Effects of “Noncontingent Reinforcement Plus Differential Reinforcement of Alternative Behavior“ and “Response Interruption and Redirection“ on a Child's Vocal Stereotypy Maintained by Automatic Reinforcement

Abstract

Purpose: In this study, the authors investigated the effective treatment of repetitive and noncontextual vocal behaviors of a 5-year-old child (John) with an autism spectrum disorder. Background: Autism is a life-long disability characterized by deficits in social interactions, communication, and behavior. Children with autism often display stereotypic movements that are characterized by their repetitive and nonfunctional nature. Although it is believed that stereotypic behaviors might be automatically reinforced by the sensory consequences produced by engaging in the response, some evidence also shows that stereotypy can be related to social or demand consequences. Meanwhile, stereotypic behaviors can interfere with auditory processing, discrimination learning, and appropriate social behaviors. The focus of a treatment for frequent engagement in stereotypic movements by children with autism has been examined because this type of behavior may hamper children's development. Non-contextual vocalization is one stereotypic behavior that children with autism often display. However, there has been relatively limited research focused on the treatment of vocal stereotypy for children with autism. Specifically, it is difficult to treat if vocal stereotypy is self-reinforcing (i.e., automatic reinforcement). An approach to treating vocal stereotypy maintained by automatic reinforcement is response interruption and redirection (RIRD). To block vocal stereotype, RIRD treatment may involve teachers initiating vocal demands with whichthe child readily complies Previous research revealed the positive effects of RIRD on reducing the level of vocal stereotype. Another approach to developing treatment for automatic reinforcement has focused on noncontingent access to preferred items (NCR). According to operational definition of NCR, it is hypothesized that if the child chooses to spend more time with the alterative stimuli, rather than engage in the aberrant response (e.g., vocal stereotype), these stimuli can effectively compete with the aberrant response. But, both approaches (RIRD and NCR) have their own limitations. The treatment of RIRD is labor-intensive while NCR alone was not effective as a treatment. Method: Functional analyses (FA) were implemented to identify the function of John's stereotypical behavior. Using the methods described by Iwata and his colleagues (1982/1994), vocal stereotype was assessed in four specific conditions (i.e., attention, demand, alone, control/play) to determine which specific consequences (e.g., attention, escape, or sensory) were maintaining the behaviors. According to previous preference assessment, a cookie served as strong reinforcement for John, and could be used to promote the use of appropriate language. In addition, differential reinforcement of alternative behavior (DRA) was included to eliminate the limitation of NCR as well as strengthen appropriate communication (e.g., request). Following FA, two treatment packages, ”RIRD” and ”NCR plus DRA,” were implemented in an ABCACBC design to determine whether either RIRD or NCR plus DRA could reduce John's vocal stereotypy. Findings: The results of FA suggested that vocal stereotypy was maintained by automatic reinforcement. The findings suggested that NCR plus DRA can significantly reduce the behavior of noncommunicative vocalization maintained by automatic reinforcement. The findings also revealed that NCR plus DRA produced levels of appropriate vocal behaviors more thanthose observed in both baseline and RIRD phases. Conclusions/Implications: This study suggests that highly preferred stimuli may compete with engagement in automatically reinforced challenging behaviors. Implications of this study are also discussed in this paper.