Practice of an alternative behavior as intervention for object stereotypy: Comparison of contingent and noncontingent implementation across evoking stimuli.

Abstract

We evaluated contingent and noncontingent practice of an alternative behavior (appropriate play) as intervention for stereotypy that occurred with two play objects in a 5-year old boy with autism. Contingent practice was implemented as a consequence for stereotypy, and the rate of noncontingent practice was matched (yoked) to that schedule. On average, stereotypy with one object (blocks) was less frequent during implementation of both contingent and noncontingent practice, but neither procedure had a sustained positive effect with the second play object (figures). Appropriate play did not improve consistently with intervention. Issues related to treating object stereotypy are discussed. Key Words: stereotypy, alternative response training, noncontingent intervention, autism ********** Stereotypy in the form of repetitive, invariant motor responses is a defining characteristic of children with autistic disorder (American Psychiatric Association, 1994). Common stereotypic behaviors include hand flapping, body rocking, and head shaking. Stereotypy is a concern because it interferes with learning, competes with acquisition of adaptive skills, and is socially stigmatizing. Behavior analysis research suggests that stereotypy frequently is automatically reinforced by the sensory consequences it produces (Lovaas, Newsome, & Hickman, 1987). Providing noncontingent access to preferred leisure and play materials can be effective in reducing stereotypic behaviors maintained by automatic reinforcement (LeBlanc, Patel, & Carr, 2000). However, most studies have targeted stereotypy that does not include contact with objects, for example, hand mouthing and saliva play (Piazza et al., 2000; Vollmer, Marcus, & LeBlanc, 1994) and head rocking, face rubbing, and repetitive hand movements (Britton, Carr, Landaburu, & Romick, 2002; Wilder, Kellum, & Carr, 2000). Many children with autism display stereotypy by manipulating objects, and this situation may make it difficult to provide noncontingent access to alternative (and more preferred) stimuli. To illustrate, Carr, Dozier, Patel, Adams, & Martin (2002) reported the case of a 7-year old girl diagnosed with autistic disorder who displayed object mouthing, which involved placing a small inedible object (e.g., a pen cap) between her lips and flipping the object up and down, with either hand, in a repetitive motion (p. 38). Access to vibratory toys was made available noncontingently but did not reduce object mouthing until the procedure was combined with a response blocking intervention. Stereotypy that includes object manipulating is particularly challenging when the objects are integral to instruction or are used during leisure activities. In the present study, we focused on object stereotypy displayed by a young child with autism during play. Using alternative response training, the goal of intervention was to reduce stereotypy by increasing the child's appropriate physical contact with toys. Applied contingently, this training consisted of practicing play behaviors when object stereotypy was performed. We also evaluated whether noncontingent practice could have a decelerative effect. Compared to contingent implementation of an intervention procedure, noncontingent application may be easier and less time consuming for practitioners (Vollmer, Iwata, Zarcone, Smith, & Mazaleski, 1993). Additional contributions of the study were assessing whether play behavior improved concurrently (covaried) with the treatment of stereotypy, and determining whether these results were influenced by different play objects (evoking stimuli). METHOD Participant and Setting. Bill was a 5-year old boy diagnosed with autistic disorder. He communicated through spoken words, gestures, and simple sign language. Bill was able to identify colors, shapes, letters, and most functional objects in his surroundings. With modeling and direction from an adult, he could perform several gross-motor play activities. …