Treatment Of Stereotypy Research Articles

The effects of sensory integration on stereotypy of preschool students with autism

AbstractThe purpose of the current study was to systematically replicate the independent variable used in Moore et al.'s (2015) experiment using sensory integration therapy (SIT) as a treatment for automatically maintained stereotypy. According to sensory integration theory, providing certain sensory experiences to individuals with autism can change their repetitive behavior. Despite the lack of research supporting SIT as a valid treatment to reduce episodes of stereotypy in individuals with autism spectrum disorder (ASD), it remains a common treatment in most schools and centers designed for these individuals. The study was conducted with three preschool students with ASD using a multiple baseline design across participants to test for a functional relation between the independent variable, the participants' individualized, prescribed sensory diets and the dependent variable, their episodes of stereotypy in morning and afternoon sessions. The results do not support the use of a sensory diet as a treatment for stereotypy.

Examining Procedural Variations of Delivering Competing Stimuli in the Treatment of Stereotypy.

Competing stimulus assessments (CSA) are effective tools for identifying stimuli that compete with automatically reinforced behavior. However, Jennett et al. suggests there are cases for which non-contingent access to competing stimuli are insufficient at decreasing target responding and additional treatment components may be necessary. The purpose of the current study was to examine procedural variations (i.e., rotating competing items and prompted engagement) when presenting competing stimuli on increasing functional engagement and decreasing stereotypy. Following a functional analysis, a CSA was conducted to identify competing stimuli for four individuals with autism. Items identified were then used with two procedural variations. Levels of stereotypy, functional engagement, and item contact were measured. Results showed that for two participants both treatments were effective, while for the other two participants prompting functional engagement was more effective. Prompting functional engagement is likely a productive strategy for enhancing engagement with competing stimuli for automatically reinforced problem behavior as it may result in functional engagement becoming reinforcing in and of itself.

Assessment and treatment of stereotypy in infants at risk of autism spectrum disorder

AbstractIndividuals diagnosed with autism spectrum disorder (ASD) often engage in stereotypic behavior that is challenging to treat due to difficulties isolating the maintaining reinforcer. The purpose of this study was to identify and treat motor stereotypy in an infant at risk of ASD. Although several studies have investigated the prevalence and topographies of stereotypy in young children, none have identified the age at which it emerges and treated it before 1 year of age. Redirection of stereotypy to toy play and reinforcement for toy engagement was implemented in a multiple baseline design across topographies of stereotypy. Results indicate decreases in all topographies of stereotypy to near‐zero levels across the course of the study. These findings are discussed as they relate to the implications of identifying stereotypy in infancy and intervening as soon as it is identified.

Functional communication training and noncontingent reinforcement in treatment of stereotypy

A 6‐year‐old boy with autism spectrum disorder engaged in automatically maintained stereotypy in the form of opening and closing doors. A functional analysis confirmed that he also emitted problem behavior that was maintained by access to stereotypy. We evaluated the separate and combined effects of functional communication training and arbitrary noncontingent reinforcement on both response classes. Results showed that the combination of functional communication training and noncontingent reinforcement was more effective at reducing stereotypy than either intervention on its own, although effects on problem behavior were unclear. These results suggest that combinations of interventions may be useful in the treatment of automatically maintained problem behavior.

A systematic review and evaluation of inhibitory stimulus control procedures as a treatment for stereotyped behavior among individuals with autism

ABSTRACTPurpose: Stereotypy is pervasive among persons with autism and may impact negatively on social inclusion and learning. The implementation of resource-intensive behavioral interventions to decrease these behaviors has been questioned. Inhibitory stimulus control procedures (ISCPs) comprise a type of antecedent-based intervention that has been proposed as an effective treatment approach for stereotypy but has received limited research attention to date. Method: The current systematic review sought to examine and synthesize the literature reporting applications of ISCPs in the treatment of stereotypy among persons with autism. Treatment outcomes were analyzed quantitatively and the status of ISCPs as evidence-based practice was evaluated in accordance with the National Autism Center’s National Standards Report guidelines. Results: A total of 11 studies were reviewed with results indicating that ISCPs constituted an emerging treatment for the stereotypy exhibited by persons with autism. Conclusions: ISCPs comprise a promising intervention for stereotyped behavior but further research is required.

Prevalence of Stereotypy in Individuals with Developmental Disabilities: a Systematic Review

Although many researchers have examined the prevalence of stereotypy in individuals with developmental disabilities, the results of previous studies have not been aggregated and analyzed methodically. Thus, we conducted a systematic review of studies reporting the prevalence of stereotypy in individuals with developmental disabilities. Our results indicated that the average prevalence of stereotypy across studies was 61 % and that individuals with autism spectrum disorders had the highest reported prevalence (i.e., 88 %) across specific diagnoses. Children and adults generally had similar overall prevalence measures, but the specific forms varied with age and diagnosis. Studies using the Repetitive Behavior Scale-Revised and the Autism Diagnostic Schedule-Revised generally reported higher estimates of prevalence of specific forms of stereotypy when compared to the Behavior Problem Inventory. However, the latter seemed more sensitive than the Aberrant Behavior Checklist for overall prevalence. Studies with a low risk of bias found a lower prevalence of stereotypy than those with a high risk of bias. Our systematic review underlines the importance of continuing research efforts to improve the assessment and treatment of stereotypy in individuals with developmental disabilities.

A Case Study on the Use of Auditory Integration Training as a Treatment for Stereotypy

The purpose of the current study was to assess the effectiveness of auditory integration training (AIT) as a treatment for motor stereotypy. The participant was a 5‐year‐old boy diagnosed with autism who had been prescribed AIT. We used an ABCBCA reversal design to examine the effectiveness of AIT on stereotypy. Data were collected for 5 min before, during, and after each experimental condition. Results showed that AIT did not decrease stereotypy. In fact, the total overall occurrence of stereotypy increased and remained high, suggesting that AIT was not an effective treatment for this participant. Copyright © 2015 John Wiley & Sons, Ltd.

Sensory Integration as a Treatment for Automatically Maintained Stereotypy

According to sensory integration (SI) theory, many symptoms of autism are caused by an inability to integrate and adaptively respond to sensory input. Despite little evidence supporting SI, this form of therapy is a popular treatment for children with autism. Should these treatments work, they should be most effective for behavior maintained by sensory consequences (automatically maintained). SI activities may make these sensory consequences less reinforcing. The purpose of this study was to determine whether SI treatments could reduce automatically‐maintained stereotypy. Five individuals with autism participated. An occupational therapist prescribed sensory activities that competed with stereotypy for SI treatments. Two types of SI treatments were tested: sensory diets and brushing with deep‐pressure therapy. The effect of these treatments on stereotypy was evaluated in an ABAB design. Neither the sensory diet alone, brushing and deep pressure alone, nor both treatments combined were effective interventions for stereotypy. These results do not support the use of SI as a treatment for stereotypy. Copyright © 2015 John Wiley & Sons, Ltd.

Parametric analysis of response interruption and redirection as treatment for stereotypy.

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.

Introduction to the Special Issue: Assessment and Treatment of Stereotypy.

Stereotypy is often characterized as repetitious, invariant behavior that generates its own reinforcing consequence. Stereotypy represents a unique treatment challenge, because the consequences produced by stereotypy cannot be directly controlled by the practitioner. Likewise, practitioners have relatively few options for identifying the function of repetitive behavior. Recently, several researchers have been conducting empirical studies to address these issues. This article introduces a special issue presenting some of these recent developments in the assessment and treatment of stereotypy and related behavior.

Pre-Session Satiation as a Treatment for Stereotypy During Group Activities

Individuals with developmental disabilities may engage in automatically reinforced behaviors that may interfere with learning opportunities. Manipulation of motivating operations has been shown to reduce automatically maintained behavior in some individuals. Considering behavioral indicators of satiation may assist in identifying the point at which an abolishing operation has begun to effect behavior. The purpose of this study was to evaluate the effects of pre-session satiation of automatic reinforcement on subsequent levels of stereotypy and activity engagement during group activities for three males ages 5 to 13 years with developmental disabilities. Following functional analyses with analogue conditions, an alternating treatment design compared a pre-session access to stereotypy condition with a no-pre-session access condition prior to group activity sessions. Results indicated that pre-session satiation of the putative reinforcer produced by stereotypy was effective in decreasing stereotypy and increasing activity engagement during subsequent group activities for all participants. These findings add to the literature supporting the effectiveness of abolishing operations to decrease automatically maintained stereotypy.

RESPONSE INTERRUPTION AND REDIRECTION: CURRENT RESEARCH TRENDS AND CLINICAL APPLICATION

The objective of this paper is to provide a review of recent literature on response interruption and redirection (RIRD), a treatment for stereotypy. We discuss procedural variations and the potential mechanisms that are responsible for the effectiveness of RIRD. Clinical considerations and suggestions for future research are also discussed.

Stereotypies in Captive Primates and the Use of Inositol: Lessons from Obsessive–Compulsive Disorder in Humans

Animal stereotypies have long been used in the study of obsessive–compulsive disorder (OCD) in humans. These studies have led to the understanding of some of the molecular pathways in the disorder and the use of selective serotonin reuptake inhibitors and myo-inositol in the treatment of these conditions. If animal models, especially nonhuman primate models, were used to study human disorders and if the resulting treatments were successful, then conversely one should be able to treat nonhuman primate stereotypies with similar methods. We here summarize animal models of OCD (including nonhuman primate models) and human OCD treatments, and using successful human treatment by myo-inositol as models, recommend the use of myo-inositol in good captive management practice and the treatment of nonhuman primate stereotypies. We believe that this would be particularly useful in the treatment of stereotypies in nonhuman primates because they are physiologically so similar to humans.

Immediate and subsequent effects of differential reinforcement of other behavior and noncontingent matched stimulation on stereotypy

AbstractA three‐component multiple‐schedule and brief reversals were used to examine the effects of differential reinforcement of other behavior (DRO) and noncontingent matched stimulation (NMS) on the automatically reinforced mouthing of a child with autism. Both DRO and NMS decreased immediate engagement in mouthing, but NMS produced larger reductions in the behavior. Furthermore, NMS produced subsequent effects (i.e., when the treatment was withdrawn) similar to those of prior access, whereas DRO marginally increased subsequent engagement in mouthing. The results suggest that NMS was a functionally matched intervention for mouthing. Implications for the assessment and treatment of stereotypy and applications for future research are discussed. Copyright © 2010 John Wiley & Sons, Ltd.

Using response latency within a preference assessment.

This study evaluated the effects of using differential reinforcement of other behavior (DRO) with a differential reinforcement of alternative behavior (DRA) resetting time schedule to reduce stereotypy in a child with Rett Syndrome. The primary purpose of the investigation was to compare latency and choice as dependent measures to identify reinforcers for use within a DRO/A contingency using a resetting time schedule. The treatment contingencies were arranged to decrease the rate of stereotypy and increased functional play skills. Overall, our results support the use of latency to respond as a dependent measure for selecting reinforcers. Keywords: Response Latency, Preference Assessment, Automatic Behavior ********** When working with children who engage in inappropriate behavior, it is relatively easy to identify a social function. Through observation and manipulation of environmental variables, previous research suggests that most problem behavior is maintained by a social function (Iwata et al., 1994). Treatment for behaviors that serve an automatic function are more difficult to identify because social reinforcers are not identified. Specifically, maintaining contingencies are extremely difficult to manipulate because the behavior itself provides reinforcement (Iwata et al., 1994). Often, an attempt is made to identify activities or objects that can compete with the behavior itself (Alberto & Troutman, 2005). Alternatively, attempts can be made to identify substitutable stimuli to replace sensory reinforcement obtained by engaging in the behavior (Piazza, Hanley, & Fisher, 1996). In addition, it has been demonstrated in the literature that substitutable stimuli are (a) preferred and (b) result in decreased levels of problem behavior when presented non-contingently. The purpose of this study was to identify effective reinforcers for use in a treatment package for a young child who engaged in stereotypic behaviors maintained by automatic reinforcement. By doing so, we further sought to compare the use of choice versus response latency as a dependent measure for use within a preference assessment. We hypothesized that more effective reinforcers would be identified using response latency as a dependent measure. Specifically, because these stimuli were shown to decrease the occurrence of automatic behavior within the preference assessment, we hypothesized that they were substitutable to the behavior. Method Participants and Setting The participant was a 6-year-old female diagnosed with Rett Syndrome. She was referred by her classroom teacher for the assessment and treatment of stereotypy. Stereotypy was reported to occur at high rates in home and school settings. All observations took place in a 3.m by 4.5m room located adjacent to her classroom. The room was equipped with a two-way window for unobtrusive observation. Data Collection, and Interobserver Agreement The dependent variables were (a) inappropriate vocalizations, which were defined as loud, raspy, noises in the back of the throat occurring in brief bursts; (b) spitting which was defined as having the tongue completely out of the mouth making a spitting noise; (c) hand wringing which was defined as rubbing the pads on the fingers of one hand against the pads on the fingers of the other hand together, usually done by the shoulder; (d) hand flapping defined as moving her hands up and down either by the hips or shoulders; (e) latency, which was defined as the amount of time, in seconds, between the presentation of an item and the first occurrence of a stereotypic response; and (f) choice, which was defined as reaching for one of two objects within a concurrent operant format. Data were collected using three different observational systems: (a) partial-interval recording, (b) event recording, and (c) latency recording. All partial interval recording was collected via videotape and scored later using a 6-s recording system. …

Paradoxical rate-dependent effect of fluoxetine on captivity-induced stereotypies in bank voles

Treatment of stereotypies in human and animal clinics is still empirical due to our incomplete understanding of underlying mechanisms. As a consequence, experimental studies in controlled laboratory conditions are necessary. Bank voles ( Clethrionomys glareolus), housed in barren laboratory cages, often develop stereotyped up-and-down jumping even before the age of 1 month. The aim of this study was to investigate how captivity-induced stereotypies respond to fluoxetine (Prozac®), a selective serotonin reuptake inhibitor. During a control period of 10 days saline was administered daily s.c. to 6-month-old bank voles ( n = 24). In the subsequent 30 days, 16 animals received a dose of 10-mg/kg s.c. daily while 8 other animals were injected a dose of 20-mg/kg fluoxetine. Stereotypies, general activity, food intake and body weight were measured. Dose-related and paradoxical rate-dependent effects were found on stereotypies. After 10 days of treatment, the stereotypy levels of the animals with high pre-drug stereotypy rates decreased in contrast with those of low stereotypers which increased. No effect was found on general activity and food intake. Weekly weighing revealed an increase of weight during the total drug period and a return to pre-drug levels during the week thereafter.

Stereotypy I: A review of behavioral assessment and treatment

In this paper, we review definitional issues related to stereotypy, behavioral interpretations of stereotypy, procedures for determining operant function(s) of stereotypy, and behavioral interventions for stereotypy. In general, a preponderance of the assessment literature suggests that most forms of stereotypy are maintained by automatic reinforcement. Review of the treatment literature suggests that antecedent (e.g., environmental enrichment) and consequent (e.g., differential reinforcement of alternative behavior) interventions produce at least short-term reductions in stereotypy. Suggestions for further assessment and treatment of stereotypy are provided.

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

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. …

Facial Screening Fails in the Treatment of Stereotypy

Research has consistently supported facial screening as an effective treatment technique capable of reducing a plethora of aberrant behaviors. As yet few data are available, suggesting less than enthusiastic support for this behavioral consequence. The present investigation found facial screening accelerated the rate of stereotypy after prior reports of effective reduction of the rate of stereotypy with this individual. The advantages of rapid evaluation strategies and the need for publication of negative results are discussed.

Physical restraint, visual screening and DRI in the treatment of stereotypy

Abstract This study evaluated two treatment programs on the stereotypic responding of a profoundly retarded boy. DRI and physical restraint were used in a multiple baseline across conditions design in one setting and produced 70–80% decreases in stereotypy. DRI, restraint and visual screening were tested in another setting through an ABAB design and resulted in 82% and 94% decreases respectively. Toy contact, the behavior reinforced in the DRI procedure, increased 65% and 80% over baseline in the two settings where the DRI was in effect. The results suggest the importance of a DRI procedure to increase incompatible behavior when treating stereotypy and the use of an aversive procedure individually tailored to the subject being treated.