The Impact of Pairing on Therapeutic Rapport and Treatment Outcomes for Children with Autism

Abstract

Pairing, or conditioning a therapist as a generalized reinforcer, is a commonly recommended initial strategy in behaviour analytic intervention for children with autism. Specifically, pairing is intended to enhance the working relationship (i.e., therapeutic rapport) between a therapist and client. Recent literature has demonstrated that pairing is positively related to therapeutic rapport and therapeutic outcomes; however, few research studies have evaluated the skills necessary to pair effectively. The purpose of this study was to conduct pairing skills training (Lugo, King, Lamphere, & McArdle, 2017) and assess the effects of this training on behavioural indices of therapeutic rapport and child treatment outcomes using a concurrent multiple probe design (with replication). Four Instructor Therapists (ages 22 to 24 years old) were trained on six pairing skills using behavioural skills training with an adult confederate. Following training, this protocol was used with four children (ages 3 to 5 years old) diagnosed with autism, during the first 20 minutes of each therapy session. Therapists efficiently achieved competency on pairing skills with a confederate, but they required verbal performance feedback when generalizing learned skills to a child participant. When implemented, pairing was related to increased physical approach during free time and at the teaching table, as well as less interfering behaviour during sessions. There were no differences in accurate academic responding from baseline to intervention. The implications of study findings and future directions are discussed.