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.     

Implementing a differential reinforcement of low rates schedule to alter vocal stereotypy and task engagement in two adolescents with autism spectrum disorder

Vocal stereotypy (VS) is often observed in individuals with autism spectrum disorder (ASD) which at high rates can interfere with socialization or functioning in structured settings. There are multiple effective interventions available; yet, many procedures target the complete omission of the behavior or are only assessed at short intervals, making it unclear how they will generalize in applied settings. One intervention yet to be assessed as an individual intervention for automatically reinforced VS is differential reinforcement of low rates of behavior (DRL). In the present study, a functional analysis determined that the VS of two female adolescents with ASD was maintained by automatic reinforcement. A DRL procedure was implemented which incorporated: (a) a specified interval for reinforcement; (b) the behavioral expectations; (c) the permissible instances of VS within the interval; (d) learner feedback; and (e) the reset/non-reset aspect of the schedule. As the targeted behavior decreased across sessions, the DRL interval was systematically increased in order to thin out the schedule of reinforcement. The intervention reduced VS and increased untargeted task engagement for both participants. Applied and theoretical implications of the study as well as social validity, limitations, and future research are discussed.     

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.     

Artificial intelligence for the measurement of vocal stereotypy

Both researchers and practitioners often rely on direct observation to measure and monitor behavior. When these behaviors are too complex or numerous to be measured in vivo, relying on direct observation using human observers increases the amount of resources required to conduct research and to monitor the effects of interventions in practice. To address this issue, we conducted a proof of concept examining whether artificial intelligence could measure vocal stereotypy in individuals with autism. More specifically, we used an artificial neural network with over 1,500 minutes of audio data from 8 different individuals to train and test models to measure vocal stereotypy. Our results showed that the artificial neural network performed adequately (i.e., session-by-session correlation near or above .80 with a human observer) in measuring engagement in vocal stereotypy for 6 of 8 participants. Additional research is needed to further improve the generalizability of the approach.     

Evaluation of the immediate and subsequent effects of response interruption and redirection on vocal stereotypy

We evaluated 2 3-component multiple-schedule sequences-a response interruption and redirection (RIRD) treatment sequence and a no-interaction control sequence-using a multielement design. With this design, we were able to evaluate the immediate and subsequent effects of RIRD on 2 participants' vocal stereotypy. For both participants, RIRD produced an immediate decrease in vocal stereotypy and did not result in a subsequent increase.     

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.     

Effects of music on vocal stereotypy in children with autism

We examined the effects of manipulating the intensity (i.e., volume) of music on engagement in vocal stereotypy in 2 children with autism. Noncontingent access to music decreased immediate engagement in vocal stereotypy for each participant, but it produced only marginal effects on subsequent engagement in the behavior (i.e., after withdrawal). Manipulating the intensity of music did not produce differential effects on immediate engagement in vocal stereotypy. The implications of the results and applications for future research are discussed.     

Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: a preliminary investigation

The effects of noncontingent matched stimulation (NMS) and response blocking on a boy's stereotypic behavior were evaluated using a multiple schedule that contained three 15-min components (preintervention, intervention, and postintervention). Results showed that stereotypy was always higher after response blocking than before response blocking and was always lower after NMS than before NMS. These results suggest that response blocking may have produced deprivation for the product of stereotypy and that NMS may have provided stimulation that was similar to the product of stereotypy.     

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.     

Superimposition and withholding of edible consequences as treatment for automatically reinforced stereotypy

The delivery and subsequent withholding of tangible consequences has been previously investigated as an intervention for stereotypic behavior. The current investigation sought to extend previous research by evaluating its effectiveness and durability as treatment for stereotypy of 2 children who had been diagnosed with autism. Nonsocial functions for stereotypic behavior were identified via functional analysis. Edible items were then delivered contingent on stereotypy and were withheld in a subsequent condition. When the superimposition procedure failed to reduce stereotypy, environmental enrichment was implemented and was found to reduce the stereotypy of both participants.     

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.     

Assessment and treatment of elopement maintained by access to stereotypy

We evaluated a treatment for elopement maintained by access to stereotypic door play. First, we conducted a functional analysis of elopement that produced undifferentiated results. Next, we conducted an assessment in which we evaluated the relation between elopement and door play. Results suggested a functional relation between the 2 behaviors (i.e., elopement was maintained by contingent access to door play). Finally, we implemented functional communication training as a treatment for elopement in which access to door play was made contingent on a target appropriate communication response.     

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.     

Further analysis of subtypes of automatically reinforced SIB: A replication and quantitative analysis of published datasets

Hagopian, Rooker, and Zarcone (2015) evaluated a model for subtyping automatically reinforced self‐injurious behavior (SIB) based on its sensitivity to changes in functional analysis conditions and the presence of self‐restraint. The current study tested the generality of the model by applying it to all datasets of automatically reinforced SIB published from 1982 to 2015. We identified 49 datasets that included sufficient data to permit subtyping. Similar to the original study, Subtype‐1 SIB was generally amenable to treatment using reinforcement alone, whereas Subtype‐2 SIB was not. Conclusions could not be drawn about Subtype‐3 SIB due to the small number of datasets. Nevertheless, the findings support the generality of the model and suggest that sensitivity of SIB to disruption by alternative reinforcement is an important dimension of automatically reinforced SIB. Findings also suggest that automatically reinforced SIB should no longer be considered a single category and that additional research is needed to better understand and treat Subtype‐2 SIB.     

Effects of three types of noncontingent auditory stimulation on vocal stereotypy in children with autism

We evaluated the effects of 3 types of noncontingent auditory stimulation (music, white noise, recordings of vocal stereotypy) on 2 children with autism who engaged in high rates of vocal stereotypy. For both participants, the music condition was the most effective in decreasing vocal stereotypy to near-zero levels, resulted in the highest parent social validity ratings, and was selected as most preferred in treatment preference evaluations.