Review of the Current Research Justin Daigle MA BCBA LBA Clinical Director What is stereotypy Definition Lewis and Bodfish 1998 defined as repetitive and apparently purposeless ID: 561489
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Slide1
Effectively Treating Stereotypy
Review of the Current Research
Justin Daigle, MA,
BCBA, LBA,Clinical DirectorSlide2
What is
stereotypy?Slide3
Definition
Lewis and
Bodfish
(1998) defined as:
“
repetitive
and
apparently purposeless
body movements (e.g., body rocking), body parts movement (e.g., hand flapping, head rolling) or use of the body to generate object movement (e.g., plate spinning, string twirling
)
Lewis, M. H., &
Bodfish
, J. W. (1998). Repetitive behavior disorders in autism.
Mental Retardation and Developmental Disabilities, 80-89.
Underline added by presenter for emphasisSlide4
DSM - V
Autism Spectrum Disorder (299.00)
Persistent deficits in social communication
Restricted, repetitive patterns of behavior, interest, or activities
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5
th
ed.). Washington, DC.Slide5
Not just autism
Stereotypy can be found in various other diagnosis outside of Autism.
Found in animals and neuro-typical individuals.
One of the key diagnostic requirements for Autism.
Goldman, S., Wang, C., Salgado, M. W., Greene, P. E., Kim, M., &
Rapin
, I. (2008). Motor stereotypies in children with autism and other developmental disorders.
Developmental Medicine and Child Neurology
, 30-38.Slide6
Common examples
Hand flapping
Body rocking
Inflexibility
Closely followed routines or patterns
Prolonged fascination
Odd verbalizationsSlide7
Stereotypy
Singer (2009) discussed that the definition is too broad, all-inclusive, and not accurate to the complexity of these behaviors.
Singer, H. (2009). Motor Stereotypies.
Seminars in Pediatric Neurology, 16: 77-81. Slide8
Stereotypy
This broad definition may be why very little is understood about causality.
Singer, H. (2009). Motor Stereotypies.
Seminars in Pediatric Neurology, 16: 77-81. Slide9
Current Behavioral Theory of Stereotypy
Koegel
,
RL
& Covert, A. (1972). The relationship of self-stimulation to learning in autistic children.
Journal of Applied Behavior Analysis,
5, 381-387.
Lovaas
,
OI
, Newsom, C., & Hickman C. (1987). Self-stimulatory behavior and perceptual reinforcement.
Journal of Applied Behavior Analysis,
20, 45-68.
Rapp, JT and Vollmer,
TR (2005). Stereotypy I: A review of behavioral assessment and treatment. Research in Developmental Disabilities, 26, 527-547.Rogers, SJ & Ozonoff, S. (2005). Annotation: What do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry. 46, 1255-1268.Slide10
Stereotypy is not…
Tics
“
OCD
”-like behaviors
“
Stimming
” (Self-Stimulatory)Slide11
FunctionSlide12
Function
Social Positive (Attention)
Social Negative (Escape)
Automatic Positive (Sensory Stimulation)
Automatic Negative (Pain Alleviation)
Iwata, B. (2013, April),
Functional Analysis and Treatment of Severe Behavior Disorders
, Lecture conducted from Austin, TX. Slide13
Stereotypy Function
Research States:
Iwata, B. (2013, April),
Functional Analysis and Treatment of Severe Behavior Disorders
, Lecture conducted from Austin, TX.
Positive Reinforcement
Negative Reinforcement
Social
Automatic
Social
Automatic
?
Yes
?
?Slide14
In Practice
There seems to be indications of stereotypy being maintained by social functions; however, few conclusive studies have been published to support this. Slide15
Of Import
Research States:
Positive Reinforcement
Negative Reinforcement
Social
Automatic
Social
Automatic
?
Yes
?
?
Current Functional Analysis methodology is unable to determine automatic negative as a function. Slide16
Ethical Concern
It is often considered conceptually unethical to eliminate behaviors maintained by automatic negative.
Our current assessments (FA and
FBA
) are able to identify automatic as a function, but cannot distinguish between automatic positive and automatic negative.
Is it ethical to target automatically maintained behavior for elimination?Slide17
Of Import
Research States:
Positive Reinforcement
Negative Reinforcement
Social
Automatic
Social
Automatic
?
Yes
?
?
By definition – may not be possible. We define it as “functionless”. We really
mean
“no social function”Slide18
TreatmentSlide19
Response interruption and redirection
Ahearn (2007) published the first article about this commonly used intervention. Subsequent articles have been published improving methodology.
Ahearn, W. H., Clark, K. M., MacDonald, R. P., & Chung, B. I. (2007). Assessing and treating vocal stereotypy in children with autism.
Journal of Applied Behavior Analysis
, 263-275.Slide20
Response interruption and redirection
RIRD
Procedure:
Block the response (incompatible if verbal)
Require a correct response to 3
high-
p
tasks
If correct, therapy continues
If incorrect, procedure continues to repeat
Ahearn, W. H., Clark, K. M., MacDonald, R. P., & Chung, B. I. (2007). Assessing and treating vocal stereotypy in children with autism.
Journal of Applied Behavior Analysis
, 263-275.Slide21
Ahearn, W. H., Clark, K. M., MacDonald, R. P., & Chung, B. I. (2007). Assessing and treating vocal stereotypy in children with autism.
Journal of Applied Behavior Analysis
, 263-275.Slide22
Pros/Cons -
RIRD
Advantages
Limitations
Effective
DTT
cannot be run effectively
Easy
Staff
Trained
Requires mastered items
Stereotypy
an a low frequency
Possible extinction side effects
Possible punishment
side effects
Must
be in close proximity
Must be consistently implemented
Kliebert
, M., Tiger, J., Toussaint, K. (2009) An approach to identifying the conditions under which Response Interruption will reduce automatically reinforced problem behavior.
Behavior Analysis in Practice
. 4(1), 17-26.Slide23
Non-
RIRD
INTERVENTIONS
Extinction-Based Procedures
Punishment-Based Procedures
Reinforcement-Based Procedures
Miscellaneous Procedures
Treatment PackagesSlide24
Extinction - Based
Extinction-based interventions would require the removal of the reinforcer.
If maintained by Automatic, reinforcer cannot be withheld without devices.
This leads to “sensory extinction”Slide25
Sensory Extinction
Advantages
Limitations
Effective
Requires equipment
Relatively easy
process
May not sustain without equipment
Can be consistently implemented
Extinction
burst (sometimes)
Extinction-induced variability
Results are limited
Rapp, JT, & Vollmer,
TR
(2005). Stereotypy I: A review of behavioral assessment and treatment.
Research in Developmental Disabilities.
26, 527-547.Slide26
Punishment - Based
Contingent work (
Kliebert
in 2009 suggested that this may be why
RIRD
works – never studied)
Response cost seems be ineffective in isolation (Daigle et al 2013), but an effective part of a treatment package (
Falcomata
et al 2004)
Daigle, J., Cordova, S., & Hebert, E. (2013, May).
Using a response cost procedure to reduce stereotypy.
Symposium presented at the annual conference of the Association of Behavior Analysis International, Minneapolis, MN.
Kliebert
, M., Tiger, J., Toussaint, K. (2009). An approach to identifying the conditions under which Response Interruption will reduce automatically reinforced problem behavior.
Behavior Analysis in Practice. 4(1), 17-26.Falcomata
, T. S., Roane, H. S.,
Hovanetz
, A. N., Kettering, T. L., & Kenney, K. M. (2004). An evaluation of
rosponse
cost in the treatment of inappropriate vocalizations maintained by
authomatic
reinforcement.
Journal of Applied Behavior Analysis
, 83-87.Slide27
Punishment - Based
Advantages
Limitations
Effective as a package
Side effects
of punishment
Quick results
Increase in aggression
Easily
Generalizable
May not be effective in isolation
Is a social consequence
to a non-social problem
Rapp, JT, & Vollmer,
TR
(2005). Stereotypy I: A review of behavioral assessment and treatment.
Research in Developmental Disabilities.
26, 527-547.Slide28
Reinforcement- Based
Non-Contingent Reinforcement (NCR) is commonly used and very effective. (Rapp & Vollmer 2005; Carroll & Kodak 2014)
Carroll, R.A. & Kodak, T. (2014). An evaluation of interrupted and uninterrupted measurement of vocal stereotypy on perceived treatment outcomes.
Journal of Applied Behavior Analysis,
47, 264-276.
Rapp
, JT, & Vollmer,
TR
(2005). Stereotypy I: A review of behavioral assessment and treatment.
Research in Developmental Disabilities.
26, 527-547.Slide29
Carroll, R.A. & Kodak, T. (2014). An evaluation of interrupted and uninterrupted measurement of vocal stereotypy on perceived treatment outcomes.
Journal of Applied Behavior Analysis,
47, 264-276.Slide30
NCR Summary
Advantages
Limitations
Most Effective
Difficult to Implement
Can run
DTT
May take some time to work
Easily
Generalizable
Difficult
to coordinate
No Adverse
Side Effects
Carroll, R.A. & Kodak, T. (2014). An evaluation of interrupted and uninterrupted measurement of vocal stereotypy on perceived treatment outcomes.
Journal of Applied Behavior Analysis,
47, 264-276.Slide31
Reinforcement- Based
DRO
and
DRL
Procedures have been shown to be effective. (Daigle &
Duhon
, 2013; Singh et al. 1981; Wacker et al. 1990)
Daigle, J.,
Duhon
, D. (2013, May).
Using a differential reinforcement of low-occurring behaviors (
DRL
) procedure to reduce stereotypy.
Symposium presented at the annual conference of the Association of Behavior Analysis International, Minneapolis, MN
.Singh, N.N., Dawson, M.J., & Manning, P. (1981). Effects of spaced responding
ERL
on the stereotyped behavior of profoundly retarded persons.
Journal of Applied Behavior Analysis,
14, 521-526
Wacker, D.P.,
Steege
,
M.W
., Northup, J.,
Sasso
, G., Berg, W.,
Reimers
, T., et al. (1990). A component analysis of functional communication training across three topographies of severe problematic behavior.
Journal of Applied Behavior Analysis,
23, 417-429.Slide32
Daigle, J.,
Duhon
, D. (2013, May).
Using a differential reinforcement of low-occurring behaviors (DRL) procedure to reduce stereotypy. Symposium presented at the annual conference of the Association of Behavior Analysis International, Minneapolis, MN.Slide33
DR
Summary
Advantages
Limitations
Effective
Difficult to Implement
Can run
DTT
May take some time to work
Easily
Generalizable
Difficult
to coordinate
No Adverse
Side Effects
Daigle, J.,
Duhon
, D. (2013, May).
Using a differential reinforcement of low-occurring behaviors (
DRL
) procedure to reduce stereotypy.
Symposium presented at the annual conference of the Association of Behavior Analysis International, Minneapolis, MN
.Slide34
Miscellaneous
Dib (2007) suggested improving teacher’s implementation of
DTT
, could reduce stereotypy
Stimulus
Control (Haag & Anderson 2004; Rapp et al. 2009)
Dib, N. &
Sturmey
, P. (2007). Reducing student stereotypy by improving teachers’ implementation of discrete-trial teaching.
Journal of Applied Behavior Analysis.
40. 339-343
Haag, S.S., & Anderson,
C.M
. (2004).
Establishing stimulus control of self-stimulatory responding by an antecedent stimulus using punishment. Unpublished doctoral dissertation, West Virginia University, Morgantown. Rapp, JT, Patel, M.,
Ghezzi
, P., O’Flaherty, C., &
Titterington
, C. (2009). Establishing stimulus control of vocal stereotypy displayed by young children with autism.
Behavioral Interventions.
24, 85-105.Slide35
Miscellaneous
Kern et al. (1984) show reductions after exercise
Functional Alternative have been suggested by Piazza et al. (2000
) and Rapp (2006)
Kern, L.,
Koegel
,
R.L
. & Dunlap, G. (1984). The influence of vigorous versus mild exercise on autistic stereotyped behavior.
Journal of Autism and Developmental Disorders
, 14 57-67.
Piazza, C.C.,
Adelinis
, J.D., Hanley,
G.P., Goh, H.L., & Delia, M.D. (2000). An evaluation of the effects of matched stimuli on behaviors maintained by automatic reinforcement.
Journal of applied Behavior Analysis,
36, 297-307
.
Rapp, JT (2006). Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: A preliminary investigation. Slide36
Treatment Packages
NCR, Contingent Demand, and Response Cost (Athens et al 2005)
NCR and Response Cost (
Falcomata
et al 2004)
Athens, E., Vollmer, T.,
Sloman
, K., St. Peter
Pipkin
, C. (2008). An analysis of vocal stereotypy and therapist fading.
Journal of Applied Behavior Analysis
. 41, 291-297.
Falcomata
, T. S., Roane, H. S., Hovanetz, A. N., Kettering, T. L., & Kenney, K. M. (2004). An evaluation of response cost in the treatment of inappropriate vocalizations maintained by automatic
reinforcement.
Journal of Applied Behavior Analysis
, 83-87
.Slide37
Summation
We do not have a full understanding of the causes of stereotypy.
Providers frequently provide treatment without a full understanding of invention alternatives.
Researchers are needed to increase the body of literature within this area. Slide38
Contact
Justin@TCAcadiana.com
www.justindaigle.weebly.com