving treatment outcomes for children receiving behavior-analytic services (Allen & Warzak, 2000; Hayward et al., 2009). Multiple research studies have demonstrated the utility of parent-implemented behavioral strategies (Barton & Fettig, 2013; Fava et al., 2011), as well as parent-supported behavioral strategies (Grindle et al., 2012). Parental involvement in treatment has also been considered to distinguish effective behavioral programming from ineffective behavioral programming (Hayward et al., 2009). Therefore, whether the role of a parent is primarily focused on supporting the generalization of skills developed in treatment settings or directly serving as the primary behavior change agent, they are always a central figure in creating lasting behavior change.
Coaching parents and providing resources are necessary to assist parents in effectively participating in behavior-analytic services (Allen & Warzak, 2000; Barton & Fettig, 2013). Existing parent-coaching strategies include telehealth
53 Cody Morris
cody.morris@salve.edu
1 Department of Psychology, Salve Regina University, 144 Metro Center Blvd., Warwick, RI 02886, USA
2 A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
3 Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
consultation (Tomlinson et al., 2018) and behavioral skills training (Suberman & Cividini-Motta, 2019), among others (Barton & Fettig, 2013; Crone & Mehta, 2016; Patterson et al., 2012). Despite the availability of effective parent-coaching strategies, variability in the success of parent-coaching/support strategies persists (Gunning et al., 2020). Given the persistence of these issues, identifying resources to improve parent involvement in behavior-analytic services is important.
Kestner et al. (2019) reviewed effective teacher practices that they argued were "baseline classroom conditions" necessary for effective behavioral assessment and intervention. Four basic and necessary skills were identified to help teachers establish instructional environments and reduce challenging behavior. Two of the skills were related to instructional design (i.e., creating appropriate curricula and providing opportunities for active student responding). The other two skills focused on instruction delivery (i.e., delivering effective instruction/transition and providing feedback/reinforcement). Although these recommended strategies specifically focused on the classroom setting, the same baseline conditions would likely be necessary in any setting requiring instruction.
Parents participating in lessons or interventions are not likely responsible for learning instructional design or creating interventions. Behavior analysts or teachers should provide that information. However, to successfully implement programs or interventions supplied by professionals, parents do need the skills related to instruction delivery (Helton & Alber-Morgan, 2018). By helping parents first establish skills related
514
Behav Analysis Practice (2021) 14:513-522
to instruction, behavior analysts can help parents build the foundational skills necessary to effectively implement behavioral interventions and learn advanced parenting skills.
Recommendations for effective components of parent-delivered instruction come from a variety of sources. Behavior-analytic research has validated many strategies for improving parent-delivered instruction, as has research from related disciplines like clinical psychology. Although some disciplines may recommend strategies counterproductive to behavior-analytic methods, many other disciplines recommend strategies that are conceptually consistent with behavior-analytic intervention and complement common practices within the field. For example, parent-child interaction therapy (PCIT; Eyberg, 1999; McNeil & Hembree-Kigin, 2011) is an evidence-based parent-training program developed within the field of clinical psychology that targets a broad range of behavior problems for children (McNeil & Hembree-Kigin, 2011). PCIT not only has a long-established research base supporting its use (Thomas et al., 2017) but also is very consistent with behavioral principles (see Peterson et al., 2018).
Identifying and synthesizing parent-delivered instruction strategies from the plethora of available resources presents many challenges. Therefore, the purpose of this article is to review essential strategies for parent-delivered instruction that are likely to maximize compliance with instruction while minimizing the likelihood of challenging behavior. This article includes a description of the selection and scope of included strategies, a description of each recommended strategy, recommendations for how to use the effective instruction guidelines, and a conclusion. In addition to the written explanation of the core components of instruction, resources are provided for practitioners seeking to implement these strategies right away (see the Appendix).
Selection and Scope of the Strategies
The particular strategies reviewed in this article were collected over time from a wide range of sources, including behavior-analytic research papers, research papers from related disciplines (e.g., clinical psychology), and books/manuals. Over the years, through clinical experience and consultation, the list of recommendations has been refined and focused. The recommendations provided in this article are not an exhaustive list of every best-practice strategy related to instruction nor a panacea for all parenting difficulties. Rather, the strategies outlined in this article are meant to help practicing behavior analysts identify, prioritize, and coach foundational skills needed for parents to deliver and support behavioral interventions.
The conceptual foundations and research supporting each strategy will be discussed individually. The research for most of the strategies included in this article was completed with
children between the ages of 2 and 13 years with a range of behavioral challenges and developmental disabilities. Because functional skills, abilities, and needs can vary greatly between clients with relatively similar demographics (e.g., age, diagnoses, problem behavior), creating a precisely targeted population for the strategies is difficult. Therefore, it is recommended that practitioners use their clinical judgment to determine whether each strategy would fit the idiosyncratic needs of their clients. After practitioners determine their clients' needs, the strategies can be selectively targeted when coaching parents in these skills. The parent resource discussed later can also be modified in accordance with the individualization of the strategies.
Effective Strategies for Instruction
For the purpose of this article, the basic strategies for effectively presenting instruction are separated into four categories. The first category includes strategies that should be implemented just before instruction to help establish the appropriate environment for the instruction. The second category includes strategies that should be prioritized when delivering instruction. The third category includes prompting correct responding to instructions. The fourth and final category includes process-level considerations and strategies. With the aim of describing the categories in approachable, parent-friendly terms, the four categories are labeled as "prior to the instruction," "presenting the instruction," "prompting," and "keeping things positive." By labeling the four categories in this manner, the full list can be referred to as the "4 Ps" of parent-delivered instruction. A parent-friendly handout describing each recommendation is provided and discussed later in the article.
Prior to the Instruction
To help create an environmental context that supports compliance with instructions, parents should take steps prior to the presentation of an instruction. Each strategy listed in this section is primarily focused on increasing the saliency of the instruction and removing stimuli that may block or overshadow the evocative features of the instruction (Dinsmoor, 1995). To maximize the effectiveness of the strategies listed in this section, they should be implemented immediately before the instruction is placed. The two strategies recommended are to remove distractors from the environment and increase your proximity.
Remove Distractors From the Environment
Prior to presenting any instruction, parents should be taught to remove distractors from the environment as best as possible. Distractors in a home setting might include games, videos,
Behav Analysis Practice (2021) 14:513-522
515
and siblings. Although removing every distractor from the environment prior to instruction may be impossible, removing as many competing stimuli as feasible will increase the relative salience of the instruction. By increasing the salience of the instruction, the likelihood of it controlling the response is increased (T. Smith, 2001). Behavior analysts working with parents to improve this facet of their instruction delivery should help parents prioritize which variables to target and which strategies to use. For instance, families with multiple children may experience difficulty managing each child's behavior simultaneously, which may be partly due to each sibling's behavior blocking the effects of the instruction. Therefore, a therapist may work with a parent to target one child's behavior at a time while distracting any other children with appealing alternative activities. The parent could then rotate lessons or instruction time with each of the children.
Increase Your Proximity
Prior to presenting an instruction, parents must adjust their proximity to maximize the saliency of the instruction. Even with distractors removed from the environment, an instruction shouted from another room is not likely as salient as one presented from directly next to the child (Conroy et al., 2004). Additionally, a child with a history of noncompliance receiving intermittent negative reinforcement in the form of escape from demands will have experienced a greater likelihood of avoidance or escape when parents are not nearby, thereby weakening the effects of the instruction presented in isolation from the physical presence of the parent. Therefore, the physical presence of the parent can add supplemental stimuli that converge with the stimulus produced by the instruction to increase the strength of compliance (Michael et al., 2011).
Behavior analysts coaching parents to increase their proximity must help them determine the appropriate distance. It is important that safety is prioritized at all times, so parents of children with aggressive behaviors should implement this strategy while remaining out of reach of the child. For example, a parent presenting a demand to a child who is likely to attempt to strike them should approach the child before the instruction but place themselves behind a barrier like a coffee table to restrict the child's access to engage in physical aggression. The other important aspect of selecting the appropriate distance is preventing the overshadowing of the instruction. Parents who position themselves distractingly close to the child in an attempt to intimidate or coerce compliance may, in fact, unintentionally add stimuli that overshadow the salience of the instruction.
Presenting the Instruction
To deliver effective instruction, parents should ensure that each instruction includes critical components that increase
the likelihood of compliance and decrease the likelihood of challenging behavior. Strategies listed under this section concentrate on specific components that should all be combined when presenting an instruction. The five strategies recommended when presenting the instruction are as follows: look the child in the eyes, remain quiet and calm, and present clear instructions.
Look the Child in the Eyes
Attending to stimuli is necessary for those stimuli to affect behavior. Orienting toward stimuli is a foundational prerequisite skill for attending to stimuli (see Taylor & DeQuinzio, 2012, for a review of attending skills). To increase the likelihood that a child attends to an instruction, parents should attempt to establish eye contact prior to instruction delivery. By looking at the child in the eyes, the parents are providing the child the opportunity to reciprocate that eye contact, which would signal that the child is attending to the parent and would therefore be a more likely recipient of the instructional stimuli (Hamlet et al., 1984). When behavior analysts work with families of children who do not have these preattending skills and may not provide eye contact, those skills should be targeted first, as they are essential for engaging in instruction (Stephenson & Hanley, 2010). In addition to establishing attending behaviors, eye contact may have similar properties to increased proximity in terms of converging stimulus control.
Remain Quiet and Calm
When parents present instructions, their tone of voice can affect the likelihood of appropriate responding to that instruction (Conroy et al., 2004; Thomas et al., 2017). This effect may be due to a number of factors, such as emotional and aggressive reactions and/or increased escape or avoidance behaviors. If parents present instructions in a hostile or aggressive manner by yelling, snapping, or saying the instruction in a way that clearly signals their frustration, those stimuli could act as aversive stimuli. Research suggests that the presentation of aversive stimuli (positive punishment) could produce the side effects of emotional and aggressive behaviors and escape/ avoidance behaviors (Newsom et al., 1983). In addition, stimuli associated with the frustration of parents could signal at least two contrasting contingencies likely to affect the future frequency of noncompliance. The first potential contingency is that changes in the tone of voice signal impending termination of the instruction because the parents give up and remove the instruction when they become upset (see Sick Social Cycle in Malott & Shane, 2014). The second potential contingency is that changes in the tone of voice (e.g., yelling) signal that the parent is more likely to follow through with a demand than when they use neutral or calm tones, thereby weakening the effectiveness of neutral and calm tones (Eyberg, 1999;
516
Behav Analysis Practice (2021) 14:513-522
McNeil & Hembree-Kigin, 2011), meaning children may learn that yelling is a signal for compliance, whereas neutral tones are not.
Behavior analysts working with parents who are learning baseline skills related to presenting instruction should help them navigate this challenging strategy. It is unreasonable to expect that parents never become frustrated or stressed when working with their children. So, instead of providing overly simple recommendations like "Do not become emotional," behavior analysts should help parents learn strategies to reduce their need to present instructions when upset. One strategy may be proactively taking a break from instruction by asking another caregiver to take over instruction temporarily. To further help, behavior analysts should clarify that the recommendation to avoid emotional instructions does not mean that parents should always avoid showing emotions to their children. Parental demonstration of emotions in the right context is a healthy and important aspect of the overall parent-child relationship (Gottman & Gottman, 2013; Hajal & Paley, 2020).
Present Clear Instructions
The importance of clarity of instruction cannot be overstated. The three crucial aspects of effective instruction all share the same basic goal: to present instructions in a simple, clear, and concise manner. The strategies are to give one direction at a time, present instructions as statements instead of questions, and make "do" requests instead of "don't" requests.
Give One Direction at a Time Providing one single and simple instruction at a time helps control for extraneous variables related to the complexity of a response. For example, the following instruction could be too complex: "Use the bathroom, wash your hands, and then find your sister to tell her dinner is ready." If a parent presents a multistep instruction and the child only partially complies, it may be unclear if the failure to complete the instruction is due to an inability to perform the task or another cause (Maurice et al., 1996; McNeil & Hembree-Kigin, 2011). Furthermore, some instructions may sound like a single instruction, such as "clean up your room," but involve a series of steps, such as putting away toys, placing books on the shelf, hanging up clothes, and making the bed (McNeil & Hembree-Kigin, 2011, p. 108). Behavior analysts working with parents should help them simplify instructions and slowly introduce more complex instructions by systematically increasing the number of directions given at once (Maurice etal., 1996).
Present Instructions as Statements Instead of Questions There is an old saying that goes "Don't ask a question unless you want an answer." By presenting instructions in a question format (e.g., "Can you hand me the phone?"), extraneous
variables are added that will require additional discrimination by the child. A child hearing an instruction in a question format must determine whether the verbal message is actually a question they must answer or instructions they must follow (Kazdin, 2013, p. 5). Whether by confusion or deviancy, a child could provide an answer (e.g., "no") and have technically been correct in their responding. Thus, instructions should be presented as statements such as "Hand me the phone" (Eyberg, 1999; McNeil & Hembree-Kigin, 2011). Behavior analysts working with parents should provide clear guidelines about the format of instructions and work with them to prevent this error.
Make "Do" Requests Instead of "Don't" Requests Providing a specific instruction to stop an undesirable behavior may be effective in the short term, but the behavior that replaces the undesirable behavior may not be any more appealing. Therefore, prompting an alternative behavior in place of behavior that should be stopped is a clearer and more efficient way of decreasing the undesirable behavior and replacing it with a desirable behavior (Adelinis & Hagopian, 1999; Fisher et al., 1998; Kazdin, 2013, pp. 54-57). For example, a child may begin to jump down the hallway if told to stop running but would walk if told to do so specifically. "Do" requests also simplify the contingency for the child who would otherwise be responsible for not only engaging in a correct response but also determining what that response is (Eyberg, 1999; McNeil & Hembree-Kigin, 2011). In addition, a "don't" request could possibly be associated with aversive stimuli that could needlessly elicit further undesirable behavior (McNeil & Hembree-Kigin, 2011). Behavior analysts working with parents should help them identify desirable behaviors that could replace common undesirable behaviors.
Prompting
Unfortunately, it is unlikely that every instruction presented will be followed perfectly each time it is presented. In fact, research shows that typically developing children who are not referred to treatment only comply with an average of approximately 60% of demands the first time given (McNeil & Hembree-Kigin, 2011, pp. 34-35). Therefore, supplemental stimuli to prompt correct and complete responding are often required. The two strategies described in this section target important aspects of prompting a response. These strategies are to give the child time to begin the task and to adjust guidance as necessary.
Give the Child Time to Begin the Task
Time-delay prompts are effective at teaching a variety of skills (Walker, 2008). Therefore, parents who present instructions should be trained to embed a time-delay prompt between the
Behav Analysis Practice (2021) 14:513-522
517
presentation of an instruction and any additional prompting. By inserting a brief time-delay prompt, parents allow the child the opportunity to begin the task independently and avoid placing repeated demands (Forehand & McMahon, 1981). However, establishing the appropriate delay criteria can be difficult. The desired latency between the instruction and beginning the task is idiosyncratic to the type of task and the child being presented the instruction. Standard time delays in time-delay prompts are usually set at 3 or 4 s (Cooper et al., 2019, p. 407); however, research on compliance with task instruction lists appropriate latencies between 5 and 180 s (Danforth, 2001; Stansbury et al., 2012). Therefore, behavior analysts working with parents should help them identify the appropriate time criteria for the delay and work with them to establish a plan to use progressive or constant time-delay strategies (see Walker, 2008). Additionally, behavior analysts could coach parents to use effective advance notice warnings (e.g., 2-min warnings). However, advance notice warnings have shown mixed results and, therefore, require additional considerations (see Brewer et al., 2014; Wilder et al., 2010).
Adjust Guidance as Necessary
In the event that a child fails to engage in correct responding, repeating the instruction is likely to be ineffective and can potentially have deleterious effects on the discriminative stimuli associated with the instruction (Kazdin, 2013, p. 22). As an alternative to repeating the instruction, parents should be trained to use appropriate prompting strategies and effectively fade prompts from use (Miles & Wilder, 2009; Tarbox et al., 2007). Because research on the comparative prompting procedures is mixed (see Cengher et al., 2018), behavior analysts should work with parents to identify prompting procedures that fit the context and are most effective for the individual child.
Keeping Things Positive
To maintain a healthy and productive instructional environment while instructions are presented, steps should be taken to ensure an encouraging dynamic (Forehand & McMahon, 1981). Although the strategies listed under this section are not necessarily a part of the instruction delivery, they are crucial aspects of the overall process that are interwoven with instruction. Each strategy listed here is focused on increasing the reinforcing properties of the parent-instructor while they present instructions. These strategies are to praise more than you demand, refrain from negative comments, and create choices.
Praise More Than You Demand
Praise is a critical and foundational skill for parents (Eyberg, 1999; McNeil & Hembree-Kigin, 2011). Although praise is a consequence-based strategy, it is still relevant to instruction
delivery because praise-to-demand ratios have been demonstrated to affect compliance with demands (Kestner et al., 2019). To maintain a supportive learning environment and reinforce desirable behaviors, praise should be delivered at a ratio of at least 5:1 with corrective feedback (Cook et al., 2017; Flora, 2000; Kestner et al., 2019). To most effectively use praise, it should be delivered immediately after a response and in a behavior-specific format (Sutherland et al., 2000), which consists of providing a general praise statement followed by labeling the specific behavior that warranted the praise (e.g., "Nice job handing over the iPad."). Many parents likely struggle with the rate and the content of praise, so behavior analysts working with parents should help them establish effective practices. For example, a behavior analyst working with a parent who has difficulty delivering enough praise may recommend the use of a timer to prompt praise, or select a specific behavior to monitor and praise when it is observed. In addition to helping parents establish effective rates and content of praise, behavior analysts should be careful to help parents avoid backhanded compliments that would likely diminish the effectiveness of the praise (e.g., "Nice job handing over the iPad. I wish you had done it the first time I asked.").
Refrain From Negative Comments
As described in the rationale provided in the Remain Quiet and Calm section of this article, presenting aversive stimuli can have the same side effects as positive punishment, which include emotional and aggressive behaviors, as well as escape/ avoidance behaviors. Negative comments directed toward or about the child may have aversive properties and should therefore be withheld and avoided. In addition, criticism can draw attention to the undesirable behavior, which can be problematic if the child's behavior is attention maintained (Eyberg, 1999; McNeil & Hembree-Kigin, 2011). However, refraining from negative comments should not be confused with providing error correction, which is an effective and necessary component of training skills. The primary difference between corrective feedback and negative comments is that negative comments often pertain to previous behaviors that are no longer relevant to error correction. Instead of providing immediate feedback to the child to assist them in improving future performance, negative comments are not aimed at helping the child improve performance but are likely tied to other rein-forcers unrelated to the child's behavior.
Behavior analysts working with parents to provide instruction should help establish expectations around the use of negative comments. Parents may benefit from learning that there are blatant forms of criticism (e.g., "You are being stupid."), as well as sarcastic forms ("Nice job . . . finally."; McNeil & Hembree-Kigin, 2011). When negative comments are observed, they could be a sign that the parents need a break from the session or that there is a more systemic problem. If
518
Behav Analysis Practice (2021) 14:513-522
behavior analysts observe repeated use of negative comments that are not resolved by proactive breaks from a session, they might consider providing explicit coaching on appropriate interactions with the child.
Create Choices
Embedding opportunities for the child to choose aspects of the task can help improve compliance and decrease challenging behaviors (Dunlap et al., 1994; Munk & Repp, 1994; Newman et al., 2002; O'Connor & Daly, 2018; Peterson et al., 2017; Thomas et al., 2017). By including choices in instruction, the putative aversive context is altered, which may produce an abolishing operation by decreasing the relative aversiveness of a task (R. G. Smith, 2011, p. 310). Therefore, when appropriate, choice options should be included in the course of instruction.
Aspects of tasks that can be amendable to choice options include the sequence of task completion, the specific method for completing a task, and in some cases, the task itself. For example, when two nonsequential tasks are to be completed, the parent could present both options concurrently and allow the child to allocate their responding to whichever task they prefer to complete first. Following the completion of the first task, the parent could then prompt the completion of the second task. However, some children may attempt to bargain or argue their way out of a task when given choice options. This could be due to choice overload or other issues with the choice arrangement (see Miller et al., 2017). If that occurs, the choice should be removed, and the parents should instruct task completion irrespective of the child's preference. Behavior analysts working with parents should help them establish opportunities to build choice into an instructional sequence, and help them avoid issues related to bargaining.
How to Use the Effective Instruction Guidelines
The information described in the previous sections has been simplified and summarized in a parent-friendly handout titled "The 4 Ps of Parent-Delivered Instruction" (shown in the Appendix). Taken together, this article and Appendix can be used as a guide for practitioners in coaching parents to deliver effective instruction. The review of research and conceptual foundations of each strategy was meant to help educate practitioners about the strategies so that they can use and modify them based on the treatment context. Alternatively, the parent-friendly handout is meant to help guide parents as they use the strategies.
The complete list of all 12 strategies may be overwhelming to parents if targeted simultaneously. Therefore, practitioners recommending these strategies to parents should first evaluate
their baseline skills. If the parent already incorporates components of some of the strategies when delivering instruction, those recommendations could be removed from the handout to simplify instruction. If parents do require coaching on each strategy, practitioners should consider selectively introducing components in subsections instead of introducing all 12 components simultaneously. Strategies can be prioritized based on the parent's skills, client needs, and context. Practitioners should use clinical judgment to select an appropriate approach for introducing this information and coaching the associated skills.
Although each recommended strategy has extensive research supporting its use, idiosyncratic variables are sure to influence their effectiveness. In addition, research has not yet been conducted evaluating the combination of all recommended strategies. Therefore, behavior analysts should work with families to individualize the included recommendations to maximize ecological validity and effectiveness with each individual client. Cultural considerations should be made when adapting these strategies to fit clients' needs (see Helton & Alber-Morgan, 2018).
In addition to the strategies included in this article, practitioners may wish to also promote the inclusion of complementary strategies to fit the needs of their individual clients. This article specifically focused on instruction delivery and did not include other important instructional design or consequence-based strategies. To maximize the effectiveness of any parent-delivered intervention, practitioners should provide coaching on all components of an intervention. For example, additional information on consequence-based interventions like reinforcement and error correction will be helpful (see Marchand-Martella et al., 2004; Peterson et al., 2003), as will information about instructional design (see Lipschultz & Wilder, 2017; Munk & Repp, 1994).
Finally, behavior analysts should be careful to provide alternative options to parents if problem behaviors worsen over time. Although effective instruction delivery may increase the likelihood of appropriate responding and decrease the likelihood of challenging behaviors, some clients may need more advanced procedures and require additional assessment. Therefore, behavior analysts should carefully track the effectiveness of these strategies and provide additional resources when necessary.
Future research is needed to further improve parent-delivered instruction. Although each strategy included in this review is supported by experimental research, the combination of all the strategies has not yet been evaluated. Research that evaluates the combination of the recommended strategies, as well as studies that conduct component analyses of the package, would be valuable in improving resources and strategies for parents involved with behavior-analytic treatment. Additionally, further research on coaching materials, such as
Behav Analysis Practice (2021) 14:513-522
519
handouts, will help improve the support strategies for coaching parents to deliver behavioral interventions.
Conclusion
Parents have an essential role in creating and maintaining behavior change for their children—the clients of behavior analysts. To create lasting behavior change in their clients where it truly matters, behavior analysts must equip parents with the skills and resources needed to support that change. The purpose of this article was to describe strategies and create resources related to the essential skills needed for effective parent-delivered instruction. To that end, a synthesized list of 12 foundational components of effective parent-delivered instruction was provided that pulled from a variety of sources within and beyond behavior analysis. A parent-friendly handout summarizing each strategy was included. Taken together, it is hoped this review along with the included resources will aid practitioners in helping parents support behavior change in their children.
Compliance with Ethical Standards
Conflict of interest   We have no known conflicts of interest to disclose. Ethical approval   Not applicable. Funding   Not applicable.
Appendix
The 4 Ps of Parent-Delivered Instruction
Prior to the Instruction
• Remove Distractors From the Environment1' 2' 3
- Loud and/or busy environments can prevent your message from getting through. Helpful examples include removing/blocking access to a toy, asking a sibling to leave the area, or stopping the task you are engaging in.
• Increase Your Proximity4' s' 6
- Distance matters. Get close to the child, but not so close that your presence may be intimidating or provoke aggression.
Presenting the Instruction
• Look the Child in the Eyes1'2' 6'7
- Eye contact helps establish compliance by assuring that you have the child's attention and that they have yours.
• Remain Quiet and Calm4' 8' 9'10
- Showing emotion to your child is helpful and necessary in the appropriate context, but showing them that you are upset by yelling or snapping at them during a moment that you are attempting to gain compliance may be counterproductive. Children with behavioral challenges may be especially reactive to any perceived emotional response from parents. Remaining quiet and calm helps avoid an escalation of behaviors from the child.
• Give One Direction at a Time1'2'3'10
- Directions should be simple, clear, and concise. Explanations and logic can be used after compliance tasks are completed and should not be used for bargaining or any other reason during the direction. Over time, the number of directions/tasks can be slowly increased.
• Present Instructions as Statements Instead of Questions1'2'9'10'11
- Don't ask a question unless you want an answer. The instruction "Do you want to clean your area?" can lead to an answer "No!" whereas the instruction "Please clean your area" does not lead to an opportunity for an unwanted but technically appropriate response of "No." This does not mean you shouldn't give choices (described below).
• Make "Do" Requests Instead of "Don't" Requests9'10'12
- If the child is engaging in an inappropriate behavior, find an alternative behavior that they can do instead. This can often be a "positive opposite," meaning the appropriate alternative behavior is incompatible with the undesirable behavior. For instance, if the child is running around the room when they should be at the table working, instead of saying "Stop running," you should say, "Have a seat at the table and begin your work."
Prompting
• Give the Child Time to Begin the Task1'2'3'13
- The amount of time that it takes to begin a task can vary with each task and each child. Providing an appropriate amount of time to allow the child to begin the task without further assistance is a critical step in helping your child develop independent skills. Therefore, when presenting an instruction, a time window should be
520
Behav Analysis Practice (2021) 14:513-522
given to the child before additional guidance is provided. In some cases, it may also be helpful to provide advance notice if transitioning from one activity to another (e.g., "I need you to get started on the laundry in 2 minutes.").
• Adjust Guidance as Necessary11'14'1S'16
- If your child does not begin complying with the demand, do not repeat the instruction over and over again. That can appear as nagging and cause the instructions to lose their salience. Instead, you should provide the minimum guidance necessary to complete the task successfully.
Keeping Things Positive
• Praise More Than You Demand9'10'17'18
- The more challenging a child's behavior, the more you should praise and reinforce other appropriate behaviors. Praise/encouragement should be delivered at least five times for every one corrective statement or demand placed.
• Refrain From Negative Comments9'10'11
- Talking about the problem behavior to the child or around the child may increase the likelihood of that behavior. Although corrective feedback should be provided when appropriate, extra comments irrelevant to assisting the child should be avoided.
• Create Choices19' 20
- Giving a child the opportunity to control some aspect of the task helps increase the likelihood of compliance and completion of complex tasks. When options exist that would not interfere with the completion of the task, present them to the child and allow them to choose how they will complete the task. However, it is important to note that this strategy is not permitting the child to bargain or argue their way out of completing a task.
Selected References
1 Sarokoff, R. A., & Sturmey, P. (2004). The effects of behavioral skills training on staff implementation of discrete-trial teaching. Journal of Applied Behavior Analysis, 37(4), 535-538. https://doi.org/10.1901/jaba.2004.37-535.
2 Maurice, C, Green, G, & Luce, S. C. (Eds.). (1996). Behavioral intervention for young children with autism. Pro-Ed.
3 Smith, T. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Other Developmental Disabilities, 16(2), 86-92. https://doi.org/10.1177/ 108835760101600204.
4 Conroy, M. A., Asmus, J. M., Ladwig, C. N., Sellers, J. A., & Valcante, G. (2004). The effects of proximity on classroom behaviors of students with autism in general education settings. Behavioral Disorders, 29(2), 119-129. https://doi. org/10.1177/019874290402900201.
5 Michael, J., Palmer, D. C, & Sundberg, M. L. (2011). The multiple control of verbal behavior. The Analysis of Verbal Behavior, 27(1), 3-22.
6 Stephenson, K. M., & Hanley, G. P. (2010). Preschoolers' compliance with simple instructions: A descriptive and experimental evaluation. Journal of Applied Behavior Analysis, 43(2), 229-247. https://doi.org/10.1901/jaba.2010. 43-229.
7 Hamlet, C. C, Axelrod, S., & Kuerschner, S. (1984). Eye contact as an antecedent to compliant behavior. Journal of Applied Behavior Analysis, 17, 553-557. https://doi.org/10. 190 l/jaba.1984.17-553.
8 Gottman, J., & Gottman, J. J. (2013). Emotion coaching: The heart of parenting. The Gottman Institute.
9 Eyberg, S. M. (1999). Parent-child interaction therapy: Integrity checklists and session materials, http://www.pcit. org.
10 McNeil, C. B., & Hembree-Kigin, T. L. (2011). Parent-child interaction therapy (2nd ed.). Springer.
11 Kazdin, A. E. (2013). The everyday parenting toolkit: The Kazdin method for easy, step-by-step, lasting changing for you and your child. Houghton Mifflin Harcourt.
12 Adelinis, J. D., & Hagopian, L. P. (1999). The use of symmetrical "do" and "don't" requests to interrupt ongoing activities. Journal of Applied Behavior Analysis, 32(4), 519— 523. https://doi.org/10.1901/jaba.1999.32-519.
13 Walker, G. (2008). Constant and progressive time delay procedures for teaching children with autism: A literature review. Journal of Autism and Developmental Disorders, 38(2), 261-275. https://doi.org/10.1007/sl0803-007-0390-4.
14 Tarbox, R. S. F., Wallace, M. D., Penrod, B., & Tarbox, J. (2007). Effects of three-step prompting on compliance with caregiver requests. Journal of Applied Behavior Analysis, 40(4), 703-706. https://doi.org/10.1901/jaba.2007.703-706.
15 Miles, N. I., & Wilder, D. A. (2009). The effects of behavioral skills training on caregiver implementation of guided compliance. Journal of Applied Behavior Analysis, 42(2), 405-410. https://doi.org/10.1901/jaba.2009.42-405.
16 Wilder, D. A., & Atwell, J. (2006). Evaluation of a guided compliance procedure to reduce non-compliance among preschool children. Behavioral Interventions, 21(4), 265-272. https://doi.org/10.1002/bin.222.
17 Kestner, K. M., Peterson, S. M., Eldridge, R. R, & Peterson, L. D. (2018). Considerations of baseline classroom
Behav Analysis Practice (2021) 14:513-522
521
conditions in conducting functional behavior assessments in school settings. Behavior Analysis in Practice, 12(2), 452-465. https://doi.Org/l 0.1007/s40617-018-0269-1.
18 Cook, C. R., Grady, E. A., Long, A. C, Renshaw, T, Codding, R. S., Fiat, A., & Larson, M. (2017). Evaluating the impact of increasing general education teachers' ratio of positive-to-negative interactions on students' classroom behavior. Journal of Positive Behavior Interventions, 19(2), 67-77. https://doi.0rg/lO.l 177/1098300716679137.
19 Dunlap, G, dePerczel, M., Clarke, S., Wilson, D., Wright, S., White, R., & Gomez, A. (1994). Choice making to promote adaptive behavior for students with emotional and behavioral challenges. Journal of Applied Behavior Analysis, 27(3), 505-518. https://doi.org/10.1901/jaba.1994.27-505.
20 Newman, B., Needelman, M., Reinecke, D. R., & Robek, A. (2002). The effect of providing choices on skill acquisition and competing behavior of children with autism during discrete trial instruction. Behavioral Interventions, 17, 31-41. https://doi.org/10.1002/bin.99.
References
Adelinis, J. D., & Hagopian, L. P. (1999). The use of symmetrical "do" and "don't" requests to interrupt ongoing activities. Journal of Applied Behavior Analysis, 32(4), 519-523. https://doi.org/10. 1901/jaba.l999.32-519.
Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33(3), 373-391. https://doi.org/10.1901/jaba.2000.33-373.
Barton, E. E., & Fettig, A. (2013). Parent-implemented interventions for young children with disabilities: A review of fidelity features. Journal of Early Intervention, 35(2), 194-219. https://doi.org/10. 1177/1053815113504625.
Brewer, A. T., Strickland-Cohen, K., Dotson, W., & Williams, D. C. (2014). Advance notice for transition-related problem behavior: Practice guidelines. Behavior Analysis in Practice, 7(2), 117-125. https://d0i.0rg/l 0.1007/s40617-014-0014-3.
Cengher, M., Budd, A., Farrell, N., & Fienup, D. M. (2018). A review of prompt-fading procedures: Implications for effective and efficient skill acquisition. Journal of Developmental and Physical Disabilities, 30(2), 155-173. https://doi.org/10.1007/sl0882-017-9575-8.
Conroy, M. A., Asmus, J. M., Ladwig, C. N., Sellers, J. A., & Valcante, G. (2004). The effects of proximity on classroom behaviors of students with autism in general education settings. Behavioral Disorders, 29(2), 119-129. https://doi.org/10.1177/ 019874290402900201.
Cook, C. R, Grady, E. A., Long, A. C, Renshaw, T., Codding, R. S., Fiat, A., & Larson, M. (2017). Evaluating the impact of increasing general education teachers' ratio of positive-to-negative interactions on students' classroom behavior. Journal of Positive Behavior Interventions, 19(2), 67-77. https://doi.org/10.1177/ 1098300716679137.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied behavior analysis (3rd ed.). Hoboken, NJ: Pearson Education.
Crone, R. M., & Mehta, S. S. (2016). Parent training on generalized use of behavior analytic strategies for decreasing the problem behavior of children with autism spectrum disorder: A data-based case study.
Education and Treatment of Children, if 9(1), 64-94. https://www. muse.jhu.edu/article/612000. Danforth, J. S. (2001). Altering the function of commands presented to boys with oppositional and hyperactive behavior. The Analysis of Verbal Behavior, 18(1), 31-49. https://doi.org/10.1007/ BF03392969.
Dinsmoor, J. A. (1995). Stimulus control: Part II. The Behavior Analyst, 18(2), 253-269. https://doi.org/10.1007/BF03392712.
Dunlap, G, DePerczel, M., Clarke, S., Wilson, D., Wright, S., White, R., & Gomez, A. (1994). Choice making to promote adaptive behavior for students with emotional and behavioral challenges. Journal of Applied Behavior Analysis, 27(3), 505-518. https://doi.org/10.1901/ jaba. 1994.27-505.
Eyberg, S. M. (1999). Parent-child interaction therapy: Integrity checklists and session materials, http://www.pcit.org.
Fava, L., Strauss, K., Valeri, G, D'Elia, L., Arima, S., & Vicari, S. (2011). The effectiveness of a cross-setting complementary staff-and parent-mediated early intensive behavioral intervention for young children with ASD. Research in Autism Spectrum Disorders, 5(4), 1479-1492. https://doi.Org/10.1016/j.rasd.2011. 02.009.
Fisher, W. W., Adelinis, J. D., Thompson, R. F£, Worsdell, A. S., & Zarcone, J. R. (1998). Functional analysis and treatment of destructive behavior maintained by termination of "don't" (and symmetrical "do") requests. Journal of Applied Behavior Analysis, 31(3), 339-356. https://doi.org/10.1901/jaba.1998.31-339.
Flora, S. R. (2000). Praise's magic reinforcement ratio: Five to one gets the job done. The Behavior Analyst Today, 1(4), 64.
Forehand, R, & McMahon, R. J. (1981). Helping the noncompliani child: A clinician's guide to parent training. Guilford Press.
Gottman, J., & Gottman, J. J. (2013). Emotion coaching: The heart of parenting. The Gottman Institute.
Grindle, C. F., Hastings, R. P., Saville, M., Hughes, J. C, Huxley, K., Kovshoff, H, Griffith, G. M., Walker-Jones, E., Devonshire, K., & Remington, B. (2012). Outcomes of a behavioral education model for children with autism in a mainstream school setting. Behavior Modification, 36(3), 298-319. https://doi.org/10.1177/ 0145445512441199.
Gunning, C, Holloway, J., & Grealish, L. (2020). An evaluation of parents as behavior change agents in the Preschool Life Skills program. Journal of Applied Behavior Analysis. Advance online publication. https://doi.org/10.1002/jaba.660.
Hajal, N. J., & Paley, B. (2020). Parental emotion and emotion regulation: A critical target of study for research and intervention to promote child emotion socialization. Developmental Psychology, 56(3), 403-417. https://doi.org/10.1037/dev0000864.
Hamlet, C. C, Axelrod, S., & Kuerschner, S. (1984). Eye contact as an antecedent to compliant behavior. Journal of Applied Behavior Analysis, 17, 553-557. https://doi.org/10.1901/jaba.1984.17-553.
Hayward, D., Gale, C, & Eikesefh, S. (2009). Intensive behavioural intervention for young children with autism: A research-based service model. Research in Autism Spectrum Disorders, 3(3), 571—580. https://doi.0rg/lO.lOl6/j.rasd.2OO8.i2.OO2.
Helton, M. R., & Alber-Morgan, S. R. (2018). Helping parents understand applied behavior analysis: Creating a parent guide in 10 steps. Behavior Analysis in Practice, 11(4), 496-503. https://doi.org/10. 1007/s40617-018-00284-8.
Kazdin, A. E. (2013). The everyday parenting toolkit: TheKazdin method for easy, step-by-step, lasting changing for you and your child. Houghton Mifflin Harcourt.
Kestner, K. M., Peterson, S. M., Eldridge, R. R, & Peterson, L. D. (2019). Considerations of baseline classroom conditions in conducting functional behavior assessments in school settings. Behavior Analysis in Practice, 12(2), 452-465. https://doi.org/10. 1007/s40617-018-0269-l.
522
Behav Analysis Practice (2021) 14:513-522
Lipschultz, J., & Wilder, D. A. (2017). Recent research on the high-probability instructional sequence: A brief review. Journal of Applied Behavior Analysis, 50(2), 424-428. https://doi.org/10. 1002/jaba.378.
Malott, R. W., & Shane, J. T. (2014). Principles of behavior (7th ed.) Pearson.
Marchand-Martella, N. E., Slocum, T. A., & Martella, R. C. (2004). Introduction to direct instruction. Pearson/AUyn & Bacon.
Maurice, C, Green, G., & Luce, S. (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Pro-Ed
McNeil, C. B., & Hembree-Kigin, T. L. (2011). Parent-child interaction therapy (2nd ed.). Springer.
Michael, J., Palmer, D. C, & Sundberg, M. L. (2011). The multiple control of verbal behavior. The Analysis of Verbal Behavior, 27(1), 3-22. https://doi.org/10.1007/BF03393089.
Miles, N. I., & Wilder, D. A. (2009). The effects of behavioral skills training on caregiver implementation of guided compliance. Journal of Applied Behavior Analysis, 42(2), 405^110. https://doi. org/10.190 l/jaba.2009.42-405.
Miller, J. R, Kaplan, B. A., Reed, D. D., & White, L. D. (2017). Effects of array size on preschoolers' preference and engagement: A behavioral translation of choice overload. Behavior Analysis: Research and Practice, 17(1), 74-83. https://doi.org/10.1037/bar0000067.
Munk, D. D., & Repp, A. C. (1994). The relationship between instructional variables and problem behavior: A review. Exceptional Children, 60(5), 390-401. https://doi.org/10.1177/ 001440299406000502.
Newman, B., Needelman, M., Reinecke, D. R, & Robek, A. (2002). The effect of providing choices on skill acquisition and competing behavior of children with autism during discrete trial instruction. Behavioral Interventions, 17,31 41. https://doi.org/10.1002/bin.99.
Newsom, C, Favell, J. E., & Rincover, A. (1983). The side effects of punishment. In S. Axelrod & J. Apsche (Eds.), Effects of punishment on human behavior (pp. 285-316). Academic Press.
O'Connor, M. A., & Daly III, E. J. (2018). Selecting effective intervention strategies for escape-maintained academic-performance problems: Consider giving 'em a break! Journal of School Psychology, 66, 41-53. https://doi.Org/10.1016/j.jsp.2017.09.003.
Patterson, S. Y., Smith, V., & Mirenda, P. (2012). A systematic review of training programs for parents of children with autism spectrum disorders: Single subject contributions. Autism, 16(5), 498-522. https:// doi.org/10.1177/1362361311413398.
Peterson, S. M., Frieder, J. E., Quigley, S. P., Kestner, K. M., Goyal, M., Smith, S. L., Dayton, E., & Brower-Breitwieser, C. (2017). Concurrent schedules of reinforcement as "challenges" to maintenance. Education and Treatment of Children, 40(1), 57—76.
Peterson, S. M., Morris, C, Kestner, K, Quigley, S., Aljadeff-Abergel, E., & Goetz, D. (2018). Applied behavior analysis: Foundations and applications. In C. McNiel, L. Quetsch, & C. Anderson (Eds.), Handbook of parent-child interaction therapy for children on the autism spectrum, pp 21-40. Springer.
Peterson, S. M., Peterson, L. D., & Lacy, L. N. (2003). How to deal with students who challenge and defy authority. Pro-Ed.
Smith, R. G. (2011). Developing antecedent interventions for problem behavior. In W. W. Fisher, C. C. Piazza, & H. S. Roane (Eds.), Handbook of applied behavior analysis, pp 297—396. Guilford Press.
Smith, T. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Other Developmental Disabilities, 16(2), 86—92. https ://doi.org/l 0.1177/10883 5760101600204.
Stansbury, K, Haley, D., Lee, J., & Brophy-Herb, H. E. (2012). Adult caregivers' behavioral responses to child noncompliance in public settings: Gender differences and the role of positive and negative touch. Behavior and Social Issues, 21(1), 80-114. https://doi.org/10. 5210/bsi.v21i0.2979.
Stephenson, K. M., & Hanley, G. P. (2010). Preschoolers' compliance with simple instructions: A descriptive and experimental evaluation. Journal of Applied Behavior Analysis, 43(2), 229—247. https://doi. org/10.1901/jaba.2010.43-229.
Suberman, R, & Cividini-Motta, C. (2019). Teaching caregivers to implement mand training using speech generating devices. Journal of Applied Behavior Analysis, 53(2), 1098-1110. https://doi.org/10. 1002/jaba.630.
Sutherland, K. S., Wehby, J. PL, & Copeland, S. R. (2000). Effect of varying rates of behavior-specific praise on the on-task behavior of students with EBD. Journal of Emotional and Behavioral Disorders, 8, 2-8. https://doi.org/10.1177/106342660000800101.
Tarbox, R. S., Wallace, M. D., Penrod, B., & Tarbox, J. (2007). Effects of three-step prompting on compliance with caregiver requests. Journal of Applied Behavior Analysis, 40(4), 703-706. https://doi. org/10.1901/jaba.2007.703-706.
Taylor, B. A, & DeQuinzio, J. A. (2012). Observational learning and children with autism. Behavior Modification, 36(3), 341-360. https://doi.org/10.1177/0145445512443981.
Thomas, R., Abell, B., Webb, H. J., Avdagiv, E., & Zimmer-Gembeck, M. J. (2017). Parent-child interaction therapy: A meta-analysis. Pediatrics, 140(3), 3-15. https://doi.org/10.1542/peds.2017-0352.
Tomlinson, S. R., Gore, N, & McGill, P. (2018). Training individuals to implement applied behavior analytic procedures via telehealth: A systematic review of the literature. Journal of Behavioral Education, 27(2), 172-222. https://doi.org/10.1007/sl0864-018-9292-0.
Walker, G. (2008). Constant and progressive time delay procedures for teaching children with autism: A literature review. Journal of Autism and Developmental Disorders, 38(2), 261-275. https://doi.org/10. 1007M0803-007-0390-4.
Wilder, D. A., Nicholson, K, & Allison, J. (2010). An evaluation of advance notice to increase compliance among preschoolers. Journal of Applied Behavior Analysis, 43(4), 751—755. https://doi. org/10.190 l/jaba.2010.43-751.
Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.