Modeling is a strategy for teaching children with autism spectrum disorder (ASD) that has a strong evidence base (National Autism Center (NAC) 2009) and can be implemented either in vivo or via video recordings. Studies have demonstrated that modeling is effective for teaching a wide variety of skills including social (Apple et al. 2005; Bellini et al. 2007), play (D’Ateno et al. 2003; Hine and Wolery 2006; Jahr et al. 2000), and communication skills (Buffington et al. 1998; Charlop and Milstein 1989). Through the use of modeling and practice, learners have not only acquired new skills, but have also demonstrated generalization and maintenance effects (Carr and Darcy 1990; Charlop et al. 1983; Gena et al. 2005; Ihrig and Wolchick 1988; Secan et al. 1989). Researchers have utilized modeling and practice within two very similar procedures: the teaching interaction procedure (TIP) and behavioral skills training (BST).

Recently, there has been confusion between the TIP and BST as researchers have labeled procedures inaccurately (e.g., stating that a procedure is BST when in fact it is the TIP) or have stated that one procedure is a form of the other procedure. For example, Ferguson et al. (2013) stated, “A form of behavioral skills training called the teaching interaction procedure, has shown positive results in teaching individuals with ASD and [intellectual disabilities] social skills…” (p. 294). Given that (a) these procedures are similar across many components, (b) both procedures are being implemented with children diagnosed with ASD, and (c) there are still key differences between the two procedures, we felt it was important to conduct a review, analysis, and commentary for the two procedures.

There are several purposes for writing this paper. First, to provide a brief overview of the two procedures to increase professional and consumer familiarity with each procedure. The overview of the two procedures will describe the components of each and provide historical information and context on the origins and development of two procedures. The second purpose of this paper is to highlight the differences between the teaching interaction procedure and behavioral skills training and describe why these differences are important in the conceptualization of both procedures. Third, to provide an analysis of the empirical evidence for the two procedures as they directly relate to their implementation for individuals diagnosed with ASD. Finally, to provide recommendations for future researchers and clinicians. The content of this paper is based upon evidence available from empirical studies, writings from professional sources (e.g., books, chapters, or conferences) and the authors personal experiences working with professionals in the field of ASD and ABA in multiple settings (e.g., clinical, school, and research settings). Therefore, this paper provides an analysis and commentary for the two procedures.

Overview of the Two Procedures

Teaching Interaction Procedure

The teaching interaction procedure (TIP) is a systematic teaching package which consists of six steps (Phillips et al. 1974). The first step of the procedure involves labeling and identifying the skill to be learned within the session. The second step is providing meaningful rationales for why the learner should display the behavior, which is drawn from the learner’s daily experience. Third, the targeted behavior is broken down into smaller steps and the learner verbally states each of the steps. Fourth, the teacher provides both an appropriate demonstration and inappropriate demonstration (Leaf et al. 2012a, b) of the targeted behavior; the learner must then discriminate whether a demonstration is appropriate and identify why the demonstration was appropriate or inappropriate. Fifth, the learner role-plays the targeted behavior until he or she displays 100 % of the steps correctly. The final component, feedback, occurs throughout the entire TIP, which is the use of positive reinforcement for correct responding and role-playing, and corrective feedback for incorrect responding or role-playing. In clinical settings, there may be subtle variations in the number of steps; however, the major elements of the procedure are still implemented.

The TIP was created as a component of the Teaching Family Model; it was utilized to improve the overall functioning of pre-delinquent and delinquent youth. Phillips et al. (1974) were the first professionals to use the term “teaching interaction” when they described the procedure in The Teaching Family Handbook. Since the TIP was first conceptualized, it has been described in several curriculum books (e.g., Hazel et al. 1983; Dowd et al. 1994) and evaluated in various research studies (e.g., Harchik et al. 1992). In 1992, Harchik and colleagues evaluated the effectiveness of the TIP to teach group home staff members to better implement a token economy, increase the amount of time adults engage with group home members in activities, and increase the number of teaching components utilized throughout the day. The results of this study demonstrated the TIP was an effective strategy to increase all of these behaviors.

Despite professionals implementing the TIP clinically (Leaf et al. 2011), it was not until 2009 that the TIP was first empirically evaluated for individuals diagnosed with ASD (Leaf et al. 2009). Leaf and colleagues evaluated the effects of a TIP, paired with a token economy, on increasing social skills across four broad domains (i.e., social communication, social play, social emotional sills, and social friendships). The researchers utilized a multiple baseline design across skills and replicated across participants. The results indicated the TIP was successful at increasing the rate at which all of the participants of demonstrated all targeted social skills. Since this research, there have been several studies that have evaluated the effectiveness of the TIP for teaching individuals diagnosed with ASD (e.g., Dotson et al. 2013; Kassardjian et al. 2013; Leaf et al. 2012a, b). Within these and other studies, the TIP has shown to be an effective teaching strategy for individuals diagnosed with ASD.

Behavioral Skills Training

A second teaching package that utilizes modeling and rehearsal is behavioral skills training (BST). BST is a multi-component training package used to teach a skill or skill set(s). BST employs four teaching techniques: instruction, modeling, rehearsal, and feedback (Miltenberger 2012). The delivery of BST involves the teacher first providing learners with written and/or verbal instructions outlining the relevant components of the target skill or skill set(s). During or following instructions, the teacher provides a model of the behavioral component. The teacher may use video modeling and/or live demonstration to model the targeted skill set(s) (Miltenberger 2012). Next, the learners are given an opportunity to rehearse or practice the behavioral component/step(s). Rehearsal may occur with actors or confederates in a simulated environment or in a more naturalistic context with the intended population. The final component, feedback, may be conducted either during the rehearsal phase of training or after. Feedback involves the teacher identifying instances in which the participant did or did not engage in the targeted skill(s). If the participant engages in the targeted skill(s) correctly, the teacher provides praise and external reinforcement, if necessary. If the learner engages in the targeted skill(s) incorrectly, the therapist provides feedback, typically in the form of an instruction, and the learner practices again until he or she meets the performance criteria (Miltenberger 2012).

The four components that comprise BST (i.e., instruction, modeling, rehearsal, and feedback) have been used within various social skills training programs (e.g., Bornstein et al. 1977; Brady 1984; Turner et al. 1978; Whitehill et al. 1980). However, it was not until 1984 that instructions, modeling, rehearsal, and feedback were described empirically using the term “behavioral skills training” (Breidenbach 1984). Breidenbach (1984) used BST to teach 34 typically developing school-aged children, divided into three groups, appropriate anger management skills. A pre- and post-test analysis of each group’s performance identified statistically significant differences between pre- and posttest responding within two of the three groups, indicating an increase in skill acquisition for most of the participants.

Furthermore, it was not until 2004 that BST was investigated empirically within an intervention for individuals with an ASD (Sarakoff and Sturmey 2004). Using a multiple baseline design across participants, Sarakoff and Sturmey (2004) taught three special education teachers to implement discrete trial teaching with a child with an ASD. The results of this study demonstrated that the teachers achieved significant gains in the percentage of correct discrete-trial teaching responses following BST. In 2013, Kornacki et al. used BST to teach one adult with autism how to engage in a conversation with a peer. The researchers utilized naturalistic probes to measure the effects of BST on the participant’s conversation skills. The results indicated increases in conversation skills for the participant and demonstrated that the behavior maintained overtime.

Differences Between TIP and BST

While both TIP and BST consist of instruction, modeling, and role-playing, the two procedures differ in two major ways.

Rationales

One difference between the TIP and BST is providing meaningful rationales for why the student should engage in the targeted behavior. When teachers implement a TIP, they always provide a meaningful and realistic rationale for why the student should engage in the targeted behavior, which is not a standard component of BST. When the TIP was first developed, rationales were considered a critical component for several reasons. First, it was hypothesized that the provision of rationales could result in quicker fading of supplemental reinforcement for demonstration of target behaviors. It was hypothesized that with the early introduction and pairing of potential naturally occurring consequences and with student development of an internal locus of control with the provision of rationales and that fading of artificial consequences would be facilitated (Braukmann et al. 1983). Second, rationales were utilized in an attempt to teach students that their own behavior, positive or negative, has an impact on the outcomes that they face. For example, rationales may teach a student that engaging in rude behaviors to a judge may result in the student going to prison, rather than the student viewing the judge as a means to get him/her out of prison. A third reason why rationales were considered a critical component was the presumption that the rationale would serve as a reminder to the learner of why she/he should display the behavior during naturally occurring situations.

BST has not utilized rationales as a core component (Miltenberger 2012). One reason could be that recent research has shown that rationales, as the sole intervention, may not result in behavior change (Wilder et al. 2010). Therefore, many professionals believe that adding a rationale is unnecessary and may not be the most efficient way to teach individuals diagnosed with ASD. A second reason why rationales may not be included within BST is the learners may not understand the rationale and; therefore, the rationale would have no impact on the student’s behavior. Finally, there are some instances where providing a rationale may not be appropriate for a student such as with individuals in which the prerequisite skills (e.g., receptive and expressive language) have not been thoroughly established.

Demonstrations of Inappropriate Behaviors

The second difference between the TIP and BST is found in the implementation of the modeling component. When implementing BST, the teacher typically only models the skill(s) correctly; however, when implementing a TIP, correct and incorrect models are typically provided (similar to the cool versus not cool procedure; Leaf et al. 2012a, b). Proponents of the TIP provide both a correct and incorrect demonstration for several reasons. First, social behaviors are often nuanced, and a student may not be able to discriminate between an appropriate and an inappropriate social behavior if those nuances are not highlighted. Thus, highlighting and contrasting these nuances may lead to better skill acquisition and generalization. Second, students may continually display the targeted skill(s) incorrectly within their natural environment. Providing the correct demonstration only may not highlight what he or she is doing incorrectly. However, providing an incorrect model, in addition to the correct model, may better provide more opportunities for the learner to identify what she/he is doing incorrectly and help define the parameters of correct responding.

Proponents of BST may not demonstrate the behavior incorrectly for several reasons. First, providing an incorrect demonstration would model inappropriate behavior, which could increase the probability of the student displaying the skill(s) incorrectly. Second, a student may not require a demonstration of the incorrect response and providing an incorrect demonstration would highlight inappropriate behavior. Finally, students may find the inappropriate demonstrations reinforcing and find reinforcement value in being “naughty” and demonstrating inappropriate behaviors.

Analysis of the Two Procedures for Individuals Diagnosed with ASD

Finding the Articles

Search Procedure

In order to obtain empirical articles pertaining to both the TIP and BST for individuals with ASD, we conducted four different searches of the published literature.

First, we conducted a search through the electronic database PsychINFO. To find articles, a variety of keywords were used (i.e., “modeling,” “rehearsal,” “behavioral rehearsal,” “teaching interactions,” and “behavioral skills training”). These keywords were also used with the terms “autism” and “developmental disabilities.” The articles we searched were published between the years of 1960 and 2013.

Second, we used the electronic database ERIC. A variety of keywords were used alone and in-conjunction with one another (i.e., “behavioral skills training,” “behavioral rehearsal,” and “instruction + feedback + modeling”). These keywords were also used with the terms “autism” and “developmental disabilities.” The articles we searched were published between the years of 1960 and 2013.

Third, we manually searched the abstracts for every issue of the following peer-reviewed journals: Journal of Applied Behavior Analysis, Focus on Autism and Other Developmental Disorders, Journal of Autism and Developmental Disorders, Behavior Analysis in Practice, Research in Autism Spectrum Disorders, Research in Developmental Disabilities, Journal of Positive Behavior Interventions, Education and Treatment of Children, and Education and Training in Autism. We selected these journals as they commonly publish research relating to both applied behavior analysis and autism. Although there may be other autism-related journals and/or behavior analytic journals, many of these studies would be captured with ERIC or PsychINFO.

Finally, for every study that we found, we evaluated the reference section to determine if there were any articles that met our requirements for inclusion (outlined below).

Inclusion Criterion

There were several criteria for a study to be included in this review. First, the study had to be published in a peer-reviewed journal. Second, the study had to be published between 1960 and 2013. Third, the study had to include one participant who had an official diagnosis or characteristics of either autistic disorder, autism spectrum disorder, Aspergers Syndrome, PDD-NOS, or Retts. Fourth, the study had to have utilized single-subject methodology and could not be a group design, review, or commentary. Fifth, the article had to either explicitly state that they utilized one of the two procedures (e.g., stating that they used behavioral skills training) or state all of the steps of either BST or TIP in the methods section if either label was not provided. Sixth, the study had to be used to target skill(s) of the individual a diagnosed with ASD. Therefore, studies where BST was use to train a staff (even if that staff was an individual diagnosed with ASD) were excluded from this review. Finally, objective data had to have been utilized as the main dependent measure.

Results of the Search

The results of this search yielded a total of 43 possible articles. We excluded 29 of articles as they did not meet at least one of the inclusion criterion (outlined previously). Table 1 provides a list of all the studies that were excluded from this review, and the reason each was excluded. After excluding the 29 articles, 14 articles remained which were assigned to either TIP or BST.

Table 1 Excluded articles
Full size table

Article Assignment

For an article to be considered as utilizing the TIP, the researchers had to: (a) label the behavior, (b) provide a rationale to the participant, (c) break the behavior down into smaller components, (d) have the teacher demonstrate the behavior, (e) have the learner role-play the behavior, and (f) provide feedback. There were a total of eight articles included that were assigned to TIP.

For an article to be considered as utilizing BST, the researchers had to: (a) provide instructions, (b) model the behavior for the student, (c) have the learner role-play the behavior, (d) provide feedback to the learner, and (e) not provide a rationale (as this would make it a teaching interaction procedure). There were a total of six articles included that were assigned to BST.

Measurement of the Two Procedures

Independent Variables

We analyzed seven independent variables across the studies that evaluated the TIP and BST. We first evaluated the number of children diagnosed with ASD and ages of the children who were evaluated in each study. Second, we evaluated whether a TIP or BST was implemented in a one-to-one instructional format, small group instructional format, or a large group instructional format. Third, we evaluated the skills that were taught to each participant. Fourth, we evaluated how the researchers measured skill acquisition (e.g., role-play probes, naturalistic probes, and generalization probes). Fifth, we evaluated the mastery criterion utilized for each study. Sixth, we evaluated if and when generalization data was taken for each study. Seventh, we evaluated the experimental design utilized within each study. Finally, we evaluated the steps utilized that compromised the TIP or BST.

Dependent Variables

We also evaluated the effectiveness of both the TIP and BST across three dependent variables. First, we evaluated the percentage of participants’ skills that reached the stated mastery criterion; if no mastery criterion was stated, we evaluated the percentage of skills that showed a desired treatment effect (i.e., behavioral change in the desired direction). Second, we utilized visual analysis to assess levels of generalization; generalization effects were categorized as high, moderate, or low.

Third, we evaluated the percentage of non-overlapping data (PND) between baseline and maintenance data across all skills taught for each study (Scruggs and Mastropieri 2001). PND is a percentage calculated to signify the effectiveness of a single-subject intervention across multiple studies. To calculate PND, we first identified the highest baseline data point. Next, we determined the number of maintenance sessions. Then, we calculated the number of maintenance sessions that were higher than baseline divided by the total number of maintenance sessions (Scruggs and Mastropieri 2001). For example, if there were 9 maintenance sessions above the highest baseline data point and 10 total intervention sessions, we divided 9 by 10 and multiplied by 100 to get a PND score of 90 %. Scores equal to or greater than 90 % were categorized as highly effective, 70 to 89 % was categorized as moderately effective, 50 to 69 % was categorized as minimally effective, and below 50 % was categorized as ineffective.

We did not utilize PND to evaluate data taken during intervention, as PND does not accurately take into account learning curves. For example, if the highest point in baseline was 0 % of steps displayed correctly and during the first intervention session the participant displayed 0 % of steps displayed correctly followed by 100 % (intervention session 2), 100 % (intervention session 3), and 100 % (intervention session 4) of steps correctly, most clinicians and researchers would regard the results as outstanding; however, this would yield a PND score of 75 % which falls in the moderately effective category. Therefore, PND should be limited to comparisons of pre-intervention to post-intervention.

Levels of Effectiveness

We analyzed the measures taken on dependent variables (described above) to determine whether the TIP or BST implemented in each study was effective, somewhat effective, or ineffective. For a study to be categorized as effective, the participants had to reach mastery criterion on at least 85 % of all skills taught, demonstrate high levels of generalization, and obtain a PND score that equated to moderate to high levels of maintenance. For a study to be categorized as somewhat effective, the participant had to reach mastery criterion on 75 to 84 % of skills taught, show varied levels of generalization, and obtain a PND score that equated to moderate to high levels of maintenance. A study was categorized as ineffective if the participant met any of the following conditions: reached mastery criterion on less than 74 % of skills, demonstrated low levels of generalization, or obtained a PND score that equated to minimally effective or ineffective. If a study did not measure generalization or maintenance, then that measure was not calculated in the determination of the effectiveness of the procedure within that study.

Analysis

Teaching Interaction Procedure

There were a total of eight studies that met the inclusion criteria for the TIP. The authors of all eight studies explicitly identified the intervention they employed as a TIP, although one of the studies (Ferguson et al. 2013) also referred to the TIP as a form of BST. Three studies did not meet all of the inclusion criteria.

Table 2 displays the results across the different evaluations conducted on the independent variables for the TIP. All eight studies utilized single subject designs; however, one study also analyzed its data utilizing inferential statistics (Ferguson et al. 2013). Across these eight studies, there were a total of 38 participants with ages ranging from 4 to 30 years old; the majority of studies evaluated participants who would be in kindergarten or early elementary school. The TIP has been most commonly implemented to teach social behaviors for children with ASD, with one study specifically teaching conversational and vocational skills (Dotson et al. 2010). Skill acquisition was determined one of two ways: role-play probes or naturalistic probes. Role-play probes are a methodologically weak method to measure skill acquisition, as they are part of the teaching procedure and can be heavily influenced by the model that occurred previously and/or the feedback received throughout the TIP. Naturalistic probes are a more stringent method to measure skill acquisition, as they occur prior to teaching. No priming, prompting, or reinforcement is provided that could affect performance, so performance is more likely to represent the individual’s response in everyday life.

Table 2 IV information
Full size table

Table 3 provides the results of the evaluations conducted on the dependent variables for studies that utilized the TIP. Six studies were classified as being effective, one study was determined to be somewhat effective, and one study was determined to be ineffective. The TIP implemented by Ferguson et al. (2013) was considered to be a somewhat effective study because, across all of the participants, there were varying and adequate levels of generalization. The TIP implemented by Dotson et al. (2010) was considered to be ineffective due to low levels of generalization. The majority of the research has shown that the TIP was effective in teaching the targeted skill(s) to individuals diagnosed with ASD; participants were able to reach mastery criterion on the majority of skills taught and showed high levels of maintenance.

Table 3 DV information
Full size table

Behavioral Skills Training

The results of our independent variable analysis can also be found on Table 2. All six studies used a variation of the multiple baseline design. There were a total of 21 participants who have been taught using BST. The ages ranged from 6 years old to 30 years old, with the majority of studies utilizing adolescents or adults. There were a wide variety of skills taught to the 21 participants and included task engagement, job skills training, and conversation skills. Probes were the primary measure used to evaluate behavior change.

Table 3 provides results for the evaluations conducted across the dependent variables of the six studies that utilized BST. All but Burke et al. (2010) showed that participants reached mastery criterion or an increase in the rate of the targeted behavior following intervention. There were varying levels of generalization displayed after intervention; however, three studies (i.e., Kornacki et al. 2013; Palmen and Didden 2012; Taras et al. 1988) did not evaluate generalization. When we evaluated PND for maintenance, four of the six studies yielded highly effective results. Overall, according to our criterion, three of the studies were classified as effective, one as somewhat effective, and two as ineffective.

Conclusions and Recommendations

The purpose of this paper was to describe two procedures commonly implemented with individuals diagnosed with ASD, clarify the conceptual framework of each procedure, and evaluate the empirical research of each procedure as it applies to individuals diagnosed with ASD. The TIP and BST have a long history in the field of ABA. Both have been implemented clinically with hundreds of individuals diagnosed with and without ASD, and both have been evaluated in peer-reviewed empirical research. Additionally, the TIP and BST share common components including labeling, demonstration, role-play, and feedback. Despite these similarities, there are differences between the two procedures including the provision of a rationale and the type of demonstrations implemented, and given these differences, it is important for both researchers and professionals to appropriately label the procedure utilized.

Unfortunately, we have observed within the literature base and during clinical observations that the procedures are being mislabeled or that the terminology has changed over time (e.g., procedures that fit the definition of a TIP are being labeled BST). Clinicians and researchers will often label a procedure BST when they are, in actuality, implementing a TIP (i.e., providing rationales and incorrect models). When researchers and professionals label the procedure being evaluated incorrectly they lack conceptual precision, which could hinder clarity in understanding efficient and effective means to change behavior (Baer et al. 1968). In the future, when rationales are included with labeling, demonstration, role-play, and feedback, researchers and professionals should label the procedure as a TIP. When rationales are not included with labeling, demonstration, role-play, and feedback, the procedure should be labeled as BST. Doing this will help facilitate future comparative research and better allow determination of whether the use of rationales is an important component of behavior change procedures. With this clarity in our terms, practitioners could have clear and accurate information about which procedures they should adopt in their clinical work.

Some professionals have suggested that instead of labeling specific procedures (e.g., the teaching interaction procedure or behavioral skills training), we should just describe them by their component parts (e.g., labeling, rationales, modeling, role-playing, and feedback). Although this might be more technically correct and more scientific in nature (Baer et al. 1968), labeling procedures solely by their component parts could hinder the adoption of the field of ABA by the mainstream. That is, providing consistent labels for procedures (e.g., TIP, BST, discrete trial training, etc.) is more user-friendly for the consumer of our services. ABA is not merely a science of human behavior, but also an applied clinical and service discipline, which allows a great number of professionals (e.g., teachers, clinicians, and interventionists) to help an even greater number of individuals. Providers and consumers alike operate in environments that adopt, communicate about, train in, and utilize interventions at the procedural (as apposed to the component) level (e.g., discrete trial teaching, habit reversal, pivotal response training, and token economies). Further, and unfortunately, there are several procedures with little to no empirical support (e.g., social stories, social thinking, or floortime) utilized during intervention with individuals diagnosed with ASD. All of these procedures are carefully and attractively labeled, have names with face validity and marketing appeal to consumers, and, in some instances, are trademarked. To adequately support applied intervention with empirically supported methodologies and be accessible to its consumers, it behooves the field of ABA to label its procedures consistently and correctly and not just refer to them by their component parts.

A second mistake observed in the literature and in general clinical practice is that many professionals have stated that the TIP is a form of BST (Ferguson et al. 2013). The TIP was created in the early years of ABA, and the term “teaching interactions” was coined in the literature 10 years prior to the introduction of BST. Therefore, it is more historically accurate to describe BST as a form/variation of the TIP, and not the other way around. Many professionals today are not familiar with the history of the field of ABA; however, it is important that we protect our history and portray it accurately both within the field and to the general public. We have, for example, seen that professionals commonly misstate what occurred at the UCLA Young Autism Project (e.g., minimum of 40 hours per week versus an average of 40 hours per week; Leaf 2015), no longer understand respondent conditioning and its place in the history of ABA (Leaf 2015), and disregard shaping as a behavior change strategy in favor of prompting. We hope that future professionals in the field will begin to better understand the history of the field and the origins of widely implemented procedures. This may lead to better understanding of the theoretical basis for intervention procedures as well as rationales for choosing between available procedures which in turn can yield better results in our clinical work with individuals with ASD.

The main difference between the TIP and BST is the provision of the rationale. The research on the use of rationales remains mixed. That is, some studies have shown rationales to be important during skill acquisition (Braukmann et al. 1983), and some studies have demonstrated rationales are not an important component in skill acquisition (Wilder et al. 2010). The issue of whether rationales are an effective or essential component in the context of the TIP is an unanswered empirical question. Future researchers need to compare the TIP to BST to determine if rationales are actually a critical component. This evaluation should go beyond mere skill acquisition and evaluate generalization, long-term maintenance, development of cause and effect concepts, and whether supplemental reinforcement can be faded quicker with the provision of a rationale. If rationales lead to improvements in these areas, then clinicians should elect to implement the TIP as opposed to BST. Additionally, it may be that rationales are more important with certain populations or for teaching certain kinds of skills and this too needs to be explored empirically.

The evaluation and analysis of the TIP and BST for individuals diagnosed with ASD have shown that both procedures are effective. In addition, both procedures have been evaluated with populations other than ASD and have met the criterion to be considered evidence based (Horner et al. 2005). However, more research is required with both procedures to identify the conditions under which each is effective, particularly with regard to population-specific outcomes. There have been a limited number of studies using either procedure to teach individuals with ASD specific skills. Future researchers should continue to evaluate the procedures with more individuals diagnosed with ASD and on a wider range of skills. Second, most of the participants have been higher functioning, and it is unknown if the procedures would be effective for lower functioning individuals diagnosed with ASD or what the pre-requisites for the procedures to be effective. Third, future research should also examine training novice professionals and parents on both procedures. Finally, both procedures could be compared to other common alternative procedures (e.g., social thinking, social stories, and floortime) and other behavioral analytic procedures (e.g., video modeling, script fading, and discrete trial teaching) to identify the most effective and efficient procedures.

In conclusion, the TIP and BST are two procedures that are similar, yet separated by a key difference that warrants a conceptual and technical separation of the two procedures. Professionals in the field of ABA should be familiar with both procedures, understand the history of both procedures, and be able to identify the differences between the two procedures, at least until it is determined whether the differences are important in terms of skill acquisition. Despite their differences, both procedures are effective and parents and professionals are well-advised to continue to implement them with individuals diagnosed with ASD.