Children with autism often need interventions to increase socially appropriate behaviors and decrease socially inappropriate ones. Stereotypic behaviors are targeted for reduction because they can occur at high rates, may have adverse social consequences and may be disruptive to those around the individual. In addition, stereotypic behaviors can interfere with skill acquisition which can negatively impact social and academic areas. Stereotypy comes in two forms: repetitive vocal and fine/gross motor responses.
Stereotypic behaviors are often difficult to treat because they may be automatically reinforced by the sensory consequences that the stereotypic behavior itself produces. For example, a boy may repeatedly flap his hands because of the sensation produced from the air against his face or a girl may continuously lick her fingertips because of the oral sensation of the salty taste on her tongue. One intervention involves allowing access to the stereotypic behavior during specific times of the day by isolating the specific source of stimulation in an effort to decrease the stereotypy overall throughout the day. Using the examples from above, providing the boy that flaps his hands access to a fan and providing salty snacks to the girl during specific times of the day may decrease the stereotypy throughout the day.
Another intervention to decrease stereotypic behavior is to physically “block” the behavior from occurring which then blocks the sensory stimulation (e.g. putting gloves on a boy that bites his fingers for the tactile sensation of his fingers against his teeth, physically blocking a girl from hitting her head against a table for the auditory sensation the banging sound produces). This type of response blocking or sensory extinction often is used to decrease the inappropriate behavior by withholding the sensory stimulation produced by the stereotypic behavior. By withholding the sensory stimulation produced from the behavior (putting it on extinction) the behavior may decrease. Alterations to the environment such as the gloves or padding to the environment may decrease the behavior but appropriate alternatives (e.g. providing gummy bears as a snack for the boy that likes the sensory feeling against his teeth or providing the girl with a drum to bang during appropriate times) must be provided and replacement behaviors taught (e.g. appropriately requesting gummy bears or the drum).
However, using response blocking or sensory extinction with a child engaging in vocal stereotypy becomes complicated because of the feasibility of it. In an effort to utilize an intervention for vocal stereotypy, a response interruption and redirection (RIRD) has been evaluated in two studies to determine its effectiveness. A similar study used contingent demands on stereotypy and response cost to determine its effectiveness to decrease vocal stereotypy. In essence, the vocal stereotypy is “blocked” because it is interrupted by requesting the child to complete a series of demands and then redirecting him/her. The idea behind RIRD is to decrease the probability of the vocal stereotypy and increase appropriate behaviors (i.e. answering social questions, vocal imitation).
In Ahearn et al., 2008, vocal stereotypy was defined as instances of noncontextual or nonfunctional speech and included babbling, singing, repetitive grunts, and squeals. The vocal stereotypy of two boys and two girls ranging from 3- to 11- years-old was decreased by having them complete a series of consecutive vocal responses contingent on the stereotypy occurring. For example, if vocal stereotypy occurred, the instructor gained the child’s attention by prompting him/her and then the child was required to complete either an intraverbal response (e.g. “what’s your name”, “where do you live?”) or echoic (e.g. say “ball”, etc.) depending on the child’s functioning level. Vocal responses were required until the child complied with 3 consecutive vocal responses with the absence of the vocal stereotypy. Following the third consecutive vocal responses, the teacher would provide social praise (e.g. “Nice job using your words!”). Not only did vocal stereotypy decrease in the four children, but appropriate phrases increased in three of the children.
In Cassella et al., 2011, vocal stereotypy was defined as a variety of vocalizations and repetition of words and phrases. The vocal stereotypy of two boys ranging from 4- to 7-years-old was decreased by having them complete a one-step direction that did not require a vocal response contingent on the vocal stereotypy occurring. For example, if vocal stereotypy occurred, the instructor gained the child’s attention by prompting him/her and then the child was required to complete a receptive motor task (e.g. “clap hands”). Behavior specific praise was given following completion of the task (e.g. “Thanks for clapping your hands!”). Results of the study showed that although vocal stereotypy decreased when RIRD was implemented, it did not remain low in its absence. Additionally, although vocal stereotypy decreased, appropriate vocalizations did not increase.
In Athens et al., 2008 vocal stereotypy was defined as loud, repetitive, noncontextual verbalizations (e.g. saying “banana” when this was not appropriate) and repetitive loud, unintelligible vocalizations (e.g. “ahhh”). The vocal stereotypy of one 11-year-old boy was decreased using a series of vocal demands (similar to RIRD) in addition to a response cost (e.g. removal of the toy he was playing with for 10 seconds) contingent on the vocal stereotypy occurring. For example, if vocal stereotypy occurred, the instructor gained the child’s attention and then the child was required to complete a vocal task (e.g. “What color is it?”). If vocal stereotypy occurred following the completion of the vocal task, another vocal demand was placed. If vocal stereotypy occurred after the second vocal demand, the response cost (e.g. removal of the toy) was implemented. Compliance with the vocal response resulted in brief praise (e.g. “Nice job!”). Results of the study showed that vocal stereotypy decreased and that the response cost was rarely needed to decrease the stereotypy.
There are several implications and limitations that need to be noted from these studies. First, all three studies note that implementation of demands contingent on vocal stereotypy have functioned as a punisher. Decreasing a behavior (punishment or extinction) may lead to an increase in novel problem behaviors so positive reinforcement should be used in conjunction with RAISD. Additionally, although all studies did not target appropriate vocalizations, an alternative appropriate behavior should be taught to replace the behavior that is targeted for decrease. Finally, in two of the studies the intervention consisted of an incompatible vocal response contingent on vocal stereotypy. In one study it required a motor response which also decreased the vocal stereotypy. Future research should compare the use of RIRD using vocal demands to the use of RIRD using motor demands to determine which intervention is more effective at decreasing vocal stereotypy.
Behavior analysts use evidence-based practices like those described above to help individuals to decrease their behavior and increase appropriate skills. Contact our offices in Brandon, Tampa, or Wesley Chapel to set up a complimentary consultation to discuss how these and other techniques may benefit your family.