Functional analysis and treatment of verbal perseverations displayed by an adult with autism

An Assessment of Response to Conversation Cues of Uninterest Conducted via Telehealth

Individuals diagnosed with autism spectrum disorder (ASD) exhibit deficits in social interaction and communication. Kronfli, Vollmer, et al. developed an in-person assessment to evaluate participant response to social cues indicating uninterest in a conversation. In the current study, we sought to extend these procedures to the assessment of conversation skills via telehealth given the ongoing pandemic and so that participants in remote areas could receive services. Participants were exposed to a hierarchy of social cues of uninterest ranging in salience from one-word responses to a clear verbal statement of uninterest until they demonstrated sensitivity to a social cue. One participant who did not demonstrate sensitivity to any cues received instruction using Behavioral Skills Training. Initial results support the utility of using a remote assessment model to screen for sensitivity to specific social cues in conversations and to provide services to participants via telehealth.

A translational evaluation of listener interest on the presentation of conversation topics to individuals who exhibit restricted interests

Listener behavior has been shown to influence speaker behavior. However, little is known about the extent to which listener behavior can influence countertherapeutic outcomes. This study evaluated the influence of listener interest on the topics presented by adult participants conversing with an experimenter acting as an individual who exhibited restricted interests. Each session consisted of a 5‐min conversation, during which the participant was instructed to talk about 3 topics. We compared the duration of topic presentation across phases in which the experimenter behaved as an interested listener for 1 topic or for all 3 topics. Results showed that topic presentation was controlled by listener interest and all participants reported that the simulation was believable, acceptable, and useful. Although preliminary, these findings have implications for understanding possible undesirable interactions between individuals diagnosed with autism spectrum disorder who exhibit restricted interests and their peers or caregivers.

Echolalia from a transdiagnostic perspective

BACKGROUND & AIMS

Echolalia, the repetition of one's or others' utterances, is a behavior present in typical development, autism spectrum disorder, aphasias, Tourette's, and other clinical groups. Despite the broad range of conditions in which echolalia can occur, it is considered primarily through a disorder-specific lens, which limits a full understanding of the behavior.

METHOD

Empirical and review papers on echolalia across disciplines and etiologies were considered for this narrative review. Literatures were condensed into three primary sections, including echolalia presentations, neural mechanisms, and treatment approaches.

MAIN CONTRIBUTION

Echolalia, commonly observed in autism and other developmental conditions, is assessed, observed, and treated in a siloed fashion, which reduces our collective knowledge of this communication difference. Echolalia should be considered as a developmental, transdiagnostic, and communicative phenomenon. Echolalia is commonly considered as a communicative behavior, but little is known about its neural etiologies or efficacious treatments.

CONCLUSIONS

This review is the first to synthesize echolalia from a transdiagnostic perspective, which allows for the direct comparisons across and within clinical groups to inform assessment, treatment, conceptualization, and research recommendations.

IMPLICATIONS

Considering echolalia transdiagnostically highlights the lack of consensus on operationalization and measurement across and within disorders. Clinical and research future directions need to prioritize consistent definitions of echolalia, which can be used to derive accurate prevalence estimates. Echolalia should be considered as a communication strategy, used similarly across developmental and clinical groups, with recommended strategies of shaping to increase its effectiveness.

Biopsychological correlates of repetitive and restricted behaviors in autism spectrum disorders

BACKGROUND

Autism Spectrum Disorder (ASD) is considered a neurodevelopmental condition that is characterized by alterations in social interaction and communication, as well as patterns of restrictive and repetitive behaviors (RRBs). RRBs are defined as broad behaviors that comprise stereotypies, insistence on sameness, and attachment to objects or routines. RRBs can be divided into lower-level behaviors (motor, sensory, and object-manipulation behaviors) and higher-level behaviors (restrictive interests, insistence on sameness, and repetitive language). According to the DSM-5, the grade of severity in ASD partially depends on the frequency of RRBs and their consequences for disrupting the life of patients, affecting their adaptive skills, and increasing the need for parental support.

METHODS

We conducted a systematic review to examine the biopsychological correlates of the symptomatic domains of RRBs according to the type of RRBs (lower- or higher-level). We searched for articles from the National Library of Medicine (PubMed) using the terms: autism spectrum disorders, ASD, and autism-related to executive functions, inhibitory control, inflexibility, cognitive flexibility, hyper or hypo connectivity, and behavioral approaches. For describing the pathophysiological mechanism of ASD, we also included animal models and followed PRISMA guidelines.

RESULTS

One hundred and thirty-one articles were analyzed to explain the etiology, continuance, and clinical evolution of these behaviors observed in ASD patients throughout life.

CONCLUSIONS

Biopsychological correlates involved in the origin of RRBs include alterations in a) neurotransmission system, b) brain volume, c) inadequate levels of growth factors, d) hypo- or hyper-neural connectivity, e) impairments in behavioral inhibition, cognitive flexibility, and monitoring and f) non-stimulating environments. Understanding these lower- and higher-level of RRBs can help professionals to improve or design novel therapeutic strategies.

The Effects of a Procedure to Decrease Motor Stereotypy on Social Interactions in a Child With Autism Spectrum Disorder

Repetitive and stereotypic motor movements and vocal behavior are among the diagnostic characteristics of autism spectrum disorder (American Psychiatric Association, 2013, Diagnostic and Statistical Manual of Mental Disorders [5th ed.]. Washington, DC: Author). Motor stereotypy can interfere with the acquisition and demonstration of many adaptive skills and may socially stigmatize individuals, limiting the development and maintenance of peer relationships. The current study evaluated the effects of a differential reinforcement procedure used to establish discriminative stimulus control over the rate of motor stereotypy. In the second experimental phase, the child was taught a multistep self-management program using the differential reinforcement procedure. The data indicate that the procedure was effective in decreasing the rate of motor stereotypy across all evaluated settings for an increased duration. Although motor stereotypy was not completely eliminated by the procedure, a large reduction in rate was observed, as well as a large increase in the initiation of and response to social interactions. The findings are discussed in terms of social validity and the establishment and transfer of stimulus control.

Supportive employment practices: perspectives of autistic employees

Purpose

Employment can make an important contribution to individual well-being, for example, by providing people with a sense of purpose; however, autistic individuals face significant barriers to entering the workforce. This is reflected in high levels of underemployment and unemployment, with an estimated 80% of autistic people unemployed worldwide. This is higher than both other disability groups and people without disabilities. Research is needed to identify strategies that facilitate the sustained employment of autistic adults. This study aims to examine the perspectives of autistic individuals participating in a specialized employment program within the information and communication technology sector.

Design/methodology/approach

Three focus groups were conducted with nine adults on the autism spectrum. Data were analyzed using an inductive approach according to established guidelines, which included coding and categorizing data into themes.

Findings

Focus group analysis revealed four themes: trainees’ previous work experiences; expectations of the employment program; recruitment and selection processes; and training and transition. Several factors associated with the changes to the recruitment and selection process were found to benefit the autistic employees.

Originality/value

Few studies have characterized the work experiences of adults on the autism spectrum. Tailored employment processes that challenge traditional human resource management practices can increase the participation of autistic individuals in the workforce. Strategies for promoting the success of these programs are discussed.

Partner Perceptions of Conversations with Individuals with Autism Spectrum Disorder

Pragmatic difficulties resulting in problems with reciprocal conversation are widely studied in individuals with autism spectrum disorder (ASD). There is some consensus on the conversation differences between individuals with autism compared to neurotypical groups and groups with other developmental delays. There is little information on whether conversation partners (neurotypical or with ASD) of individuals with ASD find these differences problematic. The results indicate that behaviors reported to be the most problematic were not necessarily behaviors commonly addressed in research. Further, some conversational capacities that have received less research focus were perceived as more problematic. Although conversation partners who had ASD themselves reported the frequency of behaviors similarly to the neurotypical group, they did not find the behaviors as problematic.

Functional analysis and intervention of perseverative speech in students with high-functioning autism and related neurodevelopmental disabilities

Although perseverative speech is a common characteristic of individuals with high-functioning neurodevelopmental disabilities, little is known about the operant functions of these verbalizations. We conducted analogue functional analyses of perseverative speech for 2 students using reinforcement contingencies that included alone, attention, control, escape, and tangible conditions. Results showed the following patterns: attention only (Charlotte) or multiply determined including an attention function (Paul). We then tested an intervention for perseverative speech maintained by social positive reinforcement that included differential reinforcement of alternative behavior and extinction of perseverative speech for 1 participant. The intervention reduced perseverative speech, but did not increase appropriate speech until we added a prompting component. We then replicated this three-component intervention with Paul. The results showed moderate to high decreases in levels of perseverative speech and increased appropriate verbalizations in both cases. The results systematically replicated the interventions of previous studies by adding a prompting component to the intervention.

Psychoeducational Interventions for Adults With Level 3 Autism Spectrum Disorder: A 50-Year Systematic Review

There is face validity to the expectation that adults with level 3 autism spectrum disorder (ASD-3) will benefit from a range of psychoeducational interventions. This paper reviews the empirical evidence supporting the effectiveness of these interventions, many of which are currently used in clinical settings. We reviewed 56 peer-reviewed studies of psychoeducational interventions for adults with ASD-3, written in English and since 1968, that met our criteria. The reviewing team included educators, clinicians, researchers, and a biostatistician. The available literature was limited, and most, if not all, of the studies presented some significant methodological limitations. When using Cochrane's criteria to assess seven key outcome domains-activities of daily living, aggressive/destructive behaviors, emotional functioning, language/communication skills, self-injurious behaviors, stereotypy/mannerisms, and vocational skills-we found only moderately reliable evidence to support the effectiveness of interventions designed to improve emotional functioning in adults with ASD-3. The reliability of evidence relevant to the six other outcome domains was rated as low or very low. Based on this review, we suggest directions for future study of interventions for adults with ASD-3, including topics, subpopulations, and approaches that should be explored. We also propose some crucial changes in how future studies regarding this population should be designed, analyzed, and documented, while balancing clinical considerations with scientific/educational utility.

Functional Behavioral Assessment-based interventions on adults' delusions, hallucinations and disorganized speech: A single case meta-analysis

The Functional Behavioral Assessment (FBA) approach involves the use of single-case designs (SCD) to study the problem behavior-environment contingencies and conduct interventions that consider this functional relationship. Although this approach has been considered an evidence-based practice (EBP) for the treatment of several psychological problems, no meta-analytic studies of FBA-based interventions on delusions, hallucinations and disorganized speech -commonly operationalized as "atypical vocalizations"- have been carried out. Therefore, the purpose of this study was to review and synthesize the results of FBA-based interventions on adults' atypical vocalizations. We conducted a systematic review and a multi-level meta-analysis of these interventions, using a recently developed effect size estimator for SCD studies (i.e., log response ratio). All the studies that met our eligibility criteria provided evidence supporting the effectiveness of FBA-based interventions on atypical vocalizations, with an overall average effect size of a 72% reduction. Both the publication year and the methodological quality were found to be significant moderators. Despite some methodological limitations, we can conclude that FBA-based interventions are effective to reduce atypical vocalizations. The implications of these results could be of interest for the mental health community.

The effectiveness of the peak relational training system and corresponding changes on the VB-MAPP for young adults with autism

The current investigation sought to extend prior research evaluating the use of the PEAK Relational Training System as a comprehensive treatment model in improving language skills demonstrated by individuals with autism. Baseline PEAK-Direct Training and Verbal Behavior Milestone Assessment and Placement Program (VB-MAPP) assessments were conducted across 3 adult male participants, and scores on the PEAK-Direct Training assessment were used to select targets for intervention. Language instruction guided by the PEAK-Direct Training module was implemented for 45 to 69 days across participants. Results suggest that participants mastered target skills throughout the training phase, and VB-MAPP test probes showed an increasing trend. Follow-up probes suggested that scores on the VB-MAPP maintained when training was discontinued. In addition, participants demonstrated an increase in assessment scores on the PEAK-Direct Training assessment in the follow-up phase, including the mastery of untargeted verbal skills.

Functional analysis of inappropriate social interactions in students with Asperger's syndrome

We analyzed the inappropriate social interactions of 3 students with Asperger's syndrome whose behavior was maintained by social positive reinforcement. We tested whether inappropriate social behavior was sensitive to social positive reinforcement contingencies and whether such contingencies could be reversed to increase the probability of socially appropriate responding. Our results show that social positive reinforcers can be identified for inappropriate social interactions and that appropriate social behaviors can be sensitive to reinforcement contingency reversals.

A systematic review of psychosocial interventions for adults with autism spectrum disorders

Individuals with autism spectrum disorders (ASD) spend the majority of their lives as adults, and psychosocial interventions show promise for improving outcomes in this population. This research conducted a systematic review of all peer-review studies evaluating psychosocial interventions for adults with ASD. A total of 1,217 studies were reviewed, only 13 met inclusion criteria. The majority of studies were single case studies or non-randomized controlled trials, and most focused on applied behavior analysis or social cognition training. Effects of psychosocial treatment in adults with ASD were largely positive ranging from d = 0.14-3.59, although the quantity and quality of studies is limited. There is substantial need for the rigorous development and evaluation of psychosocial treatments for adults with ASD.

Functional analysis and treatment of the delusional statements of a man with multiple disabilities: a four-year follow-up

Although delusional statements in people with intellectual disabilities and traumatic brain injury can be treated using behavioral interventions, none have demonstrated long-term treatment effects. In the current study, a functional analysis demonstrated that delusional statements were maintained by attention. Differential reinforcement of alternative behavior and extinction of delusional statements resulted in near elimination of delusional statements and an increase in nondelusional statements. Follow-up at 6 months, 1, 2, and 4 years indicated that treatment gains were maintained with continued staff training.

Use of differential reinforcement to reduce behavior problems in adults with intellectual disabilities: a methodological review

The least-restrictive-alternative guideline for providing treatment emphasizes the use of non-aversive procedures to reduce maladaptive behaviors in individuals with intellectual disability (ID). Differential reinforcement (DR) is an excellent example of such a non-aversive, reinforcement based behavioral intervention. The purpose of this literature review was to summarize and provide a methodological analysis of studies, conducted between 1980 and 2009, using a DR contingency to reduce problem behaviors in adults with ID. A total of 31 studies were located that met the inclusion criteria. Of these, 15 reported DR to be an effective intervention when used independently. Of the remaining, 10 studies found DR to be useful as part of a treatment package, and six found a DR contingency used independently to be ineffective, and only observed treatment effects when an aversive component was added. Very few studies assessed the use of DR in older adults and in individuals with mild ID; these reflect areas of future research. A methodological analysis found that several studies did not report information on key methodological variables; for example, conducting a functional analysis and a stimulus preference assessment to guide choice of treatment and reinforcers, thinning very dense DR schedules, assessing collateral behaviors, generalization of behavior change across settings and implementers, and following up treatment outcomes over time. The overall positive findings about the effectiveness of DR are encouraging; however, more methodologically robust studies would serve to make such findings more conclusive and practically relevant for implementation in natural settings for adults with ID.

Behavioural intervention practices for stereotypic and repetitive behaviour in individuals with autism spectrum disorder: a systematic review

AIM

The purpose of this systematic review was to examine the quality of conduct of experimental studies contributing to our empirical understanding of function-based behavioural interventions for stereotypic and repetitive behaviours (SRBs) in individuals with autism spectrum disorders (ASDs).

METHOD

Systematic review methodology was used to identify relevant articles, to rate the level of evidence and quality of conduct of the studies, and to extract data systematically.

RESULTS

Ten single case studies examining 17 participants (14 males, 3 females; age 2y 11mo-26y) diagnosed with various ASDs were included. Overall, studies reported decreases in SRBs using behavioural interventions and some collateral increase in desirable behaviours.

INTERPRETATION

Only a small number of intervention studies for SRBs explicitly state the function of the behaviour; therefore, relatively little is known about the efficacy of SRB interventions in relation to the range of possible behavioural functions. Evidence supporting SRB interventions is preliminary in nature, and caution should be used in choosing and implementing SRB intervention practices for individuals with ASDs.

Using conversation analysis to explore the recurrence of a topic in the talk of a boy with an autism spectrum disorder

Some higher functioning individuals with autism spectrum disorders (ASDs) are reported to produce perseverative talk, especially around 'special interests'. Topic perseveration is a form of pragmatic impairment captured in Prizant and Rydell's (1993) continuum of unconventional verbal behaviour in autism. Although widely reported, there is little systematic empirical research into this phenomenon. This paper considers the utility of Conversation Analysis in developing knowledge in this area, drawing upon data involving a boy with an ASD interacting with a researcher and a mobile robot platform. Although a frequency analysis of the boy's talk on a single topic may suggest that it is perseverative in nature, in a sequential analysis of both talk and non-spoken activities this study aims to show how these may be interactionally-embedded. It is suggested that, in considering the interactional salience of apparently perseverative talk, it can be useful to explore the participation framework in which the topic is revisited.

The reinforcing effect of contingent attention on verbal perseverations of two children with severe visual impairment

The frequency of verbal perseverations of two children with severe visual impairment was reduced using differential reinforcement of appropriate speech coupled with extinction of perseverative utterances. A reversal design in which baseline and intervention were alternated in an A-B-A-B sequence was employed to show the functional relationship between the target behaviors and the treatment procedure. There was a marked increase in appropriate utterances and a correlated decrease in perseverative ones. These findings suggest that this singular feature of the language of certain children with visual impairment is, under natural conditions, probably maintained by the attention provided by their caregivers.

A methodology for assessing the functions of emerging speech in children with developmental disabilities

An approach based on Skinner's (1957) theory of verbal behavior has been developed to understand and teach elementary communication skills to children with autism and developmental disabilities (Sundberg & Partington, 1998). However, few studies have directly examined the characteristics of emerging language in children with developmental disabilities. The purpose of this study was to develop and evaluate an assessment for identifying the elementary functions of vocal speech in children. Participants were 4 children with developmental disabilities, aged 6 years to 12 years, who exhibited at least one distinguishable vocal response (word or phrase) frequently in the natural environment. The assessment focused on three verbal operants delineated by Skinner (mand, tact, and intraverbal). One or more functions were identified for at least one vocal response of each child. Results suggested that this assessment would be useful for (a) evaluating Skinner's theory, (b) guiding decisions about language training for individual children, and (c) studying the nature of expressive language development in children with developmental disabilities.