Response Interruption and Redirection for Stereotypy: A Quality Review and Ethical Considerations

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.

Vocal stereotypy is a commonly occurring challenging behavior in children with autism spectrum disorder (ASD) that is frequently maintained by automatic reinforcement and often interferes with skill acquisition. Matched stimulation (MS), and response interruption and redirection (RIRD) are two interventions that have been demonstrated to be effective in reducing the occurrence of vocal stereotypy with participants with ASD. The current study sought to determine if the combination of MS (noncontingent music) and RIRD was more effective at reducing vocal stereotypy than RIRD alone and if the parents of children with ASD found the combination of MS and RIRD more socially valid than RIRD alone. The results suggested that the combined intervention resulted in greater suppression of vocal stereotypy and increased occurrences of on-task behavior in both participants. Additionally, RIRD required fewer implementations and had a shorter duration when combined with MS. Results suggest that the combination of MS and RIRD may be an effective intervention outside of highly controlled settings.

Response interruption and redirection (RIRD) alone and in combination with reinforcement-based interventions have been effective in reducing automatically-reinforced stereotypy. However, it is unclear whether differential reinforcement of an alternative behavior (DRA) alone would be effective in decreasing stereotypy. In addition, it is unclear whether the combination of DRA and redirection may affect appropriate alternative responding. The purpose of this study was to evaluate the relative effectiveness of DRA alone and in combination with RIRD as treatment for stereotypy while measuring collateral effects on accuracy and rate of completion of appropriate alternative behavior. Three individuals, with an autism spectrum disorder, who exhibited motor stereotypy maintained by automatic reinforcement, participated. The effects of DRA alone and DRA with RIRD were evaluated using a combination of reversal and multielement designs. During DRA, a high preference edible was delivered contingent on an appropriate academic response, and no programmed consequences were provided for motor stereotypy. During DRA with RIRD, a redirection procedure was added, which involved interruption and presentation of instructions to engage in motor compliances contingent on stereotypy. Results suggest that direct reductive procedures, such as RIRD, may be necessary for reducing automatically-reinforced stereotypy. However, RIRD did not negatively impact academic performance.

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

Response interruption and redirection (RIRD) is a behavioral intervention designed to interrupt challenging behaviors maintained by automatic reinforcement (e.g., stereotypy) and promote adaptive alternative responses. To inform this chapter, 54 peer-reviewed studies evaluating RIRD alone or as component of a larger intervention were considered along with systematic literature reviews. RIRD is an evidence-based practice for treatment of motor and vocal stereotypy. RIRD is most effective when it is paired with a focused effort to increase appropriate behavior. In some cases, targeted stereotypic behavior decreases but other undesirable forms of challenging behavior may emerge during RIRD. Additional research elucidating the operant mechanisms responsible for behavior change during RIRD and evaluating the social validity and acceptability is warranted. It is not always necessary or desirable to target stereotypy for reduction. Intervention should be considered when the stereotypy interferes with learning, limits opportunities for inclusion or independence, or negatively affects quality of life.

Response interruption and redirection (RIRD) is an effective intervention for decreasing stereotypy. During RIRD, contingent on occurrences of stereotypy, therapists interrupt the behavior and prompt the participant to complete an alternative response. Although RIRD has been implemented by teachers in classrooms, it requires continuous monitoring of participants to be implemented with fidelity and may be difficult for teachers to manage. The present study evaluated the effectiveness of RIRD when implemented in classrooms. In addition, we evaluated if novice teaching assistants could be trained to implement RIRD. Finally, a descriptive analysis of treatment integrity errors during RIRD was conducted. Three children and teaching assistants participated. Following a written instructions baseline, the teaching assistants were trained to implement RIRD using modeling, rehearsal, and feedback. The training increased the accuracy of RIRD implementation for all participants. Incorrectly initiating and terminating RIRD were the most common treatment integrity errors observed.

Response interruption and redirection (RIRD), a procedure in which demands are delivered contingent on stereotypy, has been shown to reduce vocal and motor stereotypy maintained by automatic reinforcement. However, RIRD can be time consuming and can interrupt ongoing activities and access to reinforcement for appropriate behavior. We attempted to address these limitations by comparing the effectiveness of RIRD using the standard 3-demand procedure to RIRD using just 1 demand. Results showed that RIRD with 1 demand was effective in reducing stereotypy for all participants, required fewer demands overall, and resulted in shorter implementation time. In addition, 2 participants showed an increase in appropriate play during RIRD. These results suggest RIRD with 1 demand may be an effective and less intrusive procedure for reducing stereotypy.

Although response interruption and redirection (RIRD) and multiple schedule arrangements have sometimes been shown to be effective in reducing stereotypy for individuals with autism spectrum disorder (ASD), important questions remain about optimal methods for facilitating generalization and social validity. In the current study, we sought to extend the literature on stereotypy treatment and MSAs in several ways. First, we programmed for generalization by conducting sessions with two exemplars of two different categories of activities (i.e., school work, toy play) and assessing generalization with novel exemplars and activities and during the participant's typical instructional program. Second, we used RIRD instructions that were contextual models of appropriate behavior relevant to each activity. Third, during the free access component of the multiple schedule, we used a child's play tent as a first step toward teaching participants to engage in stereotypy during private free time. For all three participants with ASD, stereotypy decreased quickly and substantially, with reductions generalizing to novel activities and contexts. An extensive social validity assessment with board‐certified behavior analysts indicated high social acceptability of the goals, procedures, and outcomes.

Publication bias is the disproportionate representation of studies with large effects and statistically significant findings in the published research literature. If publication bias occurs in single-case research design studies on applied behavior-analytic (ABA) interventions, it can result in inflated estimates of ABA intervention effects. We conducted an empirical evaluation of publication bias on an evidence-based ABA intervention for children diagnosed with autism spectrum disorder, response interruption and redirection (RIRD). We determined effect size estimates for published and unpublished studies using 3 metrics, percentage of nonoverlapping data (PND), Hedges' g, and log response ratios (LRR). Omnibus effect size estimates across all 3 metrics were positive, supporting that RIRD is an effective treatment for reducing problem behavior maintained by nonsocial consequences. We observed larger PND for published compared to unpublished studies, small and nonsignificant differences in LRR for published compared to unpublished studies, and significant differences in Hedges' g for published compared to unpublished studies, with published studies showing slightly larger effect. We found little, if any, difference in methodological quality between published and unpublished studies. While RIRD appears to be an effective intervention for challenging behavior maintained by nonsocial consequences, our results reflect some degree of publication bias present in the RIRD research literature.

Vocal stereotypy, or repetitive, noncontextual vocalizations, is a problematic form of behavior exhibited by many individuals with autism spectrum disorder (ASD). Recent research has evaluated the efficacy of response interruption and redirection (RIRD) in the reduction of vocal stereotypy. Research has indicated that RIRD often results in reductions in the level of vocal stereotypy; however, many previous studies have only presented data on vocal stereotypy that occurred outside RIRD implementation. The current study replicated the procedures of previous studies that have evaluated the efficacy of RIRD and compared 2 data-presentation methods: inclusion of only data collected outside RIRD implementation and inclusion of all vocal stereotypy data from the entirety of each session. Subjects were 7 children who had been diagnosed with ASD. Results indicated that RIRD appeared to be effective when we evaluated the level of vocal stereotypy outside RIRD implementation, but either no reductions or more modest reductions in the level of vocal stereotypy during the entirety of sessions were obtained for all subjects. Results suggest that data-analysis methods used in previous research may overestimate the efficacy of RIRD.

The relation between contextually appropriate vocalizations (AV) and vocal stereotypy (VS) has yet to be established within the response interruption and redirection (RIRD) literature. RIRD may promote AV by suppressing VS and/or by functioning as incompatible responses. The occurrence of VS and AV was assessed during baseline, RIRD alone, and RIRD combined with a differential reinforcement system for AV (RIRD + DRI) for a 5‐year‐old child with autism. Results showed an increase in AV once RIRD was implemented and further increases in AV and decreases in stereotypy when the token system of reinforcement for AV was implemented. Copyright © 2012 John Wiley & Sons, Ltd.

Response interruption and redirection (RIRD) is a common treatment for automatically reinforced vocal stereotypy; it involves the contingent presentation of task instructions. Tasks that are included in RIRD are typically selected based on caregiver report, which may affect the efficacy of RIRD. The purpose of the current study was to evaluate the role of task preference in the efficacy of RIRD for four participants who engaged in vocal stereotypy. We conducted task-preference assessments and selected tasks of varying preferences to include in RIRD. For three out of four participants, the results showed that RIRD with higher preference tasks was not effective at reducing vocal stereotypy, whereas RIRD with lower preference tasks was effective for all participants.

Response interruption and redirection (RIRD) is an intervention that involves presenting demands or other types of distracters to interrupt an interfering behavior and redirect it to a more appropriate response. It targets the decrease of repetitive, stereotypic, and self-injurious behaviors. Research indicates that stereotypy is commonly maintained by automatic reinforcement (Rapp & Vollmer, 2005). Ahearn, Clark, MacDonald, and Chung (2007) were the first to evaluate the use of RIRD as a behavioral intervention for vocal stereotypy. Due to the success of RIRD as being the one behavioral intervention that not only decreases vocal stereotypy but may increases engagement in appropriate vocalizations the authors chose to examine additional studies that have used RIRD to address vocal stereotypy in children with autism in order to see if the replication and expansion of RIRD has continued to produce support for this intervention. Ten single-subject design studies were identified between 2000 and 2016. With such a limited number of studies, all showing positive results, future research should focus on replicating and expanding RIRD as a behavioral intervention to address vocal stereotypy in children with autism.

Previous research implies that stereotypic behavior tends to be maintained by the sensory consequences produced by engaging in the response. Few investigations, however, have focused on vocal stereotypy. The current study examined the noncommunicative vocalizations of 4 children with an autism spectrum disorder. First, functional analyses were conducted in an attempt to identify the function of each child's behavior. For each of the participants, it was found that vocal stereotypy was likely not maintained by the social consequences. Following assessment, response interruption and redirection (RIRD) was implemented in an ABAB design to determine whether vocal stereotypy could be successfully redirected. RIRD involved a teacher issuing a series of vocal demands the child readily complied with during regular academic programming. Vocal demands were presented contingent on the occurrence of vocal stereotypy and were continuously presented until the child complied with three consecutively issued demands without emitting vocal stereotypy. For each child, RIRD produced levels of vocal stereotypy substantially lower than those observed in baseline. For 3 of the children, an increase in appropriate communication was also observed. The children's teachers were trained to implement RIRD. Brief follow-up probes and anecdotal information implied that the treatment had a positive impact in the natural environment.

Motor stereotypy can be a challenging behavior to decrease, particularly when the behavior is maintained by the sensory consequences the response itself produces. Response interruption and redirection (RIRD) has proven to be an effective treatment in reducing the rate of stereotypy for individuals diagnosed with an autism spectrum disorder. Though it is an effective treatment, the RIRD procedure requires intensive resources to implement. Additionally, low treatment integrity could have detrimental effects on the efficacy of the treatment. Differential reinforcement of other behavior (DRO) is another effective treatment that has been shown to reduce the rate of stereotypy. DRO is not as staff intensive; however, it is not always an effective treatment when used alone. The current study compared the effects RIRD and DRO on motor stereotypy in an ABAB design with both treatments being implemented in the B phase. Three students diagnosed with an autism spectrum disorder participated. Our findings demonstrated that the treatment of motor stereotypy is idiosyncratic to the individual. For two participants, the RIRD procedure was more consistently effective than DRO. For the other participant the DRO was at least equally effective as RIRD.