Immediate and subsequent effects of matched and unmatched stimuli on targeted vocal stereotypy and untargeted motor stereotypy

Multiple schedules of conjugate reinforcement and extinction: A translational model for assessing automatically reinforced behavior

This study evaluated the extent to which a conjugate reinforcement schedule (CONJ) involving a contingency between pedaling a stationary bike and viewing a preferred movie could serve as a translational preparation for the analysis of automatically reinforced behavior. In part, researchers examined whether providing participants with either an accurate or an inaccurate rule about the extinction (EXT) component of a multiple schedule (MULT) contributed to the development of control by the MULT (CONJ EXT) schedule. Results show schedule control emerged for four of five participants who received the accurate rule and none of the five participants who received the inaccurate rule. In addition, participants who received accurate rules typically increased pedaling during CONJ components that followed two consecutive EXT components, suggesting that they experienced deprivation for audio and visual stimulation generated by pedaling. These preliminary findings suggest that researchers could use this translational preparation to identify matched interventions for some automatically reinforced behavior.

Exploring Subtypes of Repetitive Behavior in Children with Autism Through Functional Analysis and Wearable Technology: a Pilot Biobehavioral Assessment

Objectives

Prior research has established assessment methodologies, such as functional analysis to identify specific contexts in which restricted and repetitive behavior (RRB) occurs, and measures of heart rate variability (HRV) to index the level of autonomic arousal in individuals with autism spectrum disorder (ASD). Yet, a gap remains in integrating multiple assessment methodologies to examine the complex underlying mechanisms of RRB. This study piloted a multi-disciplinary approach to assess both the functional behavioral and neurophysiological factors that may underlie occurrences of RRB. The study (a) evaluated the effect of a modified functional analysis protocol on delineating functional subtypes of RRB and (b) explored the effect of using a wearable technology within a functional analysis on identifying the relationship between RRB and HRV.

Method

A single-case alternating treatment design was used to randomly alternate noncontingent low-stimulation and high-stimulation conditions in a modified functional analysis protocol. Simultaneous measurement of RRB and HRV was obtained through direct behavioral observations and a wristband that collects blood volume pulse, respectively. Visual analysis of time series data was used to determine the functional subtypes of RRB, and nonparametric correlational analyses were conducted to determine the association between HRV and RRB.

Results

Findings from a sample of six participants suggest preliminary effectiveness of the assessment protocol in identifying subtypes of RRB and a significant correlation between HRV and RRB.

Conclusions

This study demonstrates the potential effect and usability of a wearable technology-aided biobehavioral approach to assess RRB and HRV in individuals with ASD.

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.

Understanding the Influence of Social and Motor Context on the Co-occurring Frequency of Restricted and Repetitive Behaviors in Autism

The social and motor context in which restricted and repetitive behaviors (RRBs) occur in autism and their relationship to social traits are not well-understood. Participants with and without autism completed tasks that varied in social and motor engagement and RRB frequency was measured. Motor and verbal RRBs were most common, RRBs varied based on motor and social context for participants with autism, and social engagement was associated with lower motor and verbal RRBs. Significant correlations between RRBs and autism severity, social synchrony, and nonverbal mental age were also found. This research confirms the importance of context for understanding RRBs during on-going tasks and raises questions about whether the factors that elicit vocal and motor RRBs are unique for individual children.

Further Analysis of the Immediate and Subsequent Effect of RIRD on Vocal Stereotypy

Although numerous studies have shown that response interruption and redirection (RIRD) can decrease vocal stereotypy displayed by children with autism spectrum disorder, relatively few have evaluated the subsequent effects of RIRD. We evaluated the immediate (when a change agent implemented RIRD) and subsequent (after a change agent discontinued RIRD) effects of RIRD on two participants' vocal stereotypy using a nonconcurrent multiple baseline design with an embedded reversal design combined with a multiple schedule. As a part of the analysis, we conducted the fourth component 25 min after the third component. In addition, we compared the effects of RIRD with 5-min and 20-min components on both participants' vocal stereotypy. Results show that (a) RIRD during either 5-min or 20-min components decreased each participant's immediate engagement in vocal stereotypy, (b) only RIRD during 20-min components decreased each participant's subsequent engagement in vocal stereotypy relative to the no intervention component, and (c) the subsequent effects of RIRD did not extend into the fourth component for either participant.

To What Extent Do Practitioners Need to Treat Stereotypy During Academic Tasks?

Researchers frequently argue that a child’s engagement in stereotypy may compete with his ability to acquire academic skills, engage in appropriate social interactions, or both; however, few studies have directly tested these suppositions. We used a five-phase assessment to evaluate the extent to which behavioral interventions with a progressively greater number of components were necessary to decrease stereotypy and increase correct responding during academic instructions for five children diagnosed with autism spectrum disorders. For one participant, stereotypy decreased when instructors provided standard instruction without specific intervention for stereotypy. For two participants, stereotypy decreased when instructors provided standard instruction plus antecedent intervention for stereotypy with continuous music. For another participant, stereotypy decreased when instructors provided enhanced consequences for correct responding during standard instruction without either antecedent or consequent intervention for stereotypy. For the final participant, stereotypy decreased and correct responding increased when instructors provided standard instruction and consequent intervention for stereotypy.

Reliability and Validity of Indirect Assessment Outcomes: Experts versus Caregivers

Clinicians often conduct indirect assessments (IAs; e.g., Durand & Crimmins, 1988; Iwata, DeLeon, & Roscoe, 2013; Matson & Vollmer, 1995) such as questionnaires and interviews with caregivers to gain information about the variables influencing problem behavior. However, researchers have found poor reliability and validity of IAs with respect to determining functional variables. There are numerous variables that might influence the efficacy of IAs as an assessment tool, one of which is the skill set of the person completing the IA. For example, it may be possible to increase the validity and reliability of IAs by having individuals with certain skill sets such as a background in behavior analysis and FBA ("experts") complete them. Thus, the purpose of this study was to compare the reliability (i.e., agreement with respect to function and specific IA questions) and validity (i.e., agreement between the outcome of IAs and a functional analysis) of IAs completed by caregivers and "experts" for each of eight children who emitted problem behavior. We found that experts were more likely than caregivers to agree on IA outcomes with respect to (a) overall interrater agreement, (b) item-by-item agreement, and (c) the highest-rated function(s) of problem behavior. Experts were also more likely to correctly identify the function(s), based on comparisons of the results of the IAs and FAs. In addition, caregivers were more likely to (a) disagree on hypothesized functions and (b) identify multiple incorrect functions. The use of experts for completing IAs could have significant impact on their utility and provide a novel method for more rapidly completing the FBA process and developing a function-based treatment.

Using Mobile Technology to Reduce Engagement in Stereotypy: A Validation of Decision-Making Algorithms

We developed an iOS app, the iSTIM, designed to support parents of children with autism spectrum disorders (ASD) in reducing common repetitive vocal and motor behavior (i.e., stereotypy). The purpose of our study was to preliminarily test the decision-making algorithms of the iSTIM using trained university students to implement the assessments and interventions. Specifically, we examined the effects of the iSTIM on stereotypy and functional engagement in 11 children with ASD within alternating treatment designs. Using the iSTIM reduced engagement in stereotypy for eight participants and increased functional engagement for four of those participants. Our results indicate that the iSTIM may decrease engagement in stereotypy but that some of the decision-making algorithms may benefit from modifications prior to testing with parents.

Further Analysis of the Predictive Effects of a Free-Operant Competing Stimulus Assessment on Stereotypy

We conducted five experiments to evaluate the predictive validity of a free-operant competing stimulus assessment (FOCSA). In Experiment 1, we showed that each participant’s repetitive behavior persisted without social consequences. In Experiment 2, we used the FOCSA to identify high-preference, low-stereotypy (HP-LS) items for 11 participants and high-preference, high-stereotypy (HP-HS) items for nine participants. To validate the results of the FOCSAs (Experiment 3), we used a three-component multiple schedule to evaluate the immediate and subsequent effects of an HP-LS stimulus, an HP-HS stimulus, or both (in separate test sequences) on each participant’s stereotypy. Results of Experiment 3 showed that the FOCSA correctly predicted the immediate effect of the HP-LS stimulus for 10 of 11 participants; however, the FOCSA predictions were less accurate for the HP-HS stimulus. Results of Experiment 4 showed that a differential reinforcement of other behavior procedure in which participants earned access to the HP-LS for omitting vocal stereotypy increased all five participants’ latency to engaging in stereotypy; however, clinically significant omission durations were only achieved for one participant. Experiment 5 showed that differential reinforcement of alternative behavior in which participants earned access to the HP-LS stimulus contingent upon correct responses during discrete-trial training reduced targeted and nontargeted stereotypy and increased correct academic responding for all four participants. The potential utility of the FOCSA is discussed.

Decreasing Stereotypy Using NCR and DRO With Functionally Matched Stimulation

We conducted a series of studies on multiple forms of repetitive behavior displayed by four children with autism spectrum disorder. Study 1 showed that each participant’s highest probability repetitive behavior persisted in the absence of social consequences, thereby meeting the functional definition of stereotypy. Study 2 showed that preferred, structurally matched stimulation decreased each participant’s targeted (highest probability) stereotypy, as well as their non-targeted (lower probability) stereotypy. Study 3 showed that for three participants, non-contingent access to preferred stimulation decreased immediate and, to some extent, subsequent engagement in targeted and non-targeted stereotypy. For the fourth participant, non-contingent access to preferred stimulation decreased immediate engagement in the targeted stereotypy, but increased subsequent engagement in non-targeted stereotypy; this subsequent increase was attenuated by reducing the duration of access to the preferred stimulus. Study 4 showed that a trial-based differential reinforcement of other behavior (DRO) procedure systematically increased the period of time for which the targeted stereotypy was not displayed for three of three participants. In addition, results showed that the participants’ non-targeted stereotypy either decreased or was unchanged when DRO was provided for the targeted stereotypy.

Using Single-Case Experiments to Support Evidence-Based Decisions: How Much Is Enough?

For practitioners, the use of single-case experimental designs (SCEDs) in the research literature raises an important question: How many single-case experiments are enough to have sufficient confidence that an intervention will be effective with an individual from a given population? Although standards have been proposed to address this question, current guidelines do not appear to be strongly grounded in theory or empirical research. The purpose of our article is to address this issue by presenting guidelines to facilitate evidence-based decisions by adopting a simple statistical approach to quantify the support for interventions that have been validated using SCEDs. Specifically, we propose the use of success rates as a supplement to support evidence-based decisions. The proposed methodology allows practitioners to aggregate the results from single-case experiments to estimate the probability that a given intervention will produce a successful outcome. We also discuss considerations and limitations associated with this approach.

Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand?

PURPOSE

Echolalia is a common element in the communication of individuals with autism spectrum disorders. Recent contributions to the literature reflect significant disagreement regarding how echolalia should be defined, understood, and managed. The purpose of this review article is to give speech-language pathologists and others a comprehensive view of the available perspectives on echolalia.

METHOD

Published literature from the disciplines of behavioral intervention, linguistics, and speech-language intervention is discussed. Special areas of focus include operational definitions, rationales associated with various approaches, specific procedures used to treat or study echolalic behavior, and reported conclusions.

CONCLUSIONS

Dissimilarities in the definition and understanding of echolalia have led to vastly different approaches to management. Evidence-based practice protocols are available to guide speech-language interventionists in their work with individuals with autism spectrum disorders.

Using Conditional Percentages During Free-Operant Stimulus Preference Assessments to Predict the Effects of Preferred Items on Stereotypy: Preliminary Findings

To date, researchers have not identified an efficient methodology for selecting items that will compete with automatically reinforced behavior. In the present study, we identified high preference, high stereotypy (HP-HS), high preference, low stereotypy (HP-LS), low preference, high stereotypy (LP-HS), and low preference, low stereotypy (LP-LS) items based on response allocation to items and engagement in stereotypy during one to three, 30-min free-operant competing stimulus assessments (CSAs). The results showed that access to HP-LS items decreased stereotypy for all four participants; however, the results for other items were only predictive for one participant. Reanalysis of the CSA results revealed that the HP-LS item was typically identified by (a) the combined results of the first 10 min of the three 30-min assessments or (b) the results of one 30-min assessment. The clinical implications for the use of this method, as well as future directions for research, are briefly discussed.

Evaluation of Interventions to Reduce Multiply Controlled Vocal Stereotypy

This study examined four interventions targeted at decreasing multiply controlled vocal stereotypy for a 12-year-old boy diagnosed with autism spectrum disorder and a severe intellectual disability. These interventions included Noncontingent Music, Differential Reinforcement of Other Behaviors, Self-Recording, and Functional Communication Training (FCT). In addition to measuring vocal stereotypy during each condition, task engagement and challenging behavior were also monitored. Across conditions, vocal stereotypy did not vary significantly from baseline except in FCT, when it decreased significantly. Task engagement was higher in this condition as well. It is hypothesized that FCT provided an enriched environment by increasing social interaction and access to desired items as well as removal of less preferred activities. For these reasons, there was a decrease in the need for the participant to engage in vocal stereotypy and challenging behavior and increase in his ability to engage in a task.

Evaluating the Effects of Matched and Unmatched Stimuli on Nail Biting in Typically Developing Children

We evaluated the effects of matched and unmatched stimuli on nail biting for three typically developing children and adolescents. Antecedent-based assessments identified conditions when subjects were most likely to engage in nail biting. Treatment included the noncontingent delivery of four types of highly preferred stimuli: items hypothesized to match the oral, the tactile, or both the oral and tactile stimulation inherent to nail biting, as well as items that did not involve oral or tactile stimulation. Results suggested that all forms of alternative stimulation decreased nail biting.

Effects of Noncontingent Social Interaction on Immediate and Subsequent Engagement in Vocal and Motor Stereotypy in Children With Autism

This study evaluated the effects of noncontingent social interaction (SI) on immediate and subsequent engagement in vocal and motor stereotypy in three children with autism. During SI, a therapist delivered continuous interaction in the form of reading aloud from a Kindle™ e-reader. Results showed that when compared with a no-interaction baseline sequence, SI decreased immediate engagement vocal stereotypy for all three participants without increasing subsequent engagement for any participant. Furthermore, SI also increased immediate engagement in motor stereotypy for one participant, decreased immediate engagement in motor stereotypy for two participants, but did not increase subsequent engagement in motor stereotypy for any participant. Some clinical implications and limitations of the findings are discussed.

Pre-Session Satiation as a Treatment for Stereotypy During Group Activities

Individuals with developmental disabilities may engage in automatically reinforced behaviors that may interfere with learning opportunities. Manipulation of motivating operations has been shown to reduce automatically maintained behavior in some individuals. Considering behavioral indicators of satiation may assist in identifying the point at which an abolishing operation has begun to effect behavior. The purpose of this study was to evaluate the effects of pre-session satiation of automatic reinforcement on subsequent levels of stereotypy and activity engagement during group activities for three males ages 5 to 13 years with developmental disabilities. Following functional analyses with analogue conditions, an alternating treatment design compared a pre-session access to stereotypy condition with a no-pre-session access condition prior to group activity sessions. Results indicated that pre-session satiation of the putative reinforcer produced by stereotypy was effective in decreasing stereotypy and increasing activity engagement during subsequent group activities for all participants. These findings add to the literature supporting the effectiveness of abolishing operations to decrease automatically maintained stereotypy.

Immediate and Subsequent Effects of Response Interruption and Redirection on Targeted and Untargeted Forms of Stereotypy

A number of studies have shown that response interruption and redirection (RIRD) decreases immediate engagement in targeted stereotypic behaviors; however, its effects on untargeted stereotypy have not yet been studied, and its effects following removal of treatment are unclear. We evaluated the immediate and subsequent effects of RIRD on targeted motor stereotypy, as well as untargeted but higher probability vocal stereotypy, of two participants diagnosed with autism, using a three-component multiple-schedule design. Treatment with RIRD decreased immediate engagement in motor stereotypy for both participants, and did not increase subsequent engagement above baseline levels for either participant. In addition, RIRD produced modest changes in immediate engagement in untargeted vocal stereotypy for both participants. We briefly discuss the clinical implications and limitations of the findings from this study.