Choice as an Antecedent Intervention

Study: Kern, Mantegna, Vorndran, Bailin, & Hilt (2001)

Study Type: Single-Subject Design

Descriptive Information Usage Acquisition and Cost Program Specifications and Requirements Training

Choice-making opportunities implemented as an antecedent intervention. The purpose of choice-making interventions is to promote engagement by providing the opportunity for student decision-making and agency with regard to assignment choice and/or order.

Choice is intended for use in Kindergarten through middle school. The program is intended for use with students with disabilities, intellectual disabilities, emotional or behavioral disabilities, autism, and any student at risk for emotional and/or behavioral difficulties.

The area of focus is externalizing behavior, which includes: physical aggression, verbal threats, property destruction, noncompliance, high levels of disengagement, and disruptive behavior.

Choice as an antecedent intervention is a non-commercial intervention and, therefore, does not have a formal pricing plan.

Choice is designed for use with individual students, small groups of 6-8 students, or with a classroom of students.

Only one interventionist is needed to implement the program.

The program includes highly specified teacher manuals or instructions for implementation.

The program does not require technology for implementation.

No training for the interventionist is required.

No training manuals or materials are available.

There are no minimum qualifications for the interventionist.

The program is not affiliated with a broad school or classwide management program.

There is no ongoing support available for practitioners.


Participants: Convincing Evidence

Risk Status: Based on observed problem behaviors



Age/ Grade



Socioeconomic status

Disability Status

ELL status

Other Relevant Descriptive Characteristics

Case 1: Danny

7 yrs old/1st grade


Not specified

Not specified

ADHD diagnosis

Not specified

High rates of problem behavior that resulted in admission to short-term inpatient hospital facility where this participant's intervention was conducted. Problem behaviors included tantrums, aggression, disruption, and noncompliance. Behaviors served an escape function. 

Case 2: Kelly

15 yrs old


Not reported

Not reported

Moderate intellectual disability and tuberous sclerosis

Not reported

Often fixated on topics or unresponsive. Rarely used communicative language and frequently engaged in echolalia. Used polaroid pictures as her primary mode of communication. Typically required extensive verbal prompting as a result of noncompliance. Attended an approved private school serving students with emotional and behavioral problems where the study was conducted. Engaged in noncompliance and off-task behavior both at school and at work. 

Case 3: Shannon

11 yrs old


Not reported

Not reported

Mild intellectual disability, ADHD

Not reported

Attended a self-contained special education classroom in a public elementary school. Independent in self-care and living skills but was noncompliant when requested to complete tasks. Engaged in aggressive, disruptive behaviors for which she was hospitalized in an inpatient facility. The study took place in this setting. Behaviors served as an escape function.     

Training of Instructors:

 Danny-all sessions were conducted by a therapist who had extensive training and experience with children who exhibit behavior problems.

Kelly- sessions conducted by her classroom teacher.

Shannon- sessions conducted by a therapist who had extensive training with children who engaged in challenging behavior.

Design: Convincing Evidence

Does the study include three data points or sufficient number to document a stable performance within that phase? Yes

Is there opportunity for at least three demonstrations of experimental control? Yes

If the study is an alternating treatment design, are there five repetitions of the alternating sequence? Not applicable

If the study is a multiple baseline, is it concurrent? Not applicable

Implemented with Fidelity: Unconvincing Evidence

Description of when and how fidelity of treatment information was obtained: Not reported

Results on the fidelity of treatment implementation measure: Not reported

Measures Targeted: Partially Convincing Evidence

Targeted Measure

Reliability statistics

Relevance to program focus

Exposure to related support among control group

Problem Behavior- Direct Observation

Inter-rater agreement-assessed during 26-29% of sessions, Mean agreement for Danny was 94% (range 82-100%); for Shannon was 99% (range, 96-100%)

Highly relevant


Engagement- Direct Observation

Inter-rater agreement for Danny was 97% (range, 93-99%); for Kelly was 96% (range 90-100%)

Highly relevant



Broader Measure

Reliability statistics

Relevance to program focus

Exposure to related support among control group






Mean ES Targeted Outcomes: N/A

Mean ES Administrative Outcomes: N/A

Effect Size:

Visual Analysis (Single-Subject Designs): Convincing Evidence

Description of the method of analyses used to determine whether the intervention condition improved relative to baseline phase (e.g. visual analysis, computation of change score, mean difference): Visual inspection

Results in terms of within and between phase patterns:

Danny- When no choice was offered, high rates of problem behaviors were observed.  Conditions when Danny had a choice of the task sequence were associated with near zero frequencies of problem behavior. No Choice conditions were associated with low rates of engagement, whereas Choice conditions were associated with high engagement rates.

Kelly- Choice conditions were associated with higher rates of engagement than No Choice conditions.  Some overlapping points can be seen.

Shannon- No Choice conditions were associated with variable but elevated intervals with problem behavior, whereas Choice conditions were associated with near zero intervals with problem behavior.  When the No Choice Yoked condition was implemented, an increasing trend in the percentage of intervals with problem behavior was observed.  When the Choice condition was reimplemented, problem behaviors again decreased to near zero levels.  

Disaggregated Outcome Data Available for Demographic Subgroups: No

Target Behavior(s): Externalizing

Delivery: Individuals, Small groups (n=6-8), Classrooms

Fidelity of Implementation Check List Available: No

Minimum Interventionist Requirements: No specific qualifications or training needed

Intervention Reviewed by What Works Clearinghouse: No

What Works Clearinghouse Review

This program was not reviewed by What Works Clearinghouse.

Other Research: Potentially Eligible for NCII Review: 0 studies