An evaluation of response cost in the treatment of inappropriate vocalizations maintained by automatic reinforcement

Stimulus Avoidance Assessment: A Systematic Literature Review

Board certified behavior analysts are ethically required to first address destructive behavior using reinforcement-based and other less intrusive procedures before considering the use of restrictive or punishment-based procedures (ethics standard 2.15; Behavior Analyst Certification Board, 2020). However, the inclusion of punishment in reinforcement-based treatments may be warranted in some cases of severe forms of destructive behavior that poses risk of harm to the client or others. In these cases, behavior analysts are required to base the selection of treatment components on empirical assessment results (ethics standard 2.14; Behavior Analyst Certification Board, 2020). One such preintervention assessment is the stimulus avoidance assessment (SAA), which allows clinicians to identify a procedure that is likely to function as a punisher. Since the inception of this assessment approach, no studies have conducted a systematic literature review of published SAA cases. These data may be pertinent to examine the efficacy, generality, and best practices for the SAA. The current review sought to address this gap by synthesizing findings from peer-reviewed published literature including (1) the phenomenology and epidemiology of the population partaking in the SAA; (2) procedural variations of the SAA across studies (e.g., number of series, session length); (3) important quality indicators of the SAA (i.e., procedural integrity, social validity); and (4) how the SAA informed final treatment efficacy. We discuss findings in the context of the clinical use of the SAA and suggest several avenues for future research.

Concerns About ABA-Based Intervention: An Evaluation and Recommendations

For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.

A retrospective analysis of stereotypy: Applicability of the behavioral subtyping model

Recent research on automatically reinforced self-injurious behavior (ASIB) has identified specific patterns of responding in functional analyses that correlate with intervention efficacy (Hagopian et al., 2015; Hagopian et al., 2017). Whereas research by Hagopian et al. (2015, 2017) points to an important development in the assessment and treatment of ASIB, it is unclear if the applicability extends to automatically reinforced noninjurious behaviors, including stereotypy. Therefore, the current study replicated the methods of Hagopian et al. (2017), extending this research to published cases of stereotypy and related behavior. The behavioral subtype for each case was identified, and where applicable, the subtype was compared to intervention outcome data. The categorization of data sets as either Subtype 1 or Subtype 2 did not correspond with specific treatment outcomes. Unlike the results of Hagopian et al. (2015, 2017), reinforcement-based interventions were not more likely to be effective for Subtype 1 stereotypy than for Subtype 2 stereotypy.

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.

Stimulus Control Procedure for Reducing Vocal Stereotypies in an Autistic Child

Stereotyped vocal behavior exhibited by a seven-year-old child diagnosed with autism spectrum disorder and maintained by automatic reinforcement was placed under stimulus control through discrimination training. The training consisted of matching a green card (SD) with free access to vocal stereotypy and a red card (SD-absent) with interruption of stereotypy and vocal redirection. At the same time, appropriate behaviors were reinforced. After discrimination training, the child rarely engaged in vocal stereotypy in the red card condition and, to a greater extent, in the green card condition, demonstrating the ability to discriminate between the two different situations. After the training, the intervention began. Once they reached the latency criterion in the red stimulus condition, the child could have free access to vocal stereotypy (green card condition). The latency criterion for engaging in stereotypy was gradually increased during the red card condition and progressively decreased during the green card condition. The intervention follows a changing criterion design. This study indicates that stimulus discrimination training is a useful intervention to reduce vocal stereotypy in an autistic child.

Examining the Collateral Effects of Reducing Voice Level on Vocal Stereotypy and Functional Speech

The current study examined the collateral effects of an antecedent intervention for decreasing speech volume on vocal stereotypy. After teaching the participant to use a conversational voice level by providing visual feedback from a decibel meter app, conversational voice levels were differentially reinforced in the presence of a green card. Differential effects in voice magnitude during a green-card condition and a no-card condition were demonstrated using an alternating-treatments design. Results showed a decrease in volume of speech during the green-card condition, an overall decrease in vocal stereotypy, and a decrease to zero levels in loud stereotypical vocalizations. The implications of these findings on the treatment of vocal stereotypy are discussed.

An evaluation of a punisher assessment for decreasing automatically reinforced problem behavior

We extended research on the identification and evaluation of potential punishers for decreasing automatically reinforced problem behavior in four individuals with autism spectrum disorder. A punisher selection interview was conducted with lead clinicians to identify socially acceptable punishers. During the treatment evaluation, treatment phases were introduced sequentially and included noncontingent reinforcement (NCR), NCR and differential reinforcement of alternative behavior (DRA), and NCR-and-DRA with punishment. During the NCR-and-DRA with punishment phase, four to five potential punishers were evaluated using a multielement design. Dependent measures included the target problem behavior, appropriate item engagement, and emotional responding. For all participants, NCR-and-DRA was not effective and punishment was necessary. However, the most effective punisher identified in the context of NCR-and-DRA differed across participants.

Treatment of severe problem behaviour in children with autism spectrum disorder and intellectual disabilities

Children with autism spectrum disorder (ASD) and intellectual disabilities (ID) present with problem behaviour at rates disproportionately higher than their typically-developing peers. Problem behaviour, such as self-injury, aggression, pica, disruption, and elopement result in a diminished quality-of-life for the individual and family. Applied behaviour analysis has a well-established research base, detailing a number of assessment and treatment methods designed to address behaviour problems in children with ASD and ID. Although the variables that lead to the emergence of problem behaviour are not precisely known, those that are currently responsible for the maintenance of these problems can be identified via functional behaviour assessment, which is designed to identify events that occasion problem behaviour, consequences that maintain it, as well as other environmental factors that exert influence on the behaviour. Corresponding function-based treatment is implemented when environmental determinants are identified, with the aim of decreasing or eliminating problem behaviour, as well as teaching the individual to engage in more appropriate, alternative behaviour. In some cases, when problem behaviour is under the control of both environmental and biological variables, including psychiatric conditions, combining behavioural and pharmacological interventions is viewed as optimal, although there is limited empirical support for integrating these approaches.

Trial-Based Functional Analysis Informs Treatment for Vocal Scripting

Research on trial-based functional analysis has primarily focused on socially maintained challenging behaviors. However, procedural modifications may be necessary to clarify ambiguous assessment results. The purposes of this study were to evaluate the utility of iterative modifications to trial-based functional analysis on the identification of putative reinforcement and subsequent treatment for vocal scripting. For all participants, modifications to the trial-based functional analysis identified a primary function of automatic reinforcement. The structure of the trial-based format led to identification of social attention as an abolishing operation for vocal scripting. A noncontingent attention treatment was evaluated using withdrawal designs for each participant. This noncontingent attention treatment resulted in near zero levels of vocal scripting for all participants. Implications for research and practice are presented.

An integrated model for guiding the selection of treatment components for problem behavior maintained by automatic reinforcement

We evaluated the usefulness of 2 assessments to guide treatment selection for individuals whose prior functional analysis indicated that automatic reinforcement maintained their problem behavior. In the 1st assessment, we compared levels of problem behavior during a noncontingent play condition and an alone or ignore condition. In the 2nd, we assessed participants' relative preferences for automatic reinforcement and social reinforcers in a concurrent-operants arrangement. We used the results of these 2 assessments to assign 5 participants to a treatment based on noncontingent access to social reinforcers or to a treatment based on differential access to social reinforcers. We conducted monthly probes with the participants over 10 to 12 months to evaluate the effects of the treatment procedures. All participants showed reductions in problem behavior over this period.

Evaluation of Interventions to Reduce Multiply Controlled Vocal Stereotypy

This study examined four interventions targeted at decreasing multiply controlled vocal stereotypy for a 12-year-old boy diagnosed with autism spectrum disorder and a severe intellectual disability. These interventions included Noncontingent Music, Differential Reinforcement of Other Behaviors, Self-Recording, and Functional Communication Training (FCT). In addition to measuring vocal stereotypy during each condition, task engagement and challenging behavior were also monitored. Across conditions, vocal stereotypy did not vary significantly from baseline except in FCT, when it decreased significantly. Task engagement was higher in this condition as well. It is hypothesized that FCT provided an enriched environment by increasing social interaction and access to desired items as well as removal of less preferred activities. For these reasons, there was a decrease in the need for the participant to engage in vocal stereotypy and challenging behavior and increase in his ability to engage in a task.

The effects of matched stimulation and response interruption and redirection on vocal stereotypy

Stereotypy has been classified as repetitive behavior that does not serve any apparent function. Two procedures that have been found to reduce rates of vocal stereotypy effectively are response interruption and redirection (RIRD) and noncontingent access to matched stimulation (MS). The purpose of the current study was to evaluate the effects of RIRD alone, MS alone, and MS combined with RIRD. One participant's results suggested similar suppressive effects on vocal stereotypy across treatment conditions. For the second participant, a slightly greater suppression of stereotypy was associated with MS + RIRD. In addition, both participants emitted a greater frequency of appropriate vocalizations in conditions with RIRD. Data suggest that the addition of MS might facilitate the implementation of RIRD in applied settings.

The association for behavior analysis international position statement on restraint and seclusion

A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called restraint and seclusion. Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the content of the statement. The Executive Council accepted the statement, and it was subsequently approved by a two-thirds majority vote of the general membership. It now constitutes official ABAI policy. The position statement is posted on the ABAI Web site (www.abainternational.org/ABA/statements/RestraintSeclusion.asp). The purpose of the position statement is to provide guidance to behavior analysts and other professionals interested in the position of ABAI on these controversial topics. In extreme cases, abuses of procedures erroneously used in the name of behavior analysis are not defensible. On the other hand, behavior analysts acting ethically and in good faith are provided with guidelines for sound and acceptably safe practice. To the extent that behavior-analytic positions influence public policy and law, this statement can be presented to officials and lawmakers to guide informed decision making. At the conclusion of the document, a bibliography is provided of articles and presentations considered by one or more task force members in developing the position statement.

Three myths from the language acquisition literature

THREE POPULAR ASSERTIONS HAVE HINDERED THE PROMOTION OF AN EMPIRICIST APPROACH TO LANGUAGE ACQUISITION: (a) that Brown and Hanlon (1970) claimed to offer data that parents do not reinforce their children's grammaticality; (b) that Brown and Hanlon also claimed to offer data that parents do not provide negative evidence (i.e., corrective feedback) for ungrammaticality; and (c) that Gold (1967) claimed to offer a formal proof showing that, without negative evidence, a child cannot acquire a language solely from environmental input. In this paper I offer introductory comments on the nature-nurture distinction (including interactionism, and the nativists' claim to have found a gene for language). Next I debunk the three aforementioned assertions by arguing that the authors (Brown & Hanlon; Gold) never made the claims attributed to them; review evidence on the role of reinforcement and corrective feedback in language acquisition; and offer some concluding comments.

Effects of three types of noncontingent auditory stimulation on vocal stereotypy in children with autism

We evaluated the effects of 3 types of noncontingent auditory stimulation (music, white noise, recordings of vocal stereotypy) on 2 children with autism who engaged in high rates of vocal stereotypy. For both participants, the music condition was the most effective in decreasing vocal stereotypy to near-zero levels, resulted in the highest parent social validity ratings, and was selected as most preferred in treatment preference evaluations.

Treating Vocal Stereotypy With Environmental Enrichment and Response Cost

The authors describe the assessment and treatment of vocal stereotypy in two children diagnosed with an autism spectrum disorder. Both the case studies evaluated the effectiveness of response cost (RC). The RC interventions quickly reduced and eventually eliminated the vocal stereotypy in one participant and reduced it to near-zero levels in the second. Postintervention probes for one participant confirmed the continued reduction of vocal stereotypy 1 month after treatment and its elimination 8 months after treatment. Directions for future research are also discussed.

Vocal Stereotypy in Individuals With Autism Spectrum Disorders

Vocal stereotypy is a common problem behavior in individuals with autism spectrum disorders that may interfere considerably with learning and social inclusion. To assist clinicians in treating the behavior and to guide researchers in identifying gaps in the research literature, the authors provide an overview of research on vocal stereotypy in individuals with autism spectrum disorders. Specifically, the authors review the research literature on behavioral interventions to reduce engagement in vocal stereotypy with an emphasis on the applicability of the procedures in the natural environment and discuss the clinical implications and limitations of research conducted to date. Researchers have shown that several antecedent-based and consequence-based interventions may be effective at reducing vocal stereotypy. However, the review suggests that more research is needed to assist clinicians in initially selecting interventions most likely to produce desirable changes in vocal stereotypy and collateral behavior in specific circumstances.

An analysis of vocal stereotypy and therapist fading

A functional analysis for a boy with Down syndrome and autism suggested that vocal stereotypy was maintained by automatic reinforcement. The analysis also showed that instructions and noncontingent attention suppressed vocal stereotypy. A treatment package consisting of noncontingent attention, contingent demands, and response cost effectively reduced vocal stereotypy. The treatment package remained effective even when noncontingent attention was removed, making the procedure easier to implement. Also, the presence of the therapist in the room with the participant was faded systematically. After completion of fading, vocal stereotypy remained low during conditions similar to the no-consequence phase of the functional analysis.

Assessment and treatment of aggressive behavior without a clear social function

We conducted functional analyses of two individuals' aggressive behavior. Results of each of the initial functional analyses were inconclusive with respect to the role of social reinforcers in the maintenance of the behavior. Further assessment was conducted to clarify the role of social reinforcers. One individual's results suggested social reinforcers were relevant while results for the second individual remained inconclusive. Treatment evaluations conducted with both individuals suggested manipulation of social consequences could be used to reduce aggressive behavior even though, in one case, no clear social function was apparent.

Assessing and treating 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.

Further evaluation of methods to identify matched stimulation

The effects of preferred stimulation on the vocal stereotypy of 2 individuals were evaluated in two experiments. The results of Experiment 1 showed that (a) the vocal stereotypy of both participants persisted in the absence of social consequences, (b) 1 participant manipulated toys that did and did not produce auditory stimulation, but only sound-producing toys decreased his vocal stereotypy, and (c) only noncontingent music decreased vocal stereotypy for the other participant, but sterotypy paradoxically increased when toys were presented with music. Using a three-component multiple schedule, the results of Experiment 2 showed that the vocal stereotypy of both participants remained below preintervention levels following the removal of auditory stimulation and that 1 participant's vocal stereotypy increased following the removal of contingent reprimands. These patterns suggest that auditory stimulation functioned as an abolishing operation for vocal stereotypy and reprimands functioned as an establishing operation for vocal stereotypy. Together, the two experiments provide a method for identifying alternative stimulation that may substitute for automatically reinforced behavior.