THE EFFECTS OF MATCHED STIMULATION AND RESPONSE INTERRUPTION AND
REDIRECTION ON VOCAL STEREOTYPY
Jessica June Love
B.A., California State University, Sacramento, 2007
THESIS
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
PSYCHOLOGY
(Applied Behavior Analysis)
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
FALL
2010
THE EFFECTS OF MATCHED STIMULATION AND RESPONSE INTERRUPTION AND
REDIRECTION ON VOCAL STEREOTYPY
A Thesis
by
Jessica June Love
Approved by:
_____________________________________________, Committee Chair
Caio F. Miguel, Ph.D
_____________________________________________, Second Reader
Becky Penrod, Ph.D
_____________________________________________, Third Reader
Daniela Fazzio, Ph.D.
_________________________
Date
ii
Student: Jessica June Love
I certify that this student has met the requirements for format contained in the University format manual,
and that this thesis is suitable for shelving in the Library and credit is to be awarded for the thesis.
__________________________, Graduate Coordinator
JianJian Qin, Ph.D
Department of Psychology
iii
_________________
Date
Abstract
of
THE EFFECTS OF MATCHED STIMULATION AND RESPONSE INTERRUPTION AND
REDIRECTION ON VOCAL STEREOTYPY
by
Jessica June Love
Stereotypy has been classified as repetitive behavior that does not serve an apparent function. Two
procedures that have been found to effectively reduce rates of vocal stereotypy are Response
Interruption and Redirection (e.g., Ahearn, Clark, & MacDonald, 2007) and Matched Stimulation (e.g.,
Rapp, 2007). The purpose of the study was to evaluate the effects of Response Interruption &
Redirection (RIRD) alone, Matched Stimulation (MS) alone, and MS implemented in conjunction with
RIRD. Data were analyzed using a multitreatment design. Results for participant one suggested
suppressive effects on vocal stereotypy were equivalent for all treatment conditions. For participant two,
a slightly greater suppression of stereotypy was associated with MS + RIRD. Both participants exhibited
greater frequency of appropriate vocalizations with conditions containing an RIRD component. Session
length and number of implementations was also found to be lower during MS + RIRD for one
participant. The data suggested that the addition of matched stimulation may facilitate the
implementation of RIRD in applied settings; however replication with additional participants is needed.
_____________________________________________, Committee Chair
Caio F. Miguel, Ph.D
______________________________
Date
iv
ACKNOWLEDGEMENTS
The author would like to thank her advisor and mentor Dr. Caio Miguel for all of his guidance
in the development and implementation of the study. She would also like to thank Dr. Becky Penrod for
all of her helpful suggestions with the manuscript and design of the study. Also, thank you to Dr. Daniela
Fazzio for all of her feedback with the manuscript and defense. Moreover, she would like to recognize
Jonathan Fernand for his aid in the data collection of this study. Special thanks to Jillian LaBrie,
Timothy Fechter, and the entire Verbal Behavior Lab for direct or indirect support as the study
progressed from design to reality. Finally, she would like to thank those who provided support or
encouragement during her graduate years at Sac State.
v
TABLE OF CONTENTS
Page
Acknowledgements……………………………………………………………………………………… v
List of Figures…………………………………………………………………………………………. viii
Chapter
1. INTRODUCTION…………………………………………………………………..………....….......1
Etiological Theories………………………………………………………………………….....2
Functions of stereotypy…………………………………………………….………....2
Additional Functions……………………………………………………....……..…...4
Social Significance…………………………………………………………………....………..4
Treatment .....................………………………………………………………….....……….....7
Antecedent Interventions……………………………………………...……….……..7
Consequence Interventions………..…………………………………….…………....9
2. METHOD……………………………………………………………………………...…..…...…...17
Participants, Settings, and Materials………………………….……………………...........….17
Stimulus Preference Assessment..............................................................................................18
Response Measurement............................................................................................................20
Functional Analysis..................................................................................................................21
Assessment Design....................................................................................................21
Assessment Conditions..............................................................................................22
Assessment of Matched Stimuli..............................................................................................24
Assessment Design...................................................................................................24
Assessment Conditions.............................................................................................24
Treatment................................................................................................................................25
Response Measurement………………………...…………………………….…....25
Experimental Design and Conditions……...........………………....……………....26
Social Validity………………………………………..............…………...…...…..32
vi
Interobserver Agreement (IOA)…..……….…………...………….….………........33
Treatment Integrity……………………..………………….………...………..........34
3. RESULTS……………………………………………...………………………...…...……….........36
Stimulus Preference Assessment…………………...………………..………..……...…..…..36
Functional Analyses (FA)………………………………...……………...……....……...........37
Matched Stimuli Assessment (MSA)...………………………………...………...…………..39
Treatment…………………………...……………………...………………………...….......................43
Social Validity……………………………………………………………..……………..………….....51
4. DISCUSSION………………………...………………………………………..…..………….…....54
Implications…..…………………………………………..……………………....………......56
Limitations..……………………………………………………..,…………….......……........57
Conclusions………..…………………………………...……………………..……...…........59
Future Research……….……………………………………...………………….....…….......59
Appendix A. Modified RAISD Intake Form……..…………………………………..…..……….…...62
Appendix B. Preference Assessment Data Sheet……………………………………..…...…………..63
Appendix C. Functional Analysis Data Sheet……………………………………………....………....64
Appendix D. Experiment Data Sheet…………………………………………………........……….....65
Appendix E. VRIRD List 1………………………………………………………………........……....66
Appendix F VRIRD List 2………………………………………………………………..…..….…....67
Appendix G VRIRD List 3……………………………………………………………..…..………....68
Appendix H. Social Validity VRIRD Scale……………………………………………..…..………...69
Appendix I. Social Validity MS Scale…………………………………………………..…..………...70
Appendix J. Treatment Integrity RIRD DATA Sheet…………………………………….…..….........71
Appendix K. Treatment Integrity MS DATA Sheet………….…………………………….…..……..72
REFERENCES……………………………………………………………………………….….…...73
vii
LIST OF FIGURES
Page
1. Figure 1 Functional Analysis data – Ivan and Troy ………………………………………….........38
2. Figure 2 Matched Stimulation Assessment data –Ivan………………………………………..........40
3. Figure 3 Matched Stimulation Assessment data –Troy……………………………………….........42
4. Figure 4 Vocal Stereotypy and Appropriate Vocalizations data – Ivan..........……,,,…...................47
5. Figure 5 Vocal Stereotypy and Appropriate Vocalizations data – Troy.…...............……….....…..48
6. Figure 6 (top) Average RIRD Implementations – Both participants………………….…...……....50
7. Figure 6 (bottom) Average Session Length data – Both participants……………...….…………...50
8. Figure 7 Social Validity for RIRD and Matched Stimulation……………….……………………..53
viii
1
Chapter 1
INTRODUCTION
The term stereotypy is used to define behavior that is characterized by repetitive movements
that do not appear to serve an adaptive function (Baumeister & Forehand, 1973; Berkson & Davenport,
1962). Repetitive behaviors are present in typically developing infants (Kravitz, & Boehm, 1971;
Thelen, 1981; Berkson, Tupa, & Sherman, 2001; Berkson, 2002) and are comprised of various
topographies such as body rocking, head rolling, and complex hand movements (Maclean, Ellis,
Galbreath, Halpern, Baumeister, 1991). Typically, engaging in repetitive behaviors does not become a
problem unless performed excessively. Berkson (1967) suggests two broad categories under the term
“stereotypy,” specifically repetitive movements such as handflapping, as well as non-repetitive
movements such as limb and muscle tensing.
Although the term stereotypy is commonly used in behavior analysis to refer to specific
behavioral topographies, the term does not imply any particular function. Hagopian and Toole (2009) for
instance, suggest that the word ‘‘stereotypy’’ should be reserved only for referring to behavior that has
been demonstrated to be maintained by automatic reinforcement namely, response produced stimuli
(Vaughan & Michael, 1982). Despite this suggestion, the term stereotypy continues to be loosely used to
describe topographic qualities of behavior (e.g., repetitive, rhythmical).
This poses a problem for those in the field of behavior analysis who treat stereotypy because
there is no general consensus for a precise definition. Currently the term “stereotypy” continues to be
used as a label for a structural response class (defined by its repetitive characteristics) as opposed to a
functional class (defined by maintenance through specific consequences the behavior(s) produce). From
a behavioral analytic perspective, this is an issue to be resolved; as many behaviors although
topographically identical can serve different functions both within and across individuals. Tr Öster (1994)
echoes this notion, relating that, “it is conceivable that certain forms of stereotypy adopt specific
functions depending on their own particular sensory and/or social consequences, so that they are
2
controlled by specific discriminative stimuli.”(p. 82). Such notions are supported by Iwata, Dorsey,
Slifer, Bauman and Richman (1982/1994) as findings regarding functions of self-injury varied across
individuals as well.
Etiological Theories
Regarding the etiology of stereotypical behavior, there are many accounts as to its initial
acquisition and function(s). Two of the most widely accepted viewpoints are homeostasis and operant
interpretations. The homeostasis interpretation assumes that stereotypy increases arousal in
understimulating environments and decreases it in overstimulating environments (Willemsen-Swinkels,
Buitelaar, Dekker, & Van Engeland, 1998). The operant account describes stereotypy as an early
response in an infant’s repertoire that is first maintained through automatic reinforcement, but may also
later serve to produce other social consequences such as caregiver attention or the presentation of
tangible items (e.g., Thelen, 1987).
Functions of Stereotypy
Stereotypy often appears to be automatically maintained by consequences of a sensory nature.
Behavior-analytic research suggests that stereotypical responding functions to provide sensory input to
an individual, either because of too little or too much environmental input (Lovaas, Newsom, &
Hickman, 1987). These consequences may be so reinforcing that opportunities to engage in them may
even serve as reinforcers for other behaviors (Hung, 1978; Wolery, Kirk, & Gast, 1985, Charlop-Christy
& Haymes, 1996, 1998; Charlop, Kurtz, & Casey, 1990).
Lovaas, Newsome and Hickman (1987) described what they called “perceptual reinforcement”
as explanation for the maintenance of stereotypical behaviors. They proposed that behaviors classified
in a stereotypical response class were operant responses which were maintained by either interoceptive
or exteroceptive perceptual consequences. These consequences were asserted to be produced by
physically engaging in the behavior itself, or a product from an individual engaging with a particular
arrangement of external stimuli in the environment (e.g., spinning a plate to produce visual stimulation).
3
Although not a conceptually original work, Lovaas et al. (1987) was a significant publication
regarding stereotypic behavior. It provided a more complete theory of stereotypy’s development and
characteristics through specific reference to behavioral principles. The notion of automatic
reinforcement was first communicated by Skinner in previous works, for example, Verbal Behavior in
1957. Later, Vaughn and Michael (1982) formally extended and clarified Skinner’s work on automatic
reinforcement. They defined automatic reinforcement as “reinforcement that is not mediated by the
deliberate action of another person” (p. 219). Lovaas et al. suggested the term of perceptual
reinforcement to help explain the contingencies which might lead to the acquisition and maintenance of
stereotypic behavior. Their emphasis was placed on the idea that stereotypy is a learned behavior and
may be initially reinforced by the social community; but later maintained without mediation by others.
Although an interesting argument, currently there are no studies to support the notion that stereotypy is
initially acquired through instruction by the social community.
One rationale for this idea is supported by the highly elaborate and idiosyncratic properties of
stereotypy. Because of the wide variation of stereotypic responses; it is difficult to discard
environmental variables that contribute to shaping or maintenance of such complex behavior. Examples
included repetition of vocal phrases and songs; thought initially to be responses that were taught via
reinforcement by the social environment. However, when the individual(s) contact the sensory
consequences of engaging in specific behaviors, sensory consequences may later compete and
effectively function to reinforce and maintain the behavior(s). Overall, the main argument was that the
authors did not feel there was enough evidence in favor of the notion that stereotypical behavior could
be maintained by social consequences.
Rapp and Vollmer (2005) later refined the perceptual reinforcement theory and related that
stereotypical behavior may be explained through more parsimonious means. Specifically, their
conceptualization of the maintenance of stereotypy was called, “The automatic reinforcement
hypothesis” They described several key features of stereotypy that supports this hypothesis. They are:
(1) stereotypy persists in the absence of social consequences (2) environmental enrichment is correlated
4
with reductions of stereotypy (3) reduction or elimination of the sensory product(s) of stereotypy
produces a reduction in stereotypy itself (4) contingent access to stereotypy functions as reinforcement
for other behaviors and (5) restricting access to or providing prior access to stereotypy results in
subsequent increases or decreases, suggesting that stereotypy is affected by motivating operations (p.
530).
Additional Functions
Although many authors suggest that the primary function of stereotypy is automatic
reinforcement, it is important to note that many have shown that stereotypic behavior can serve multiple
functions including social positive/negative consequences (e.g., Durand & Carr, 1987; Mace, Browder &
Lin, 1987; Mace & Belfiore, 1990; Kennedy, Meyer, Knowles, and Shukla, 2000; Tang, Patterson, &
Kennedy 2003). To further explain, stereotypy may appear and persist in an individual’s repertoire
simply due to the reinforcing sensory properties of engaging in the behavior itself; however, the
individual may contact other contingencies in the environment. As a result the stereotypical behavior(s)
become sensitive to other consequences (i.e., social positive or social negative reinforcement) and may
be emitted later under different stimulus conditions. It is also noteworthy to mention that stereotypy may
only occur in the presence of specific stimuli (Watters & Wood, 1983; McEntee & Saunders, 1997; Carr,
Yarborough, & Langdon, 1997; Van Camp, Lerman, Kelley, Roane, Contrucci, & Vorndran, 2000;
Friman, 2000; Rapp, 2004).
Social Significance
Stereotypic behavior is a socially significant behavior to address as it constitutes a significant
portion of the repertoires of individuals with disabilities. In a recent study in 2003, Hall, Thorns, and
Oliver found via continuous recording methods that duration of stereotypy averaged as high as 83% of
leisure periods and 33% of vocational training periods for 4 students with severe mental retardation.
Although stereotypy is not exclusive to individuals with Autism, an increased prevalence of
both its rate and intensity of responding characterize the disorder. It is so prevalent, that stereotypy has
been a defining feature of Autism since the original description of the disorder in 1943 (Lewis &
5
Bodfish, 1998). Current diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders
Fourth edition, (DSM IV) still includes stereotyped or ritualistic behaviors and patterns of interest, along
with social interaction and communication deficits as the three major domains of Autism Spectrum
Disorder (Lewis & Bodfish, 1998). It has been asserted that individuals with Autism engage in a
significantly higher rate of repetitive behaviors and a greater number of topographies of stereotypy in
comparison to individuals with other developmental disorders such as mental retardation (Bodfish,
Symons, Parker, & Lewis, 2000). Because of the widespread occurrence of stereotypy in populations
with Autism, this warrants the use of participants with such a diagnosis in the proposed study.
There are various reasons why stereotypy is a socially significant behavior to target for
reduction. It can interfere with learning, compete with more functional responses in the individual’s
repertoire, and stigmatize the individual. General detrimental effects of stereotypy have been
demonstrated in literature such as Matson, Kiely, and Bamburg (1997). They found that individuals who
engage in stereotypy exhibited larger deficits in listener and speaker behavior, performing daily living
activities necessary for upkeep of a safe and clean home environment, developing interpersonal
relationships, and engaging in functional, leisure activities alone or with others.
To further expand the argument of general social significance, stereotypy may constitute a large
percentage of an individual’s repertoire. For example, Repp and Barton (1980) found during a
comparison observation of licensed versus unlicensed residential units for individuals with mental
retardation; clients in licensed housing were engaging in self-stimulatory behavior in a range between
7% and 47% during the day; and an average of 27% for unlicensed cottages.
Competition with engagement in appropriate behaviors in general was also demonstrated by
Repp, Karsh, Deitz and Singh (1992). By observing the behavior of individuals with developmental
disabilities consistently over several days, they found that stereotypic behaviors constituted 22% to 74%
of individuals’ time.
Previous literature has also demonstrated a negative relationship between engagement of
stereotypy and acquisition of academic skills. Koegel and Covert (1972) in particular demonstrated that
6
stereotypy shared an inverse relationship with correct discrimination trials. Results indicated that during
discrimination training for when and when not to engage in lever pressing, correct discrimination
responses did not occur until a punishment procedure was implemented contingent upon engagement in
stereotypy. Similar findings of detrimental relations of stereotypy and correct responding were
demonstrated in Morrison and Rosales (1997) for a counting task.
Stereotypic responses can also directly compete and displace socially appropriate behaviors
such as toy play. For example, the mouthing of leisure items can compete with appropriate interaction
with toys (Tarbox, Tarbox, Ghezzi & Wallace, 2007; Epstein, Doke, Sajwaj, Sorrel & Rimmer, 1974). In
addition, Koegel, Firestone and Dunlap (1974) demonstrated that unreinforced, spontaneous, appropriate
play increased when self-stimulatory behavior was suppressed.
Durand and Carr (1987) also related that stereotypical behavior may preclude integration into
nonsegregated environments as well as occasion social stigmatization. Regarding vocal stereotypy
specifically, it is often considered a concern to caregivers because it can be disruptive to others around
the individual (Athens, Vollmer, Sloman, Pipkin, 2008).
Loftin, Odon, and Lantz (2008) findings support this notion as they experimentally
demonstrated an inverse relationship between social initiations and engagement in repetitive motor
responses. Additional literature demonstrating the effects stereotypy on social interaction was conducted
by Matson, Minshawi, Gonzalez, and Mayville, (2006). Their study contained 120 participants, which
consisted of individuals with self-injurious behavior (SIB), stereotypy, or neither SIB nor stereotypy
(control group). They found that individuals who exhibited stereotypy (N = 30) had significantly fewer
general positive social skills than the control group (N = 30). They also found that the comorbidity of
both SIB and stereotypy amplified this negative effect on social skills.
Finally, a more recent demonstration of stereotypy’s effects on social interaction was described
by Lee, Odom and Loftin (2007). They evaluated the effectiveness of a peer-training intervention
strategy to increase social skills in three children with Autism. During baseline the children with Autism
emitted high rates of stereotypy and low rates of social interaction. After implementation of a peer
7
prompting strategy, results not only showed an increase in social interactions for the children, but also a
concomitant decrease in simultaneous motor/vocal stereotypical responding.
Treatment
Because functions of behaviors vary across individuals, Applied Behavior Analysis (ABA) is an
ideal science to foster the development of treatment for stereotypy. ABA uses systematic collection of
data and takes a functional approach toward behavior. As a result of such methods, many types of
treatment for stereotypy have been developed and have been demonstrated to be effective. Some
treatments also address other repetitive behaviors such as tics and SIB. Studies regarding other behaviors
similar to stereotypy will be included as some researchers (e.g., Sprague, Holland, & Thomas, 1997)
assert that both stereotypy and other types of repetitive behavior such SIB can manifest as rhythmic
and/or repetitious patterns. Because of the essential topographical, functional, and developmental
similarities they will be included in the review.
Treatments can be divided into three broad categories, antecedent and consequence
interventions, and a combination of both (packages). Antecedent interventions are those types of
treatments in which the practitioner or experimenter seeks to control behavior through manipulation of
environmental events before the individual has the opportunity to engage in the target behavior. In
contrast, consequence interventions involve the delivery of a consequence contingent upon individual(s)
engaging in the target behavior.
Antecedent Interventions
The main types of antecedent interventions are: environmental enrichment, physical exercise,
non-contingent reinforcement, matched stimulation. Antecedent manipulations are stimulus conditions
that are arranged before a behavior has an opportunity to occur. Their purpose is to arrange stimulus
conditions that decrease the likelihood of target behavior occurrence.
Environmental enrichment. Environmental enrichment involves introduction of a variety of
activities and objects in the environment. Results in previous literature are mixed, some demonstrating a
decrease in stereotypy as more opportunities to engage in activities are available (e.g., Berkson, Mason
8
& Saxon 1963; Horner, 1980; Vollmer, Marcus & Le Blanc, 1994; Ringdahl, Vollmer, Marcus & Roane;
1997) and others (e.g., Duker & Rasing, 1989; McEntee & Saunders,1997) have found results
counterintuitive to this notion.
Physical exercise. Other treatments involve the modification of the individual’s internal
environment, specifically through physical exercise. Several studies examined the effects of jogging on
stereotypy (Kern, Koegal, Dyer, Dunlap, & Fenton, 1982; Kern, Koegal, & Dunlap, 1984). Other
literature investigated the effects of antecedent exercise by evaluating other activities such as roller
skating (Powers, Thibadeau, & Rose, 1992) or playing with leisure items such as rubber playground
balls (Watters & Watters, 1980).
Non-contingent reinforcement. Another antecedent manipulation that has been used for the
successful reduction of stereotypic behavior is noncontingent reinforcement (NCR). The term
noncontingent reinforcement (NCR) refers to the delivery of an aberrant behavior’s known reinforcer on
a response-independent basis (Carr, Coriaty, Wilder, Gaunt, Dozier, Britton, Avina & Reed, 2000).
Treatment effects of NCR after one year of implementation have been demonstrated across a variety of
repetitive behaviors such as SIB ( e.g.,Lindberg, Iwata, Roscoe, Worsdell, & Hanley, 1997) as well as
stereotypy (e.g., Britton, Carr, Landaburu, & Romick, 2002). Noncontingent reinforcement has also been
considered to increase the efficacy of other procedures such as extinction for the reduction of other
aberrant behaviors such as aggression (O’Reilly, et al., 2006; 2007).
Matched stimulation. A behavioral intervention for reduction of stereotypy that can be even
theoretically framed as non-contingent reinforcement is matched stimulation. Matched stimulation is
based on the theoretical premise that some reinforcers may be considered “highly substitutable” and can
be readily traded for each other due to their functional similarity (Green & Freed, 1993). The mechanism
for the reduction of stereotypy is theorized to be that if an item’s properties can effectively substitute for
the products of stereotypy, it serves as an abolishing operation for those consequences. An abolishing
operation (AO) is a motivating operation that decreases the reinforcing effectiveness of a stimulus,
object, or event (Cooper, Heron & Heward, 2007, p. 689).
9
Matched stimulation has been in practice since the late 1970’s (Rincover, Cook, Peoples, &
Packard, 1979) and is also still part of more current interventions (Higbee, Change & Endicott, 2005;
Goh, Iwata, Shore, Deleon, Lerman, Ulrich & Smith, 1995; Piazza, Fisher, Hanley, LeBlanc, Worsdell,
Lindauer, & Keeney, 1998; Fisher, Lindauer, Alterson, & Thompson 1998; Piazza, Adelinis, Hanley,
Goh, & Delia, 2000; Rapp, 2006, 2007). Again, although considerable literature has demonstrated the
efficacy of treatment effects for matched stimulation some studies relate no such effects (e.g., Ahearn,
Clark, Debar, & Florentino, 2005).
Consequence Interventions
Consequence interventions are those which involve the delivery of some type of stimulus or
consequence contingent upon a behavior. The aim of consequence interventions is to create a learning
history for the individual so that if similar stimulus conditions are encountered in the future, the behavior
is less likely to occur. Many consequence interventions that will be discussed involve some form of
punishment. Punishment is defined as the process of arranging a consequence for response that makes
responding less likely. The stimulus specifically arranged as the consequence is labeled a punisher
(Catania, 2007).
Lerman and Vorndran (2002) argue that punishment may be critical to the treatment of some
problem behaviors when the precise source of reinforcement cannot be identified or controlled.
Stereotypy is a prime candidate for punishment interventions; as it is often difficult or impossible to
control delivery of the reinforcer. This may be because the reinforcer is a sensory consequence, or
completely unknown to the clinician/experimenter. Although punishment has been widely studied and
effectively utilized, there is overall agreement that interventions should be designed to be as minimally
intrusive or restrictive as possible (Vorndran & Lerman, 2006).
Early punishment. Early consequence interventions involved the delivery of intrusive stimuli.
These stimuli were assumed to function as punishers and included contingent shock, verbal reprimands,
and even physically shaking the participant (e.g., Baumeister & Forehand, 1972). More humane
interventions such as overcorrection were found to be effective (e.g., Epstein, Doke, Sajwaj, Sorrell, &
10
Rimmer, 1974; Wells, Forehand, Hickey, & Green, 1977; Harris & Wolchik, 1979) even when directly
compared to more intrusive methods such as contingent shock and physical slapping (Fox & Azrin,
1973).
Response cost. Response cost is the contingent removal of a preferred stimulus (Keeney, Fisher,
Adelinis, & Wilder, 2000). It has been demonstrated to be effective either alone or in treatment packages
to reduce a variety of problem behaviors such as: aggression through the contingent removal of
preferred music (Keeney et al., 2000); SIB through the removal of attention contingent upon participant
engagement in SIB; academic off-task behavior in children with ADHD through the removal of points
(Jurbergs, Palcic, & Kelley, 2007); and destructive behavior for a child with Autism by contingent
removal of tokens (Foxx & Meindl, 2007).
Response cost has been utilized in more recent studies and has been found to be effective (e.g.,
Keeney, Fisher, Adelinis, & Wilder, 2000; Falcomata, Roane, Hovanetz & Kettering, 2004; Jurbergs,
Palcic, & Kelley, 2007; Foxx & Meindl, 2007; Athens, Vollmer, Sloman, & Pipkin, 2008).
Differential punishment. Response cost has also been utilized to differentially punish vocal
stereotypy; thereby bringing the aberrant behavior under stimulus control. Stimulus control is exerted
through the repeated presentation of the punisher in the presence of an external stimulus, to the extent
that such pairings eventually inhibit the punished behavior in the presence of that stimulus (for further
explanation, see Rilling, 1977).
Punishing stereotypy in one environment and allowing it to occur in another may seem
counterintuitive. Some may argue that stereotypy should never be allowed to occur; however, one may
also argue that stereotypy is inappropriate only in specific contexts. It has even been demonstrated to
provide some benefits, as studies have shown that contingent access to stereotypy can be used as a
reinforcing event (e.g., Charlop, Kurtz, & Casey, 1990; Hanley, Iwata, Thompson, & Lindberg, 2000). If
an individual has a limited leisure skill repertoire and limited array of stimuli available to effectively
function as reinforcers for other behaviors, access to stereotypy may be utilized as a reinforcer during
educational programming. Examples of interventions that successfully brought stereotypy under control
11
of specific stimuli are: Brusa and Richman (2008) and Rapp, Patel, Ghezzi, O’Flaherty, and Titterington
(2009).
Sensory extinction. Sensory extinction is a procedure in which attempts are made to mask or
remove certain sensory consequences. The procedure was originally developed by Rincover (1979) in
attempts to reduce “self stimulatory” behavior in three children: two with Autism and one with profound
mental retardation. Rincover utilized procedures to mask or remove the auditory, visual, and
proprioceptive consequences that were hypothesized to maintain stereotypic responding for each
participant. For example, auditory feedback from one participant’s plate spinning was removed by
carpeting the table on which the plate was set. Rincover was successful in reducing all participants’
stereotypical behavior through variations of sensory extinction, and other researchers found the
procedure to be useful for object dropping (Dalrymple, 1989) and vocal stereotypy (Aiken & Salzberg,
1984).
Response blocking. In the past, response blocking was thought to be a possible variation of
sensory extinction (Reid, Parsons, Philips, & Green, 1993). However, it is not typical of most extinction
procedures. Response blocking is a procedure in which the target behavior is permitted to occur but the
individual is prevented (usually by physical means) from contacting subsequent reinforcement (Lerman
& Iwata, 1996). In some circumstances, only the precursor to a behavior is allowed to occur before
blocking is implemented. Some argue that an alternative interpretation of the effects of response
blocking is that the physical contact associated with the procedure could function as a punishing
stimulus (Lerman & Iwata, 1996). Response blocking has been demonstrated to be effective for the
reduction of an array of repetitive behaviors that are at least partially maintained by automatic
reinforcement. Such behaviors include but are not limited to: eye gouging (Lalli, Livezey & Kates,
1996) and handmouthing (Reid, Parsons, Philips, & Green, 1993; Lerman & Iwata, 1996; Carr, Dozier,
Patel, Adams & Martin, 2002). Response blocking can also evoke detrimental side effects such as
decreased object interaction (Lerman, Kelley, Vorndran, & VanCamp, 2003) and aggression (Hagopian
& Adelinis, 2001; Hagopian & Toole, 2009).
12
Differential reinforcement of other behavior (DRO). DRO is a laboratory-based schedule in
which reinforcement is delivered if a particular response has not been emitted for a specified interval of
time (Barton, Brulle, & Repp, 1987). It has been demonstrated as effective for reducing handflapping,
headweaving, (Barton, Bulle, & Repp, 1987; Aurand, Sisson, Aach, & Hassalt, 1989) and vocal
stereotypy (Taylor, Hoch, & Weissman, 2005; Rozenblat, Brown, Reeve & Reeve, 2009).
Response interruption and redirection (RIRD). The consequence intervention most relevant to
this study is response interruption and redirection. RIRD has been shown to be effective in suppressing
both motor (Fisher, Lindauer, Alterson & Thompson, 1998; Paisey, Whitney, & Wainczak, 1993;
Thompson, Fisher, Piazza, & Kuhn, 1998) and vocal stereotypy (Ahearn, Clark, & MacDonald, 2007;
Miguel, Clark, Tereshko, & Ahearn, 2009). Given that response interruption in conjunction with other
treatments (noncontingent reinforcement, differential reinforcement of incompatible behavior) has been
shown to be effective for reducing motor stereotypy (Fisher, Lindauer, Alterson & Thompson, 1998;
Paisey, Whitney, & Wainczak, 1993; Thompson, Fisher, Piazza, & Kuhn, 1998) it will be discussed more
in depth regarding the reduction of vocal stereotypy; as this is the topic of interest for this study.
Only three studies on RIRD for the treatment of vocal stereotypy (Ahearn, Clark, & and
MacDonald, 2007; Miguel, Clark, Tereshko, & Ahearn, 2009; Liu-Gitz & Banda, 2010) have been
conducted. Ahearn et al. conducted a study with 4 participants: 2 boys and 2 girls diagnosed with
Autism. They were selected for vocal stereotypy that interfered with participation in educational
activities or occurred at unacceptable levels outside class. Their ages ranged from 3 to 11-years old.
Functional analyses indicated that two participant’s vocal stereotypy was maintained in the absence of
social consequences with a clear differentiation of highest levels in the alone condition; the other two
participants displayed a lack of differentiation in responding, but highest levels occurred during the play
and alone conditions, suggesting an automatic function.
The effects of response interruption and redirection (RIRD) were tested in an ABAB
withdrawal design. Sessions were five minutes long; however, the session clock was stopped for the
entire duration that RIRD was implemented. RIRD consisted of the immediate delivery of three
13
demands either in the form of vocal imitation or social questions, contingent upon participant
engagement in vocal stereotypy. Demands continued to be delivered until the participant complied with
three consecutive demands in the absence of stereotypy. Social praise was delivered at the end of the
third consecutive demand, and appropriate vocalizations were honored (if possible) during all sessions.
Results indicated that stereotypy reduced for all participants as a function of implementing RIRD;
however, appropriate vocalizations increased for only three out of four participants. In addition,
maintenance probes in the natural environment displayed significant treatment gains for three
participants: participant one’s pretreatment levels reduced from a pretreatment range of 33% and 44%,
to a post-treatment range of 1% and 4% in the natural environment. Participant three displayed a
pretreatment range of 25% and 77% and the post-treatment range subsequently reduced to 3% and 13%.
The fourth participant engaged in stereotypy during pretreatment between 54% and 78% of the time, and
during post-treatment engaged in stereotypy for 16% and 24% of observations. Probe data was not
available for participant two.
In a follow-up study, Miguel, Clark, Tereshko, and Ahearn (2009), evaluated the effects of
RIRD as the sole intervention component compared with RIRD in conjunction with a Selective
Serotonin Reuptake Inhibitors (SSRIs) medication. The specific SSRIs medication under examination
was sertraline (Zoloft®) and an ABABC reversal design was used. The participant was a 4-year-old boy
diagnosed with Autism. A functional analysis suggested maintenance of stereotypy via automatic
reinforcement. During baseline conditions there were no programmed consequences for stereotypy,
however the medication of 10 mg of Sertraline was present. Treatment for vocal stereotypy was then
instated through the subsequent treatment phase through the implementation of RIRD (while the
medication was still in place.) The next treatment condition faded out sertraline over the course of five
days and RIRD was still used as a consequence for stereotypy. Follow up sessions were then conducted
with implementation of RIRD in the absence of sertraline; to evaluate the effects of the efficacy of RIRD
with the reduced likelihood that traces of sertraline were present in the participant. Results indicated that
stereotypy during the presence of only sertraline was averaging at 49%, and an immediate decrease to
14
averages around 11% was observed when RIRD was introduced in the following condition. In addition,
appropriate vocalizations averaged 9.3 occurrences per session and increased to 22.4 across all sessions
of RIRD. A reversal following this condition displayed recovery of baseline levels of vocal stereotypy.
During the fading of RIRD effects were replicated as there was again an immediate decrease in vocal
stereotypy and increase in appropriate vocalizations. Follow up sessions confirmed the unlikelihood that
sertraline was influencing responding; as vocal stereotypy remained low and appropriate vocalizations
maintained rates at previous treatment levels.
More recently, Liu-Gitz & Banda (2010) replicated Ahearn et al,. by evaluating the
effectiveness of the RIRD on vocal stereotypy for a ten-year old boy with Autism in an educational
setting. Findings indicated that RIRD effectively reduced vocal stereotypy. Its suppressive effects were
replicated within the participant through use of an ABAB reversal design. This study further expanded
research on RIRD by using social questions related to the participant’s preferred topics (e.g., “Who do
you like in Toy Story?”). The procedure was also implemented by the participant’s teacher, thereby
providing more evidence for feasibility of the implementation in the natural classroom environment.
Purpose
The aforementioned studies on the treatment of stereotypy which are most relevant to this study
are those which examined efficacy of matched stimulation (e.g., Rapp, 2006, 2007) and RIRD for either
vocal (e.g., Ahearn et al., 2007; Miguel et al., 2009; Liu-Gitz & Banda, 2010) or motor stereotypy (e.g.,
Fisher, Lindauer, Alterson & Thompson, 1998; Paisey, Whitney, & Wainczak, 1993; Thompson, Fisher,
Piazza, & Kuhn, 1998). It seems that there are no treatment package analyses of both matched
stimulation (MS) and RIRD components for the reduction of vocal stereotypy. To date, there are only
three published studies on RIRD for the treatment of vocal stereotypy (Ahearn et al., 2007; Liu-Gitz,
2010; Miguel et al., 2009) and none which specifically evaluate both RIRD and MS treatments in
conjunction. Matched stimulation and response interruption and redirection to toy manipulation have
been evaluated together as a treatment package for motor stereotypy (Cicero, 2007) but none to date
have evaluated the package’s efficacy for vocal stereotypy.
15
Hypothetically, access to matched stimulation produces a reduction in vocal stereotypy due its
abolishing effect for the auditory stimulation produced by engagement in vocal stereotypy. Rapp’s
(2006) findings support the notion of the presence of MOs for products of stereotypy in that participant
post session levels of stereotypy were higher after implementation of response blocking; as opposed to
low levels after access to matched stimulation. O’Reilly, Sigafoos, Edrisinha, Lancioni, Cannella, Choi,
and Baretto (2006) evaluated the effects of antecedent manipulations alone and in conjunction with
extinction (EXT). Results of their study also indicated that problem behavior occurred at higher levels
during extinction sessions when participants did not have prior access to the reinforcers. Later studies by
O’Reilly and colleague (2007, 2008) replicated these findings with additional participants and under
more naturalistic conditions. Taken together, these results advocate the supplementation of NCR to
either a punishment or extinction procedure.
In light of these findings, this study will seek to extend the literature that has used combinations
of response interruption and an NCR procedure on motor stereotypy (e.g., Lerman, Kelley, Vorndran,
and Van Camp, 2003; Thompson et al., 1998; Fisher, Lindauer, Alterson, and Thompson, 1998; Carr,
Dozier, Patel, Adams, & Martin, 2002) to the behavior of vocal stereotypy. The matched stimulation in
conjunction with RIRD condition will be evaluated to determine if matched stimulation can increase the
effectiveness of RIRD by (theoretically) abolishing or attenuating the MO for the auditory products of
vocal stereotypy. The treatment phase comprised solely of RIRD will experimentally demonstrate
whether vocal stereotypy will remain suppressed; given that the MO will again be present.
There are several purposes of this study. The first is to extend treatment packages comprised of
response interruption and NCR for reduction of motor stereotypy (e.g., Lerman, Kelley, Vorndran, and
Van Camp, 2003; Thompson et al., 1998; Fisher, Lindauer, Alterson, and Thompson, 1998; Carr, Dozier,
Patel, Adams, & Martin, 2002; Cicero, 2007) to the behavior of vocal stereotypy. Next, it will also
extend sparse literature which has evaluated RIRD for the treatment of vocal stereotypy (Ahearn et al.,
2007; Miguel et al., 2009; Liu-Gitz & Banda, 2010). It will also evaluate effects of antecedent
manipulations on the efficacy of punishment procedures (RIRD specifically) as opposed to extinction
16
procedures (O’Reilly et al., 2006; 2007; 2008). Finally, it will evaluate relative efficacy of MS and
RIRD treatment components both alone and in combination for the suppression of vocal stereotypy. This
will be accomplished through a component analysis within a reversal design.
17
Chapter 2
METHOD
Participants, Setting and Materials
Participants were two children with a diagnosis of Autism Spectrum Disorder (ASD) (DSM IVTR, 2005, American Psychiatric Association, 2005). Participants were recruited through direct caregiver
contact. Both participants were able to communicate vocally and could sit for a minimum of 5 minutes at
a desk or chair in the absence of aggression (for example, hitting, kicking, punching, etc.) or self-injury
(e.g., scratching, hitting, biting him/herself.) Finally, both participants were found to engage in vocal
stereotypy that was at least partially maintained by automatic reinforcement as determined by a
functional analysis (Iwata, Dorsey, Slifer, Bauman and Richman, 1982/1994). Participants were referred
to the study by parents because the repetitive language was intrusive in either school settings, public
settings, or both.
Ivan was an 8 year old male whose primary means of communication was vocal behavior. He
was able to request for items using the mand frame, “I want _____,” but was not observed to do so
unless the item was very highly preferred. He could tact colors, numbers, count, and his fine motor skills
were that of typical peers. His parents reported that language deficits and vocal stereotypy were the areas
containing his greatest deficits and that his academic skills were comparable to typical peers. His
sessions were conducted in the parent’s home located in Folsom, California. Sessions were conducted in
the participant’s bedroom. The room was 9 by 11 feet and was equipped with a bed, a small table and
two chairs, various leisure items, and dual-mirrored closet doors. Ivan was not on any kind of
medications throughout the duration of the study. Sessions were conducted 2-3 days per week, and total
session duration varied depending on the condition.
Troy was a 9 year old male who was able to request for items using full sentences (e.g., “I want
Elmo please.”). He could also tact colors, count, and identify numbers. His parents reported that his
general academic abilities were comparable to his same-age peers. He did not take any medication for
18
the duration of the study, and sessions were conducted in the experimental room at the university. The
room was 7 by 10 feet and equipped with a table and two chairs, a bulletin board, and equipped with a
video camera and toys. Sessions were conducted 3 days per week, and total session duration varied
depending on the condition.
Stimulus Preference Assessment
The preference assessment was used to identify potentially reinforcing items in a systematic
manner; as reinforcement effects are often idiosyncratic across individuals (Vollmer & Iwata, 1991).
Before any assessments began, three sessions of a multiple stimulus without replacement (MSWO)
preference assessment were conducted. The procedure was based on those by DeLeon and Iwata (1996).
Some items used for the preference assessments were identified via a modified Reinforcer Assessment
for Individuals with Severe Disabilities (RAISD) form (Fisher, Piazza, Bowman, & Amari, 1996; see
Appendix A). Other items used were supplied by the experimenter and anecdotally observed as
preferred.
The brief MSWO assessments functioned to identify preferred items pertinent to the
individual's current motivating operation(s), prevent satiation of items by identifying several preferred
items to rotate between or among sessions, and reaffirm in a systematic manner that items used during
previous session(s) remain preferred. The selection of the brief MSWO preference assessment was
chosen based on results of Carr, Nicolson, and Higbee (2000). It also served to identify the relative
rankings of preference among items. Finally, the brevity of assessments were used to prevent satiation
effects during sessions that required leisure items (Egel, 1981; Roane, Vollmer, Ringdahl and Marcus,
1998).
Ten items were present for an initial 3 sessions of the brief MSWO. After the initial 3 sessions,
the seven items identified as highly and moderately preferred were made available during the daily,
single sessions of a brief MSWO. A single brief MSWO was conducted each day before sessions
commenced.
19
Leisure items were arranged in a semi-circle on the floor, and the participant was free to
manipulate the item(s) of his/her choice. The participant began on the outside of the semi-circle. Prior to
a session, the experimenter led the participant around the circle to ensure contact each stimulus. During
initial sampling, the experimenter placed the participant’s hand on the items and modeled appropriate
item manipulation. After each item was sampled, the participant was moved approximately 0.6 m (about
2 feet) from the assessment area. The therapist then withdrew from the assessment area, and the
assessment began.
The experimenter then delivered the instruction, “Go play” and the participant selected an item.
The experimenter was located beside the stimulus array and presented social attention. Upon selection,
participants had 30-s to engage with the item while the experimenter randomly rearranged the remaining
items to a new location. Items were rearranged so that they were across the circle from their previous
location. Rearrangement of items helped to control for location bias. After the 30-s elapsed, the item was
removed from the array. This process continued until only one item remained or no response occurred
for 30-s.
During the assessment, observers scored item selection by recording the order in which items
were chosen. A choice was defined as any participant contact with an item using his or her hand, and
manipulating the object for 5 seconds or longer.
Only one brief MSWO assessment was conducted each day before sessions, regardless of the
number of sessions. Items classified as highly preferred were those that were ranked overall first to third
of the pool, while moderately preferred items were items that were overall ranked fourth through
seventh. Scoring for the preference assessment was live.
Items used for the functional analysis (FA) sessions were highly and moderately preferred toys
that did not produce sound. The use of toys that did not produce sounds served to control for potential
suppressive effects that these sounds may have exerted on stereotypy levels (e.g., Fisher, Lindauer,
Alterson, & Thompson, 1998; Higbee, Chang, & Endicot, 2005; and Rapp 2006, 2007). Highly
preferred items that were used during FA sessions were not anecdotally observed to suppress stereotypy.
20
The four items identified as moderately preferred from the daily MSWO were used during the treatment
and baseline sessions. Items were rotated to prevent satiation (Egel, 1981).
For Ivan, a Mr. Potato Head, mosaic magnet and face-making magnet toys, books and puzzles,
animal figurines, coloring books, cars, whiteboard, Dora blocks, and Diego blocks were made available
during the preference assessment. The same toys were made available for Troy during the intial MSWO.
Before treatment began, new toys were introduced for Troy due to satiation effects of the first set. The
second set consisted of a wire ball toy, silly putty, magna doodle, magnet and faces toy, a pin-head toy,
cars, “Don’t break the Ice” game, Mr. Potato Head, coloring books, and whiteboard.
Response Measurement
For Ivan, vocal stereotypy was defined as any instance of noncontextual phrases or repetitions
of noncontextual words, phrases or sounds. It included repetitions of phonemes (e.g. “Na na na”) or
phrases (e.g. “J is for Jaguar.”), delayed echolalia (e.g., “We go to the Dr. First, then blockbuster”), lip
popping and repetitious sounds with a closed mouth (e.g. “bbbbbb” sound with mouth closed but lips
vibrate). Sound effects in the absence of appropriate toys (e.g., “Shoo!” or “Vroom”), rhythmic breathing
patterns (“huh huh huh” or “heh heh heh”), and noncontextual repetitive “Blowing” (as though blowing
out a candle in the absence of appropriate stimuli) were also included. Appropriate vocalizations
included requests for items, attention, or breaks. Tacting items (e.g. “Tiger” in the presence of a tiger
figurine) and repeating a delivered instruction were also appropriate responses.
For Troy, vocal stereotypy was defined as any instance of noncontextual or nonfunctional
speech, it included breathing in rhythmic or patterned episodes (“huh huh huh” or “heh heh heh”),
“sipping sounds” (breathing inward through pursed lips), and single episodes of the phoneme “MMM”.
Repetitions of words, phonemes (k-k-k, tuh tuh tuh), or noncontextual high pitched squeals or squeaks,
and reciting of movie or video game scripts were also included. Conversely, appropriate vocalizations
included requests for items, attention, or breaks, tacting items, (e.g. “Blue” in the presence of a blue toy),
or singing or humming with a tune while playing with toys.
21
For both participants, repetitive mands (e.g., “I want break, I want break”), or tacts (e.g., “Tiger,
Tiger”) were not scored as stereotypy unless the phrase was noncontextual (e.g., “Crocodile, Crocodile”
when no crocodile was present, or when the participant wasn’t looking at the crocodile while repeating
the tact). Data on vocal stereotypy were collected using continuous duration recording as modeled by
Ahearn, et al. (2007) (see Appendix B). This consisted of dividing the total number of seconds in which
vocal stereotypy occurred by the total number of seconds in the session (300 s) multiplied by 100%.
Interobserver agreement was calculated by dividing the number of intervals with agreements by the total
number of intervals with agreements plus disagreements and multiplying by 100%.
Functional Analysis
To experimentally determine the function of the participant’s vocal stereotypy, a functional
analysis (FA) was conducted (Iwata et al., 1982/1994). Three conditions were included in the functional
analysis in the fixed order: no consequence, attention, and demand. The rationale for the fixed order was
to increase the likelihood that the appropriate corresponding motivating operations for each consequence
were present for each condition. The purpose of the FA was to determine if the function of vocal
stereotypy was not mediated by social consequences; namely, maintained by automatic reinforcement.
For the purpose of this study, only participants who had automatically maintained stereotypy were
retained for the experiment. Results from the functional analysis were used to systematically infer the
function(s) of each participant’s engagement in vocal stereotypy. Previous studies have shown than
stereotypy can be maintained by socially mediated consequences (Kennedy, Meyer, Knowles, & Shukla,
2000). Functions of stereotypy were evaluated through visual inspection and comparison of each
condition’s data via a scatter-plot graph.
Assessment Design
Each session was five minutes in duration, as brief sessions in functional analyses have been
experimentally demonstrated to yield results equivalent to longer session lengths such as 15 minutes
(Wallace & Iwata, 1999). The abbreviated functional analysis was conducted according to procedures by
Roscoe, Carreau, MacDonald, and Pence (2008). The same experimenter conducted the all conditions of
22
the functional analysis for both participants. A 2:1 ratio of no consequence conditions per attention and
demand was conducted. This ratio was found by Roscoe and colleagues to be effective to more quickly
assess the function of a behavior if it is maintained by automatic reinforcement. This method was
considered appropriate as both participants’ stereotypy appeared to be insensitive to social consequences
during intake observations.
Assessment Conditions
For both Ivan and Troy, a no consequence condition was implemented based on the procedures
of Athens and colleagues (2008). A no consequence condition was used for Ivan instead of a not
interaction because parent report indicated that he frequently engaged in stereotypy when playing alone
with toys. A no consequence condition was used for Troy because he was frequently observed to elope
from the experimental room in the absence of a tangible items or activities. He was also observed to
wiggle loose teeth in the absence of an activity. This behavior directly competed with stereotypy, so this
modification was deemed appropriate.
No Consequence. The purpose of this condition was to evaluate stereotypy in the absence of
social consequences. In other words, to test for maintenance though automatic positive or automatic
negative reinforcement. The participant had access to two moderately preferred toys that did not produce
sound. The experimenter sat in a chair across from the participant and neither talked nor looked at the
participant. The person filming was across from the participant and also did not interact with him. Any
objects that may have produced sound if hit (e.g., a metal bookshelf) were removed if possible. No
edible items were made available. Moderately preferred toys were used so that they would not compete
with stereotypy (Ahearn et al., 2005). In other words, no social consequences were delivered if
stereotypy occurred. Appropriate vocalizations were not reinforced.
If the behavior persists under in the absence of social consequences, evidence is provided that
the behavior is possibly maintained by some aspect of the sensory consequences that the behavior(s)
produce (e.g., Rincover, 1978; Rincover, Cook, Peoples, & Packard, 1979; Lovaas, Newsom, &
23
Hickman, 1987); or possibly attenuate private stimuli such as aversive physiological stimulation (Van
Camp, et al., 2000).
Attention. The purpose of this condition test was to test sensitivity of stereotypy to social
positive reinforcement. In previous literature, bizarre and repetitive vocalizations have been found by
either functional analysis or experimental design to be maintained by or at least sensitive to social
consequences such as the delivery of attention (Liberman, Teigen, Patterson, & Baker, 1973; Wilder,
Masuda, O’Conner, & Baham, 2001; Arntzen, Tønnessen, & Brouwer, 2006).
In this condition, the participant and experimenter sat in a room where two moderately
preferred toys (that did not produce sound) were available on a table. Only two toys were made available
because previous research has shown that stimulus variation with low to moderately preferred stimuli
can compete with highly preferred stimuli (Najdowski, Wallace, Penrod, & Cleveland, 2005). This was
to prevent the possibility that a variety of stimuli may compete with attention as a reinforcer. No edible
items were made available.
The experimenter directed the participant to "play with the toys" while she "does some work."
The experimenter sat in a chair across the room and behaved to look as though she was reading a book
or magazine. Contingent upon the participant engaging in vocal stereotypy, the experimenter responded
with a brief verbal interaction (e.g., “Please be quiet,” or “That’s too loud”) paired with brief physical
contact of a non-punitive nature (e.g., hand on shoulder). The experimenter responded to the participant
on an FR 1 schedule for each occurrence of vocal stereotypy. All other behaviors were ignored.
Appropriate vocalizations were not reinforced during this condition, as was considered implementation
of treatment.
Demand. The demand condition is designed to approximate stimulus conditions in the natural
environment in which vocal stereotypy may be maintained though social negative reinforcement by
producing the postponement, reduction, or removal of a demand/task. Previous literature (Durand &
Carr, 1987; Durand & Crimmins, 1987; and Mace & Belfiore, 1990) has found a range of aberrant
24
and/or repetitive vocalizations that serve this function or are at least sensitive to the aforementioned
social consequences.
In the demand condition, the experimenter presented tasks similar to those presented during the
participant’s school or day treatment program. Tasks were selected based on caregiver report and
consisted of 4 tasks relevant to the participant’s programming at school or in afterschool programs.
Tasks were not mastered (e.g. less than 80% correct) and non-vocal to allow physical prompting if
needed. Tasks were randomly rotated. Demands for Ivan included: hanging a shirt on a coat hanger,
tying a shoe, folding a shirt, and buttoning a shirt. Demands for Troy included: solving 3-digit
multiplication problems, tying a shoe, catching a ball, and putting pennies into a box with one hand.
A least-to-most prompting hierarchy was used for all task presentations. Contingent upon the
participant engaging in stereotypy, the experimenter removed the task for 15 seconds. This procedure
was implemented on a reinforcement schedule of FR 1. The experimenter did not reinforce appropriate
vocalizations during this condition. No edible items or toys were made available.
Assessment of Matched Stimuli
Assessment Design
The purpose of this pre-experimental procedure was to demonstrate that the items used in the
treatment conditions would suppress vocal stereotypy and were therefore appropriately classified as
“matched stimuli.” The assessment was conducted in multielement fashion and three conditions were
rapidly alternated: baseline, toys with sound, and toys with no sound. Baseline was alternated with one
condition at a time to avoid carryover effects. During phase one, baseline was rapidly alternated with
toys with sound condition, during phase two, baseline was rapidly alternated with toys with no sound
condition. Phase one was then reinstated to replicate effects of matched toys.
Assessment Conditions
Baseline (no interaction). The purpose of the baseline condition was to evaluate vocal
stereotypy levels in the presence of the experimenter only. The experimenter sat in the room with the
participant, but did not interact with him/her in any way. No leisure items or materials were present. Any
25
objects in the room were removed which potentially produced sound if hit (e.g., a metal bookshelf).
Although sessions began seated in a chair, the participant was free to move about the room and was not
redirected back to it.
Toys with sound. The purpose of the toys with sound condition was to evaluate vocal stereotypy
levels in the presence of toys which produced sound. All items made available produced some form of
auditory stimulation; as it was assumed that the auditory stimulation matched or effectively substituted
for the sensory consequences typically produced by engaging in vocal stereotypy (Rapp 2007). Four
preferred items (as indicated by the preference assessment) were used. These toys were anecdotally
observed to be associated with low levels of stereotypy. Two sets comprised of two toys each were
evaluated in the matched stimulation assessment.
The participant was seated at a table or on the floor and presented with the matched stimuli. If
the participant did not manipulate an item (to produce the sound) for a minimum of two seconds, the
experimenter manipulated an item to produce auditory stimulation. This functioned to ensure consistent
delivery of matched stimulation throughout and across sessions. After demonstrating that in the presence
of both sets of toys stereotypy was at least partially suppressed; the two sets were used and rotated
during treatment conditions which required a matched stimulation component. Sets were rotated during
treatment conditions to avoid satiation effects.
Toys without sound. The purpose of the toys without sound condition was to evaluate vocal
stereotypy levels in the presence of the same toys as those utilized in the “toys with sound” condition;
however the toys’ batteries were removed. This sought to isolate the effects of the toys’ sounds on vocal
stereotypy; leaving only tactile and visual stimulation.
Treatment
Response Measurement
Data were collected on five dependent variables for each participant: vocal stereotypy,
appropriate vocalizations, frequency of implementation of RIRD, and session length, and social validity
scores. Vocal stereotypy was measured using continuous duration recording (Ahearn et al., 2007). The
26
total number of seconds of participant engagement in vocal stereotypy in each session was divided by
the total number of seconds in the session (300 s) and multiplying the quotient by 100% to calculate the
proportion of the session in which stereotypic behavior occurred.
A duration recording method was chosen to measure stereotypy because recent literature on
response interruption and redirection and matched stimulation (e.g., Ahearn et al., 2007; Rapp, 2006,
2007) employed such methods. In addition, previous literature for other interventions for stereotypical
behavior such as McEntee and Saunders (1997) and Fisher, Lindauer, Alterson, and Thompson (1998)
utilized the same measurement method. Further support for duration recording is voiced by Gardenier,
MacDonald, and Green (2004). They assert that duration recording is the most preferred method for
accuracy of recording of multidimensional behaviors such as stereotypy; although more convenient
methods such as momentary time sampling (MTS) have been shown to be accurate for applied settings.
Appropriate vocalizations and implementations of RIRD were measured in cumulative
frequency per session for each participant. One RIRD implementation was defined with the onset as the
experimenter saying the participant’s name, prompt delivery and participant compliance with 3 vocal
imitation/social questions, and the end consisted of the experimenter completing delivery of verbal
praise (e.g., “Nice job talking”). Cumulative frequency recording method was chosen as an appropriate
measure for both appropriate vocalizations and implementation of RIRD during each session because
they were typically observed in discrete episodes for these participants.
Experimental Design and Conditions
A multitreatment design was used to compare the effects of Response Interruption and
Redirection (RIRD) alone versus exposure to matched stimulation implemented in conjunction with
RIRD (Holcomb & Wolery, 1994). The letter “A” represented baseline, “B” was RIRD and matched
stimulation implemented together, “C” was matched stimulation alone, and “D” represented RIRD
alone. The conditions “C’ and “D” were counterbalanced across participants. Finally, the letter “E”
represented the most effective treatment.
27
For all participants, RIRD and matched stimulation were simultaneously introduced after the
initial baseline. After evaluation of RIRD and matched stimulation together, baseline conditions were
reinstated. The matched stimulation component was systematically removed and counterbalanced across
participants in subsequent conditions. This experimentally evaluated rates of stereotypy and appropriate
vocalizations during conditions in which the establishing operation (EO) for stereotypy was present
(RIRD only) and in which it was absent (matched stimulation in conjunction with RIRD). It also
functioned to control for sequence effects. The experiment ended with the reinstatement of the treatment
associated with the greatest suppression of vocal stereotypy.
Reversal components were added to Ivan’s design between RIRD alone conditions, MS alone
conditions, and before the final condition. It functioned to demonstrate experimental control and an
absolute treatment effect because a relative treatment effect between MS alone, RIRD alone, and MS +
RIRD were not discernable. The final condition for Ivan was RIRD alone because it was associated with
the highest levels of appropriate vocalizations. These additions made the final experimental design for
Ivan to be an ABABCDADACAD design. For Troy, reversal components were instated before the
introduction of each component alone to demonstrate experimental control, as well as to help reveal
relative treatment effects. Troy’s experiment ended with MS + RIRD because it was associated with
fewer implementations of RIRD and a similar suppression to RIRD alone. MS + RIRD was also deemed
more practical if the parents were to be trained on the procedures because it was associated with fewer
implementations than RIRD alone. These additions made the final experimental design for Troy to be an
ABABADACAB design.
RIRD probes. Prior to treatment, probes were conducted to identify appropriate vocal demands
for use during conditions containing an RIRD component. Vocal probes were conducted to assess
fluency of vocal imitation of mastered words, or responding to social questions (depending on the skill
level of the child) to which participants could consistently respond. The skills were selected based on
prior mastery as indicated by teacher or caregiver report. Fluency was defined as responding correctly
28
and independently (without prompts) for both vocal imitation and/or answering social questions, across
at least two previous teachers and settings.
Specifically, a list was created of 15 vocal imitations or social questions. These items were
identified as those that the child could emit both fluently and independently. Three lists containing ten
items were created and randomly rotated across all sessions (see Appendix C, D, and E). All words were
asked in a systematic order from the lists created during the probe session. The purpose of the lists was
to increase the likelihood of demand consistency across all experimenters.
The order of items for each list was randomly selected by assigning numbers to each item and
then drawing numbers from a hat. During session the lists were placed out of participant view on the
floor underneath the table. The three lists were rotated so that a different list was used every day (see
Appendices D and E). Prior to the start of the study, vocal skills were probed across two different
experimenters and two different settings for 89% accuracy and fluency.
Baseline. The purpose of the baseline condition was to provide a contrast condition to evaluate
responding under stimulus conditions in which the independent variables were not present. Essentially,
the baseline functioned as a predictor of the target behavior if left untreated (Wacker, et al., 1990).
Baseline conditions were conducted before any treatment conditions were instated. Baseline conditions
were also reinstated during reversal phases.
During this condition the participant was seated at a table, presented with two toys, and had the
opportunity to interact with the experimenter. The experimenter smiled and visually attended to the
participant while he played, but did not say anything unless an appropriate vocalization was emitted.
The two toys were identified as moderately preferred from the preference assessment and did not
produce auditory stimulation. Moderately preferred toys were used, as previous literature has shown that
highly preferred items, which produce unmatched stimulation, can occasion reductions in vocal
stereotypy (e.g., Ahearn et al., 2005). No programmed consequences were implemented contingent upon
vocal stereotypy. Response cost was not implemented during baseline as it was considered an inherent
part of the RIRD procedure.
29
If the participant left his chair, a least-to-most prompting hierarchy was used to redirect him
back to the chair. The least-to-most prompting hierarchy was implemented as modeled by Wilder,
Atwell, and Wine (2006). The participant had the opportunity to manipulate only one toy at a time. He
could produce the other toy by requesting the item. Both prompted and unprompted requests were
reinforced. In addition, if the participant did not manipulate an item for 5 or more seconds, the
experimenter would move the toy closer to the participant, or rearrange pieces of it to occasion visual
attending to the toy and manipulation of the item.
Appropriate vocalizations were followed by praise and, in case of a mand, the delivering of the
requested item if possible. For instance, if the participant said, ‘‘I want clapping,’’ the experimenter
responded by saying, ‘‘Nice job asking for clapping,’’ and briefly clapped for the participant. If the
participant requested an item (e.g., soda) that was not available, the experimenter responded by saying,
‘‘Nice job asking for soda, maybe we can have some later.’’
Baseline was implemented for at least three sessions or until vocal stereotypy displayed a
steady state and no trend in the data path. If a steady state was not achieved within 10 sessions of any
particular condition, the next condition was instated.
Matched stimulation in conjunction with RIRD. The main purpose of this condition was to
evaluate the effect(s) of the presence of matched stimuli as well as contingent delivery of the RIRD
procedure on levels of vocal stereotypy. Responding in this condition was compared to response levels
in baseline as well as the RIRD alone and matched stimulation alone.
This treatment condition was adapted from both Rapp (2007) for matched stimulation
procedures and Ahearn et al. (2007) for the RIRD procedure. In the matched stimulation plus RIRD
condition, the experimenter was present in the room with the participant. The participant had continuous
access to two toys that produce auditory stimulation. These were either set 1 or set 2 from the matched
stimuli assessment. The two sets of matched stimuli were rotated when more than one session was
conducted each day. The participant had the opportunity to manipulate only one toy at a time. He could
produce the other toy by requesting the item. The experimenter smiled and visually attended to the
30
participant while he played, but did not say anything unless an appropriate vocalization or stereotypy
was emitted.
A session clock/stopwatch started when session began. The participant was seated at a table and
had the opportunity to engage with two toys and interact with the experimenter. Contingent upon
engagement in vocal stereotypy, participant responding was interrupted and re-directed by the
experimenter as described by Ahearn et al. (2007).
The experimenter implemented interruption by saying the participant’s name, and delivering
instructions to occasion 3 consecutive appropriate vocalizations from the participant. If the participant
was engaging with a toy, it was removed until RIRD was completed. This procedure was classified as
response cost (Falcomata, Roane, Hovanetz, & Kettering, 2004). Response cost was implemented
according to the following protocol: contingent upon participant engagement in vocal stereotypy, the
experimenter removed the participant’s current leisure item from his/her physical grasp until RIRD was
completed. The item was returned to the participant contingent upon the absence of vocal stereotypy and
the emission of a prompted or unprompted appropriate request according to his skill level.
Response cost was incorporated into the RIRD procedure to increase the likelihood of
participant attending to the experimenter and complying with the vocal demands. In addition, response
cost also set the occasion for appropriate vocalizations, by creating a motivating operation for the toy.
In other words, response cost had the potential to alter the reinforcing effects of a particular item, and
evoke appropriate manding from the participant. Prompts were delivered if the participant did not ask for
the item back within 3 seconds after RIRD was completed. If the participant reached toward an item and
did not request, a 2 second delay was inserted before the prompt (“What do you want?”) was delivered.
This was inserted to avoid possible adventitious reinforcement of a reaching and requesting chain.
RIRD was delivered in the following manner: Contingent upon engagement in vocal
stereotypy, the experimenter said the participant’s name in a neutral tone of voice to evoke attending. At
this time a secondary observer stopped the session clock. The experimenter simultaneously initiated eye
contact with the participant and issued the instructions to occasion a vocal imitation response. The
31
instructions were a series of 3 consecutive vocal imitations of words (e.g., “Troy say ‘hopscotch,’, say
‘binder,’ say, ‘sofa’). If the participant engaged in stereotypy between appropriate responses,
instructions continued to be delivered until the participant emitted 3 consecutive appropriate
vocalizations. If the participant requested appropriately for the item during RIRD implementation, the
experimenter acknowledged the response and replied with, “in a minute we can have ____,” and then
continued delivering vocal imitation instructions until three consecutive vocalizations were emitted.
After the participant complied with the 3 vocal imitation instructions, the experimenter
delivered verbal praise (e.g., “Nice job talking”). Compliance was defined as the participant engaging in
three consecutive appropriate vocalizations in the absence of stereotypy. When the secondary observer
heard the completion of verbal praise, the session clock was resumed. In addition, the leisure item was
returned to the participant contingent upon appropriate requesting. If the participant was engaging in
vocal stereotypy at the time the experimenter returned the item, the item was removed again and RIRD
was implemented. All behaviors other than vocal stereotypy and appropriate vocalizations were ignored
(e.g. throwing of items, hitting the table). Sessions ended when 5 minutes elapsed as timed by the
session clock.
RIRD alone. This condition was implemented in the same manner as the matched stimulation
plus RIRD condition, although the two moderately preferred leisure items that were made available to
the participant did not produce any sound. The items were identified as moderately preferred from the
day’s corresponding preference assessment. Moderately preferred toys were used because highly
preferred items that produce unmatched stimulation have been demonstrated to suppress vocal
stereotypy (e.g., Ahearn et al., 2005).
Matched stimulation alone. The purpose of the matched stimulation alone condition was to
evaluate levels of stereotypy in the presence of toys that produce matched stimulation (sound). This
condition was exactly the same as the MS in conjunction with RIRD condition; however, neither RIRD
nor response cost was implemented. Essentially, no programmed consequences were delivered
32
contingent upon stereotypy. The experimenter smiled and visually attended to the participant while he
played, but did not say anything unless an appropriate vocalization was emitted.
To facilitate participant discrimination between matched stimulation and RIRD and RIRD
alone conditions, the experimenter wore a blue shirt when matched stimulation was available (paired
with the Matched stimulation + RIRD condition) and a black shirt when matched stimulation was not
available (paired with the RIRD alone condition). The experimenter also paired the instruction with the
blue shirt, “We’re going to play with toys that make noise.” With the black shirt, the experimenter
paired the instruction, “We’re going to play with quiet toys.” For baseline conditions, the experimenter
wore any color shirt other than blue or black and no instructions were given. These stimuli were used
because utilization of discriminative stimuli has been demonstrated to aid participant discrimination
between similar conditions (Doughty, Anderson, Doughty, Williams & Saunders, 2007).
Social Validity
The purpose of the social validity portion of the study was to better understand the likelihood of
caregiver comfort with watching, receiving training, and potentially implementing RIRD or matched
stimulation themselves. It was measured at the conclusion of the study through two questionnaires to
assess caregiver opinion on practicality and feasibility of each procedure. Caregiver opinion was
expressed using a 5-point Likert-scale. A lowest rating of 1 represented “strongly disagree” and the
highest rating of 5 represented “strongly agree.” Twenty-one items were included in total. Examples of
RIRD items included responding to statements such as “I liked the vocal RIRD procedure”, “If trained, I
could easily implement this procedure in my home”, etc. (see Appendix E). An example of an item for
the matched stimulation procedure included, responding to such statements as “Matched stimulation
reduced my child’s stereotypy during the session,” and “I liked the matched stimulation procedure” (see
Appendix F). The numerical scores were calculated to interpret the overall social validity of the study. In
addition, an open ended section concluded the questionnaire to provide an opportunity for caregivers to
express additional comments.
33
Interobserver Agreement (IOA)
A secondary observer who was previously trained in behavioral observation also scored data
on at least 33% of all conditions by watching the video footage. IOA was calculated for all parts of the
experiment: the functional analysis, matched stimuli assessment, baseline, and treatment sessions. An
exact agreement calculation method was used for vocal stereotypy (using the total seconds of vocal
experiment. Stereotypy was recorded by each observer and agreement was calculated as adapted from
Ahearn et al. (2007). It was calculated by dividing the smaller total of seconds recorded by one observer
by the larger total of seconds by the second observer; and then multiplied by 100%.
IOA was also calculated for appropriate vocalizations and implementations using an exact
agreement method. It was calculated for each participant by comparing the cumulative frequencies
recorded by observers. The smaller total from one observer was divided by the larger total from the
second observer, and multiplied by 100%.
During the functional analysis IOA assessed for Ivan on average 44% of all sessions.
Agreement for the occurrence of vocal stereotypy was an average of 97.0% (range 92-100%) across all
conditions. For Troy, IOA was assessed an average of 42% of all sessions of the functional analysis.
Agreement for the occurrence of vocal stereotypy was an average of 97.1% (range 91-100%).
For the matched stimuli assessment, IOA assessed for Ivan an average of 33% for set one and
33% of sessions for set two. For set one, agreement for the agreement for the occurrence of vocal
stereotypy was an average of 98.5% (range 95 – 100%). For set two, agreement for the occurrence of
vocal stereotypy was an average of 99.0% (range 97-100%). For Troy’s matched stimuli assessment,
IOA was assessed an average of 39% of sessions for set one and 38% of sessions for set 2. For set one,
agreement for the occurrence of vocal stereotypy was an average of 97.9% (range 94-100%). For set
two, agreement for the occurrence of vocal stereotypy was an average of 97.8% (range 93-100%).
For the experiment, mean IOA for vocal stereotypy and appropriate vocalizations was assessed.
IOA for Ivan was conducted on 38% of sessions. Agreement for the occurrence of vocal stereotypy was
98.9% (range 92-100%). Agreement for the occurrence of appropriate vocalizations was 100% across all
34
conditions. IOA for Troy was conducted on 38% of sessions. Agreement for the occurrence of vocal
stereotypy was 96.9% (range 80-100%) across all conditions. Agreement for the occurrence of
appropriate vocalizations was 100% across all conditions.
Across both participants, overall IOA for vocal stereotypy was an average of 97.9% and overall
IOA for appropriate vocalizations was 100%.
Treatment Integrity
Treatment integrity can provide stronger support for the independent variable as the source of
behavior change Gresham, Gansle, and Noell, (1993). For this experiment, treatment integrity of RIRD
was assessed for an overall average of 41% of sessions. Treatment integrity for matched stimulation was
assessed an average of 36% of sessions.
For the treatment integrity assessment of RIRD, each implementation was comprised of two
parts (see Appendix G). Part one was scored as correct (+) if the experimenter delivered RIRD
immediately (within two seconds) contingent upon vocal stereotypy. Likewise, part two was scored as
correct if experimenters ensured that participants responded with three consecutive compliances in the
absence of stereotypy. The entire implementation trial was scored as incorrect (-) if either part of RIRD
was implemented incorrectly. The total number of correct trials for RIRD delivery was divided by the
total number of opportunities to implement RIRD in the session. The quotient was multiplied by 100 to
yield a percentage of overall integrity for RIRD.
Finally, treatment integrity was also gathered for the conditions that required the delivery of
matched stimulation (see Appendix H). Delivery was evaluated using a partial interval recording
method. Five second intervals were used. An interval was scored as containing matched stimulation if at
any time during the 5-second interval the toys’ sounds were present. The total number of intervals for
each session (60) was divided by the number of intervals scored as containing matched stimulation. The
quotient was multiplied by 100 to yield an overall percentage of integrity for matched stimulation.
Session percentages were then added and averaged to yield a percentage of overall integrity of matched
stimulation for each participant.
35
Across both participants, treatment integrity for implementation of RIRD was 96.0% (range 92100%). In addition, matched stimulation was present for an average of 99.3% (range 93-100%) of
session intervals across both participants.
36
Chapter 3
RESULTS
Stimulus Preference Assessment
The results of Ivan’s initial stimulus preference assessment of quiet toys yielded an animal
puzzle, coloring book, and magnet toys as highly preferred. Animal figurines, Dora blocks, a
whiteboard, and Play-doh™ were moderately preferred. It was found anecdotally that Play-doh ™
occasioned mouthing and competed with stereotypy, so the next preferred item (Mr. Potato head) was
used. The results of the preference assessment using sound toys showed that a toy phone, Incredibles ™
book, and fire truck were highly preferred. A leapfrog™ letter board, Elmo ™ piano, toy helicopter, and
ladybug-shaped song toy were moderately preferred. Anecdotal observations noted that the fire truck and
ladybug occasioning moderate levels of stereotypy; therefore these toys were not used during the
matched stimulation assessment. The four most highly preferred toys included in the matched
stimulation assessment were the toy phone, Incredibles ™ book, leapfrog ™ letter board, and Elmo ™
piano. For Troy, the results of his stimulus preference assessment of quiet toys showed that Dora ™
blocks, Diego ™ blocks, and Play-doh™ were highly preferred. A Mr. Potato head, puzzles, cars, and
figurines were found to be moderately preferred. It was anecdotally found that cars competed with
stereotypy because of the rolling sound the wheels made, so the next preferred item (magnet toys)
replaced cars. A second preference assessment was conducted before the experiment began due to
satiation effects. The results of this assessment showed Don’t Break the Ice™, a magna doodle, and silly
putty to be highly preferred. Magnet toys, a pin-head toy, coloring books, and a folding wire-ball were
found to be moderately preferred.
Results of the preference assessment for sound toys showed a Disney™ Hunchback of Notre
Dame electronic book, ladybug song toy, and Elmo™ piano were highly preferred. A musical helicopter,
quacking duck keychain light, and Elmo™ poke toy were found to be moderately preferred. The
Hunchback of Notre Dame book, ladybug song toy, and quacking duck light were associated with
37
moderate to high levels of stereotypy, so they were used for the matched stimulation assessment. The
musical helicopter, Elmo™ piano, Elmo™ poke, and pirate ship were chosen as they were the most
highly preferred items associated with the lowest levels of stereotypy.
Functional Analyses (FA)
Figure 1 (top panel) depicts the results for Ivan’s functional analysis. His FA showed some
differentiation between conditions. Rates of stereotypy were slightly lower during demand (M = 24%)
and attention conditions (M = 22%) compared to the no consequence condition (M = 35%). Because
there was no clear differentiation, an extended no consequence condition was conducted. Stereotypy
persisted with repeated exposure to the extended no consequence condition (M = 60%), suggesting an
automatic function for his stereotypy. Figure 1 (bottom panel) depicts the results for Troy’s functional
analysis. His data showed clear differentiation between conditions during the second half of the
functional analysis. Rates of stereotypy were lower during demand (M = 14%) and attention conditions
(M = 14%) compared to the no consequence condition (M = 35%); thereby suggesting an automatic
function.
38
Figure 1. The top panel depicts the percent occurrence of vocal stereotypy during Ivan’s functional
analysis sessions. The bottom panel depicts percent occurrence of vocal stereotypy during Troy’s
functional analysis sessions.
39
Matched Stimuli Assessment (MSA)
For Ivan’s MSA, Set 1 was comprised of an electronic telephone toy that produced songs,
animal sounds, and labels of letters and numbers; and a Disney Incredibles ™ electronic book that
produced sound effects. Results for Ivan’s MSA for Set 1 are depicted in Figure 2 (top panel). During
phase one, there was differentiation between the no interaction (M = 33.3%) and toys with sound
condition (M = 5.3%); demonstrating that the toys suppressed stereotypy. During phase two, rates of
stereotypy were substantially higher during the no interaction condition (M = 62.3%) and the toys with
no sound condition (M = 32%). This demonstrated that tactile effects of the toys were not suppressing
stereotypy during phase 1. After reinstating phase 1 conditions, stereotypy again reduced to low levels
during the toys with sound condition (M = 8%) compared to the no interaction condition (M = 42.3%);
thereby demonstrating that the toys in Set 1 functioned as matched stimuli.
During Ivan’s MSA for Set 2, he had access to a Leapfrog™ letter board which produced letter
labels, sounds of letters, and sound effects; and an electronic Elmo™ piano. Results for Set 2 are
depicted in Figure 2 (bottom panel). During phase one, there was differentiation between the no
interaction (M = 41%) and toys with sound condition (M = 2.7%); demonstrating that the toys
suppressed stereotypy. For phase 2, rates of stereotypy occurred at a high rates in both the no interaction
(M = 60.3%) and toys with no sound condition (M = 46.3%). When phase 1 conditions were reinstated,
the effects were replicated with low levels during the toys with sound condition (M = 7.7%) compared to
the no interaction condition (M = 56%). Results indicated that the toys in Set 2 also functioned as
matched stimuli.
40
Figure 2. Percentage of vocal stereotypy occurrence for Ivan during matched stimulation assessment of
Set 1 (top panel) and Set 2 (bottom panel)
41
For Troy’s MSA, Set 1 was comprised of an electronic Elmo™ piano and a battery operated
pirate ship that produced songs, counting, and cannon sounds. Results for Troy’s MSA for Set 1 are
depicted in Figure 3 (top panel). During phase one, there was differentiation between the no interaction
(M = 23.3%) and toys with sound condition (M = 4%); demonstrating that the toys suppressed
stereotypy. During phase two, rates were similar between the no interaction condition (M = 14%) and the
toys with no sound condition (M = 13.5%). This demonstrated that the toy’s tactile stimulation alone was
not sufficient to suppress stereotypy. Phase 1 conditions were then replicated with similar suppressive
effects during the toys with sound condition (M = 1%) compared to the no interaction condition (M =
20.7%). This assessment demonstrated that the toys in Set 1 functioned as matched stimuli.
Set 2 was comprised of a battery operated helicopter that produced songs, counting, color
labels, etc.; and an Elmo ™ poke toy that produced various phrases and sound effects. Results for Troy’s
MSA for Set 2 are found in Figure 3 (bottom panel). During phase one, there was clear differentiation
between the no interaction (M = 1.3%) and toys with sound condition (M = 20%); demonstrating that the
toys suppressed stereotypy. During phase two, the no interaction condition (M = 9.7%) and the toys with
no sound condition (M = 12.3%) displayed somewhat equivalent levels. The increase in stereotypy
during the no sound condition demonstrated that the toy’s tactile stimulation was not suppressing
stereotypy during phase 1. Phase 1 conditions were replicated with similar differentiation compared to
the first implementation. The toys with sound condition suppressed stereotypy (M = 2%) although
stereotypy was on average lower during the no interaction condition (M = 9.7%). This assessment
provided evidence that the toys in Set 2 functioned as matched stimuli.
42
Figure 3. Percentage of vocal stereotypy occurrence for Troy during matched stimulation assessment for
Set 1 (top panel) and Set 2 (bottom panel).
43
Treatment
Figure 4 depicts the percentage of vocal stereotypy for Ivan during baseline and treatment
conditions. Vocal stereotypy occurred at moderate to high levels during initial baseline levels at an
average of 37%. Responding was variable but stable. Upon introduction of MS + RIRD, stereotypy
levels immediately decreased; averaging 2.1% across the phase. Return to baseline resulted in similar
levels of the first baseline with an average of 33.7%. MS + RIRD was again instated, and suppressive
effects of the package were replicated with a slightly higher average of 5.8% rate of stereotypy. RIRD
was then removed from the package to examine effects of MS alone on stereotypy, resulting in an
average rate of 5.5% for stereotypy. RIRD alone was subsequently instated as the sole treatment
component, with an average of 5%; showing little change in stereotypy levels. Baseline was then
instated and stereotypy exhibited some carryover effects from the previous RIRD condition. After two
sessions, stereotypy levels recovered and increased to a high of 57% and averaged 19.3%. The MS alone
condition was then implemented a second time, yielding a higher average (11.8%) compared to the first
implementation of this component. Baseline was then reinstated a fifth time and stereotypy levels
immediately increased to a single session of 61%. Finally, RIRD alone was implemented as the final
treatment because it was associated with the higher rates of appropriate vocalizations, and low rates of
stereotypy. This phase replicated suppressive effects of the first implementation of RIRD. It was
associated with an average stereotypy rate of 4.3%.
Figure 4 also displays Ivan’s rates of appropriate vocalizations. During the initial baseline,
appropriate vocalizations occurred at very low frequency. The average was 0.7 per session and a high of
2 per session. With the introduction of MS + RIRD, appropriate vocalizations modestly increased to an
average of 2.6 per session, with a high of 7 appropriate vocalizations corresponding to the first session
of this phase. Although the increase was small, experimental control was demonstrated during the
second implementation of baseline conditions. In this phase appropriate vocalizations immediately fell
to zero and averaged zero across all three consecutive sessions. When MS + RIRD was instated a second
time, appropriate vocalizations immediately increased and averaged a higher rate of 7 per session.
44
Subsequently, the RIRD alone component was removed and MS alone was introduced. Appropriate
vocalizations occurred at a low average of 0.8 per session, with highest rates of 2 per session. RIRD
alone was then instated and the matched stimulation component removed. Rates of appropriate
vocalizations increased to an average of 4.6 per session, and a high of 9. Next, another reversal to
baseline was inserted, and appropriate vocalizations fell to zero; thereby demonstrating experimental
control. The effects of RIRD alone were replicated during the subsequent reinstatement of the condition,
with appropriate vocalizations averaging 6 per session. Reversal to baseline conditions yielded three
consecutive sessions of zero appropriate vocalizations. The second introduction of MS alone
demonstrated little change in appropriate vocalizations, with an average of 0.3 per session and the
highest rate per session was a single occurrence. During the final reversal to baseline Ivan’s appropriate
vocalizations increase slightly to a rate of 2 for the single session. The final treatment component of
RIRD was implemented and chosen because it was the treatment component associated with moderate
rates of appropriate vocalizations and low rates of stereotypy. It was concluded as the most appropriate
treatment because RIRD alone and MS + RIRD produced similar results, and Ivan would not have
regular access to sound toys during school programming. During the final phase appropriate
vocalizations occurred at an average of 3.9 per session, however a session high of 6 was observed.
Figure 5 depicts the percentage of vocal stereotypy for Troy during baseline and treatment
conditions. Vocal stereotypy occurred at moderate levels during initial baseline levels at an average of
16%. Responding was stable with the exception of a rate of 25% during session four. Upon introduction
of MS + RIRD, percentage of stereotypy immediately fell to 3% during the first session, and averaged
1% over all sessions of this condition. Baseline conditions were then reinstated, and stereotypy levels
recovered to an even greater average of 25%. Anecdotally, it was noted during these sessions that Troy
was looking at the experimenters and the camera at a lower rate. There may have been reactivity to the
experimenter and camera during the first baseline conditions. With the second implementation of MS +
RIRD, stereotypy immediately decreased to a percentage of zero during the first session, and over three
sessions averaged 0.7%. Another reversal to baseline was introduced, again with stereotypy recovering
45
to previous baseline levels at a rate of 29%. RIRD alone was instated, and stereotypy was found to
occur at a slightly higher average of 6.7%. Data were observed to be stable before a single session of
baseline was introduced, and stereotypy recovered to a higher rate of 35%. MS alone was subsequently
instated, and stereotypy was occurred at lower levels than RIRD alone, averaging 2.4% across sessions.
A final return to baseline was inserted, and yielded an even higher average of 45% across sessions. This
was a fourth demonstration of experimental control. Finally, MS + RIRD was introduced as the last
treatment because it was observed to be associated with the lowest frequency of implementations, as
well as a moderate rate of appropriate vocalizations. Because of the lower rate of implementations, it
was deemed more feasible to train parents or others to implement the procedure. This condition’s effects
were replicated a third time, with rates of stereotypy occurring with low variability and an average of
1.5%.
Figure 5 also depicts the frequency of appropriate vocalizations for Troy during baseline and
treatment sessions. During initial baseline, appropriate vocalizations occurred at low levels; averaging
only 1.3 per session. With introduction of MS + RIRD, appropriate vocalizations increased to an average
of 3.8, with one session associated with a high of 8 per session. When baseline conditions were
reinstated, appropriate vocalizations reversed to previous baseline levels, with an average of 1 per
session. MS + RIRD was introduced a second time, and previous treatment effects were replicated with
an average of 3.3 per session. A single session of baseline conditions was inserted, and associated with a
rate of 1 appropriate vocalization. The MS component was then removed to examine sole effects of
RIRD. This condition was associated with a higher average of appropriate vocalizations per session
(16.6 occurrences). Although this is undoubtedly a greater increase, it is important to note that
appropriate vocalizations are yoked to the number of times RIRD is implemented. That is, at least one
appropriate vocalization is associated with the implementation of response cost in order for the
participant to re-gain access to the item after the RIRD is complete. Therefore, if RIRD is implemented
more times during one session versus another, the session containing the larger amount of
implementations will also yield a larger sum of appropriate vocalizations. On average during the RIRD
46
alone condition, RIRD was implemented 15 times per session. Another single-session return to baseline
conditions showed a decrease in appropriate vocalizations, with only one occurring during the session.
Matched stimulation was introduced as the sole treatment, and was associated with a rate of 4.4 per
session. Baseline conditions were reintroduced a final time, and exhibited a slightly higher average of 3
per session over previous baseline conditions. MS + RIRD was implemented as the final treatment, and
occurrence of appropriate vocalizations were greater than previous instatements of the condition.
Average rate of appropriate vocalizations was 6.8 per session.
47
Figure 4. Depicts the percentage of vocal stereotypy per session and frequency of appropriate
vocalizations for Ivan across all treatment conditions.
48
Figure 5. Depicts the percentage of vocal stereotypy per session and frequency of appropriate
vocalizations for Troy across all treatment conditions.
49
Figure 6 (top panel) displays the average number of RIRD implementations per session for each
participant. Overall, the number of implementations of RIRD for Ivan was relatively equal between the
two conditions. The MS + RIRD condition averaged 4.5 implementations and RIRD alone condition was
slightly higher with an average of 5.8. There was a large discrepancy between the two treatments for
Troy. The MS + RIRD condition was associated with a considerably lower frequency of
implementations, averaging 2.3 per session. The RIRD alone condition averaged 15 implementations per
session.
Figure 6 (bottom panel) displays the average session length for the MS + RIRD and RIRD
alone conditions for each participant. For Ivan, session length for the two conditions was similar. The
average session length for MS + RIRD conditions was 342.9 seconds; and the average length for RIRD
alone was 349.8. Troy’s average length per session showed MS + RIRD as lower than RIRD alone.
Average length for MS + RIRD was 313.5 seconds; RIRD alone was 389.8. Overall, both participants’
session length did not display any decreasing trends throughout the experiment. Ivan’s session length
data displayed some variability, but relatively stable. For Troy the session length remained constant for
MS + RIRD, despite increased exposure to the RIRD contingency as the study progressed.
50
Figure 6. The top panel depicts the average frequency of RIRD implementations for each participant
during RIRD alone and MS + RIRD conditions. The bottom panel depicts the average session length in
seconds for each participant during RIRD alone and MS + RIRD conditions.
51
Social Validity
Social validity measures were gathered from both participants’ caregivers at the conclusion of
the study. One measure evaluated parent opinion for the RIRD procedure and the other for the Matched
Stimulation alone procedure. Measures were dispersed after the parent viewed a brief video clip of an
RIRD treatment session, or a matched stimulation treatment session. Scores for each question ranged
from 1 as strongly disagree to 5 as strongly agree, and 3 as neutral. For the item, “I liked the vocal RIRD
procedure”, parents overall rated this item at an average of 4.5. For the item, “If trained, I could easily
implement the vocal RIRD procedure in my home”, parents rated this item as a 4.5. For the item, “I am
satisfied with my child’s response to the vocal RIRD procedure”, parents rated this at an average of 4.
The item, “Vocal RIRD reduced my child’s stereotypy during the session” was rated at an average of 4.
The item, “I thought the vocal RIRD procedure was intrusive”, parents rated at an average of 1.5. For the
item, “Vocal RIRD is a socially appropriate intervention method for my child”, parents rated at an
average of 4. For the item, “I think vocal RIRD improved my child’s rate of appropriate vocalizations
during the session”, parents rated at an average of 4.5. The item, “My child will benefit in the long run
from the procedures implemented in this study,” parents rated at an average of 4.5. The item, “Vocal
RIRD produced negative emotional reactions in my child”, was rated at an average of 1. Lastly, the item,
“I feel vocal RIRD produced little change in my child’s stereotypy rates during session”, was rated at an
average of 3 (one parent rated 2 and one parent rated 4).
Parent opinion was also assessed for the matched stimulation procedure. For the item, “I liked
the matched stimulation procedure”, parent rated an average of 4.5. For the item, “If trained, I could
easily implement the matched stimulation procedure in my home, was rated an average of 4.5. For the
item, “I am satisfied with my child’s response to the matched stimulation procedure”, parents rated an
average of 4. For the item, “Matched stimulation reduced my child’s stereotypy during the session”,
parent rated an average of 4.5. For the item, “I thought the matched stimulation procedure was intrusive”
parents rated an average of 1. For the item, “Matched Stimulation is a socially appropriate intervention
method for my child” parents rated an average of 4.5. For the item, “I think matched stimulation
52
improved my child’s rate appropriate vocalizations during the session”, parents rated an average of 4.
For the item, “My child will benefit in the long run from the procedures implemented in this study”,
parents rated an average of 4.5. For the item, “Matched Stimulation produced negative emotional
reactions in my child”, parents rated an average of 1. Finally, for the item, “I feel matched stimulation
produced little change in my child’s stereotypy rates during session”, parents rated an average of 3 (one
parent rated 2 and one parent rated 4). Parents were then asked to circle the name of the preferred
procedure, or none at all if they preferred all procedures equally. Across both parents, the most preferred
procedure was the treatment package of MS + RIRD. An additional comment made by one mother was
that she enjoyed learning about the two techniques available and wanted to someday try the procedures
in a home or school setting. Figure 7 displays the average ratings of each item in graphic form.
53
Figure 7. Depicts the average rating across both participant caregivers for RIRD (top panel) and
Matched Stimulation (bottom panel).
54
Chapter 4
DISCUSSION
For both participants, RIRD was found to both decrease stereotypy and increase appropriate
vocalizations. This is consistent with previous studies (Ahearn et al., 2007; Liu-Gitz & Banda, 2010;
Miguel et al., 2009). Vocal stereotypy was also observed to decrease for both participants during the
matched stimulation assessment and the matched stimulation alone condition. This is also consistent
with findings from Rapp (2007). Suppression in the presence of matched stimulation may have been a
result of the toys’ stimulation functioning as an abolishing operation for the products of vocal stereotypy.
Findings support results obtained by Rapp (2006) that stereotypy is sensitive to the manipulation of
motivating operations.
For Ivan, all treatment conditions showed similar effects for suppression of stereotypy, session
length and number of RIRD implementations. For Troy, matched stimulation + RIRD was more efficient
for producing low levels of stereotypy with less session time and considerably fewer implementations of
RIRD. Both participants exhibited greater frequency of appropriate vocalizations with conditions
containing an RIRD component.
Overall, both participants’ results showed different treatments as the most effective. The results
for which treatment condition was most effective may be explained in a number of ways. For Ivan,
comparable suppressive effects on stereotypy for the RIRD alone and MS + RIRD conditions may be
attributed to the RIRD component. Specifically, RIRD may have been the source of stereotypy
suppression. This is supported by Ivan’s variability of stereotypy levels during the first MS alone
condition, as well as the slight increase in rate of stereotypy during the second MS alone condition.
RIRD is also likely to be the source of the increase in appropriate vocalizations. This is supported by
observations during the MS alone condition. During MS alone Ivan engaged in fewer appropriate
vocalizations than during conditions containing an RIRD component. This may be explained by the
response cost component embedded within the RIRD procedure. Response-cost can function as a
55
transitive conditioned establishing operation (Michael 1993/2003) establishing the value of the removed
toy as a reinforcer and increasing the probability of appropriate requests.
Although RIRD is likely the source of Ivan’s behavior change, it is difficult to discern whether
response cost or vocal imitation demands were responsible for the decrease in stereotypy. Previous
research on response cost (e.g. Falcomata et al.; Rapp, 2005) has shown that contingent removal of
preferred stimuli can function as punishers for automatically maintained behavior. However, research
on vocal imitation in RIRD (Ahearn et al., 2007; Liu-Gitz & Banda, 2010; Miguel et al., 2009) also
showed suppressive effects on stereotypy. All three studies also used a response cost procedure. Ivan’s
increased amount of appropriate vocalizations associated with conditions containing RIRD was observed
to be correlated to the number of times the response cost procedure was implemented. During MS alone
conditions, response cost was not implemented. The omission of response cost during this condition may
have provided fewer opportunities for requests to be emitted. Since MS alone did not contain response
cost, a decrease in appropriate vocalizations was observed. Future studies may want to keep the response
cost component constant across all conditions to facilitate comparison. Another suggestion is to
categorize types of appropriate vocalizations, especially those that are related to the response cost
procedure. For example, it would be helpful to record the number of mands for the specific toys that
were removed while RIRD was implemented. Such information could provide better insight when large
changes in appropriate vocalizations are observed.
In contrast, Troy’s most effective treatment condition was MS + RIRD. In addition to
decreasing stereotypy and increasing appropriate vocalizations, MS + RIRD produced an average shorter
session and fewer trial implementations of RIRD. These effects are consistent with findings by O’Reilly
et al. (2006, 2007, 2008) and Rapp (2005, 2007). O’Reilly and colleagues (2006, 2007, 2008) found that
the addition of noncontingent reinforcement increased the effectiveness of procedures designed to
suppress aberrant behavior (e.g. aggression, self-injury). For Troy, because there were consistent
concomitant decreases in stereotypy during sessions with matched stimulation, matched stimulation may
be considered noncontingent reinforcement for vocal stereotypy. Matched stimulation also seemed to
56
increase the efficiency of the RIRD procedure. Rapp (2005, 2006) also found that stereotypy was
sensitive to motivating operations, and that matched stimulation suppressed stereotypy. Decreased rates
of stereotypy during conditions containing matched stimulation provide evidence that matched
stimulation functioned as an abolishing operation and was responsible or partially responsible for the
decrease. Similar to Ivan, Troy exhibited greater frequency of appropriate vocalizations during
conditions containing RIRD. His increased rate of appropriate vocalizations during the RIRD only
condition was also observed to be correlated to the number of times response cost was implemented.
A final note about treatment is that the effects of matched stimulation were long lasting over the
course of the study (approximately 3-4 months). However, future studies should evaluate the toys’
effectiveness over a longer period of time. The use of a multiple-treatments design may answer this
question.
Social validity scores indicated that both participants’ parents felt the procedures were useful,
and the preferred treatment was MS + RIRD. Both parents gave favorable ratings for both RIRD and
matched stimulation as to their utility for reduction of stereotypy and increase in appropriate
vocalizations. The only question that did not indicate favor of the procedures was, “I feel matched
stimulation produced little change in child’s stereotypy rates during session.” For this question, one
mother indicated that she agreed with this statement. However, she agreed with all other questions
indicating favorable evaluation of both RIRD and matched stimulation. The overall results of the social
validity scoring supports the piloting of parent training in RIRD, matched stimulation, or MS + RIRD.
Parents may enjoy the flexibility of having a variety of procedures to use, depending on the situation and
their availability to provide treatment for their child.
Implications
Because both participants differed in the most effective treatment, this indicates that treatment
effects of RIRD, MS, and MS + RIRD may vary across individuals. For Ivan, since all treatment
conditions showed similar effects for suppression of stereotypy, this is valuable information for
practitioners. His results suggest that there are several alternatives available to treat stereotypy. If a
57
parent or therapist is unavailable to implement RIRD, stereotypy may be prevented by providing access
to matched stimulation. In situations in which an adult is available, RIRD may then be implemented with
potentially equally effective results. In addition, data showing that MS + RIRD is equally effective to
RIRD alone is also useful information. In environments in which matched stimulation may not be
available or feasible to implement (e.g., stores, movie theaters, etc.); practitioners can be confident that
RIRD alone can be a viable alternative to MS + RIRD in the event that sound toys are unavailable.
The most interesting finding for Troy was that conditions containing matched stimulation and
RIRD contained fewer implementations than RIRD alone . One possible limitation of RIRD is the effort
that may be necessary to consistently implement it. In the applied setting, these results can lead to
decreased therapist time and human resources needed to treat vocal stereotypy. In addition, fewer
implementations may result in faster training for parents, teachers, aids, etc.; as well as increase the
likelihood that RIRD is implemented more consistently in non-controlled environments. Overall, the
addition of matched stimulation may address a possible limitation of RIRD and make it more feasible to
use.
Limitations
Although important findings were drawn from this study, some of its limitations will be noted.
Ivan’s data was undifferentiated across conditions of MS +RIRD, RIRD alone, and matched stimulation
alone. Although treatment effects were replicated, it cannot be determined that data were the result of
equivalent effects or carryover effects. One possibility is that there may have been some carryover
effects from the MS + RIRD condition to the MS alone. The presence of the same toys and the same
blue shirt of the experimenter may have possibly functioned as discriminative stimulus for contingent
delivery of RIRD (punishment). It is possible that since the second implementation of MS alone resulted
in higher rates of stereotypy, that the first effects are in part due to carryover effects from the previous
MS + RIRD condition. Future studies may pair an additional instruction with the MS +RIRD condition
to convey to the participant that RIRD will be delivered during the session. Another way to facilitate
58
discrimination could be to use different sound toys during the MS + RIRD condition compared to MS
alone.
Another limitation of the study was the brevity of the 5-minute session length. Because sessions
were short, this may have contributed to Ivan’s results of equivalent effects across treatments. It is
possible that matched stimulation effects may have decreased in efficacy if longer sessions of exposure
were used. Although RIRD was found to be effective for stereotypy suppression, long-term effects
cannot be determined from this study because sessions were brief. Anecdotally, Troy was observed to
engage in stereotypy while waiting in the lobby or while riding the elevator before session. Ivan was also
observed to engage in stereotypy throughout the home before sessions began. Both participants were
also observed to engage in increased rates of stereotypy when on breaks between treatment sessions. It
may be that the brevity of 5-minute sessions may have prevented the treatment effects from generalizing
to different times of the day, or different environments. Other studies (e.g., Ahearn et al., 2007; Liu-Gitz
& Banda, 2010; Miguel et al., 2009) all used 5-minute session lengths, so this limitation is not unique to
this study.
A final limitation of the study was that a small amount of toys remained constant and
participants had access to only a total of two toys during a session. This was true of all conditions
containing both matched and unmatched toys. Overall, frequency of appropriate vocalizations for each
participant was somewhat low and observed to be correlated to the RIRD procedure. There is a
possibility that appropriate vocalizations were low because the participant satiated on the two toys;
thereby reducing motivating operations to request for the toys. In addition, the small amount of toys may
also have removed other potentially evoking stimuli from the environment. Additional toys may have
occasioned more appropriate tacts or comments from the participants.
Another explanation for the low frequency of appropriate vocalizations could have been the
nature of interaction protocol for the conditions. The experimenter did not talk to the participant unless
the participant appropriately vocalized first. This is an unnatural setting, as adults typically do not play
by watching and waiting for children to speak. In contrast, adults embed comments and questions
59
throughout play. Therefore, the lower frequency of independent, appropriate vocalizations may have
been the result of the absence of evoking stimuli from the adult. Increased adult comments may have
occasioned additional appropriate comments, requests, etc. from the participant; although it may have
also functioned to reinforce stereotypy.
Conclusions
In summary, the addition of matched stimulation was found to increase suppression of vocal
stereotypy for one participant, and for another participant all treatment combinations were found to yield
somewhat equivalent results. Appropriate vocalizations were found to be the highest when RIRD was
implemented. Parent report indicated a preference for the treatment package of MS + RIRD.
Essentially, it was found that stereotypy can be reduced in a number of ways by different
behavioral mechanisms. It is likely that matched stimulation alone was effective to reduce stereotypy for
both participants because it functioned as an abolishing operation for stereotypy. For Troy, the addition
of a matched stimulation component to RIRD led to a greater decrease in stereotypy than each
component alone; indicating that treatment packages may have additive effects.
These findings provide more information for practitioners for the types of treatments that are
available for vocal stereotypy. They can use this information to help decide which treatment may be the
most effective, efficient, and appropriate for their unique environment conditions. Matched stimulation
alone may be useful when adult interruption is not possible or feasible. MS + RIRD may be an effective
procedure to aid the training of parents. This is supported by the fewer implementations associated with
the package. Furthermore, fewer implementations have the potential to facilitate greater consistency of
implementation in the natural environment. Overall, treatment effects were slightly different across the
two participants, showing that programs for stereotypy reduction should be tailored to the individual and
his/her environment.
Future Research
While this study examined the effects of MS, RIRD, and MS + RIRD on appropriate
vocalizations, the type of appropriate vocalization and the context were not recorded. Most of the
60
participant appropriate vocalizations were observed to be mands evoked from the response cost
procedure of RIRD. There were also some tacts of objects. Future research should examine different
types of appropriate vocalizations associated with RIRD. In addition, it should examine the
environmental conditions during RIRD sessions to occasion a variety of appropriate vocalizations rather
than mands alone.
It may also be helpful to examine more naturalistic means of evoking vocal imitation during
RIRD instead of using arbitrary words. Examples might include taking the toy the child currently is
playing with (e.g. a tiger toy) and prompting the appropriate tact (e.g., “say tiger”). Anecdotally, Ivan
was observed to sometimes emit the RIRD probe words in the absence of stereotypy. The
aforementioned modifications to the RIRD vocal imitation component may increase the likelihood that
appropriate vocalizations will come under the control of the appropriate stimuli in the environment;
rather than under control of other contingencies. Two possibilities were that Ivan was engaging in
appropriate vocalizations either to prevent RIRD delivery, or because in the past sessions these specific
topographies produced reinforcement. Future research using different vocal imitation procedures may
help decrease the likelihood that arbitrary vocalizations evoked by the RIRD procedures will not be
inadvertently reinforced.
Future research should also examine the long-term effects of both matched stimulation and
RIRD. Long-term effects of matched stimulation once the toy(s) are removed are unknown. Future
research should measure stereotypy for longer than 15 minutes (Rapp, 2006) after access to matched
stimulation. Furthermore, duration of matched stimulation effects after prolonged exposure (e.g. 2 hours
of session time) is also unknown. It may be helpful to examine levels of stereotypy both before and after
the session to both determine duration of effects, in addition to examining any behavioral contrast effects
of RIRD. This latter suggestion is based on the anecdotal reports of participants engaging more
stereotypy both between and after sessions.
Finally, since parent opinion of this study indicated a preference for MS + RIRD, the efficacy
of MS + RIRD, RIRD, and MS alone should be evaluated in the context of parent implementation.
61
Evaluating the ease of parent implementation and preference for each procedure may yield valuable
information on their feasibility and practicality for the home environment. Such information may
produce more socially valid procedures that facilitate generalization of treatment effects from the lab to
the home.
62
APPENDIX A
Modified RAISD Intake Form
The purpose of this survey is to obtain information about the toys that you believe would be useful as
rewards for your child.
If you have signed the consent form, please answer the following questions regarding your child’s
preferences:
1. Some children really enjoy toys like puzzles, books, blocks, figurines, musical toys, playdoh, etc.
What are the specific toys your child really likes?
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
2. Please go back to the list in question number one, and place a number in each box to rank these toys
from most favorite (1) to least favorite (10).
3. Are there any toys that you would prefer your child not to play with during our study?
___________________________________________________________________
63
APPENDIX B
Preference Assessment Data Sheet
64
APPENDIX C
Functional Analysis Data Sheet
65
APPENDIX D
Experiment Data Sheet
66
APPENDIX E
VRIRD List 1
1. Scissors
2. Ladder
3. Zipper
4. Blanket
5. Marker
6. Sofa
7. Magnet
8. Closet
9. Rhino
10. Pencil
67
APPENDIX F
VRIRD List 2
1. Blanket
2. Binder
3. Sofa
4. Magnet
5. Closet
6. Rhino
7. Pencil
8. Ladder
9. Marker
10. Carpet
68
APPENDIX G
VRIRD List 3
1. Zipper
2. Marker
3. Carpet
4. Ladder
5. Scissors
6. Backpack
7. Binder
8. Rhino
9. Hopscotch
10. Magnet
69
APPENDIX H
Social Validity VRIRD Scale
After watching the video sessions, please answer all questions honestly and to the best of your ability.
This will help to interpret the overall social validity of the study for future reference.
1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree
1. I liked the vocal RIRD procedure.
1
2
3
4
5
2. If trained, I could easily implement the vocal RIRD
procedure in my home.
1
2
3
4
5
3. I am satisfied with my child’s response to the vocal
RIRD procedure.
1
2
3
4
5
4. Vocal RIRD reduced my child’s stereotypy during
the session.
1
2
3
4
5
5. I thought the vocal RIRD procedure was intrusive.
1
2
3
4
5
6. Vocal RIRD is a socially appropriate intervention
method for my child.
1
2
3
4
5
7. I think vocal RIRD improved my child’s rate of
appropriate vocalizations during the session.
1
2
3
4
5
8. My child will benefit in the long run from the
procedures implemented in this study.
1
2
3
4
5
9. Vocal RIRD produced negative emotional reactions
in my child.
1
2
3
4
5
10. I feel vocal RIRD produced little change in my
child’s stereotypy rates during session.
1
2
3
4
5
Please provide any additional comments/suggestions about the procedure:
70
APPENDIX I
Social Validity MS Scale
After watching the video sessions, please answer all questions honestly and to the best of your ability.
This will help to interpret the overall social validity of the study for future reference.
1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree
1. I liked the matched stimulation procedure.
1
2
3
4
5
2. If trained, I could easily implement the
matched stimulation procedure in my home.
1
2
3
4
5
3. I am satisfied with my child’s response to the matched
stimulation procedure
1
2
3
4
5
4. Matched stimulation reduced my child’s stereotypy during
the session.
1
2
3
4
5
5. I thought the matched stimulation procedure was intrusive.
1
2
3
4
5
6. Matched Stimulation is a socially appropriate intervention
method for my child.
1
2
3
4
5
7. I think matched stimulation improved my child’s rate of
appropriate vocalizations during the session.
1
2
3
4
5
8. My child will benefit in the long run from the
procedures implemented in this study.
1
2
3
4
5
9. Matched Stimulation produced negative emotional reactions
in my child.
1
2
3
4
5
10. I feel matched stimulation produced little change in my
child’s stereotypy rates during session.
1
2
3
4
5
11. Please circle one as your preferred procedure, or circle no preference if all are equally
preferred..
Vocal RIRD
Matched Stimulation
Matched stimulation plus RIRD No Preference
Please provide any additional comments/suggestions about the procedure(s):
71
APPENDIX J
Treatment Integrity RIRD DATA Sheet
72
APPENDIX K
Treatment Integrity MS DATA Sheet
73
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