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Errorless compliance to parental requests: Treatment effects and generalization
BEHAVIORTHERAPY24, 209-226, 1993
Errorless Compliance to Parental Requests: Treatment Effects and Generalization JOSEPH M . DUCHARME MICHELE POPYNICK
Surrey Place Centre Toronto, Ontario, Canada Four children with developmental disabilities were trained to follow parental instructions using an "errorless" compliance training approach requiring no punishment or remedial consequence. Initially, the children and their parents were observed to determine the likelihood of child compliance to a range of parental requests. Requests were then categorized into four levels, from requests associated with high probabilities of compliance (Level 1) to those associated with low probabilities (Level 4). During the first treatment phase, parents presented the children with requests from Level 1 and reinforced compliant responses. After several sessions at Level 1, parents gradually introduced Level 2 requests. Succeeding probability levels were sequentially introduced over several sessions. High compliance levels were obtained throughout treatment, even for Level 4 requests. Covariant reductions in maladaptive behavior and generalization to untrained requests were obtained. Gains were maintained up to 3 months after treatment.
Treatment of child noncompliance to parental requests has been the subject of many research studies over the last two decades. There are at least two reasons for this emphasis. First, noncompliance is one of the most prevalent behavior problems in children (e.g., Bernal, Klinnert, & Schultz, 1980; Forehand, 1977; Forehand, King, Peed, & Yoder, 1975; Johnson, Wahl, Martin, & Johansson, 1973). Second, there is evidence to suggest that compliance may be a "keystone" behavior; that is, the development of compliance may be sufficient for the promotion of behavioral gains in other areas. Specifically, several studies have reported correlations between increases in compliance levels and reductions in frequency of severe maladaptive behavior (e.g., Cataldo,
This research was supported by a grant from Surrey Place Centre. The authors would like to express their appreciation to Maurice Feldman, Nicole Walton-Allen, and Ron Van Houten for their comments on an earlier draft of this paper; and to Kim Crozier, Holly Lucas, and Edite Pontes for their assistance with data collection and summary. Requests for reprints should be sent to Joe Ducharme, Ph.D., Behavioural Science Research and Education Division, Surrey Place Centre, 2 Surrey Place, Toronto, Ontario, Canada, M5S 2C2. 209 0005-7894/93/0209-022651.00/0 Copyright 1993 by Associationfor Advancementof Behavior Therapy All rights of reproduction in any form reserved.
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Ward, Russo, Riordan, & Bennett, 1986; Parrish, Cataldo, Kolko, Neef, & Egel, 1986; Russo, Cataldo, & Cushing, 1981). Effective strategies for treatment of noncompliance have been developed and evaluated, most notably by Forehand and his colleagues (for reviews of this research, see Forehand & McMahon, 1981; McMahon & Forehand, 1984). Most behavioral treatment packages for teaching compliance consist of several components, including the provision of effective requests, the reinforcement of compliant responses, and the implementation of a consequence for noncompliance. Typically, the consequence involves either a punishment procedure (usually time-out) contingent on failure to follow the parental request (e.g., Budd, Green, & Baer, 1976; Forehand & King, 1977; Peed, Roberts, & Forehand, 1977; Scarboro & Forehand, 1975; Wahler, 1969) or a physical guidance procedure, in which the parent manually guides the child through the motions of the requested behavior (e.g., Neef, Shafer, Egel, Cataldo, & Parrish, 1983; Parrish et al., 1986; Whitman, Zakaras, & Chardos, 1971). Although time-out and physical guidance have been demonstrated to be expeditious in the treatment of noncompliance, both procedures require the physical manipulation of the child. Such procedures can be particularly problematic with children who are severely oppositional and resistive to physical interventions. It has been noted, for example, that vigorous resistance on the part of the child to attempts to implement time-out procedures is common (Roberts, 1982; 1984; Roberts & Powers, 1990). There is clearly a need to develop strategies for reducing the confrontational parent-child interactions that may occur as a side effect of time-out and other procedures requiring physical manipulation of the child or to develop compliance training procedures that do not require physical intervention. "Errorless" teaching procedures (Lambert, 1975; Lancioni & Smeets, 1986; Stoddard & Sidman, 1967; Terrace, 1966; Touchette, 1968; Touchette & Howard, 1984; Weeks & Gaylord-Ross, 1981) may offer one means of teaching compliance without the use of physical intervention. In an errorless teaching paradigm, the initial conditions presented to the student make the task to be learned very simple. Subsequently, more difficult conditions are gradually introduced, until the individual is responding to the difficult task with the same high rate of correct responses as to the simple task. Learning is thus accomplished with fewer errors and undesirable responses than in a conventional trial-and-error learning approach. Gold and Barclay (1973), for example, compared two procedures for teaching persons with developmental disabilities to discriminate between two bolts that varied only slightly in length. With the errorless procedure, the subjects were first exposed to a graduated series of easier bolt discriminations, starting with a discrimination between two bolts widely divergent in length, before being presented with the target discrimination. With the second procedure, the subjects were simply exposed to the difficult discrimination with no graduated pre-exposure~ The errorless task promoted more effective and efficient learning than the trial-and-error task. An errorless approach could be adapted to the teaching of compliance by initially exposing the child to a broad range of requests and demand situations to which there is a high probability of compliance (and thus numerous occasions for reinforcer provision). Subsequently, over several days or weeks,
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requests to which the child is slightly less likely to comply can be gradually faded in. Compliance should thus occur at such a high rate that few errors (i.e., noncompliant responses) would occur. The lower probability requests could be progressively introduced until the child followed all requests (even those to which compliance was highly unlikely) at a high rate. With this approach, a physical consequence for noncompliance should be unnecessary, as such undesirable responses should be much less likely to occur than in more conventional compliance training approaches. The errorless approach has the additional advantage of allowing compliance training to occur without any initial exposure of the child to high demand situations that have been shown to produce high rates of maladaptive behavior in some individuals (e.g., Cart & Newsom, 1985; Centre, Deitz, & Kaufman, 1982; Carr & Durand, 1985; Weeks & Gaylord-Ross, 1981). With errorless compliance training, difficult demand situations are faded in slowly, after the child has shown high levels of compliance to less demanding requests. In the present study, we examined the use of errorless compliance training across 4 children with developmental disabilities who were referred for treatment because of severe noncompliance to parental requests and other maladaptive behavior. The effects of this treatment strategy on compliance levels, concomitant maiadaptive behavior, and generalization requests were assessed.
Method
Subjects and Setting Subjects were 4 children with developmental disabilities referred to an outpatient treatment center for behavior management because of severe noncompliance to parental requests, as well as aggression, tantrums and/or other oppositional behavior. These children were randomly selected from a much larger pool of referred children with similar presenting problems. Child 1 was a fiveyear-old boy with Down syndrome (IQ = 84, Stanford-Binet, 4th ed.). Child 2 was an eight-year-old girl (IQ = 55, WISC-R); Child 3 was an eight-year-old boy (IQ = 65, WISC-R); and Child 4 was a five-year-old boy (IQ = 47, Stanford-Binet, 4th ed.). All intelligence assessment information was drawn from agency casebooks or school records. All 4 children were living at home with their parents. The mothers of the children served as intervention agents in this study. The mothers' education level ranged from a community-college degree (Child 1 and 4) to completion of high school grades ll (Child 2) and 12 (Child 3). All sessions were conducted in the families' homes. The home setting of sessions varied depending on the type of request provided to the child (e.g., a request that involved dressing was implemented in the child's bedroom). The two female therapists who conducted the study each possessed a Bachelor's degree in psychology.
Design A multiple baseline across subjects design was employed (Barlow & Hersen, 1984). This design was selected over a within subject multiple baseline design across probability levels due to the potential interdependence of the proba-
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bility levels during treatment. The data for Child 2 was collected nonconcurrently (Issacs, Embry, & Baer, 1982; Iwata, Pace, Kalsher, Cowdery, & Cataldo, 1990; Watson & Workman, 1981); that is, baseline was initiated approximately 12 weeks after the other 3 subjects.
Dependent Measures Throughout all phases of the study, mother-child interactions were videotaped by therapists who followed the participants to various locations of the family residence. All data were coded from these videotapes. Before videotaping was initiated, one or two sessions were conducted to acclimatize the children to the presence of the camera and the therapist. Compliance. The primary dependent measure in this study was the percentage of parental requests to which child compliance was obtained. The child was considered compliant if he or she initiated the appropriate motor response to the request within 10 s of the request and completed the response within 40 s. Failure to exhibit a motor response, failure to initiate within 10 s, or failure to complete within 40 s, even if the appropriate motor response was exhibited, was considered noncompliance. Event recording was used to code all compliance data. Each event was initiated by a request provided by the parent and ended by one of three alternatives: (a) the failure of the child to initiate the task within 10 s, (b) the failure of the child to complete the task within 40 s, or (c) the successful completion of the task within 40 s of the request (the latter two options were considered only if the child initiated the requested activity within 10 s of the request). Maladaptive behaviors. Maladaptive behaviors were recorded from the videotapes of all compliance sessions. The maiadaptive behaviors were specific to each child, and included aggression, screaming, crying, verbal opposition (e.g., saying "no" or "I don't want to") and disruptive behavior (e.g., throwing or destroying household materials). Each behavior was scored for occurrence or nonoccurrence during each compliance event (i.e., multiple maladaptive behaviors were coded as an occurrence with no differentiation between the number of behaviors which may have occurred during the compliance event). The data on maladaptive behavior provided a measure of the effect of the errorless compliance training strategy on behaviors other than those specifically targeted.
Interobserver Agreement Interobserver agreement was obtained by two independent, experimentally uninformed observers during videotape coding of sessions randomly selected from each of the phases, across all children. The observers were either therapists for mother/child dyads other than the one currently being observed or students who had been trained to code observational data. Agreement was obtained on 23070 of sessions (15o70 of empirical analysis, 29070 of baseline, 20070 of Level 1, 2107o of Level 2, 28070 of Level 3, 28°70 of Level 4, 23070 of transition, 24070 of generalization probes, and 40070 of follow-up sessions). Overall agreement was calculated on a trial-by-trial basis for compliance and averaged 95o7o for empirical analysis (range 90 to 100070), 95070 for base-
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line (range 84 to 100°70), 100% for Level 1, 9707ofor Level 2 (range 90 to 100070), 99070 for Level 3 (range 95 to 100%), 98% for Level 4 (range 90 to 100%), 97% for transition (range 86 to 100%), 9807ofor generalization probes (range 92 to 100%), and 87% for follow-up sessions (range 75 to 100%). Overall agreement for maladaptive behavior was also calculated on a trialby-trial basis and averaged 86°70for empirical analysis (range 77 to 95%), 85070 for baseline (range 70 to 100%), 94070 for Level 1 (range 86 to 100%), 97070 for Level 2 (range 94 to 100070),91°70for Level 3 (range 80 to 100070),91070for Level 4 (range 89 to 91%), 96°7o for transition (range 88 to 100%), 8907o for generalization probes (range 67 to 100%), and 9307o for follow-up sessions (range 87 to 100070).
Assessment of Compliance Probabilities Checklist probability analysis. Parents were interviewed and provided with a list of approximately 200 commonly used requests. The list sampled several domains of compliance, such as requests related to dressing (e.g., "put on your socks"), hygiene (e.g., "comb your hair"), leisure (e.g., "throw me the ball"), and social interaction (e.g., "give me a hug"). The parents were asked to rate each request according to the likelihood of compliance by the child, as follows: (a) "almost always" (76 to 100070of the time), (b) "usually" (51 to 7507oof the time), (c) "occasionally" (26 to 50070of the time), and (d) "rarely" (0 to 25°7o of the time). Empirical probability analysis. To empirically assess the probability levels for specific requests, the parents were videotaped in sessions in which they presented their child with 48 requests selected from the compliance checklist (12 requests from each of the four levels of compliance probability, as rated by the parents). The selection of requests was restricted to those that could be easily completed by the child in 30 s or less. Over approximately ten 60-min empirical analysis sessions, the parents were required to present the 48 requests 10 times each, in random order, pacing the requests so that they occurred approximately every 30 to 90 s. The parents were provided with a list of requests to include in the session. Approximately 2 hr were spent on parent training of request provision prior to the first empirical probability analysis session, with brief (approximately 10 min) reviews of procedures provided before all subsequent sessions. Each parent training session involved the use of modeling, role-playing, and performance feedback. During training, the parents were taught to present the request in the imperative, in a polite but firm tone of voice, and to avoid repetitions of the request. They were also instructed to involve themselves in activities that were part of their daily routine during the empirical probability analysis sessions, so that the request presentation would appear natural to the child. Parents were asked to do whatever they usually did as a consequence of their child's compliance or noncompliance to their requests.
Hierarchical Categorization of Requests Based on the results of the empirical analysis, the requests were arranged in order of lowest to highest probability of compliance. The requests were then
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divided into four categories, roughly approximating the following compliance probability levels: Level 1 (76 to 100°70 compliance); Level 2 (51 to 75°7o compliance); Level 3 (26 to 50°7o compliance); and Level 4 (0 to 25°7o compliance). From the 48 requests assessed, l0 requests were chosen for each probability level. In situations in which there were not enough requests in one of the probability levels, new requests were evaluated with the parent and child until all request levels were filled. Requests were selected from a broad range of compliance domains (e.g., hygiene, dressing) to increase the likelihood of generalization to requests that were not included in treatment sessions (e.g., Day & Homer, 1986; Day & Homer, 1989; Ducharme & Feldman, 1992; Homer, McDonnell, & Bellamy, 1986).
Procedure Baseline. Three of the 10 requests per level (12 requests in total) were randomly selected for baseline assessment of compliance (all 12 baseline requests were subsequently included in treatment). Each request was presented once by the parent in each baseline session. During the baseline sessions, parents were asked to use the same request presentation and consequence procedures as in the empirical analysis, described above. The number of baseline sessions per child varied from three to nine sessions for multiple baseline purposes. Treatment-Phase 1 (Level 1 requests). After baseline measures were collected, parents were trained, using modeling, role-playing, and performance feedback procedures, to implement treatment sessions in which the child was presented with requests from Level 1. Approximately 2 hr were spent on parent training prior to the first treatment session, with brief (approximately 10 min) reviews of procedures provided before all subsequent treatment sessions. The parents were taught to provide enthusiastic praise and physical contact (e.g., hugs, kisses, pats) after each compliant response. Parental reports and therapist observations prior to the initiation of the study suggested that parental praise and physical contact could be used as reinforcers for all children but one (Child 3) who did not enjoy physical contact. For this child, the mother was instructed to use only praise as a consequence for compliance. Parents were instructed to use no consequence for noncompliance other than continuing with ongoing household activities and proceeding with the next request on the list after approximately 60 s. The treatment sessions took place approximately two times per week. The mode of request presentation was identical to that used during the empirical analysis and baseline. The parent provided each of 7 requests from Level 1 three times each. Repetitions of the same request were never presented consecutively. Only 7 of the 10 requests per level were used in treatment because 3 requests per level were employed to assess generalization (see Generalization Probes, below). Phase 1 was continued with each child until relatively stable percentages of compliance were achieved (typically four or five sessions). Outside of the sessions, parents were asked to do one of two things: (a) avoid giving requests to their child from untrained probability levels, or (b) do tasks for the child that corresponded to requests from untrained levels.
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These procedures were requested of the parents to keep everyday compliance situations as compatible with ongoing treatment as possible. Transitions. Before moving to the next level of requests, transition sessions were conducted to make the passage from one phase to the next less abrupt. In transition sessions, the parents were required to provide requests to the child from both adjoining request levels. During the first session of Transition 1, for example, the parents presented the seven requests from Level 1 twice, and the seven requests from Level 2 once. During the second session of Transition 1, the parents presented the Level 1 requests once and the Level 2 requests twice. Transition sessions were repeated if the child's compliance diminished during the previous session. Phase 2, 3 and 4 (Level 2, 3 and 4 requests). These phases were conducted exactly as in Phase 1, with the exception that only Level 2 requests were employed in Phase 2, Level 3 requests in Phase 3, and Level 4 requests in Phase 4.
Generalization Probes Each mother/child dyad was videotaped during baseline, and all subsequent phases to evaluate the extent of generalization obtained during treatment. Generalization probe sessions for a specific treatment phase typically occurred after several treatment sessions had taken place for that phase and were conducted less frequently than treatment sessions (1 or 2 generalization probe sessions per treatment phase). Almost all generalization probes occurred on the same day as treatment sessions. During these generalization probes, the parent and child were monitored on all four levels of requests. Of the 10 requests designated to each level during the hierarchical categorization, 6 requests per level were included as part of each generalization probe session (i.e., 24 requests in total). Three of these 6 requests per level (i.e., 12 total requests) were not included in the treatment sessions. These requests (generalization requests) served as measures of generalization to requests at the same probability level. The other 3 requests (training requests) were included in the treatment sessions and thus served as a comparative measure of compliance to specifically trained requests. The mode of request presentation and consequence procedures during generalization probes was identical to the empirical analysis and baseline sessions. The generalization probes provided two distinct measures of generalization: (a) within-level generalization and (b) across-level generalization. Within-level generalization was defined as the extent of correspondence between percentage of compliance to training requests and generalization requests within the same probability level. This provided a measure of how the child responded after treatment at a specific probability level to requests at the same level that had not been included in treatment. Across-level generalization was defined as the extent of correspondence between percentages of compliance to requests from the probability level being trained and each of the remaining untrained probability levels after each phase of treatment. This measure allowed us to determine after treatment at a specific probability level whether the child generalized to requests from other proba-
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bility levels not yet trained. Across-level generalization assessment thus provided a means of determining the number of probability levels of requests requiring training before widespread generalization to all probability levels was obtained.
Follow-up Follow-up sessions were identical to baseline sessions, with requests from all four levels being assessed. Follow-up sessions were conducted at two weeks, one month, and two months for Child 1 and 2. Child 3 was available for a fourth follow-up at three months and Child 4 was unavailable for follow-up.
Consumer Satisfaction As a means of assessing the social validity of the intervention (Wolf, 1978), parents were asked by the therapist involved with the family to complete the applicable sections of the Parent's Consumer Satisfaction Questionnaire (Forehand & McMahon, 1981; McMahon, Tiedmann, Forehand, & Griest, 1984) during follow-up. The sections which related to the present intervention involved satisfaction with the overall program and satisfaction with the therapist. These sections of the questionnaire are comprised of items scored on a 7-point scale, with the high end of the scale (7) representing the highest degree of satisfaction with the intervention.
Results Treatment The treatment data for the four children are presented in Figure 1. Each baseline session point represents a mean percentage of compliance to the combination of all four probability levels of requests provided to the child during that session. The treatment data reflect compliance to requests from the specific probability level being trained in that phase (or to combinations of requests from adjacent levels in transitions). The overall mean percentage of compliance across all four children in baseline was 44°70. The shaded areas in Figure 1 represent the mean percentage of child compliance to parental requests prior to treatment (i.e., empirical analysis and baseline requests combined) from the probability level being trained in that phase. These means include all available pretreatment data. They therefore provide the most comprehensive measure against which to compare the treatment data because they encompass, across a range of situational factors (e.g., time of day, fatigue of the child), the numerous response repetitions that are required to calculate pretreatment probability levels. Comparisons can thus be made between pretreatment and treatment levels at each probability level. Figure 1 shows that in Phase 1 of treatment, all four children responded at or near pretreatment levels for Level 1 (76-100070) requests. The overall means for pretreatment and treatment compliance data across the four children were 84070 and 90070 respectively. This correspondence between pretreatment and treatment data was expected in Phase 1, as high probability requests were used and large gains in compliance percentages during treatment were not possible. During Phase 2, the effects of errorless compliance training began to emerge.
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Although the overall mean for pretreatment was 60070 for Level 2 requests, the overall mean for treatment data was 89070. The difference between pretreatment and treatment compliance levels became more prominent in Phase 3. The overall mean for Level 3 requests in pretreatment was 39070 and in treatment, 85°70. In Phase 4, the gains made during treatment over pretreatment
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levels culminated; the overall percentage of compliance increased from 16070 in pretreatment to 86070 in treatment. The data during transitions were consistent with the data during the four treatment phases, with percentages of compliance typically over 80070. After treatment was completed, compliance skills were maintained for all three children with whom follow-up sessions were conducted. All of the follow-up compliance means were above 80070.
Maladaptive Behavior The percentages of requests followed by maladaptive behavior during baseline and treatment are shown in Figure 2. For comparison purposes, the shaded areas in Figure 2 represent the mean pretreatment percentages (including both empirical analysis and baseline data) of requests that were followed by maladaptire behavior from the probability level being trained in that phase. As with the compliance data, each baseline data point in Figure 2 represents responses to requests from a combination of all four probability levels. The overall mean percentage of maladaptive behavior across all four children in baseline was 34070. For Level 1 requests, the overall mean percentages of maladaptive behaviors across the four children in pretreatment and treatment (Phase 1) were 15070 and 10070,respectively. For Level 2 requests, the difference between pretreatment and treatment percentages became more pronounced. The overall mean was 21070 for pretreatment and 9070 for treatment (Phase 2) requests. When Level 3 requests were introduced in treatment, the overall mean was 4407o for pretreatment and 11070for treatment (Phase 3) requests. The differences between the overall pretreatment and treatment means were most substantial for Level 4 requests. The pretreatment mean was 51070and the treatment (Phase 4) mean was 10070.These data indicated that, prior to treatment, maladaptive behavior increased as the probability of compliance decreased. However, after treatment, the differences in levels of maladaptive behavior between probability levels were virtually eliminated, with substantial reductions occurring in Levels 3 and 4. Levels of maladaptive behavior during transitions were consistent with those obtained during the four phases of treatment. Rates of maladaptive behavior were maintained at similar low levels during follow-up. During 6 of the 10 follow-up sessions, no maladaptive behavior occurred.
Generalization Within-level generalization. Generalization within each compliance probability level is depicted in Figure 3. A generalization criterion of 75070was used, as this was the lower limit for the highest compliance probability level in the present study. Achievement of this level of generalization would therefore ensure that the children were responding to the generalization requests as they would to Level 1 requests, which did not require intervention prior to treatment. Increases in mean percentages of compliance from pretreatment to treatment were obtained for all probability levels of requests (with the exception of Level 1, where no increases were expected because compliance to requests
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TREATMENT LEVEL 1 TRANS1 LEVEL 2 T~NS = (76-100%) (51-75%)
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in this category were high probability prior to intervention). Criterion levels of compliance were obtained for 13 out of 16 of the training request means during treatment. Criterion levels were achieved for 12 of the 16 generalization request means.
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I~G. 3. Mean percentage of compliance to training and generalization requests in pretreatment and the four treatment phases during generalization probe sessions.
Across-levelgeneralization. Generalization results to untrained probability levels are presented in Figure 4. As can be seen in this histogram, each phase of training produced moderate increases in compliance to untrained levels over the previous phase of treatment, in most cases. Criterion levels were typically not obtained, however, until requests from that level were included in treat-
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merit. It would appear that in the absence of a remedial or punishment consequence for noncompliance, training o f only high probability request levels was insufficient for generalization to requests from lower probability levels; training through all four phases was necessary to ensure widespread increases in compliance to requests from all probability levels.
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Consumer Satisfaction The Parent's Consumer Satisfaction Questionnaire was filled out by the mothers of three of the four children (parents of Child 4 were unavailable for follow-up). The mother of Child 1 averaged 6.3 (7 representing the highest degree of satisfaction), with a score of 7 on 71070 of the items. The mother of Child 2 averaged 6.9, with 93°7o of the items attaining the highest score. The mother of Child 3 averaged 6.3, with a score of 7 on 43°7o of the items.
Discussion The present study was designed to examine errorless compliance training in four children with developmental disabilities. The results indicated the following: First, the compliance training package was effective at producing high percentages of compliance to a broad range of requests from all probability levels without requiring a physical consequence for noncompliance. Second, the compliance training procedures produced concomitant decreases in untreated maladaptive behavior during compliance situations. Third, generalization to untrained requests within the same level of probability as the requests being trained was obtained in most cases. Fourth, an analysis of all four levels of compliance probability during each phase of treatment suggested that training with requests from higher probability levels was not sufficient to obtain compliance to requests from lower levels. Generally, training through the graduated series of request levels was necessary to guarantee compliance to all levels of requests when physical consequences for noncompliance were not used. Finally, follow-up results with three of the four children showed that the gains had been maintained over a 2- to 3-month follow-up. The finding that generalized compliance to a broad range of requests can be acquired and maintained without any punishment or remedial procedure is very encouraging, considering the current trend toward treatment approaches that require little intrusion on the parent and the child (e.g., Horner et al., 1990). Because parents are able to provide abundant reinforcement for compliant responses during the early stages of errorless compliance training, the subsequent utilization of lower probability requests can occur without increased levels of noncompliance, thus diminishing the need for physical intervention. With children who tend to resist constraints, or who may even find such contact enjoyable (resulting in the potential provision of reinforcement for noncompliance), a strategy such as errorless compliance training may provide a viable alternative to conventional compliance training strategies. The analyses of maladaptive behavior in the present study provided evidence of the broader effects of errorless compliance training. The demonstration, prior to treatment, of an inverse relationship between compliance probability level and rate of maladaptive behavior extends the findings of previous studies, in which high demand situations have been shown to correlate with aberrant behavior (e.g., Carr & Newsom, 1985; Centre, Deitz, & Kaufman, 1982; Carr & Durand, 1985; Weeks & Gaylord-Ross, 1981). Reductions in maladaptive behavior were substantial after treatment was initiated, however,
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suggesting that errorless compliance training procedures are likely to produce the same covariant reductions in severe problem behavior as have been obtained in studies examining more conventional approaches to compliance training (e.g., Cataldo et al., 1986; Parrish et al., 1986; Russo et al., 1981). Because the children in the present study were not exposed to highly demanding conditions until tolerance was established to less demanding conditions, they continued to exhibit low levels of problem behavior, even when requests previously associated with high levels of maladaptive behavior were introduced. The results of generalization probe sessions indicated that the compliance training package produced generalization to requests never included in treatment sessions. This is an important finding, as it demonstrates that by including only a sample of requests in treatment sessions, generalization to a broader range of requests can be obtained. These results suggest that the use of multiple and diverse request exemplars (e.g., Stokes & Baer, 1977; Stokes & Osnes, 1989) to sample the broad range of desired responses that define the skill to be trained (e.g., generalized compliance) can promote generalization to exemplars never included in training (e.g., Day & Horner, 1989; Ducharme & Feldman, 1992; Horner, McDonnell, & Bellamy, 1986). These results support previous research indicating that child compliance to parental requests may form a response class (e.g., Bucher, 1973; Neef et al., 1983). It should be noted, however, that criterion level generalization occurred more readily to requests within the same probability level than to requests across untrained probability levels. It was necessary to train through all four levels of compliance probability before widespread gains in compliance to all levels of requests were obtained. The consumer satisfaction data suggested that the gains obtained were clinically significant. Although posttreatment data demonstrated that a small percentage of parental requests still produced noncompliant and maladaptive responses, parents indicated a high degree of satisfaction with both the overall treatment and the therapist. This finding should be viewed with caution, however, as the consumer satisfaction data were collected by the therapist involved with the family, presenting a potential parental response bias. It should also be noted that researchers working in the area of compliance have indicated that parents should be warned against setting unrealistic goals and overcontrolling their children (e.g., Forehand & McMahon, 1981). This recommendation would suggest that the failure to obtain perfect compliance and zero rates of maladaptive behavior should not be viewed as a weakness of the present study. There were limitations to the present research which warrant discussion. First, the design of the study did not allow a component analysis of the errorless compliance training package. The procedure involved the presentation of requests in a graduated manner, the reinforcement of compliant responses, and a procedure for continuing with ongoing household activities and request presentation after noncompliant responses (which may have contributed extinction effects to the treatment). It is not clear from the present study which aspects of the treatment were primarily responsible for the behavior changes
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observed. Future studies should examine the component effects of each of these procedures to determine their relative importance to the treatment package. A second limitation relates to the intensity of the therapist involvement required in the present study. The errorless compliance training procedure, as described in this paper, required a large number of intensive on-site sessions with the mother/child dyads. Future research should investigate the extent to which the entire assessment and treatment process can be abbreviated (i.e., fewer requests, fewer repetitions of each request, fewer sessions conducted in each phase) without losing treatment, covariation, and generalization effects. Such a study will allow the development of the most efficient, practical, and clinically useful version of errorless compliance training. Similarly, the use of fewer compliance probability levels (e.g., three) should be examined to ascertain whether all four probability levels are necessary to achieve optimal treatment results. Finally, the present study was conducted with a small sample of children with developmental disabilities. Errorless compliance training should be replicated with a larger number of subjects, and with nondevelopmentally disabled Dopulations, to determine the generality of the treatment results. This treatment strategy may be beneficial to children who are at risk for abuse or who have witnessed family violence, because it allows the parents to learn and model noncoercive ways of encouraging compliance and appropriate behavior. Further, errorless compliance training maximizes and capitalizes on the successes of the child, which may be advantageous for children with low self-esteem, a common characteristic of child victims of family violence (Hughes, 1983).
References Barlow, D. H., & Hersen, M. (1984). Singlecase experimentaldesigns. New York: Pergamon Press. Bernal, M. E., Klinnert, M. D., & Schultz, L. A. (1980). Outcome evaluation of behavioral parent training and client-centered parent counselling for children with conduct problems. Journal of Applied Behavior Analysis, 13, 677-691. Bucher, B. (1973). Some variables affecting children's compliance with instructions. Journal of Experimental Child Psychology, 15, 10-21. Budd, K. S., Green, D. R., & Baer, D. M. (1976). An analysis of multiple misplaced parental social contingencies. Journal of Applied Behavior Analysis, 9, 459-470. Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111-126. Carr, E. G., & Newsom, C. (1985). Demand-related tantrums: Conceptualization and treatment. Behavior Modification, 9, 403-426. Cataldo, M. E, Ward, E. M., Russo, D. C., Riordan, M., & Bennett, D. (1986). Compliance and correlated problem behavior in children: Effects of contingent and non-contingent reinforcement. Analysis and Intervention in Developmental Disabilities, 6, 265-282. Centre, D. B., Deitz, S. M., & Kaufman, M. E. (1982). Student ability, task difficulty, and inappropriate classroom behavior. Behavior Modification, 6, 355-374. Day, H. M., & Homer, R. H. (1986). Response variation and the generalization of a dressing skill: Comparison of single instance and general case instruction. Applied Research in Mental Retardation, 7, 189-202.
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Day, H. M., &Horner, R. H. (1989). Building response classes: A comparison of two procedures for teaching generalized pouring to learners with severe disabilities. Journal of Applied Behavior Analyis, 22, 223-229. Ducharme, J. M., & Feldman, M. A. (1992). Comparison of staff training strategies to promote generalized teaching skills. Journal of Applied Behavior Analysis, 25, 165-179. Forehand, R. (1977). Child noncompliance to parental requests: Behavioral analysis and treatment. In M. Hersen, R. M. Eisler, & P. M. Miller (Eds.), Progress in behavior modification (Vol. 5). New York: Academic Press. Forehand, R., & King, H. E. (1977). Noncompliant children: Effects of parent training on behavior and attitude change. Behavior Modification, 1, 93-108. Forehand, R., King, H. E., Peed, S., & Yoder, P. (1975). Mother-child interactions: Comparison of a non-compliant clinic group and non-clinic group. Behavior Research and Therapy, 13, 79-84. Forehand, R., & McMahon, R. J. (1981). Helping the non-compliant child." A clinician's guide to parent training. New York: Guilford Press. Gold M. W., & Barclay, C. R. (1973). The learning of difficuR visual discriminations by moderately and severely retarded. Mental Retardation, 11, 9-11. Homer, R. H., Dunlap, G., Koegel, R. L., Carr, E. G., Sailor, W., Anderson, J., Albin, R. W., & O'Neill, R. E. (1990). Toward a technology of "nonaversive" behavioral support. Journal of the Association for Persons with Severe Handicaps, 15, 125-132. Homer, R. H., McDonnell, J. J., & Bellamy, G. T. (1986). Teaching generalized skills: General case instruction in simulation and community settings. In R. H. Homer, L. H. Meyer, & H. D. Fredericks (Eds.), Education of learners with severe handicaps: Exemplary service strategies (pp. 289-314). Baltimore: Paul H. Brookes. Hughes, H. M. (1983). Psychological functioning of children in a battered women's shelter: A preliminary investigation. American Journal of Orthopsychiatry, 53, 525-531. Issacs, C. D., Embry, L. H., & Baer, D. M. (1982). Training family therapists: An experimental analysis. Journal of Applied Behavior Analysis, 15, 505-520. Iwata, B. A., Pace, G. M., Kalsher, M. J., Cowdery, G. E., & Cataldo, M. E (1990). Experimental analysis and extinction of self-injurious escape behavior. Journal of Applied Behavior Analysis, 23, 11-27. Johnson, S. M., Wahl, G., Martin, S., & Johansson, S. (1973). How deviant is the normal child? A behavioral analysis of the preschool child and his family. In R. D. Rubin, J. E Brady, & J. D. Henderson (Eds.), Advances in Behavior Therapy (Vol. 4) New York: Academic Press. Lambert, J. (1975). Extinction by retarded children following discrimination learning with and without errors. American Journal of Mental Deficiency, 80, 286-291. Lancioni, G. E., & Smeets, P, M. (1986). Procedures and parameters of errorless discrimination training with developmentally impaired individuals. International Review of Research in Mental Retardation, 14, 135-164. McMahon, R. J., & Forehand, R. (1984). Parent training for the noncompliant child. In R. E Dangel & R. A. Polster (Eds.), Parent training: Foundations of research and practice. New York: Guilford Press. McMahon, R. J., Tiedman, G. L., Forehand, R., & Griest, D. L. (1984). Parental satisfaction with parent training to modify child noncompliance. Behavior Therapy, 15, 293-303. Neef, N. A., Shafer, M. S., Egel, A. L., Cataldo, M. E, & Parrish, J. M. (1983). The class specific effects of compliance training with "do" and "don't" requests: Analogue analysis and classroom application. Journal of Applied Behavior Analysis, 16, 81-99. Parrish, J. M., Cataldo, M. E, Kolko, D., Neef, N. A,, & Egel, A. (1986). Experimental analysis of response covariation among compliant and inappropriate behavior. Journal of Applied Behavior Analysis, 19, 241-254. Peed, S., Roberts, M., & Forehand, R. (1977). Evaluation of the effectiveness of a standardized
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parent training program in altering the interactions of mothers and their noncompliant children. Behavior Modbqcation, 1, 323-350. Roberts, M. W. (1982). Resistance to timeout: Some normative data. Behavioral Assessment, 4, 237-246. Roberts, M. W. (1984). An attempt to reduce time out resistance in young children. Behavior Therapy, 15, 210-216. Roberts, M. W., & Powers, S. W. (1990). Adjusting chair timeout enforcement procedures for oppositional children. Behavior Therapy, 21, 257-271. Russo, D. C., Cataldo, M. E, & Cushing, P. J. (1981). Compliance training and behavioral covariation in the treatment of multiple behavior problems. Journal of Applied Behavior Analysis, 14, 209-222. Scarboro, M. E., & Forehand, R. (1975). Effects of two types of response contingent timeout on compliance and oppositional behavior of children. Journal of Experimental ChildPsychology, 19, 252-264. Stoddard, L. T., & Sidman, M. (1967). The effects of errors on children's performance on a circleellipse discrimination. Journal of the Experimental Analysis of Behavior, 10, 261-270. Stokes, T. E, & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349-367. Stokes, T. F., & Osnes, P. G. (1989). An operant pursuit of generalization. Behavior Therapy, 337-355. Terrace, H. S. (1966). Stimulus Control. In W. K. Honig (Ed.), Operant behavior: Areas of Research and Application. New York: Appleton-Century-Crofts. Touchette, P. E. (1968). The effects of graduated stimulus change on the acquisition of a simple discrimination in severely retarded boys. Journal o f the Experimental Analysis of Behavior, H, 39-48. Touchette, P. E., & Howard, J. S. (1984). Errorless learning: Reinforcement contingencies and stimulus control transfer in delayed prompting. Journal o f Applied Behavior Analysis, 17, 175-188. Wahler, R. G. (1969). Oppositional children: A quest for parental reinforcement control. Journal o f Applied Behavior Analysis, 2, 159-170. Watson, E J., & Workman, E. A. (1981). The non-concurrent multiple baseline across-individuals design: An extension of the traditional multiple baseline design. Journal of Behavior Therapy and Experimental Psychiatry, 12, 257-259. Weeks, M., & Gaylord-Ross, R. (1981). Task difficulty and aberrant behavior in severely handicapped students. Journal of Applied Behavior Analysis, 14, 449-463. Whitman, T. L., Zakaras, M., & Chardos, S. (1971). Effects of reinforcement and guidance procedures on instruction-following behavior of severely retarded children. Journal of Applied Behavior Analysis, 4, 283-290. Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214. RECEIVED: July 16, 1992 ACCEPTED: December 22, 1992
Errorless Compliance to Parental Requests: Treatment Effects and Generalization JOSEPH M . DUCHARME MICHELE POPYNICK
Surrey Place Centre Toronto, Ontario, Canada Four children with developmental disabilities were trained to follow parental instructions using an "errorless" compliance training approach requiring no punishment or remedial consequence. Initially, the children and their parents were observed to determine the likelihood of child compliance to a range of parental requests. Requests were then categorized into four levels, from requests associated with high probabilities of compliance (Level 1) to those associated with low probabilities (Level 4). During the first treatment phase, parents presented the children with requests from Level 1 and reinforced compliant responses. After several sessions at Level 1, parents gradually introduced Level 2 requests. Succeeding probability levels were sequentially introduced over several sessions. High compliance levels were obtained throughout treatment, even for Level 4 requests. Covariant reductions in maladaptive behavior and generalization to untrained requests were obtained. Gains were maintained up to 3 months after treatment.
Treatment of child noncompliance to parental requests has been the subject of many research studies over the last two decades. There are at least two reasons for this emphasis. First, noncompliance is one of the most prevalent behavior problems in children (e.g., Bernal, Klinnert, & Schultz, 1980; Forehand, 1977; Forehand, King, Peed, & Yoder, 1975; Johnson, Wahl, Martin, & Johansson, 1973). Second, there is evidence to suggest that compliance may be a "keystone" behavior; that is, the development of compliance may be sufficient for the promotion of behavioral gains in other areas. Specifically, several studies have reported correlations between increases in compliance levels and reductions in frequency of severe maladaptive behavior (e.g., Cataldo,
This research was supported by a grant from Surrey Place Centre. The authors would like to express their appreciation to Maurice Feldman, Nicole Walton-Allen, and Ron Van Houten for their comments on an earlier draft of this paper; and to Kim Crozier, Holly Lucas, and Edite Pontes for their assistance with data collection and summary. Requests for reprints should be sent to Joe Ducharme, Ph.D., Behavioural Science Research and Education Division, Surrey Place Centre, 2 Surrey Place, Toronto, Ontario, Canada, M5S 2C2. 209 0005-7894/93/0209-022651.00/0 Copyright 1993 by Associationfor Advancementof Behavior Therapy All rights of reproduction in any form reserved.
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Ward, Russo, Riordan, & Bennett, 1986; Parrish, Cataldo, Kolko, Neef, & Egel, 1986; Russo, Cataldo, & Cushing, 1981). Effective strategies for treatment of noncompliance have been developed and evaluated, most notably by Forehand and his colleagues (for reviews of this research, see Forehand & McMahon, 1981; McMahon & Forehand, 1984). Most behavioral treatment packages for teaching compliance consist of several components, including the provision of effective requests, the reinforcement of compliant responses, and the implementation of a consequence for noncompliance. Typically, the consequence involves either a punishment procedure (usually time-out) contingent on failure to follow the parental request (e.g., Budd, Green, & Baer, 1976; Forehand & King, 1977; Peed, Roberts, & Forehand, 1977; Scarboro & Forehand, 1975; Wahler, 1969) or a physical guidance procedure, in which the parent manually guides the child through the motions of the requested behavior (e.g., Neef, Shafer, Egel, Cataldo, & Parrish, 1983; Parrish et al., 1986; Whitman, Zakaras, & Chardos, 1971). Although time-out and physical guidance have been demonstrated to be expeditious in the treatment of noncompliance, both procedures require the physical manipulation of the child. Such procedures can be particularly problematic with children who are severely oppositional and resistive to physical interventions. It has been noted, for example, that vigorous resistance on the part of the child to attempts to implement time-out procedures is common (Roberts, 1982; 1984; Roberts & Powers, 1990). There is clearly a need to develop strategies for reducing the confrontational parent-child interactions that may occur as a side effect of time-out and other procedures requiring physical manipulation of the child or to develop compliance training procedures that do not require physical intervention. "Errorless" teaching procedures (Lambert, 1975; Lancioni & Smeets, 1986; Stoddard & Sidman, 1967; Terrace, 1966; Touchette, 1968; Touchette & Howard, 1984; Weeks & Gaylord-Ross, 1981) may offer one means of teaching compliance without the use of physical intervention. In an errorless teaching paradigm, the initial conditions presented to the student make the task to be learned very simple. Subsequently, more difficult conditions are gradually introduced, until the individual is responding to the difficult task with the same high rate of correct responses as to the simple task. Learning is thus accomplished with fewer errors and undesirable responses than in a conventional trial-and-error learning approach. Gold and Barclay (1973), for example, compared two procedures for teaching persons with developmental disabilities to discriminate between two bolts that varied only slightly in length. With the errorless procedure, the subjects were first exposed to a graduated series of easier bolt discriminations, starting with a discrimination between two bolts widely divergent in length, before being presented with the target discrimination. With the second procedure, the subjects were simply exposed to the difficult discrimination with no graduated pre-exposure~ The errorless task promoted more effective and efficient learning than the trial-and-error task. An errorless approach could be adapted to the teaching of compliance by initially exposing the child to a broad range of requests and demand situations to which there is a high probability of compliance (and thus numerous occasions for reinforcer provision). Subsequently, over several days or weeks,
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requests to which the child is slightly less likely to comply can be gradually faded in. Compliance should thus occur at such a high rate that few errors (i.e., noncompliant responses) would occur. The lower probability requests could be progressively introduced until the child followed all requests (even those to which compliance was highly unlikely) at a high rate. With this approach, a physical consequence for noncompliance should be unnecessary, as such undesirable responses should be much less likely to occur than in more conventional compliance training approaches. The errorless approach has the additional advantage of allowing compliance training to occur without any initial exposure of the child to high demand situations that have been shown to produce high rates of maladaptive behavior in some individuals (e.g., Cart & Newsom, 1985; Centre, Deitz, & Kaufman, 1982; Carr & Durand, 1985; Weeks & Gaylord-Ross, 1981). With errorless compliance training, difficult demand situations are faded in slowly, after the child has shown high levels of compliance to less demanding requests. In the present study, we examined the use of errorless compliance training across 4 children with developmental disabilities who were referred for treatment because of severe noncompliance to parental requests and other maladaptive behavior. The effects of this treatment strategy on compliance levels, concomitant maiadaptive behavior, and generalization requests were assessed.
Method
Subjects and Setting Subjects were 4 children with developmental disabilities referred to an outpatient treatment center for behavior management because of severe noncompliance to parental requests, as well as aggression, tantrums and/or other oppositional behavior. These children were randomly selected from a much larger pool of referred children with similar presenting problems. Child 1 was a fiveyear-old boy with Down syndrome (IQ = 84, Stanford-Binet, 4th ed.). Child 2 was an eight-year-old girl (IQ = 55, WISC-R); Child 3 was an eight-year-old boy (IQ = 65, WISC-R); and Child 4 was a five-year-old boy (IQ = 47, Stanford-Binet, 4th ed.). All intelligence assessment information was drawn from agency casebooks or school records. All 4 children were living at home with their parents. The mothers of the children served as intervention agents in this study. The mothers' education level ranged from a community-college degree (Child 1 and 4) to completion of high school grades ll (Child 2) and 12 (Child 3). All sessions were conducted in the families' homes. The home setting of sessions varied depending on the type of request provided to the child (e.g., a request that involved dressing was implemented in the child's bedroom). The two female therapists who conducted the study each possessed a Bachelor's degree in psychology.
Design A multiple baseline across subjects design was employed (Barlow & Hersen, 1984). This design was selected over a within subject multiple baseline design across probability levels due to the potential interdependence of the proba-
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bility levels during treatment. The data for Child 2 was collected nonconcurrently (Issacs, Embry, & Baer, 1982; Iwata, Pace, Kalsher, Cowdery, & Cataldo, 1990; Watson & Workman, 1981); that is, baseline was initiated approximately 12 weeks after the other 3 subjects.
Dependent Measures Throughout all phases of the study, mother-child interactions were videotaped by therapists who followed the participants to various locations of the family residence. All data were coded from these videotapes. Before videotaping was initiated, one or two sessions were conducted to acclimatize the children to the presence of the camera and the therapist. Compliance. The primary dependent measure in this study was the percentage of parental requests to which child compliance was obtained. The child was considered compliant if he or she initiated the appropriate motor response to the request within 10 s of the request and completed the response within 40 s. Failure to exhibit a motor response, failure to initiate within 10 s, or failure to complete within 40 s, even if the appropriate motor response was exhibited, was considered noncompliance. Event recording was used to code all compliance data. Each event was initiated by a request provided by the parent and ended by one of three alternatives: (a) the failure of the child to initiate the task within 10 s, (b) the failure of the child to complete the task within 40 s, or (c) the successful completion of the task within 40 s of the request (the latter two options were considered only if the child initiated the requested activity within 10 s of the request). Maladaptive behaviors. Maladaptive behaviors were recorded from the videotapes of all compliance sessions. The maiadaptive behaviors were specific to each child, and included aggression, screaming, crying, verbal opposition (e.g., saying "no" or "I don't want to") and disruptive behavior (e.g., throwing or destroying household materials). Each behavior was scored for occurrence or nonoccurrence during each compliance event (i.e., multiple maladaptive behaviors were coded as an occurrence with no differentiation between the number of behaviors which may have occurred during the compliance event). The data on maladaptive behavior provided a measure of the effect of the errorless compliance training strategy on behaviors other than those specifically targeted.
Interobserver Agreement Interobserver agreement was obtained by two independent, experimentally uninformed observers during videotape coding of sessions randomly selected from each of the phases, across all children. The observers were either therapists for mother/child dyads other than the one currently being observed or students who had been trained to code observational data. Agreement was obtained on 23070 of sessions (15o70 of empirical analysis, 29070 of baseline, 20070 of Level 1, 2107o of Level 2, 28070 of Level 3, 28°70 of Level 4, 23070 of transition, 24070 of generalization probes, and 40070 of follow-up sessions). Overall agreement was calculated on a trial-by-trial basis for compliance and averaged 95o7o for empirical analysis (range 90 to 100070), 95070 for base-
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line (range 84 to 100°70), 100% for Level 1, 9707ofor Level 2 (range 90 to 100070), 99070 for Level 3 (range 95 to 100%), 98% for Level 4 (range 90 to 100%), 97% for transition (range 86 to 100%), 9807ofor generalization probes (range 92 to 100%), and 87% for follow-up sessions (range 75 to 100%). Overall agreement for maladaptive behavior was also calculated on a trialby-trial basis and averaged 86°70for empirical analysis (range 77 to 95%), 85070 for baseline (range 70 to 100%), 94070 for Level 1 (range 86 to 100%), 97070 for Level 2 (range 94 to 100070),91°70for Level 3 (range 80 to 100070),91070for Level 4 (range 89 to 91%), 96°7o for transition (range 88 to 100%), 8907o for generalization probes (range 67 to 100%), and 9307o for follow-up sessions (range 87 to 100070).
Assessment of Compliance Probabilities Checklist probability analysis. Parents were interviewed and provided with a list of approximately 200 commonly used requests. The list sampled several domains of compliance, such as requests related to dressing (e.g., "put on your socks"), hygiene (e.g., "comb your hair"), leisure (e.g., "throw me the ball"), and social interaction (e.g., "give me a hug"). The parents were asked to rate each request according to the likelihood of compliance by the child, as follows: (a) "almost always" (76 to 100070of the time), (b) "usually" (51 to 7507oof the time), (c) "occasionally" (26 to 50070of the time), and (d) "rarely" (0 to 25°7o of the time). Empirical probability analysis. To empirically assess the probability levels for specific requests, the parents were videotaped in sessions in which they presented their child with 48 requests selected from the compliance checklist (12 requests from each of the four levels of compliance probability, as rated by the parents). The selection of requests was restricted to those that could be easily completed by the child in 30 s or less. Over approximately ten 60-min empirical analysis sessions, the parents were required to present the 48 requests 10 times each, in random order, pacing the requests so that they occurred approximately every 30 to 90 s. The parents were provided with a list of requests to include in the session. Approximately 2 hr were spent on parent training of request provision prior to the first empirical probability analysis session, with brief (approximately 10 min) reviews of procedures provided before all subsequent sessions. Each parent training session involved the use of modeling, role-playing, and performance feedback. During training, the parents were taught to present the request in the imperative, in a polite but firm tone of voice, and to avoid repetitions of the request. They were also instructed to involve themselves in activities that were part of their daily routine during the empirical probability analysis sessions, so that the request presentation would appear natural to the child. Parents were asked to do whatever they usually did as a consequence of their child's compliance or noncompliance to their requests.
Hierarchical Categorization of Requests Based on the results of the empirical analysis, the requests were arranged in order of lowest to highest probability of compliance. The requests were then
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divided into four categories, roughly approximating the following compliance probability levels: Level 1 (76 to 100°70 compliance); Level 2 (51 to 75°7o compliance); Level 3 (26 to 50°7o compliance); and Level 4 (0 to 25°7o compliance). From the 48 requests assessed, l0 requests were chosen for each probability level. In situations in which there were not enough requests in one of the probability levels, new requests were evaluated with the parent and child until all request levels were filled. Requests were selected from a broad range of compliance domains (e.g., hygiene, dressing) to increase the likelihood of generalization to requests that were not included in treatment sessions (e.g., Day & Homer, 1986; Day & Homer, 1989; Ducharme & Feldman, 1992; Homer, McDonnell, & Bellamy, 1986).
Procedure Baseline. Three of the 10 requests per level (12 requests in total) were randomly selected for baseline assessment of compliance (all 12 baseline requests were subsequently included in treatment). Each request was presented once by the parent in each baseline session. During the baseline sessions, parents were asked to use the same request presentation and consequence procedures as in the empirical analysis, described above. The number of baseline sessions per child varied from three to nine sessions for multiple baseline purposes. Treatment-Phase 1 (Level 1 requests). After baseline measures were collected, parents were trained, using modeling, role-playing, and performance feedback procedures, to implement treatment sessions in which the child was presented with requests from Level 1. Approximately 2 hr were spent on parent training prior to the first treatment session, with brief (approximately 10 min) reviews of procedures provided before all subsequent treatment sessions. The parents were taught to provide enthusiastic praise and physical contact (e.g., hugs, kisses, pats) after each compliant response. Parental reports and therapist observations prior to the initiation of the study suggested that parental praise and physical contact could be used as reinforcers for all children but one (Child 3) who did not enjoy physical contact. For this child, the mother was instructed to use only praise as a consequence for compliance. Parents were instructed to use no consequence for noncompliance other than continuing with ongoing household activities and proceeding with the next request on the list after approximately 60 s. The treatment sessions took place approximately two times per week. The mode of request presentation was identical to that used during the empirical analysis and baseline. The parent provided each of 7 requests from Level 1 three times each. Repetitions of the same request were never presented consecutively. Only 7 of the 10 requests per level were used in treatment because 3 requests per level were employed to assess generalization (see Generalization Probes, below). Phase 1 was continued with each child until relatively stable percentages of compliance were achieved (typically four or five sessions). Outside of the sessions, parents were asked to do one of two things: (a) avoid giving requests to their child from untrained probability levels, or (b) do tasks for the child that corresponded to requests from untrained levels.
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These procedures were requested of the parents to keep everyday compliance situations as compatible with ongoing treatment as possible. Transitions. Before moving to the next level of requests, transition sessions were conducted to make the passage from one phase to the next less abrupt. In transition sessions, the parents were required to provide requests to the child from both adjoining request levels. During the first session of Transition 1, for example, the parents presented the seven requests from Level 1 twice, and the seven requests from Level 2 once. During the second session of Transition 1, the parents presented the Level 1 requests once and the Level 2 requests twice. Transition sessions were repeated if the child's compliance diminished during the previous session. Phase 2, 3 and 4 (Level 2, 3 and 4 requests). These phases were conducted exactly as in Phase 1, with the exception that only Level 2 requests were employed in Phase 2, Level 3 requests in Phase 3, and Level 4 requests in Phase 4.
Generalization Probes Each mother/child dyad was videotaped during baseline, and all subsequent phases to evaluate the extent of generalization obtained during treatment. Generalization probe sessions for a specific treatment phase typically occurred after several treatment sessions had taken place for that phase and were conducted less frequently than treatment sessions (1 or 2 generalization probe sessions per treatment phase). Almost all generalization probes occurred on the same day as treatment sessions. During these generalization probes, the parent and child were monitored on all four levels of requests. Of the 10 requests designated to each level during the hierarchical categorization, 6 requests per level were included as part of each generalization probe session (i.e., 24 requests in total). Three of these 6 requests per level (i.e., 12 total requests) were not included in the treatment sessions. These requests (generalization requests) served as measures of generalization to requests at the same probability level. The other 3 requests (training requests) were included in the treatment sessions and thus served as a comparative measure of compliance to specifically trained requests. The mode of request presentation and consequence procedures during generalization probes was identical to the empirical analysis and baseline sessions. The generalization probes provided two distinct measures of generalization: (a) within-level generalization and (b) across-level generalization. Within-level generalization was defined as the extent of correspondence between percentage of compliance to training requests and generalization requests within the same probability level. This provided a measure of how the child responded after treatment at a specific probability level to requests at the same level that had not been included in treatment. Across-level generalization was defined as the extent of correspondence between percentages of compliance to requests from the probability level being trained and each of the remaining untrained probability levels after each phase of treatment. This measure allowed us to determine after treatment at a specific probability level whether the child generalized to requests from other proba-
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bility levels not yet trained. Across-level generalization assessment thus provided a means of determining the number of probability levels of requests requiring training before widespread generalization to all probability levels was obtained.
Follow-up Follow-up sessions were identical to baseline sessions, with requests from all four levels being assessed. Follow-up sessions were conducted at two weeks, one month, and two months for Child 1 and 2. Child 3 was available for a fourth follow-up at three months and Child 4 was unavailable for follow-up.
Consumer Satisfaction As a means of assessing the social validity of the intervention (Wolf, 1978), parents were asked by the therapist involved with the family to complete the applicable sections of the Parent's Consumer Satisfaction Questionnaire (Forehand & McMahon, 1981; McMahon, Tiedmann, Forehand, & Griest, 1984) during follow-up. The sections which related to the present intervention involved satisfaction with the overall program and satisfaction with the therapist. These sections of the questionnaire are comprised of items scored on a 7-point scale, with the high end of the scale (7) representing the highest degree of satisfaction with the intervention.
Results Treatment The treatment data for the four children are presented in Figure 1. Each baseline session point represents a mean percentage of compliance to the combination of all four probability levels of requests provided to the child during that session. The treatment data reflect compliance to requests from the specific probability level being trained in that phase (or to combinations of requests from adjacent levels in transitions). The overall mean percentage of compliance across all four children in baseline was 44°70. The shaded areas in Figure 1 represent the mean percentage of child compliance to parental requests prior to treatment (i.e., empirical analysis and baseline requests combined) from the probability level being trained in that phase. These means include all available pretreatment data. They therefore provide the most comprehensive measure against which to compare the treatment data because they encompass, across a range of situational factors (e.g., time of day, fatigue of the child), the numerous response repetitions that are required to calculate pretreatment probability levels. Comparisons can thus be made between pretreatment and treatment levels at each probability level. Figure 1 shows that in Phase 1 of treatment, all four children responded at or near pretreatment levels for Level 1 (76-100070) requests. The overall means for pretreatment and treatment compliance data across the four children were 84070 and 90070 respectively. This correspondence between pretreatment and treatment data was expected in Phase 1, as high probability requests were used and large gains in compliance percentages during treatment were not possible. During Phase 2, the effects of errorless compliance training began to emerge.
ERRORLESS COMPLIANCE TRAINING BASELINE
217
TREATMENT
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LEVEL1 TRANS~ LEVEL2 TR/~S= LEVEL3TRANSSLEVEL4 (76-100%) (51-75%) (2¢5O%) (O-25%) 100 80 60 40 20 0 100 II1 (~
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SESSIONS FIG. 1. Percentage of requests followed by compliance across children and treatment phases, Shaded areas represent pretreatment compliance percentages to requests from each probability level,
Although the overall mean for pretreatment was 60070 for Level 2 requests, the overall mean for treatment data was 89070. The difference between pretreatment and treatment compliance levels became more prominent in Phase 3. The overall mean for Level 3 requests in pretreatment was 39070 and in treatment, 85°70. In Phase 4, the gains made during treatment over pretreatment
218
DUCHARME AND POPYNICK
levels culminated; the overall percentage of compliance increased from 16070 in pretreatment to 86070 in treatment. The data during transitions were consistent with the data during the four treatment phases, with percentages of compliance typically over 80070. After treatment was completed, compliance skills were maintained for all three children with whom follow-up sessions were conducted. All of the follow-up compliance means were above 80070.
Maladaptive Behavior The percentages of requests followed by maladaptive behavior during baseline and treatment are shown in Figure 2. For comparison purposes, the shaded areas in Figure 2 represent the mean pretreatment percentages (including both empirical analysis and baseline data) of requests that were followed by maladaptire behavior from the probability level being trained in that phase. As with the compliance data, each baseline data point in Figure 2 represents responses to requests from a combination of all four probability levels. The overall mean percentage of maladaptive behavior across all four children in baseline was 34070. For Level 1 requests, the overall mean percentages of maladaptive behaviors across the four children in pretreatment and treatment (Phase 1) were 15070 and 10070,respectively. For Level 2 requests, the difference between pretreatment and treatment percentages became more pronounced. The overall mean was 21070 for pretreatment and 9070 for treatment (Phase 2) requests. When Level 3 requests were introduced in treatment, the overall mean was 4407o for pretreatment and 11070for treatment (Phase 3) requests. The differences between the overall pretreatment and treatment means were most substantial for Level 4 requests. The pretreatment mean was 51070and the treatment (Phase 4) mean was 10070.These data indicated that, prior to treatment, maladaptive behavior increased as the probability of compliance decreased. However, after treatment, the differences in levels of maladaptive behavior between probability levels were virtually eliminated, with substantial reductions occurring in Levels 3 and 4. Levels of maladaptive behavior during transitions were consistent with those obtained during the four phases of treatment. Rates of maladaptive behavior were maintained at similar low levels during follow-up. During 6 of the 10 follow-up sessions, no maladaptive behavior occurred.
Generalization Within-level generalization. Generalization within each compliance probability level is depicted in Figure 3. A generalization criterion of 75070was used, as this was the lower limit for the highest compliance probability level in the present study. Achievement of this level of generalization would therefore ensure that the children were responding to the generalization requests as they would to Level 1 requests, which did not require intervention prior to treatment. Increases in mean percentages of compliance from pretreatment to treatment were obtained for all probability levels of requests (with the exception of Level 1, where no increases were expected because compliance to requests
ERRORLESS COMPLIANCE TRAINING BASELINE
219
TREATMENT LEVEL 1 TRANS1 LEVEL 2 T~NS = (76-100%) (51-75%)
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in this category were high probability prior to intervention). Criterion levels of compliance were obtained for 13 out of 16 of the training request means during treatment. Criterion levels were achieved for 12 of the 16 generalization request means.
220
DUCHARME AND POPYNICK
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I~G. 3. Mean percentage of compliance to training and generalization requests in pretreatment and the four treatment phases during generalization probe sessions.
Across-levelgeneralization. Generalization results to untrained probability levels are presented in Figure 4. As can be seen in this histogram, each phase of training produced moderate increases in compliance to untrained levels over the previous phase of treatment, in most cases. Criterion levels were typically not obtained, however, until requests from that level were included in treat-
221
ERRORLESS C O M P L I A N C E T R A I N I N G
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merit. It would appear that in the absence of a remedial or punishment consequence for noncompliance, training o f only high probability request levels was insufficient for generalization to requests from lower probability levels; training through all four phases was necessary to ensure widespread increases in compliance to requests from all probability levels.
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'
DUCHARME
AND POPYNICK
Consumer Satisfaction The Parent's Consumer Satisfaction Questionnaire was filled out by the mothers of three of the four children (parents of Child 4 were unavailable for follow-up). The mother of Child 1 averaged 6.3 (7 representing the highest degree of satisfaction), with a score of 7 on 71070 of the items. The mother of Child 2 averaged 6.9, with 93°7o of the items attaining the highest score. The mother of Child 3 averaged 6.3, with a score of 7 on 43°7o of the items.
Discussion The present study was designed to examine errorless compliance training in four children with developmental disabilities. The results indicated the following: First, the compliance training package was effective at producing high percentages of compliance to a broad range of requests from all probability levels without requiring a physical consequence for noncompliance. Second, the compliance training procedures produced concomitant decreases in untreated maladaptive behavior during compliance situations. Third, generalization to untrained requests within the same level of probability as the requests being trained was obtained in most cases. Fourth, an analysis of all four levels of compliance probability during each phase of treatment suggested that training with requests from higher probability levels was not sufficient to obtain compliance to requests from lower levels. Generally, training through the graduated series of request levels was necessary to guarantee compliance to all levels of requests when physical consequences for noncompliance were not used. Finally, follow-up results with three of the four children showed that the gains had been maintained over a 2- to 3-month follow-up. The finding that generalized compliance to a broad range of requests can be acquired and maintained without any punishment or remedial procedure is very encouraging, considering the current trend toward treatment approaches that require little intrusion on the parent and the child (e.g., Horner et al., 1990). Because parents are able to provide abundant reinforcement for compliant responses during the early stages of errorless compliance training, the subsequent utilization of lower probability requests can occur without increased levels of noncompliance, thus diminishing the need for physical intervention. With children who tend to resist constraints, or who may even find such contact enjoyable (resulting in the potential provision of reinforcement for noncompliance), a strategy such as errorless compliance training may provide a viable alternative to conventional compliance training strategies. The analyses of maladaptive behavior in the present study provided evidence of the broader effects of errorless compliance training. The demonstration, prior to treatment, of an inverse relationship between compliance probability level and rate of maladaptive behavior extends the findings of previous studies, in which high demand situations have been shown to correlate with aberrant behavior (e.g., Carr & Newsom, 1985; Centre, Deitz, & Kaufman, 1982; Carr & Durand, 1985; Weeks & Gaylord-Ross, 1981). Reductions in maladaptive behavior were substantial after treatment was initiated, however,
ERRORLESS COMPLIANCE TKAINING
223
suggesting that errorless compliance training procedures are likely to produce the same covariant reductions in severe problem behavior as have been obtained in studies examining more conventional approaches to compliance training (e.g., Cataldo et al., 1986; Parrish et al., 1986; Russo et al., 1981). Because the children in the present study were not exposed to highly demanding conditions until tolerance was established to less demanding conditions, they continued to exhibit low levels of problem behavior, even when requests previously associated with high levels of maladaptive behavior were introduced. The results of generalization probe sessions indicated that the compliance training package produced generalization to requests never included in treatment sessions. This is an important finding, as it demonstrates that by including only a sample of requests in treatment sessions, generalization to a broader range of requests can be obtained. These results suggest that the use of multiple and diverse request exemplars (e.g., Stokes & Baer, 1977; Stokes & Osnes, 1989) to sample the broad range of desired responses that define the skill to be trained (e.g., generalized compliance) can promote generalization to exemplars never included in training (e.g., Day & Horner, 1989; Ducharme & Feldman, 1992; Horner, McDonnell, & Bellamy, 1986). These results support previous research indicating that child compliance to parental requests may form a response class (e.g., Bucher, 1973; Neef et al., 1983). It should be noted, however, that criterion level generalization occurred more readily to requests within the same probability level than to requests across untrained probability levels. It was necessary to train through all four levels of compliance probability before widespread gains in compliance to all levels of requests were obtained. The consumer satisfaction data suggested that the gains obtained were clinically significant. Although posttreatment data demonstrated that a small percentage of parental requests still produced noncompliant and maladaptive responses, parents indicated a high degree of satisfaction with both the overall treatment and the therapist. This finding should be viewed with caution, however, as the consumer satisfaction data were collected by the therapist involved with the family, presenting a potential parental response bias. It should also be noted that researchers working in the area of compliance have indicated that parents should be warned against setting unrealistic goals and overcontrolling their children (e.g., Forehand & McMahon, 1981). This recommendation would suggest that the failure to obtain perfect compliance and zero rates of maladaptive behavior should not be viewed as a weakness of the present study. There were limitations to the present research which warrant discussion. First, the design of the study did not allow a component analysis of the errorless compliance training package. The procedure involved the presentation of requests in a graduated manner, the reinforcement of compliant responses, and a procedure for continuing with ongoing household activities and request presentation after noncompliant responses (which may have contributed extinction effects to the treatment). It is not clear from the present study which aspects of the treatment were primarily responsible for the behavior changes
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AND POPYNICK
observed. Future studies should examine the component effects of each of these procedures to determine their relative importance to the treatment package. A second limitation relates to the intensity of the therapist involvement required in the present study. The errorless compliance training procedure, as described in this paper, required a large number of intensive on-site sessions with the mother/child dyads. Future research should investigate the extent to which the entire assessment and treatment process can be abbreviated (i.e., fewer requests, fewer repetitions of each request, fewer sessions conducted in each phase) without losing treatment, covariation, and generalization effects. Such a study will allow the development of the most efficient, practical, and clinically useful version of errorless compliance training. Similarly, the use of fewer compliance probability levels (e.g., three) should be examined to ascertain whether all four probability levels are necessary to achieve optimal treatment results. Finally, the present study was conducted with a small sample of children with developmental disabilities. Errorless compliance training should be replicated with a larger number of subjects, and with nondevelopmentally disabled Dopulations, to determine the generality of the treatment results. This treatment strategy may be beneficial to children who are at risk for abuse or who have witnessed family violence, because it allows the parents to learn and model noncoercive ways of encouraging compliance and appropriate behavior. Further, errorless compliance training maximizes and capitalizes on the successes of the child, which may be advantageous for children with low self-esteem, a common characteristic of child victims of family violence (Hughes, 1983).
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