What's New in Research - Treating and Addressing Stereotypy
- Bridget Taylor, Psy.D., BCBA
Many children with autism engage in repetitive behavior that does not appear to be a function of social consequences (e.g., social attention or escape from task demands). This behavior is typically referred to as stereotypy or automatically reinforced behavior. Stereotypy is usually maintained by the reinforcing properties of the behavior itself; for example, a child may spin the wheels of a truck because it is visually appealing. Common examples of stereotypy are hand flapping, turning in circles, vocalizing portions of video or television scripts, eating non-edibles, ripping or shredding items, or making vocal noises. Stereotypy can be challenging to treat due to both its persistence and its tendency to occur in the absence of adult supervision. The good news, however, is that interventions based upon behavior analysis offer viable treatment options to address this behavior. Outlined below are several recent evaluations of various behavioral interventions aimed at the reduction of stereotypy.
Ringdahl, J.E., Andelman, A.S., Kitsukawa, K., Winborn, L C., Barretto, A., & Wacher, D.P. (2002). Evaluation and treatment of covert stereotypy. Behavioral Interventions, 17, 43-49.
In this study, the experimenters determined that the hand flapping of a child with autism occurred in the absence of social consequences, and when the child was alone. Two treatment procedures were investigated to reduce the behavior. One procedure provided regularly scheduled verbal reminders to refrain from hand flapping, while the second procedure employed a Differential Reinforcement of Other behavior (DRO) intervention. In the treatment condition utilizing verbal reminders, a stop sign paired with an adult reference to the sign provided a verbal reminder to stop flapping. The experimenters found that although hand flapping was reduced in the presence of the adult’s verbal reminder, hand flapping increased when the adult left the room, even when the adult returned intermittently to provide reminders to stop.
The DRO procedure involved presenting a preferred activity contingent upon not engaging in hand flapping for set intervals of time. During these sessions, the adult stated the contingency (e.g., “Don’t flap your hands and you can earn [the preferred toy]”), and then left the room. Once the time interval was over, the child was provided with the preferred toy. Initially, the child was only required to refrain from hand flapping for ten seconds; the interval was increased progressively to ten minutes. The DRO procedure proved more effective in maintaining low rates of hand flapping when the child was alone.
For some children, verbal reminders may not be sufficient to keep stereotypic behavior at low rates when adults are not present. A more comprehensive treatment may be warranted, such as reinforcing the nonoccurrence of the response with a highly preferred stimulus item.
Britton, L.N., Carr, J.E., Landaburu, H.J., & Romick, K.S. (2002). The efficacy of noncontingent reinforcement as treatment for automatically reinforced stereotypy. Behavioral Interventions. 17, 93-103.
In this study, the repetitive responses of head rocking, face rubbing, and other hand movements were found to be maintained by sensory consequences, and to continue independent of social consequences. The experimenters identified activities that they believed competed with the sensory consequences of the responses, such as neck massages as a competing activity to head rocking. Preference assessments were conducted to identify activities and items that the individual might engage with as an alternative to the stereotypic behavior. These preferred stimulus items or activities were then made freely available to determine if the participants would choose these activities voluntarily, rather than engage in the repetitive behavior. For all three individuals, the experimenters found that repetitive behavior remained at high levels despite the availability of preferred items or activities. However, once the individuals were prompted to engage with the stimulus items (e.g., manually guided to play with toys), stereotypy decreased.
Simple access to preferred leisure items may not be a sufficient determent to stereotypic behavior. Individuals may need to be prompted to engage with these materials so that the response is less effortful.
Mancina, C., Tankersley, & Kamps, D., Kravits, T., Parrett, J. (2000). Brief Report: Reduction of inappropriate vocalizations for a child with autism using a self-management treatment program. Journal of Autism and Developmental Disorders, 30, 599-606.
In this study, the repetitive vocalizations of a twelve-year-old girl with autism were reduced by teaching her to monitor her own behavior. The child was first taught to discriminate quiet from noisy behavior when it was modeled by an adult, and was then taught to identify when she displayed noisy behavior. A watch with an audible timer was used to signal intervals for the youngster to record if she was noisy or quiet during the designated interval. She was then taught to reinforce herself for a designated number of quiet intervals. The procedure was subsequently implemented in her public school classroom by her teacher. The self-management procedure resulted in a decrease in inappropriate vocalizations, but not in other stereotypic responses that the child displayed. Further, even though the behavior decreased, the child continued to require adult prompts to attend to the system of self-monitoring.
Some children may be able to learn to make accurate discriminations of their own behavior in order to self-monitor responses. Self-management may be a viable alternative for youngsters in public school classrooms where teachers are readily available to provide the necessary prompts for the learner to attend to the self-monitoring system. Further, reductions in stereotypic responses via self-management may be limited to those behaviors specifically targeted for intervention.
This article originally appeared in an issue of “Science in Autism Treatment”, the newsletter of the Association for Science in Autism Treatment (ASAT). It may not be republished or reprinted without advance permission from ASAT. For reprint permission please contact firstname.lastname@example.org