Assessing and treating vocal stereotypy in children with autism

Previous research implies that stereotypic behavior tends to be maintained by the sensory consequences produced by engaging in the response. Few investigations, however, have focused on vocal stereotypy. The current study examined the noncommunicative vocalizations of 4 children with an autism spectrum disorder. First, functional analyses were conducted in an attempt to identify the function of each child's behavior. For each of the participants, it was found that vocal stereotypy was likely not maintained by the social consequences. Following assessment, response interruption and redirection (RIRD) was implemented in an ABAB design to determine whether vocal stereotypy could be successfully redirected. RIRD involved a teacher issuing a series of vocal demands the child readily complied with during regular academic programming. Vocal demands were presented contingent on the occurrence of vocal stereotypy and were continuously presented until the child complied with three consecutively issued demands without emitting vocal stereotypy. For each child, RIRD produced levels of vocal stereotypy substantially lower than those observed in baseline. For 3 of the children, an increase in appropriate communication was also observed. The children's teachers were trained to implement RIRD. Brief follow-up probes and anecdotal information implied that the treatment had a positive impact in the natural environment.     

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.     

Abatement of intractable vocal stereotypy using an overcorrection procedure

We conducted a series of reversals to compare the effects of four different treatments on vocal stereotypy emitted by a 7‐year‐old boy with autism. The results showed that (1) the level of vocal stereotypy decreased during exposure to matched stimulation but returned to high levels immediately upon its removal; (2) stereotypy did not significantly decrease during differential reinforcement of other behavior; and (3) contingent withdrawal of movies and music (i.e., response cost) was only moderately effective. However, positive practice overcorrection decreased vocal stereotypy by clinically significant levels. Further, when differential reinforcement of engagement in a Lego^® building task was implemented, the level of engagement was significantly higher when positive practice overcorrection was in place than when overcorrection was withdrawn. Copyright © 2011 John Wiley & Sons, Ltd.     

Further evaluation of treatments for vocal stereotypy: Response interruption and redirection and response cost

The purpose of this study was to expand on research on treatments for stereotypy by evaluating the effects of response interruption and redirection (RIRD) and response cost (RC) alone and as a treatment package on vocal stereotypy. Treatment phases included RIRD, RC, and response interruption and redirection plus response cost (RIRD + RC). The efficacy of these treatments was determined by measuring duration of stereotypy in session and during treatment intervals. Vocal stereotypy decreased in all three treatment conditions; however, when data analysis included stereotypy occurring during treatment intervals, stereotypy during the RC condition occurred at similar levels as baseline for one treatment evaluation phase for Karl and both treatment evaluations phases for Jon. We discuss implications of these findings, limitations of the current study, and areas for future research.     

THE EFFECTS OF RESPONSE INTERRUPTION AND REDIRECTION AND SERTRALINE ON VOCAL STEREOTYPY

Although response interruption and redirection (RIRD) has been shown to be successful in reducing vocal stereotypy, recent reports have suggested that selective serotonin reuptake inhibitors (SSRIs) may also reduce these behaviors. The purpose of the current investigation was to examine the effects of RIRD with and without sertraline on automatically maintained vocal stereotypy of a 4‐year‐old boy with autism. Results suggested that vocal stereotypy decreased when RIRD was implemented and that sertraline did not affect the participant's vocal stereotypy.     

THE EFFECTS OF RESPONSE INTERRUPTION AND REDIRECTION (RIRD) AND DIFFERENTIAL REINFORCEMENT ON VOCAL STEREOTYPY AND APPROPRIATE VOCALIZATIONS

The relation between contextually appropriate vocalizations (AV) and vocal stereotypy (VS) has yet to be established within the response interruption and redirection (RIRD) literature. RIRD may promote AV by suppressing VS and/or by functioning as incompatible responses. The occurrence of VS and AV was assessed during baseline, RIRD alone, and RIRD combined with a differential reinforcement system for AV (RIRD + DRI) for a 5‐year‐old child with autism. Results showed an increase in AV once RIRD was implemented and further increases in AV and decreases in stereotypy when the token system of reinforcement for AV was implemented. Copyright © 2012 John Wiley & Sons, Ltd.     

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.     

A replication of the RIRD strategy to decrease vocal stereotypy in a student with autism

This study was conducted to decrease vocal stereotypy in a student with autism. Results of functional analysis indicated that vocal stereotypy was maintained by automatic reinforcement. We used the Response Interruption and Redirection (RIRD; Ahearn, Clark, & McDonald, 2007 ) strategy to decrease the vocal behavior. An ABAB design was used. Results indicated that the RIRD intervention successfully reduced the target behavior. Results are discussed and implications for practice are provided. Copyright © 2009 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.     

Differential reinforcement to decrease stereotypy exhibited by an adult with autism spectrum disorder

Motor and vocal stereotypies are behaviors commonly exhibited by individuals with autism spectrum disorder (ASD). Stereotypy may impede and interfere with learning new skills and decrease work performance in employment settings. Previous research has evaluated effective interventions for stereotypy; however, they have typically focused on treating stereotypy exhibited by children in structured settings. We evaluated the practicality of implementing a simple differential reinforcement of other behavior procedure with an adult with ASD in multiple, naturalistic environments. Results showed rapid decreases in motor and vocal stereotypies upon implementation of the intervention and maintenance of low levels of behavior. These data highlighted the successful treatment of stereotypy exhibited by an adult with a long history of exhibiting these behaviors. Treatment effects were replicated across multiple, naturalistic environments.     

EFFECTS OF NONCONTINGENT MUSIC ON VOCAL STEREOTYPY AND TOY MANIPULATION IN CHILDREN WITH AUTISM SPECTRUM DISORDERS

Noncontingent music has been shown to reduce engagement in vocal stereotypy in children with autism spectrum disorders, but its effects on appropriate collateral behavior remain unknown. Given that noncontingent music is typically implemented during periods of free play, clinicians may be concerned with the effects of the intervention on toy manipulation. Thus, we examined the immediate and subsequent effects of noncontingent music on engagement in vocal stereotypy and toy manipulation in four children with autism spectrum disorders by using a three‐component multiple schedule combined with a multi‐element design. The results suggest that noncontingent music (i) reduced immediate engagement in vocal stereotypy for three of four participants, (ii) never increased subsequent engagement in vocal stereotypy, and (iii) produced idiosyncratic effects on immediate and subsequent engagement in toy manipulation for two participants. The clinical implications of the results are discussed in terms of improving the treatment of vocal stereotypy using noncontingent music. Copyright © 2012 John Wiley & Sons, Ltd.     

Analyzing the multiple functions of stereotypical behavior for students with autism: implications for assessment and treatment

We studied behavioral functions associated with stereotypical responses for students with autism. In Study 1, analogue functional analyses (attention, demand, no-attention, and recreation conditions) were conducted for 5 students. Results suggested that stereotypy was multiply determined or occurred across all assessment conditions. For 2 students, stereotypy was associated with positive and negative reinforcement and the absence of environmental stimulation. For 2 other students, stereotypy occurred at high levels across all experimental conditions. For the 5th student, stereotypy was associated with negative reinforcement and the absence of environmental stimulation. In Study 2, the stereotypy of 1 student was further analyzed on a function-by-function basis. Within a concurrent-schedules procedure, alternative responses were taught to the student using functional communication training. The results of Study 2 showed that similar topographies of stereotypy, based on qualitatively different reinforcers, were reduced only when differential reinforcement contingencies for alternative forms of communication were implemented for specific response-reinforcer relations. Our results suggest that the causes of stereotypy for students with autism are complex and that the presumed association between response topography and behavioral function may be less important than previously realized.     

A Progression to Transfer RIRD to the Natural Environment

Response interruption and redirection has been shown to be effective for decreasing vocal stereotypy, but treatment effects in the natural environment have yet to be documented in the literature. A recent review indicated the paucity of studies that implemented response interruption and redirection during typically occurring activities or for sessions longer than 5–10 min. One method to promote generalization across settings may be stimulus control procedures. The purpose of the current study was to evaluate the progression of the intervention from a highly structured to a more natural setting, and across longer durations. We also investigated the extent to which a signal could acquire stimulus control over stereotypy. Although we were unable to bring stereotypy under the inhibitory control of a signal alone, we maintained low levels of stereotypy in the natural environment and ultimately extended sessions up to 30 min. Clinical implications and areas for future research are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

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.     

Further evaluation of response interruption and redirection as treatment for stereotypy

The effects of 2 forms of response interruption and redirection (RIRD)-motor RIRD and vocal RIRD-were examined with 4 boys with autism to evaluate further the effects of this intervention and its potential underlying mechanisms. In Experiment 1, the effects of motor RIRD and vocal RIRD on vocal stereotypy and appropriate vocalizations were compared for 2 participants. In Experiment 2, the effects of both RIRD procedures on both vocal and motor stereotypy and appropriate vocalizations were compared with 2 additional participants. Results suggested that RIRD was effective regardless of the procedural variation or topography of stereotypy and that vocal RIRD functioned as a punisher. This mechanism was further explored with 1 participant by manipulating the schedule of RIRD in Experiment 3. Results were consistent with the punishment interpretation.     

Response competition and stimulus preference in the treatment of automatically reinforced behavior: a comparison

Clinicians are particularly challenged by the development of interventions for behavior maintained by automatic reinforcement because reinforcers that maintain the responses often cannot be directly observed or manipulated. Researchers have conducted either preference assessments or competing items assessments when developing effective treatments for behavior maintained by automatic reinforcement. However, interventions based on these assessments have not been directly compared. The current study evaluated procedures to make such a comparison. High-competition items resulted in greater reductions in vocal stereotypy than did high-preference items for a preschool boy with autism.     

The effects of verbal operant training and response interruption and redirection on appropriate and inappropriate vocalizations

Past research has shown that response interruption and redirection (RIRD) can effectively decrease automatically reinforced motor behavior (Hagopian & Adelinis, 2001). Ahearn, Clark, MacDonald, and Chung (2007) found that a procedural adaptation of RIRD reduced vocal stereotypy and increased appropriate vocalizations for some children, although appropriate vocalizations were not targeted directly. The purpose of the current study was to examine the effects of directly targeting appropriate language (i.e., verbal operant training) on vocal stereotypy and appropriate speech in 3 children with an autism spectrum disorder. The effects of verbal operant (i.e., tact) training were evaluated in a nonconcurrent multiple baseline design across participants. In addition, RIRD was implemented with 2 of the 3 participants to further decrease levels of vocal stereotypy. Verbal operant training alone produced slightly lower levels of stereotypy and increased appropriate vocalizations for all 3 participants; however, RIRD was required to produce acceptably low levels of stereotypy for 2 of the 3 participants.     

Functional communication training and noncontingent reinforcement in treatment of stereotypy

A 6‐year‐old boy with autism spectrum disorder engaged in automatically maintained stereotypy in the form of opening and closing doors. A functional analysis confirmed that he also emitted problem behavior that was maintained by access to stereotypy. We evaluated the separate and combined effects of functional communication training and arbitrary noncontingent reinforcement on both response classes. Results showed that the combination of functional communication training and noncontingent reinforcement was more effective at reducing stereotypy than either intervention on its own, although effects on problem behavior were unclear. These results suggest that combinations of interventions may be useful in the treatment of automatically maintained problem behavior.     

THE UTILITY OF ASSESSING MUSICAL PREFERENCE BEFORE IMPLEMENTATION OF NONCONTINGENT MUSIC TO REDUCE VOCAL STEREOTYPY

We conducted a modified paired‐choice preference assessment and used a multielement design to examine the effects of noncontingent access to high‐ and low‐preference music on vocal stereotypy exhibited by children with autism. For 3 of the 4 participants, high‐preference music (a) produced lower levels of vocal stereotypy than low‐preference music and (b) reduced vocal stereotypy when compared to a no‐interaction condition. Results underscore the potential importance of assessing musical preference prior to using noncontingent music to reduce vocal stereotypy.     

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.