Application of Coaching and Behavioral Skills Training During a Preschool Practicum With a College Student With Autism Spectrum Disorder

1 Theoretical and Research Basis for Treatment

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interactions, as well as the presence of restrictive or repetitive patterns of behavior (American Psychiatric Association [APA], 2013). These deficits may result in difficulties understanding feedback and building positive relationships with others.

The Centers for Disease Control and Prevention (CDC, 2016) reported that one in 150 children born in 1992 was diagnosed with autism. Just 12 years later, in 2012, the CDC reported that the numbers had risen to one in 68 children (CDC, 2016). As a result of this rise, the number of young adults with ASD transitioning from high school into postsecondary education is increasing. Newman et al. (2011) found that, nationally, 43% of young adults with ASD are accessing postsecondary education. Cullen (2015) surveyed 25 students from five universities in an effort to determine some of the challenges college students with ASD face. A difficulty included completing and participating in collaborative group activities, both of which require proficiency in social communication and social interactions.

Individuals with ASD are at greater risk of having behavioral or psychiatric disorders, such as attention deficit hyperactive disorder (ADHD), depression, anxiety, and obsessive compulsive disorder (OCD; Hyman & Levy, 2013, p. 356; Robb, 2013, p. 530). Gillott and Standen (2007) examined stressors that lead to increased levels of anxiety in adults with ASD, as compared with the levels of anxiety in adults with intellectual disabilities (IDs). Elevated sources of stress for adults with ASD included coping with change, anticipation, sensory stimuli, and unpleasant events. These higher levels of anxiety increased the individuals’ difficulty coping with demands. This has the potential to affect the acquisition of complex skills by individuals with ASD.

Individuals with ASD frequently have deficits in executive functioning, a group of cognitive tasks related to taking in, organizing, and interpreting information in the environment so that it may be acted upon with a contextually appropriate response (Hyman & Levy, 2013). In their chapter on teacher preparation, Lignugaris/Kraft and Harris (2014) suggest that special education teachers are required to attend and respond to a wide variety of contextual cues when instructing individuals with disabilities. Special education teachers need to distinguish what in the classroom environment to attended to, or not attend to, and then use strategies, skills, and judgments that lead to positive student outcomes. This is a complex set of skills that can be directly affected by impairments in executive functioning related to ASD. It is likely that an individual with ASD, who is seeking a degree in early childhood special education (ECSE), will need supports in place to acquire the skills necessary to successfully respond to children’s needs.

University students with ASD are often less successful than their peers. Of the 43% of young adults with ASD who have enrolled in a postsecondary education program, only 38.8% completed their course of study within 8 years (Newman et al., 2011). By way of comparison, 67.4% of young adults in the general population enrolled in a postsecondary education program and 52.4% complete their course of study within 8 years (Newman et al., 2011). Accessing supports to meet academic demands becomes, essentially, the responsibility of the individual with ASD (Cullen, 2015). In a review of published literature describing supports and experiences of college students with ASD, Gelbar, Smith, and Reichow (2014) discovered a great need for research in this area. Only 20 articles published in peer-reviewed journals including a report of the experiences or supports provided to college students with ASD. The academic supports and services listed in the review included extended time on exams and assignments, accommodations to group assignments, and assistance with lecture notes. Nonacademic supports included support groups, cognitive behavior therapy, and mentor/advocates.

Mason, Rispoli, Ganz, Boles, and Orr (2012) examined the use of video modeling to improve eye contact, facial expression, and conversational turn taking with two college students with ASD. Without these skills, individuals with ASD may be limited to jobs that require only basic social skills (Smith, Belcher, & Juhrs, 1995). The participants watched a video model of target skill and then engaged in conversation with the researchers. Both participants increased their performance of the targeted conversation skills (Mason et al., 2012). This study demonstrates that video modeling, a practice typically used with children and adolescents with ASD (Bellini & Akullian, 2007), was effective with college students with ASD.

Ruble, Willis, and Crabtree (2008) used social skills therapy to address both conversational skills and problem solving in six adolescent boys with ASD. The six boys attended 12 weekly social skills groups that included didactic instruction, role-play, and feedback. Based on parent report, each boy’s ability to maintain conversations increased (Ruble et al., 2008).

One similar treatment package that has been extensively applied with children and adults with disabilities is behavioral skills training (BST; Jull & Mirenda, 2016; Lerman, Hawkins, Hillman, Shireman, & Nissen, 2015; Lerman, Hawkins, Hoffman, & Caccavale, 2013; Nigro-Bruzzi & Sturmey, 2010; Parsons, Rollyson, & Reid, 2012; Schepis, Ownbey, Parsons, & Reid, 2000; Schepis, Reid, Ownbey, & Parsons, 2001) Stewart, Carr, & LeBlanc, 2007; Towery, Parsons, & Reid, 2014). BST is an evidence-based training package that includes a description and model of a skill, followed by an opportunity for the learner to practice the skill with direct feedback until the learner meets a predetermined mastery criterion (Parsons et al., 2012). This treatment package has been used to prepare bachelor’s-level instructors such as special education teachers and speech therapists (Nigro-Bruzzi & Sturmey, 2010), and support personnel such as swim instructors and teaching assistants (Jull & Mirenda, 2016; Lerman et al., 2015; Lerman et al., 2013; Parsons et al., 2012; Schepis et al., 2000, 2001; Towery et al., 2014), as well as parents and siblings (Stewart et al., 2007). In these studies, researchers used a BST model to teach participants a range of instructional strategies that included prompting (Parsons et al., 2012; Towery et al., 2014), discrete trial instruction (Lerman et al., 2013; Schepis et al., 2000), and naturalistic/incidental teaching (Lerman et al., 2015; Nigro-Bruzzi & Sturmey, 2010; Schepis et al., 2001), or applied the BST model to swimming instruction (Jull & Mirenda, 2016) or social skills instruction (Stewart et al., 2007).

Lerman et al. (2013) examined the use of BST to teach college students with ASD to implement discrete trial instruction (e.g., presenting the trial, praising correct responses, applying correction procedures) to young children with ASD. They found that BST was a successful approach for teaching adults with ASD to implement instructional procedures. Participants increased from an average of 30% to 42% correct implementation of discrete instructional skills during baseline to 90% or above correct implementation following the application of BST.

Next, Lerman et al. (2015) examined the use of BST to instruct college students with ASD to implement mand training using an incidental teaching strategy (e.g., applying discrete instructional procedures as situations are presented in the environment) to young children with ASD. Incidental teaching presents a more complex instructional procedure than discrete trial instruction. Instructors must respond to subtle environmental and social cues that require complex discriminations, as well as implement a basic instructional routine. Participants increased their correct implementation of incidental teaching from 33% during baseline to 92% correct implementation following the application of BST. The authors noted that there is a need for research to determine whether using BST is effective to teach adults with ASD more complex instructional skills in increasingly complex settings.

2 Case Introduction

Shelly, a 22-year-old college student with ASD met the admission requirements for acceptance into the ECSE licensure program at a western university. The requirements included a minimum grade point average (GPA) of 3.0 or higher, an ACT composite of 21 or higher, and completion of undergraduate content breadth and depth classes. Prior to matriculating into the ECSE major classes and practicums, students are required to complete a practicum in a general education preschool. Despite written and oral feedback from her classroom teacher and practicum supervisor in the general education practicum, Shelly did not meet the requirements to receive a passing grade. As a consequence, an individualized coaching plan was developed to help Shelly acquire skills needed to successfully complete the practicum and prepare her for future field placements.

3 Presenting Complaints

The current report offers a case study investigating the development of an individualized observation system and the effects of the individualized coaching plan on Shelly’s acquisition of complex instructional skills in a preschool practicum. Given the previous success using a BST model to instruct adults with ASD to implement discrete trial instruction and incidental teaching (Lerman et al., 2015; Lerman et al., 2013), it is reasonable to assess the effects of implementing this model in other clinical applications and settings. The current study relied on a single-case analysis to inform instruction during coaching sessions and determine progress and generalization across practicum environments.

4 History

Shelly was initially diagnosed at 30 months with pervasive developmental disability—not otherwise specified (PDD-NOS), which is now subsumed under the ASD diagnosis (APA, 2013). Shelly’s parents sought evaluation due to concerns of a speech delay and behavioral difficulties including excessive tantrums, inflexibility, self-directed play, low muscle tone, and noncompliance. Her parents reported challenges in Shelly’s ability to adapt to preschool, with specific concerns regarding following the routines, listening to the teachers, sharing with other children, and group play. After receiving a diagnosis, Shelly’s parents reported that she received intensive speech therapy, structured social skills and pragmatic language groups, and Floortime (a type of play-based therapy implemented between the parent and child). Her parents indicated that Shelly became verbally fluent while she was in preschool. Her parents worked with different psychologists and behavioral therapists to help manage her challenging behaviors at home.

Shelly was in a mainstream educational setting throughout her school years, receiving academic supports and small group instruction to address her academic and social deficits. Shelly reported that she was treated for symptoms of OCD, anxiety, and ADHD. Psycho-educational testing performed in middle and high school showed deficits in nonverbal skills, leading to a diagnosis of dyscalculia and dysgraphia. Shelly reported that during her adolescence, she was outgoing and developed a few close friendships, though she experiencing bullying. Shelly graduated from high school at age 18 with a standard diploma and a 3.5 GPA.

As she approached the college years, Shelly indicated that her biggest challenges included perseveration on preferred topics, inflexibility, rigidity, emotional regulation (anxiety), time management, distractibility, and addiction to screens (iPhone, iPad, and computer). When asked about her desire to go to college, Shelly explained,

Several years ago, college honestly was not on my mind. I didn’t really want to eat in a cafeteria or share a room with a stranger. Technical school or going straight to work may have been less stressful for me academically, but I chose to pursue my bachelor’s because for what I want to do, a bachelor’s degree was needed. (Shelly, personal communication from interview, May 11, 2016)

Shelly reported that she still struggles socially with knowing when to end a conversation, when to let things go, and how to move on from one topic to another.

5 Assessment

We used information from Shelly’s performance to assess instructional skills and inform intervention. First, we collected information through an informal interview with the practicum supervisor, cooperating teacher, and university academic advisor. Second, we reviewed practicum evaluation records. Finally, we conducted observations of Shelly and other practicum students to determine skill differences between Shelly and her peers and establish operational definitions of critical teacher behaviors.

Concerns identified from an interview with the practicum supervisor and the practicum cooperating teacher included her proximity to children (i.e., too far away or not at eye level), staying alert and engaging with the children, providing quality opportunities to respond, and providing feedback to children that matched the instructional context. The cooperating teacher was also concerned that Shelly was interrupting the children’s learning by asking excessive questions at inappropriate times. Both the practicum supervisor and cooperating teacher expressed that they felt like they explained to Shelly the expectation for these behaviors and were frustrated that her performance did not improve after feedback was provided.

The evaluation of performance used by the practicum supervisor in the previous preschool practicum setting included a Likert-type scale that ranged from 1 to 5 with 1 representing a lack of acceptable performance and 5 representing outstanding ability. Shelly received a score of 2 on taking initiative, assisting with classroom routines, and classroom management. Comments included concerns with her ability to monitor activities across the room and assess children’s needs quickly. Other comments focused on her lack of instructional clarity and infrequent or inappropriate interactions with children. The cooperating teacher’s comments addressed Shelly’s need to be more engaged with the children, and have fewer incidents of “zoning out.” Two specific examples of written feedback provided to Shelly by the practicum supervisor were “pick up on the emotional cues from the children” and “take initiative—move quickly” (practicum supervisor, personal communication, March 13, 2015).

During the assessment and planning period, Shelly participated in a kindergarten practicum. During the practicum, she was observed and given informal feedback. Congruently, informal observations were conducted of other college students placed in the lab preschool where Shelly had previously been unsuccessful. Using this information, we identified 20 instructional and professional skills required for Shelly’s success in future practicums. This list was organized into an observation checklist with accompanying operational definitions. We divided the behaviors into four categories: professional behavior, active teaching and engagement with children, analyzing children’s behavior, and responding to children’s behavior. For a full list of the behaviors or a copy of the evaluation tool, please contact the primary author.

6 Case Conceptualization

Based on the information collected during the assessment period, Shelly demonstrated difficulty with a number of skills necessary for success in the preschool practicum. Skill deficits included a number of characteristics that are common among individuals with ASD related to social pragmatics (i.e., conversational turn taking, changing communication to match the needs of the listener, and appropriate proximity) and executive functioning (i.e., taking in and discriminating relevant stimuli in the environment and organizing it in a way to effect an appropriate response). Shelly demonstrated a great deal of difficulty understanding and applying feedback from her cooperating teachers and practicum supervisors.

Individuals with ASD may have difficulty appropriately interpreting stated rules. That is, they rigidly demonstrate an identified behavior or routine, regardless of situational subtleties that might dictate a slightly different appropriate response (Smith et al., 1995). This leads to frequently over- or undergeneralizing the application of a rule. For example, the practicum supervisor wanted the university students to use a variety of praise statements that extended beyond “good job.” Shelly interpreted this direction to be a discrete rule—“never say good job.” Moreover, she overgeneralized the “rule” and corrected others when they stated “good job.” She did not detect that the “rule” was to use a variety of engaging and interesting praise statements. Another example was Shelly’s use of a correction procedure (state, “I need you to . . .” then “I need you to . . . or I will help you”) that she learned in a previous course. This strategy is frequently taught in the early childhood courses at the university that Shelly attended as the appropriate response to use when a child is “noncompliant.” Shelly appeared to interpret that this procedure should be applied rigidly and immediately to all noncompliance. Over time, children in the classroom who made frequent behavioral errors appeared to avoid interactions with Shelly.

Another concern was Shelly’s ability to monitor the children in the classroom. She often became distracted in the classroom, or stared blankly for 20 to 30 s at a time. To provide quality learning opportunities to the children in the preschool, Shelly needed to scan across multiple children, engage in an evaluative thought process that might then govern her actions, and respond with behaviors appropriate to the situation. High levels of engagement and flexibility applying rules or procedures based on context are needed to successfully execute this complex chain of skills.

7 Course of Treatment and Assessment of Progress

Application of the BST Approach

The researcher conducted weekly 30-min observations of Shelly in her practicum. In the child care preschool and the lab preschool, the researcher observed Shelly from behind a one-way mirror. Shelly was not told when she was being observed. In the special education preschool, observations were conducted in the classroom and Shelly was aware when observations took place. Twice, in this setting, Shelly video recorded samples of her child interactions.

The data from the observations provided information about Shelly’s progress on targeted objectives, the coaching targets from previous sessions, and any concerns raised by the cooperating teacher or practicum advisor. Direct observation data (frequency counts, interval measures) as well as anecdotal information were collected during the observations. The data and anecdotal information focused on Shelly’s ability to self-correct errors, and demonstrate consistent performance across multiple children, locations, activities, and instructional arrangements. This information was then used to complete the observation checklist. (See Appendices A and B for a copy of the observation forms.) Finally, the observation checklist was analyzed to determine skills to target in coaching sessions.

Shelly met with the researcher once a week for 1-hr coaching sessions. A summary of the coaching and BST process is provided in Table 1, and Table 2 contains a description of topics discussed. BST included providing Shelly with a written summary and verbal explanation of the target behavior, a demonstration of the target skill, and role-play practice with feedback until she demonstrated the correct steps of a skill 80% of opportunities or higher. At times, Shelly used assistive technologies (i.e., vibrating interval timer, video models that she could use for practice during the week, and a decibel reader that would help her determine whether she was using the appropriate volume of speech for an activity) during coaching sessions.

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Table 1.

Steps Followed in Coaching and Behavioral Skills Training.

Step	Activities
Precoaching observation	1.  30-min observation conducted without interaction with the participant. 2.  Observation form was used and then performance was translated onto observation checklist. 3.  Information observed was used to assess current performance and identify needs to be addressed during coaching sessions.
Precoaching planning meeting	1.  Information from the observation checklist is analyzed. 2.  Critical skills are determined based on the participant’s performance and cooperating teacher’s priorities. 3.  Materials to be used during coaching session are prepared.
Coaching session	1.  Information from previous session is reviewed. 2.  New skill is introduced both orally and in writing. 3.  The skill is demonstrated. 4.  The participant engages in role-play until she performs the skill accurately 4/5 consecutive opportunities.
Postcoaching follow-up	1.  An email was sent to the participant with updated notes from the coaching session. 2.  Skills to focus on practicing during practicum for the coming week are identified.
In vivo coaching	1.  The coach provided feedback on the participant’s demonstration of skills within the practicum for approximately 1 hr weekly, following a coaching session. 2.  Direct feedback was provided as target skills occurred. 3.  When errors occurred, the coach provided models of skills and then arranged the environment to re-present an opportunity to respond for the participant.

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Table 2.

Abridge Description of Coaching Session Topics.

Practicum setting	Coaching session	Topic discussed
Child care preschool	1-2	Scanning, behavior corrections, and opportunities to praise
	3	Scanning, using an appropriate voice volume and assisting with transitions
	4-5	Providing opportunities to respond for concepts during play, and following through with praise
Lab preschool	6	Expanding on child statements and actions during play with comments and praise
	7-8	Expanded on learning of concepts during snack and small group with comments and praise
Special education preschool	9	Discrete trial instruction: delivering instructions
	10-11	Discrete trail instruction: delivering a consequence and error correction
	12	Embedded instruction: determining opportunities to embed an instruction into a routine
	13	Embedded instruction: increasing child’s engagement to provide opportunities to respond
	14	Professionalism: identifying appropriate times to converse with the other adults in the preschool environment. Embedded instruction: attending to multiple students in the group

After Shelly met the criterion on target skills during coaching sessions, she practiced the target skill during practicum. If assistive technology (i.e., an interval timer or decibel reader) was used during coaching sessions, Shelly was directed to continue using the supportive device during practicum. The researcher then attended Shelly’s practicum and provided her with further feedback in the application environment. This feedback was often paired with modeling of target skills as a form of error correction. Modeling was followed by constructing additional opportunities for Shelly to respond to the same cues.

Progress Evaluation

As part of the coaching sequence, Shelly’s progress toward the learning objectives (monitoring the classroom while engaging with children, and having frequent and varied verbal interactions with children) was monitored weekly. Shelly’s scanning and engagement with children were measured using a 15-s partial interval observation procedure. An interval was scored “correct” for scanning if she looked from one child to another or looked at a child and then looked at another point in the classroom. An interval was scored “correct” for engagement with children if she provided a verbal statement or nonvocal communication in response to a child’s bid for attention or specific request, while in close proximity (within 2 feet) to a child. The total number of intervals scored “correct” was divided by the total number of intervals to calculate a percentage of intervals (number of intervals the behavior was demonstrated/total intervals). Verbal interactions between Shelly and the children within her proximity were recorded using a frequency count and qualitatively coded into one of five response forms: instruction, question, comment, praise following correct responding, and prompt following an error. Rate was calculated using the frequency divided by the length of the observation time in which verbal interactions were recorded (number of verbal interactions/total minutes).

A second observer scored Shelly’s performance in 35% of sessions to calculate interobserver agreement (IOA). An agreement was scored if both observers’ scores in an interval were identical for verbal interactions, scanning, and engagement with children. IOA was calculated by dividing the number of intervals with agreements between observers by the total number of intervals with agreements and disagreements multiplied by 100 to yield a percentage. The mean IOA was 98.59% (range = 98.06%-99.3%).

Prior to beginning the study, Shelly received feedback in two practicum settings. Some skills that Shelly received feedback on included scanning across the classroom, maintaining close proximity to children, and using varied praise. When Shelly began her practicum in the child care preschool, concerns about her ability to appropriately engage with adults and children were similarly expressed by the cooperating teacher and program supervisor. Coaching sessions were initiated within the first week of practicum, limiting the amount of baseline data collected.

Figure 1 depicts Shelly’s performance on scanning and engagement in the child care preschool, the lab preschool, and the special education preschool. She engaged with children at a high rate, but only scanned across multiple children and locations an average of 50% of intervals. During the first coaching session, Shelly practiced the “Look, Evaluate, Respond” strategy with an emphasis on scanning at regular intervals and providing specific praise in response to the children’s behavior. Shelly was advised to carry a vibrating interval timer to alert her to regularly look up and scan across the room. In the child care preschool, Shelly’s performance on scanning steadily increased following intervention. It is possible that the decrease in scanning on Session 8 was related to Shelly being sick, as she expressed concern about getting the children sick, and left the immediate area frequently to wash her hands.

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Figure 1.

Shelly’s scanning and engagement with children in a preschool practicum.

Following the start of her lab preschool practicum, Shelly demonstrated a decrease in the number of intervals in which she scanned the classroom. Her performance subsequently recovered, but was not stable. Notably, Shelly did not consistently use the interval timer even after several reminders. In a coaching session that took place before Session 15, Shelly and the researcher reviewed her scanning and engagement performance graph. During the discussion, the researcher encouraged her to scan the classroom and engage with children more consistently. Although Shelly’s engagement increased from Sessions 16 to 20, her scanning remained highly variable. In the special education preschool placement, Shelly’s scanning generally increased and her level of engagement with the children generally decreased.

Figure 2 depicts the relationship between Shelly’s ability to engage with children while scanning the classroom across preschool settings. During baseline, the discrepancy between intervals of engagement and intervals of scanning suggest that Shelly was often engaged with the child in front of her, but rarely scanned the rest of the classroom. After intervention began in the child care preschool, the discrepancy between intervals of engagement and scanning decreased and was relatively stable, suggesting that Shelly not only continued to engage with children, but also scanned the classroom. When Shelly moved to the lab preschool, the discrepancy between engagement and scanning increased in variability. In the special education preschool, Shelly initially scanned the classroom more often than engaging with children. At Session 26, her engagement increased and she continued to scan the classroom. The difference in patterns across settings may be due to the difference in the number of skills Shelly needed to demonstrate at one time. In the child care classroom, Shelly only needed to talk with children and scan the classroom, and there was very little ongoing academic instruction. In contract, the lab preschool placed an emphasis on academic instruction, requiring Shelly to model skills, comment on children’s activities, and reinforce verbalizations (thus, the requirements for engagement increased), all while scanning the classroom. In the special education preschool, the demands for structured engagement increased substantively. Shelly was required to provide discrete trail instruction for one child and embed prescribed learning opportunities during ongoing play activities for other children. With the added demands on engagement, Shelly initially scanned the classroom more and engaged with children less frequently. As she became more comfortable with the structure of engagement, her ability to demonstrate both engagement and scanning concurrently increased.

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Figure 2.

Discrepancy between number of intervals in which Shelly demonstrated scanning minus the number of intervals in which Shelly demonstrated engagement with children.

Figure 3 depicts Shelly’s rate of verbal interactions. Shelly increased her verbal interactions with children from an average of 2.3 verbal interactions per minute before coaching in the child care preschool, to an average of four verbal interactions per minute after coaching in the child care preschool. In the lab preschool, Shelly’s rate of verbal interactions averaged 4.2 interactions per minute, which was slightly higher than the rate of interaction of her peers in the lab preschool. In addition, the researcher’s anecdotal notes suggest that the quality of Shelly’s verbal interactions improved while in the lab preschool. For example, when she began her practicum in the lab preschool, Shelly used short general statements such as, “nice work” or “come here” whereas, by the end of her lab preschool experience, she used more descriptive statements such as, “It is great to share with our friends so we are all happy” and “Tell me about your picture.” In the special education preschool, Shelly’s rate of interaction increased to 7.24 interactions per minute. It is likely that Shelly’s interaction rate increased in this setting because of the emphasis on clearly structured discrete trial instruction and embedded learning interactions.

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Figure 3.

Rate of verbal interactions with children per minute during practicum.

Shelly demonstrated variability in her scanning, engagement, and verbal interactions across the preschool practicums. This variability may have been due to the changes in requirements across environments. Most important, the quality of her interactions increased over time based on anecdotal notes and observations. Shelly received a passing grade for her practicum in the lab preschool. The practicum advisor, who had previously said Shelly should never consider working in the field of early childhood education, stated that she was impressed by the quality of interactions she saw Shelly engage in with children.

8 Complicating Factors

One consideration when providing coaching to a college student with ASD is the impact that other social and academic pressures may have on their performance. Individuals with ASD may have an elevated rate of comorbid anxiety disorders, and may perseverate on events and circumstances with more intensity than a neuro-typical individual. During the lab preschool practicum, Shelly expressed that she was experiencing anxiety related to previously failing the practicum. Behaviors that appeared to be associated with her anxiety included moving quickly across the room and back in a pacing manner, leaving interactions with children abruptly, staring in the same direction for 15 to 20 s at a time, and talking to other adults in the room about assignments and grades. It is likely that her anxiety-related behaviors contributed to performance variability across observations. Moreover, when an evaluation was approaching, her performance appeared to become increasingly variable.

Other personal situations in her social life, such as dating and roommates, may have influenced the amount of variability observed in her performance. On several occasions during her practicum in the special education preschool, Shelly was unprepared, lost equipment, or was absent from coaching sessions. While practicing embedded instruction during a coaching session, she interrupted the coaching activities several times to comment on a stressful situation involving her roommates. At the end of the session, she was reminded by the researcher to take the data sheets and materials for the embedded lesson to her practicum later that day. When the researcher arrived to observe the lesson, Shelly did not have the required data sheets or materials used during the previous coaching session.

Finally, across practicum, preservice teachers are asked to work on progressively more complex teaching skills such as, leading small groups, intervening with challenging behavior, and collecting data on children’s performance. It is likely that this increase in task demand increased the variability in Shelly’s performance within practicum and across practicum settings. Dawson and Lignugaris/Kraft (2016) observed a similar decrease in targeted skill performance as more complex instructional routines were added to teacher’s repertoires. They suggested that modifying the order in which skills are introduced and the feedback structure might help new teachers maintain previous instructional skills when new skills are introduced.

9 Access and Barriers to Care

Although the strategies taught to Shelly using the BST approach appeared to improve Shelly’s interactions with children, there are additional complex analytical skills needed for success in ECSE. It is likely that Shelly would require additional coaching, and significantly more time in practicum and student teaching, to master the range of skills required of a beginning teacher. It is important that universities provide flexible programs of study to allow college students with ASD and other disabilities opportunities to successfully complete the necessary requirements.

Teaching is a complex profession. Different classrooms likely have slightly different cultures and professional expectations. This variation results in a complex set of demands for the most skilled preservice teacher. The practicum classrooms in this case study were carefully selected for Shelly based on the cooperating teacher’s background with diverse learners, the age group of the children, and classroom structure. The goal was to maximize the probability of Shelly’s success in the practicum. Even with this level of careful placement, others in the practicum environment did not always model appropriate classroom management procedures, instruction strategies, or professional behavior. The inconsistencies within teacher preparation practicum sites add another level of complexity to an already difficult task. Shelly was first instructed to match her behavior to the other adults in the classroom; however, not all of the behavior modeled was appropriate. To address this, she was later taught to evaluate whether the particular behavior she observed was sound practice or modeled poor professional behavior, and then respond to the situation accordingly. In one practicum, the classroom staff often talked with each other rather than monitoring and engaging with children. We taught Shelly to respond to their conversation with one comment, and then excuse herself moving away from the adults and closer to the children.

Finally, the complexity of measuring some of the critical behaviors posed a challenge. Measuring instructional skills through observation can be done when there is a physical or verbal behavior associated with the skill. However, if the skill occurs as a private event, we cannot directly measure whether it is performed accurately. In the strategy “Look, Evaluate, Respond,” we defined and measured the look and respond components for verbal interactions, scanning, and engagement with children. The evaluate component occurred internally, as a private event. Although we discussed the evaluation component during coaching sessions, we could not directly measure whether Shelly was engaging in the evaluative process accurately. We could only measure her eventual response and determine the extent to which it matched the responses of her peers. That is, we collected anecdotal notes about the environment and Shelly’s response, and measured her verbal interactions and engagement with children. Regardless of whether Shelly engaged in evaluative behavior, or did not evaluate situations exactly how she was taught, her behavior improved over time in contextually appropriate ways.

10 Follow-Up

At the conclusion of the special education preschool practicum, a meeting was held to summarize Shelly’s progress and make recommendations for further intervention. The meeting included the researcher, university academic advisor, and Shelly. In addition, Shelly invited her parents to attend. Shelly was asked to define her strengths and needs as they related to the skills targeted in coaching. Her report aligned with the researcher’s perception of Shelly’s skills. During the meeting, a list of these strengths and a description of behaviors to continue practicing was provided to Shelly. Her mother, a developmental and behavioral pediatrician, indicated that she planned to further support Shelly’s maintenance of skills by providing Shelly with opportunities to practice both in her clinic and at a summer camp for children with disabilities. Shelly continued to receive supports in her subsequent practicum placements; however, the supports were decreased over time to match the supports provided within the typical university program.

11 Treatment Implications of the Case

With the increased number of adults with ASD entering postsecondary education, there is a growing need to provide a system of supports to these individuals. Furthermore, as individuals with ASD progress in their course of study, encountering new environments and more complex task demands, there is a continued need for such supports. This case study demonstrated that a BST coaching model has the potential to help individuals with ASD acquire the necessary skills for success in their field of study.

Clinicians might consider the benefits of systematically defining behaviors within their disciplines to use for teaching within a BST model. One secondary result of the implementation of a BST coaching model with Shelly included clearer communication between the lab preschool practicum supervisor and the researcher. The lab preschool practicum supervisor reported that, as a result of interactions with the researcher regarding Shelly, she changed how she provided feedback to other students in the practicum. In addition, the observation system developed to help Shelly improve her teaching skills will benefit other preservice teachers in their subsequent practicums. Thus, the development of a clear observation system, in which complex skills are broken into teachable units, has the potential to benefit both students with and without disabilities who are preparing to become ECSE teachers.

Clinicians can apply a BST coaching model when teaching generalizable professional behaviors to college students with ASD. Those general professional behaviors may have the potential to help college students with ASD obtain and maintain employment outside their field of study while seeking a degree. Following coaching, Shelly’s mother reported that Shelly demonstrated marked improvements in interacting with children and their parents in a professional and engaging manner while assisting at her clinic.

12 Recommendations to Clinicians and Students

The strategies outlined in this case example may help clinicians who teach complex social skills and executive functioning tasks to college students with ASD. Clinicians should consider first developing clear definitions of behavioral expectations and a criterion for correct performance, based on how individuals in the environment demonstrate the target skill. Using this information, clinicians might then develop a structured observation system. Later, the observation system can be used to inform coaching sessions. Expectations targeted for instruction during coaching sessions should be chosen based on their priority in the setting, how well the target can be generalized to other behaviors or settings, and the complexity of the skill compared with present level of performance. To increase the likelihood of generalization, the clinician should create a strategy with consistent language and consistent steps. In this case study, the two strategies used (i.e., rules vs. guidelines and “Look, Evaluate, Respond”) helped facilitate generalization to new practicum settings and to increasingly complex instructional contexts.