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.     

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.     

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.     

A comparison of response interruption and redirection and competing items on vocal stereotypy and appropriate vocalizations

The current study compared the reductive effects of response interruption and redirection (RIRD) and competing items (including sound-producing and nonsound-producing toys) on the vocal stereotypy exhibited by two children diagnosed with Autism Spectrum Disorder. Sound-producing toys reduced vocal stereotypy relative to nonsound-producing toys and RIRD reduced stereotypy and increased rates of appropriate vocalizations to a greater extent than providing competing items. These findings replicate and extend previous literature suggesting that RIRD and sound-producing competing items are effective methods to treat vocal stereotypy.     

Response interruption and redirection for vocal stereotypy in children with autism: a systematic replication

This study systematically replicated and extended previous research on response interruption and redirection (RIRD) by assessing instructed responses of a different topography than the target behavior, percentage of session spent in treatment, generalization of behavior reduction, and social validity of the intervention. Results showed that RIRD produced substantial decreases in vocal stereotypy. Limitations of this study were that behavior reduction did not generalize to novel settings or with novel instructors and that appropriate vocalizations did not improve.     

The role of task preference in the effectiveness of response interruption and redirection

Response interruption and redirection (RIRD) is a common treatment for automatically reinforced vocal stereotypy; it involves the contingent presentation of task instructions. Tasks that are included in RIRD are typically selected based on caregiver report, which may affect the efficacy of RIRD. The purpose of the current study was to evaluate the role of task preference in the efficacy of RIRD for four participants who engaged in vocal stereotypy. We conducted task-preference assessments and selected tasks of varying preferences to include in RIRD. For three out of four participants, the results showed that RIRD with higher preference tasks was not effective at reducing vocal stereotypy, whereas RIRD with lower preference tasks was effective for all participants.     

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.     

The effect of response interruption and redirection with and without a differential reinforcement of alternative behavior component on stereotypy and appropriate responses

Individuals with an Autism Spectrum Disorder (ASD) often engage in repetitive and stereotypic behaviors (American Psychological Association, 2013). Therefore, interventions that reduce stereotypy and potentially increase appropriate responses are of interest in the field of applied behavior analysis. The purpose of this study was to evaluate the isolated and additive effects of response interruption and redirection (RIRD) and differential reinforcement of alternative behavior (DRA) on both stereotypy and appropriate responses to determine whether either of these interventions alone or in combination is more effective and more efficient in increasing appropriate responses and decreasing stereotypy. Results showed that both RIRD and RIRD + DRA were effective interventions in decreasing stereotypy, but no procedure resulted in a sustained increase in appropriate responses.     

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.     

Comparing response blocking and response interruption/redirection on levels of motor stereotypy: Effects of data analysis procedures

Autism spectrum disorder (ASD) is marked by deficits in social communication and the presence of restrictive and/or repetitive behaviors or interests. Motor stereotypy is a form of repetitive behavior that is common in ASD. Response Interruption and Redirection (RIRD) and response blocking (RB) are two interventions found to be efficacious in reducing motor stereotypy. However, the current literature presents with inconsistencies regarding the relative efficacy of these two procedures. Thus, we sought to replicate and extend previous literature by evaluating the efficacy of both interventions on reducing motor stereotypy among 3 individuals with ASD. We also sought to evaluate how variations in data analysis affected the interpretation of treatment outcomes. Results indicated that both interventions were equally efficacious at reducing stereotypy when analyzing data exclusive of treatment‐implementation time. However, when analyzing total session time data, RB produced greater and more sustained reductions in stereotypy across all participants. These results emphasize the importance of data analysis decision‐making in evaluating intervention outcomes.     

Evaluation of publication bias in response interruption and redirection: A meta-analysis

Publication bias is the disproportionate representation of studies with large effects and statistically significant findings in the published research literature. If publication bias occurs in single-case research design studies on applied behavior-analytic (ABA) interventions, it can result in inflated estimates of ABA intervention effects. We conducted an empirical evaluation of publication bias on an evidence-based ABA intervention for children diagnosed with autism spectrum disorder, response interruption and redirection (RIRD). We determined effect size estimates for published and unpublished studies using 3 metrics, percentage of nonoverlapping data (PND), Hedges' g, and log response ratios (LRR). Omnibus effect size estimates across all 3 metrics were positive, supporting that RIRD is an effective treatment for reducing problem behavior maintained by nonsocial consequences. We observed larger PND for published compared to unpublished studies, small and nonsignificant differences in LRR for published compared to unpublished studies, and significant differences in Hedges' g for published compared to unpublished studies, with published studies showing slightly larger effect. We found little, if any, difference in methodological quality between published and unpublished studies. While RIRD appears to be an effective intervention for challenging behavior maintained by nonsocial consequences, our results reflect some degree of publication bias present in the RIRD research literature.     

Systematic review of interruption and redirection procedures for autistic individuals

Interruption and redirection (IR) procedures involve systematically disrupting an undesirable behavior and prompting an individual to engage in an alternative behavior. These procedures have been frequently assessed for reducing repetitive behaviors for autistic individuals. The primary purpose of this review was to assess IR interventions to determine whether outcomes vary according to intervention characteristics, dependent variable types, design quality, or publication status. A secondary purpose was to assess the extent to which generalization and maintenance outcomes were measured and whether characteristics of these conditions were related to outcomes. IR interventions were moderately successful for reducing repetitive behaviors but less effective for improving corollary variables such as appropriate vocalizations and functional engagement. Generalization and maintenance outcomes, when measured, were poor. Results indicate the need for alternative or augmentative procedures that focus on engagement in meaningful interactions and activities.     

Multiple schedules with response interruption and redirection to reduce stereotypy in children with autism spectrum disorder: Generalization and social validity

Although response interruption and redirection (RIRD) and multiple schedule arrangements have sometimes been shown to be effective in reducing stereotypy for individuals with autism spectrum disorder (ASD), important questions remain about optimal methods for facilitating generalization and social validity. In the current study, we sought to extend the literature on stereotypy treatment and MSAs in several ways. First, we programmed for generalization by conducting sessions with two exemplars of two different categories of activities (i.e., school work, toy play) and assessing generalization with novel exemplars and activities and during the participant's typical instructional program. Second, we used RIRD instructions that were contextual models of appropriate behavior relevant to each activity. Third, during the free access component of the multiple schedule, we used a child's play tent as a first step toward teaching participants to engage in stereotypy during private free time. For all three participants with ASD, stereotypy decreased quickly and substantially, with reductions generalizing to novel activities and contexts. An extensive social validity assessment with board-certified behavior analysts indicated high social acceptability of the goals, procedures, and outcomes.     

Intervention,stimulus control,and generalization effects of response interruption and redirection on motor stereotypy

This study evaluated the effects of response interruption and redirection (RIRD) on motor stereotypy (hand and body movements) in a child with neurodevelopmental disorders. We also assessed whether a stimulus paired with RIRD could acquire inhibitory control when tested during nonintervention conditions. Compared with baseline phases in a reversal design, RIRD decreased both hand and motor stereotypies, and there was evidence of stimulus control. Extending RIRD to a second setting was also effective. The care providers responsible for intervention implemented RIRD with fidelity, and they rated the procedure positively. Clinical and research implications from these findings are discussed.     

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.