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.     

Implementing skill-based treatment within a classroom setting for an adolescent with autism

Research exists to support the efficacy of the Interview-Informed Synthesized Contingency Analysis (IISCA) and skill-based treatment (SBT) to address problem behavior within a clinical setting. However, limited research is available to support their use in a classroom setting and especially as a tool to avoid the display of problem behavior altogether. In the current study, the IISCA, informed by an open-ended interview, was conducted with a single participant in the classroom after a prolonged absence from school due to COVID-19. Results of the IISCA were used to determine the multiple contingencies that were likely to evoke problem behavior upon re-introduction of academic task demands. A skill-based treatment was then developed based on these contingencies, which involved teaching the participant functional communication, delay tolerance, and following academic instruction in relevant contexts. After 25 treatment sessions, the participant had acquired and maintained all of these skills, including the ability to functionally communicate, tolerate removal of preferred items, and follow educational instructions within the typical classroom routine. This study shows the applicability of the IISCA and SBT when implemented within the classroom setting and when used to reintroduce educational instruction to an individual with autism after a prolonged break from school.     

Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl

In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the criterion. Overall, baseline muscle tension levels were reduced over 60%, with corresponding reductions in episodes of respiratory distress and chest pain. Subjective reports by the patient and the patient's mother indicated improvements in school attendance and overall adaptive functioning.     

Direct and distal effects of noncontingent juice on rumination exhibited by a child with autism

Previous research has demonstrated the efficacy of the noncontingent delivery of foods and liquids at suppressing rumination, the repeated regurgitation and rechewing of partially digested food. However, it is unclear how long this reduction is maintained after caregivers terminate this procedure. The current study examined the direct and distal effects of noncontingent juice on rumination by measuring the duration of rumination during juice delivery and immediately following the termination of juice delivery. Noncontingent juice suppressed rumination, but this suppression was not maintained after delivery termination.     

Evaluation of an individualized treatment program for adolescent shoplifters

This paper evaluates an individualized treatment program for adolescent shoplifters. Two hundred eighty-six juveniles charged with shoplifting were randomly assigned to treatment and control groups. Treatment contracts included combinations of fines, community service, monetary restitution, written essays, anti-shoplifting videos, apology letters, and individual and/or family counseling. Results revealed that 88% of the treatment group fully completed their treatment contracts. Furthermore, following intervention, the treatment group was rated significantly higher than the control group on personal responsibility and significantly lower on the likelihood of recidivism. Finally, compared to the control group, the treatment group displayed significantly less recidivism over a two-year follow-up period. Regression analyses revealed that several at-risk background variables were significantly associated with less successful treatment outcomes.     

The effects of directive and nondirective prompts on noncompliant vocal behavior exhibited by a child with autism

Results of an analogue functional analysis indicated that noncompliant vocal behavior exhibited by a young girl with autism was maintained by negative reinforcement. Follow-up analyses suggested that the immediate escape contingency assessed in the demand condition did not appear to maintain the behavior. Instead, noncompliant vocal behavior occurred in response to directive prompts. Nondirective prompts reduced noncompliant vocal behavior to near zero.     

Functional analysis and treatment of verbal perseverations displayed by an adult with autism

The function of perseverative speech for an adult man who had been diagnosed with autism and mental retardation was examined. Results showed that verbal perseverations were maintained by social attention. An intervention consisting of differential reinforcement of appropriate verbal responses and extinction of perseverative verbal responding was effective in decreasing verbal perseverations.     

Functional analysis and treatment of bizarre vocalizations exhibited by an adult with schizophrenia: a replication and extension

A functional analysis suggested that the bizarre vocalizations exhibited by a woman with a diagnosis of schizophrenia were maintained by attention. A treatment consisting of awareness training, competing response training, differential reinforcement of the competing response, and attention extinction was effective in reducing bizarre vocalizations. The use of self‐management based treatment components with this population and target behavior is discussed. Copyright © 2003 John Wiley & Sons, Ltd.     

Self objects and development: Infant states of mind in an adolescent girl

In the context of Fordham's model of the deintegrating-reintegrating self, the paper discusses the total quality of the baby's earliest deintegrations and the nature of what Fordham terms the self object. The use of the term ‘whole object’ in Klein's and Fordham's terminology is explored and the self object is placed in the context of Jung's construct of the self and the archetypes. The paper illustrates how residues of the self object permeated a rule-making defensive structure in a 14-year-old girl and how the therapy provided an opportunity for the defence to loosen and for elements that had been locked, as potentials, in a ‘bump car’ self object, to unfold and develop. These elements included the possibility of enjoying the feminine qualities of being a girl and exploration of the mother-infant couple and its confusions in her inner world. In addition, they included getting in touch with an infant, vulnerable part of her personality and modifying a habitual defence which was to take refuge in projective identification with an aggressive, omnipotent phantasied brother. Another important element unfolded through the separation of herself from the idealized, precept-daughter in her mother's mind. A fixed projective identification with a self object became more flexible as the object was explored and developed, and its archetypal absoluteness modified, in the therapeutic relationship.     

Functional analysis and treatment of arranging and ordering by individuals with an autism spectrum disorder

Of the diagnostic features of autism, relatively little research has been devoted to restricted and repetitive behavior, particularly topographically complex forms of restricted and repetitive behavior such as rigidity in routines or compulsive-like behavior (e.g., arranging objects in patterns or rows). Like vocal or motor stereotypy, topographically complex forms of restricted and repetitive behavior may be associated with negative outcomes such as interference with skill acquisition, negative social consequences, and severe problem behavior associated with interruption of restricted and repetitive behavior. In the present study, we extended functional analysis methodology to the assessment and treatment of arranging and ordering for 3 individuals with an autism spectrum disorder. For all 3 participants, arranging and ordering was found to be maintained by automatic reinforcement, and treatments based on function reduced arranging and ordering.     

Case study: Reinforcement control of severe aggression exhibited by a child with autism in a family home

This clinical case study describes in-home treatment of severe aggression and tantrum behavior exhibited by an 11 -year-old child with autism, using methods of differential reinforcement comparable to those of a case study by Luiselli (1990). No significant reductions in problem conduct occurred when a parent implemented differential reinforcement of other behavior (DRO) in conjunction with publicly posted ‘good behavior rules,’ physical management training, and redirection to relaxation. Control was established when the child was reinforced for compliance with task demands in conjunction with extinction, implemented directly by professional support staff working in the home. Despite demonstrable parental consistency, systematic training, and fading of supports, results were not maintained at follow-up. The generality of differential reinforcement as a practical intervention for severe aggression in family homes is questioned.     

Increasing on‐task behavior of an adolescent with autism using momentary differential reinforcement

Compliance is often defined as the completion of a discrete task specified by a preceding instruction. However, compliance could also require the completion of a cluster of tasks, such as cleaning a room, getting ready for bed, or doing homework. We conducted this study to determine if a momentary differential reinforcement schedule would increase the on‐task behavior of an adolescent with autism. The momentary differential reinforcement involved repeated momentary supervision checks, with tokens delivered for appropriate task engagement at that moment. The participant completed math worksheets and remained on task as the number of supervisions was faded from one every 30 s to one every 5 min.     

Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

Correlates of adolescent assertiveness with HIV avoidance in a four-nation sample

Adolescents are frequently admonished to be socially assertive in order to confront negative interpersonal peer influences. Since the advent of HIV/AIDS in human social chemistry, the admonition has become more critical than ever. But the warning is often proffered in the misguided presumption that social assertiveness is the all-required psycho-structure against risk. The present cross-national study examines social and sexual assertiveness in four-country adolescent samples of Nigerian, Thai, Chinese, and Japanese college students. The findings reveal that sexual rather than social assertiveness was the sine qua non against risk, cross-culturally.     

Assessment and treatment of foot-shoe fetish displayed by a man with autism

Results of a functional analysis indicated that a man diagnosed with autism engaged in bizarre sexual behavior in the presence of women wearing sandals. Several treatments proved to be ineffective or impractical. By contrast, a response-interruption/time-out procedure quickly eliminated the problem behavior in multiple settings.