EFFECTS OF VERBAL REPRIMANDS ON TARGETED AND UNTARGETED STEREOTYPY

Results of brief functional analyses indicated that motor and vocal stereotypy persisted in the absence of social consequences for five participants diagnosed with autism spectrum disorder (ASD). Subsequently, effects of a stimulus control procedure involving contingent reprimands for each participant's higher probability (targeted) stereotypy were evaluated. Results indicated that contingent verbal reprimands (i) decreased the targeted stereotypy for all five participants, (ii) decreased the untargeted stereotypy for two of five participants, and (iii) increased the untargeted stereotypy for one of five participants. Although response suppression was not achieved for any participant, three participants maintained low levels of the target stereotypy with one or two reprimands during 5‐min sessions. Furthermore, two of those participants maintained near‐zero levels of motor and vocal stereotypy during 10‐min sessions. These findings suggest that signaled verbal reprimands may be a practical intervention for reducing stereotypy in some children with ASD. Some limitations of the findings and areas of future research are briefly discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

Establishing stimulus control of vocal stereotypy displayed by young children with Autism

We examined the vocal stereotypy of three boys who were diagnosed with an Autism Spectrum Disorder (ASD). Results of functional analyses indicated that each participant's vocal stereotypy was maintained by non‐social consequences. For two participants, verbal reprimands were provided contingent on vocal stereotypy in the presence of a red card (RC). For the third participant, after verbal reprimands alone did not decrease vocal stereotypy, toys were withdrawn contingent on vocal stereotypy in the presence of the RC. For all three participants, vocal stereotypy was permitted without programmed consequences the presence of a green card (GC). The results showed that vocal stereotypy decreased in the presence of the RC for all three participants; however, vocal stereotypy came under inhibitory control of the RC for only one of the three participants. The potential utility of using punishment to develop stimulus control of automatically reinforced problem behavior in academic settings is briefly discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Evaluation and treatment of covert stereotypy

The treatment of behavior maintained by automatic reinforcement (e.g. stereotypy) can present a unique challenge if practitioners cannot control delivery of the maintaining reinforcer. Further, some individuals might engage in stereotypy only when care providers are absent. In the current evaluation, an adolescent boy's hand flapping was demonstrated to occur in the absence of social contingencies and care providers. To reduce the behavior, two treatment strategies were assessed. In the first approach, verbal reminders to refrain from hand flapping were delivered on time‐based schedules. In the second approach (differential reinforcement of other behavior, DRO), we provided access to a preferred item contingent on prespecified time lengths with no hand flapping when the participant was alone in a room. Results of the investigation indicated that the verbal reminders were unsuccessful, whereas the DRO program resulted in near‐zero levels of stereotypy. Copyright © 2002 John Wiley & Sons, Ltd.     

Comparing resetting to non‐resetting DRO procedures to reduce stereotypy in a child with autism

We compared a resetting to a non‐resetting differential reinforcement of other behavior (DRO) procedure to reduce stereotypy exhibited by young boy with autism. During the resetting DRO, a reinforcer was delivered contingent upon the absence of stereotypy during the DRO interval. If stereotypy occurred, the DRO interval was immediately reset. The non‐resetting DRO procedure was identical, except that contingent upon stereotypy, the DRO interval continued until it expired; a new DRO interval then began. Results indicate that the DRO procedures were equally effective to reduce stereotypy, but the participant preferred the resetting DRO procedure.     

Effects of multiple versus chained schedules on stereotypy and item engagement

We evaluated rates of automatically reinforced stereotypy and item engagement for 2 children with autism under multiple and chained schedules in a multielement design. Each schedule included components during which stereotypy was blocked (S–) or allowed (S+), and we used colored cards as schedule‐correlated stimuli. We report rates of stereotypy and item engagement during S– and S+ components, as well as the percentage of component time that elapsed before the first instances of stereotypy and item engagement. We observed less stereotypy and more consistent item engagement during chained‐schedule sessions, and stimulus control of stereotypy and item engagement was established with the chained schedule. A subsequent concurrent‐chains analysis revealed participant preference for the chained schedule. These results highlight the importance of contingent access to stereotypy when therapists attempt to gain stimulus control of stereotypy and increase functional item engagement.     

Further evaluation of methods to identify matched stimulation

The effects of preferred stimulation on the vocal stereotypy of 2 individuals were evaluated in two experiments. The results of Experiment 1 showed that (a) the vocal stereotypy of both participants persisted in the absence of social consequences, (b) 1 participant manipulated toys that did and did not produce auditory stimulation, but only sound-producing toys decreased his vocal stereotypy, and (c) only noncontingent music decreased vocal stereotypy for the other participant, but sterotypy paradoxically increased when toys were presented with music. Using a three-component multiple schedule, the results of Experiment 2 showed that the vocal stereotypy of both participants remained below preintervention levels following the removal of auditory stimulation and that 1 participant's vocal stereotypy increased following the removal of contingent reprimands. These patterns suggest that auditory stimulation functioned as an abolishing operation for vocal stereotypy and reprimands functioned as an establishing operation for vocal stereotypy. Together, the two experiments provide a method for identifying alternative stimulation that may substitute for automatically reinforced behavior.     

An analysis of vocal stereotypy and therapist fading

A functional analysis for a boy with Down syndrome and autism suggested that vocal stereotypy was maintained by automatic reinforcement. The analysis also showed that instructions and noncontingent attention suppressed vocal stereotypy. A treatment package consisting of noncontingent attention, contingent demands, and response cost effectively reduced vocal stereotypy. The treatment package remained effective even when noncontingent attention was removed, making the procedure easier to implement. Also, the presence of the therapist in the room with the participant was faded systematically. After completion of fading, vocal stereotypy remained low during conditions similar to the no-consequence phase of the functional analysis.     

Sensory Integration as a Treatment for Automatically Maintained Stereotypy

According to sensory integration (SI) theory, many symptoms of autism are caused by an inability to integrate and adaptively respond to sensory input. Despite little evidence supporting SI, this form of therapy is a popular treatment for children with autism. Should these treatments work, they should be most effective for behavior maintained by sensory consequences (automatically maintained). SI activities may make these sensory consequences less reinforcing. The purpose of this study was to determine whether SI treatments could reduce automatically‐maintained stereotypy. Five individuals with autism participated. An occupational therapist prescribed sensory activities that competed with stereotypy for SI treatments. Two types of SI treatments were tested: sensory diets and brushing with deep‐pressure therapy. The effect of these treatments on stereotypy was evaluated in an ABAB design. Neither the sensory diet alone, brushing and deep pressure alone, nor both treatments combined were effective interventions for stereotypy. These results do not support the use of SI as a treatment for stereotypy. Copyright © 2015 John Wiley & Sons, Ltd.     

A STIMULUS CONTROL PROCEDURE TO DECREASE MOTOR AND VOCAL STEREOTYPY

A changing criterion design was used to examine the effects of two stimuli (a green card and a red card), conditioned via discrimination training, on reducing motor and vocal stereotypy in a youngster with autism while he looked at books. During discrimination training, motor and vocal stereotypy was not interrupted in the presence of a green stimulus, but was interrupted in the presence of a red stimulus using manual guidance and appropriate behavior was reinforced. After the participant demonstrated successful discrimination of the stimuli (i.e., the absence of stereotypy in the presence of a red stimulus and the engagement in stereotypy in the presence of a green stimulus), intervention began. During intervention, upon meeting criterion for latency to engage in motor and vocal stereotypy in the presence of the red stimulus for a target duration, the participant was provided access to the green stimulus, which signaled that motor and vocal stereotypy would not be interrupted. The criterion latency to engage in stereotypy in the presence of the red stimulus was systematically increased. Simultaneously, the duration of access to the green stimulus was systematically decreased. The red and green stimuli were faded from poster boards to colored 10 × 10 cm cards, and stimulus control was generalized to the participant's classroom and to a community setting (i.e., public library). Results are discussed in terms of discrimination training as a useful intervention for reducing motor and vocal stereotypy. Copyright © 2011 John Wiley & Sons, Ltd.     

Effects of socially appropriate singing on the vocal stereotypy of children with autism spectrum disorder

This study evaluated the effects of children with autism spectrum disorder engaging in socially acceptable singing on their vocal stereotypy. A multiple‐baseline across four participants with embedded multielement designs was used to assess the effects of the singing intervention upon later occurrence of vocal stereotypy for each participant. Results showed that fewer instances of vocal stereotypy occurred during and after singing intervention sessions. Additionally, two children began to emit appropriate singing after intervention, which suggests that the topography of their vocal stereotypy (e.g., monosyllabic or screeching sounds) was altered to some extent. Overall, results suggest positive implications for teaching appropriate vocal behaviors as functional replacements for vocal stereotypy.     

Use of an Antecedent Intervention to Decrease Vocal Stereotypy of a Student With Autism in the General Education Classroom

This study examined the use of an antecedent-based intervention to reduce the vocal stereotypy of a student diagnosed with Autism within the general education classroom. The student displayed frequent nonfunctional speech and disruptive vocal sounds. An antecedent-based intervention, involving the use of qualitatively different cards—to cue the student when it was appropriate or inappropriate to engage in vocal stereotypy—was designed and implemented. An adaptive alternating treatment design was utilized and conditions were randomized and counterbalanced across treatment sessions. Data on vocal stereotypy were collected using partial interval recording. The results indicated the participant was successful in discriminating between cues and decreased stereotypy during intervention compared to baseline conditions. Similar findings were found when the intervention was implemented across a second school setting.     

A simple intervention for stereotypical engagement with an augmentative alternative communicative device

Although electronic devices may enhance the effectiveness of some behavioral interventions for children with autism spectrum disorders, such devices may also give rise to problem behavior such as repetitious button pressing (i.e., object stereotypy). Results of this study showed that a child with autism spectrum disorder only displayed high levels of object stereotypy on an iPad? when presses generated auditory output. Subsequently, results showed that when the participant used the iPad? without auditory output, his stereotypical behavior decreased and his manding for various items simultaneously increased.     

The analysis and treatment of vocal stereotypy in a child with autism

This study examined procedures for the assessment and treatment of automatically reinforced vocal stereotypy of a 6‐year‐old girl with autism. Stimulus assessments were conducted to identify toys that were correlated with higher rates of vocal stereotypy and toys that were not. A concurrent operants assessment identified preferred stimuli (toys that produced auditory stimulation), which were then used as reinforcers for the non‐occurrence of vocal stereotypy. A reversal design was used to compare the effects of a fixed time schedule of reinforcement (FT 1‐min) to differential reinforcement for the non‐occurrence of behavior (DRO) to reduce vocal stereotypy. Implementation of the FT schedule revealed no effect, whereas the DRO schedule led to a reduction in the target behavior during treatment sessions and across the school day. This study adds to the body of literature supporting the identification of matched stimuli to reduce non‐socially mediated problem behavior. Copyright © 2005 John Wiley & Sons, Ltd.     

THE EFFECTS OF MATCHED STIMULATION AND RESPONSE INTERRUPTION AND REDIRECTION ON VOCAL STEREOTYPY

Stereotypy has been classified as repetitive behavior that does not serve any apparent function. Two procedures that have been found to reduce rates of vocal stereotypy effectively are response interruption and redirection (RIRD) and noncontingent access to matched stimulation (MS). The purpose of the current study was to evaluate the effects of RIRD alone, MS alone, and MS combined with RIRD. One participant's results suggested similar suppressive effects on vocal stereotypy across treatment conditions. For the second participant, a slightly greater suppression of stereotypy was associated with MS + RIRD. In addition, both participants emitted a greater frequency of appropriate vocalizations in conditions with RIRD. Data suggest that the addition of MS might facilitate the implementation of RIRD in applied settings.     

Parent‐implemented treatment for automatically maintained stereotypy

Automatically maintained stereotypy is common among children with autism spectrum disorder. The purpose of this study was to evaluate the effect of a multicomponent parent‐implemented intervention on the reduction of motor stereotypy for a child with autism. A 2‐year‐old child and her father participated in this study. The effect of a parent‐implemented intervention was evaluated using an alternating treatment design. The results indicated that the parent‐implemented treatment package including differential reinforcement, response blocking, and a competing stimulus decreased automatically maintained motor stereotypy.     

Analysis of response allocation in individuals with multiple forms of stereotyped behavior

Three experiments were conducted to evaluate response allocation of stereotypy during free-operant and restricted-operant conditions. Five children with autism or related developmental disabilities participated in at least one and up to three of the experiments. In Experiment 1, the stereotypic response that emerged as most probable during a free-operant phase was restricted, and response allocation was again evaluated. The results for 3 participants showed that restricting the high-probability response was correlated with covarying reductions in a nontargeted stereotypy. In Experiment 2, the effect of environmental enrichment on response allocation was evaluated. One participant reallocated behavior to appropriate object manipulation, 1 participant showed no change in behavior, and a 3rd participant reallocated behavior to object manipulation only when the putative stimulus products of the object manipulation matched those of stereotypy. In Experiment 3, additional interventions were implemented to promote response reallocation. Results showed that both response restriction and reinforcement for object manipulation decreased stereotypy and increased object manipulation. Collectively, the results of these experiments point to a need for complex evaluations of interventions for stereotypy.     

The efficacy of noncontingent reinforcement as treatment for automatically reinforced stereotypy

Noncontingent reinforcement (NCR), in the form of continuous access to preferred leisure items, has recently been reported as a successful treatment for automatically reinforced aberrant behavior. However, previous research has shown that the outcome of such procedures can be compromised under certain circumstances, such as when the response effort required to access leisure items is increased. The purpose of the current study was to assess the efficacy of two variations of NCR as treatment for automatically reinforced stereotypy. In the first phase of the study, functional analyses revealed that the stereotypy of three individuals with developmental disabilities was maintained independent of social consequences. A sensory class assessment was then conducted to identify the specific sensory products that appeared to maintain the behaviors. Finally, we evaluated the effects of NCR (using stimuli identified in the previous assessments) under two conditions. In the first condition, the leisure item was made freely available, by placing it on the table in front of the participant. In the other condition, an experimenter prompted the participant to interact with the leisure item at the beginning of the session. The results indicated that NCR successfully competed with stereotypy only when participants were prompted to interact with the leisure item. These findings are discussed in the context of developing NCR interventions for automatically reinforced aberrant behavior. Copyright © 2002 John Wiley & Sons, Ltd.     

Noncontingent access to preferred sensory stimuli as a treatment for automatically reinforced stereotypy

Researchers have previously suggested that interventions designed to decrease stereotypic behavior are most effective when they include access to stimuli that are matched to the specific sensory consequences hypothesized to maintain the stereotypy. In an attempt to replicate this finding, we used stimulus preference assessments and a reversal design to evaluate the effectiveness of noncontingent access to highly preferred stimuli that were matched to the specific sensory consequences hypothesized to be maintaining the stereotypic behavior of an individual with developmental disabilities. The participant was also given noncontingent access to a highly preferred edible stimulus as a control condition. Results indicated that noncontingent access to a matched sensory stimulus produced consistent decreases in aberrant behavior while access to a highly preferred edible stimulus did not. Copyright © 2005 John Wiley & Sons, Ltd.     

A further comparison of external control and problem‐solving interventions to teach social skills to adults with intellectual disabilities

We compared the effectiveness of a problem‐solving and an external control intervention to teach social skills to two adults with mild intellectual disabilities. Each participant received the problem‐solving intervention with one social skill and the external control intervention with another social skill. The comparative effectiveness of the social skill training protocols was evaluated using individual participant alternating treatment designs. Overall, there seemed to be little difference between the interventions in terms of acquisition, generalization, or maintenance of social skills with either participant. Limitations of the current study and issues for future research are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

An evaluation of the effects of response interruption redirection and matched stimulation on vocal stereotypy

Stereotypy is one of the core diagnostic features of autism spectrum disorder and warrants behavioral intervention when it negatively impacts the person's life. The aim of this study was to evaluate the effectiveness of noncontingent matched stimulation (NCR‐M) compared with response interruption redirection (RIRD) on reducing levels of vocal stereotypy in the natural environment. Interventions were compared using an alternating treatments design followed by generalization and maintenance phases, which utilized lay people as instructors. Results showed that both RIRD and NCR‐M resulted in a reduction in vocal stereotypy for three out of four participants within an educational setting. An increase in appropriate vocalizations was found for two out of four participants for both interventions. These results suggest that both NCR‐M and RIRD were effective in reducing levels of vocal stereotypy, yet their effects on appropriate communication remain undetermined. Social validity scores were obtained following the study, which demonstrated that both interventions were met with approval across a variety of measures.