Using TAGteachTM Methods to

Increase Eye Contact Behavior

in Children with Autism
Regina Maendler, John W. Eshleman,
Traci M. Cihon
The Chicago School of Professional
Psychology

Paper presented at the Meeting of the Association for Behavior

Analysis International, May 2009
 Introduction
• Eye Contact
– Many children with autism demonstrate limited eye contact with others
(American Psychiatric Association [DSM-IV-TR], 2000).

– Eye contact may be an important prerequisite for the development of

other behavioral repertoires including mands, imitation, compliance with
instructions (Hamlet, Axelrod, & Kuerschner, 1984), as well as social interaction
(e.g., gaining and maintaining attention, conversational skills, social
initiations and reciprocations, etc.).
– Eye contact can be shaped and strengthened using the operant
paradigm (Schroder & Holland, 1968; Duran & Holland, 1971)

– Eye contact developed under contingencies that require a response to

antecedent stimuli (e.g., “look”) or aversive physical prompting
procedures may produce a conditioned avoidance response which is not
naturally maintained in the natural environment (Foxx, 1977; Hamlet, Axelrod, &
Kuerschner, 1984). Positively reinforcing free operant occurrences of eye
contact may be more effective.
 Introduction
• Immediacy of Reinforcement
– The eye contact movement cycle can be quite brief and it is not always
possible to provide immediate reinforcement contingent upon the behavior.
Precise reinforcement is essential for more effective behavior change. (Grice,
1948; Ramey & Ourth, 1971; Lattal, 1978; Fowler & Baer, 1981; Lattal, 1984; Reeve, Reeve, Brown,
Brown, & Poulson, 1992; Grace, Schwendiman & Nevin, 1998; William, 1999; Doughty & Lattal,
2003; Reilly & Lattal, 2004; Odum, Ward, Barnes, & Burke, 2006; Podleskik, Jimenez-Gomez, Ward,
& Shahan, 2006; Podlesnik & Shahan, 2007).

• Clicker Training
– Clicker training is an effective reinforcement method for a wide array of
behaviors in animal species (Pryor, Hagg, & O’Reilly, 1969; Ferguson & Rosales-Ruiz,
2001; Pryor, 1999, 2005; Fjellanger, Andersen, & McLean, 2002).

• TAGteach
– Although there is limited research, Teaching by Acoustical Guidance (TAG)
has been shown to be a successful teaching tool for developing a variety of
behaviors in humans (Madden & Hanson, 2006; Gutierrez, 2007; Libby, Weiss, & Lipcon,
2007; Rosenblum, 2007; Wasano, 2008; Weiss & Libby, 2008; Ueda, 2006).

– The majority of available research on TAG is comprised of treatment designs

which are favorable in clinical settings; although, fail to demonstrate a
functional relation between the implementation of TAG and behavior change.
However, more sound research regarding the effectiveness of TAG is
emerging.
 Method
• Participants:
– A: 3 year old male with autism diagnosis.
– B: 4 year old female with autism diagnosis.
– C: 11 year old male with autism and obsessive compulsive disorder.
• Setting:
– Home or school environment.
• Materials:
– Clicker+TM, digital timers, manual counters,
data sheets, 3 colored shirts, and various
preferred items and activities.
• Procedure:
– The experimenter engaged each student in a variety of play activities
while actively contriving opportunities for the student and the therapist to
make eye contact (e.g., contriving mands, social interactions, etc.) and
thus providing reinforcement characteristically of each experimental
condition.
– 10 minute sessions (originally 20 minutes)
 Method
• Dependent Variable
– Target Definition:
• 1) The student’s face was oriented toward the therapist, 2) the student and
therapist’s line of vision met forming a straight line (Hamlet, Axelrod, &
Kuerschner, 1984), and 3) eye gaze between student and therapist was held
for a minimum of 1 s.

• Experimental Design: Mulitelement Design

– Conditions:
• TAG: All occurrences of the target behavior were tagged with an acoustical
marker (i.e., a “ping” sound). All tagged occurrences of eye contact were
immediately followed by descriptive praise statements and contingent access
to a back up reinforcer (e.g., tangible items or activities).
• Contingent Reinforcement (CR): Descriptive praise statements as well as
access to preferred items and activities were made contingent upon any
occurrence of eye contact behavior with the therapist.
• Baseline - Non Contingent Reinforcement (NCR): General praise statements
and access to desired items and activities were provided on a fixed-interval
schedule of 30 seconds
 Results
• Data Collection:
– Daily Standard Celeration Charts (overall frequency per session)
– Successive Minutes Standard Celeration Charts (per minute frequencies within
each session)
– Cumulative records (cumulative responses per minute for each session)
• Interobserver Agreement & Treatment Integrity: 33% of all conditions

• Social Validity:
– Questionnaire (In progress)
Participant A: Daily SCC
Participant B: Daily SCC
Participant C: Daily SCC
Participant A: Within Session
Participant B: Within Session
Participant C: Within Session
Participant A: Cumulative Records

Participant A
100
Cumulative Number of Responses

90

80

70

60

50

40

30

20

10

0
1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 280 289 298 307 316 325 334 343 352 361 370 379 388 397

Successive Minutes per Session

Participant B: Cumulative Records

Participant B
160
Cumulative Number of Responses

140

120

100

80

60

40

20

0
1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262

Successive M inutes per Session

Participant C: Cumulative Records

Participant C
30
Cumulative Number of Responses

25

20

15

10

0
1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 280 289 298 307 316 325 334

Successive Minutes per Session

 Results
• Average Rates of Responding per Condition:

• Responding reached its highest per min rate first under TAG
conditions:
– Participant A: 13 responses in 1 min.
– Participant B: 11 responses in 1 min.
– Participant C: 5 responses in 1 min.
 Discussion & Implications
• Results suggest that Teaching by Acoustical Guidance (TAG) is
an effective technique for increasing eye contact behavior in
children with autism.

• TAG may be a more effective and immediate reinforcement

method than contingent reinforcement alone, especially for
responses that can have a relatively short duration and may be
difficult to capture using traditional reinforcement methods.

• TAG sessions not only produced higher rates of responding than

CR and NCR sessions, but also evoked more stable rates of
responding within sessions.
 Limitations
• Sequence effects

• Lack of discrimination between conditions

• Length of sessions

• Characteristic Consequences

• Motivating Operations

• Role of the experimenter

• IOA and possible Reactivity

 Future Research
• Expand target definition of eye contact (e.g., duration, context, in
response to antecedent stimuli, etc.).

• Shaping eye contact in those who do not currently display this

behavior.
• Effectiveness of TAG with new populations, target behaviors,
settings, etc.

• How experience with TAG might facilitate the development of

other behavioral repertoires.
• Most effective method for fading an acoustical marker (e.g.,
thinning a variable ratio schedule, fading the volume of the
auditory stimulus, etc.).
• Which acoustical stimuli serve as the most salient and effective
conditioned reinforcers (e.g., click, ping, etc.).
 References
Doughty, A. H. & Lattal, K. A. (2003). Response persistence under variable-time schedules following immediate and unsignaled delayed
reinforcement. The Quarterly Journal of Experimental Psychology, 56B, 267-277.
Ferguson, D. L. & Rosales-Ruiz, J. (2001). Loading the problem loader: the effects of target training and shaping on trailer loading
behavior of horses. Journal of Applied Behavior Analysis, 34, 409-424.
Fjellanger, R., Andersen E. K., & McLean, I. G. (2002). A training program for filter-search mine detection dogs. International Journal of
Comparative Psychology, 15, 277-286.
Foxx, R. M. (1977). Attention training: The use of overcorrection avoidance to increase the eye contact of autistic and retarded children.
Journal of Applied Behavior Analysis, 10, 489-499.
Gutierrez, R. (2007). Tagging imitation skills of students diagnosed with autism. Retrieved on May 15, 2009, from
http://www.tagteach.com/autism/CALABATAGTEACH2007.pdf
Hamlet, C. C., Axelrod, S., & Kuerschner, S. (1984). Eye contact as an antecedent to compliant behavior. Journal of Applied Behavior
Analysis, 17, 553-557.
Lattal, K. A. (1984). Signal functions in delayed reinforcement. Journal of the Experimental Analysis of Behavior, 42, 239-253.
Libby M., Weiss J., & Lipcon, A. (2007). Teaching eye contact and object imitation using tagteach. Retrieved May 15, 2009, from
http://www.tagteach.com/autism/NECC_research.pdf
Madden, K. & Hanson, R. (2006). The use of TAG for chidren with autism. Retrieved on May 15, 2009, from
http://www.tagteach.com/autism/Keri_Robert.pdf
Pryor, K. W. (1999). Don’t shoot the dog: The new art of teaching and training (rev. ed.). New York: Bantam.
Pryor, K. W., Haag, R., & O’Reilly, J. (1969). The creative porpoise: training for novel behavior. Journal of Experimental Analysis of
Behavior, 12, 653-661.
Ramey, C. T. & Ourth L. L. (1971). Delayed reinforcement and vocalization rates of infants. Child Development, 42, 291-297.
Reeve, L., Reeve, K. F., Brown, A. K., Brown, J. L., & Poulson, C. L. (1992). Effects of delayed reinforcement on infant vocalization rate.
Journal of The Experimental Analysis of Behavior, 58, 1-8.
Rosenblum, J. (2007). Using tag teach typing to students with autism. Retrieved on May 15, 2009, from
http://www.tagteach.com/autism/JRosenblum_TAG_Level_1.pdf
Sizemore, O. J. & Lattal, K. A. (1978). Unsignaled delay of reinforcement in variable-interval schedules. Journal of The Experimental
Analysis of Behavior, 30, 169-175.
Wasano, L. (2008, May). An evaluation of treatment procedures for increasing social skills: A case study. In T. McKeon (Chair), An
analysis of using an acoustical marker (tag) on the acquisition of various skills in children with autism and other developmental
disabilities. Symposium conducted at the 34th Annual Association for Behavior Analysis International Convention, Chicago, IL.
Weiss, J. & Libby, M. E. (2008, May). Demonstration of the effectiveness of using a tag to promote skill acquisition for students with
autism. In T. McKeon (Chair), An analysis of using an acoustical marker (tag) on the acquisition of various skills in children with
autism and other developmental disabilities. Symposium conducted at the 34th Annual Association for Behavior Analysis
International Convention, Chicago, IL.
Williams, B. A. (1999). Value transmission in discrimination learning involving stimulus chains. Journal of the Experimental Analysis of
Behavior, 72, 177-185.
Ueda, M. R., (2006) Tag teach. Retrieved Nay 15, 2009, from http://www.tagteach.com/autism/Maris_PPT.pdf