Evaluating the Cool Versus Not Cool Procedure via Telehealth

Abstract

Autistics/individuals diagnosed with autism spectrum disorder (ASD) commonly display qualitative impairments in social behavior that commonly result in the use of interventions directly targeting the development of social skills. The COVID-19 pandemic has highlighted the need for effective social skills interventions that can be delivered directly via telehealth. The Cool Versus Not Cool procedure has continually been documented as effective within the literature. However, its reported use has been limited to in-person delivery. The purpose of this study was to evaluate the effectiveness of the Cool Versus Not Cool procedure conducted via telehealth to teach three children diagnosed with ASD to change the conversation when someone is bored. The results of a nonconcurrent multiple-baseline across-participants design demonstrated that all three participants reached the mastery criterion in four to eight sessions. Responding generalized to another adult for two of the three participants, and all three participants maintained correct responding. Social validity measures indicated the skill was important to teach, the intervention was acceptable and effective, and the telehealth format was an acceptable replacement for in-person intervention for these three participants.

Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade

“…Four studies focused on implementing an intervention via telehealth directly with individuals with ASD. The VC platform was either OoVoo (Hepburn et al, 2016) or Zoom Video conferencing (Cihon et al, 2021;Ferguson et al, 2020;McCrae et al, 2020). Two studies utilized telehealth to administer cognitive behavioral therapy directing to children with ASD (Hepburn et al, 2016;McCrae et al, 2020).…”

“…High levels of attending and engagement were found during teaching and all participants acquired both primary responses (defined as when participant vocally stated the name of the stimulus when the stimulus was presented) and secondary responses (defined as when the participant vocally responded to a question about the stimulus when the stimulus was presented) (Ferguson et al, 2020). Lastly, a social skills intervention (the Cool Versus Not Cool intervention) was implemented via telehealth with three children with ASD; this intervention targeted the social skill of changing the conversation by recognizing when someone was bored (Cihon et al, 2021). The social skills intervention had seven steps to achieve mastery and all three participants mastered all of the steps by the end of the intervention program, whereas only two continued to reach mastery during generalization phase (Cihon et al, 2021).…”

“…Lastly, a social skills intervention (the Cool Versus Not Cool intervention) was implemented via telehealth with three children with ASD; this intervention targeted the social skill of changing the conversation by recognizing when someone was bored (Cihon et al, 2021). The social skills intervention had seven steps to achieve mastery and all three participants mastered all of the steps by the end of the intervention program, whereas only two continued to reach mastery during generalization phase (Cihon et al, 2021). All four of these studies are indicative of progress in implementing interventions directly to individuals with ASD via telehealth platforms.…”

“…Overall, the use of telehealth, specifically videoconferencing and coaching, has been found to be a feasible and satisfactory means to deliver a variety to interventions to children and adolescents with ASD. Of the intervention articles included in this review, three studies were directly and/or indirectly impacted by the COVID-19 pandemic in some way (e.g., data collection, social validity questionnaire results) and provide even more support for the use of telehealth as a means to deliver treatment effectively to children with ASD (Cihon et al, 2021;Gerow, et al, 2021a, b;Yi & Dixon, 2021). Additionally, as indicated earlier, one study focused on an intervention for mask wearing, which is still currently and vitally important (Sivaraman et al, 2021).…”

Teaching behavior analysts to create multiple baseline graphs using SigmaPlot

“…Within nonconcurrent multiple-baseline design logic, baseline phases are predetermined, and participants are randomly assigned to each baseline length as they become available (Watson & Workman, 1981). However, previous studies (i.e., Cihon et al, 2019Cihon et al, , 2021 included additional criteria within multiple-baseline logic as an attempt to improve the strength of the nonconcurrent multiple-baseline design, which was also applied within this study. Participants progressed from baseline to intervention once a stable level of responding was observed during baseline.…”