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 stability of function of automatically reinforced vocal stereotypy over time

Although prior research has suggested the function of socially reinforced problem behavior can change across time, the stability of the function of automatically reinforced behavior is largely unknown. Further, some authors have suggested automatically reinforced behavior is likely to enter into socially mediated contingencies. The present study compared 2 functional analyses conducted on the same target behavior at least 1 year apart. Participants were 6 individuals diagnosed with an intellectual or developmental disability displaying automatically reinforced vocal stereotypy. Results indicated the function of each participant's vocal stereotypy remained stable over time (i.e., no new functions were acquired); however, future research on functional stability for automatically reinforced behavior of other topographies is needed.     

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.     

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.     

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.     

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 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.     

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.     

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.     

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.     

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.     

Decreasing motor stereotypy in leisure contexts: Analysis of stimulus control with response interruption and redirection

Noncontingent access to preferred stimuli and activities may decrease stereotypic behavior in individuals with autism or other developmental disorders. However, prompted engagement, response interruption and redirection (RIRD), and/or contingent access to stereotypy may be required to achieve clinically significant reductions in stereotypy. Antecedent stimuli may also be manipulated during intervention to establish stimulus control by signaling when stereotypy will receive programmed consequences. The purpose of the current project was to replicate prior research in this area by a) evaluating the effectiveness of RIRD on motor stereotypy in an adolescent with autism and b) providing contingent access to stereotypy as a function of successively longer intervals without stereotypic behavior. We also assessed the extent that these procedures gained acceptable stimulus control. Results from this project suggest RIRD and contingent access to stereotypy may effectively decrease motor stereotypy in leisure contexts, though consistent inhibitory stimulus control may be difficult to establish.     

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 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.     

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.     

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.     

Reducing student stereotypy by improving teachers' implementation of discrete-trial teaching

Discrete-trial teaching is an instructional method commonly used to teach social and academic skills to children with an autism spectrum disorder. The purpose of the current study was to evaluate the indirect effects of discrete-trial teaching on 3 students' stereotypy. Instructions, feedback, modeling, and rehearsal were used to improve 3 teaching aides' implementation of discrete-trial teaching in a private school for children with autism. Improvements in accurate teaching were accompanied by systematic decreases in students' levels of stereotypy.