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.

Assessing and Treating Anxiety in Individuals with Autism.

Anxiety is a cluster of responses that can involve both operant and respondent behavior, which can be both public and/or private in nature, and occurs when an upcoming aversive stimulus is signaled. Despite the reported high comorbidity of autism and anxiety, there has been very limited research on how to directly assess and treat anxiety, especially with individuals who have limited communication skills. In Study 1, anxiety was assessed in five individuals with autism, ranging in age from 10 to 19 years old. Anxiety was assessed by measuring behavior during (1) a baseline (with no putative anxiety-provoking stimuli present), (2) signals for an upcoming aversive event, and (3) exposure to that aversive event. Anxiety presented in several different ways, as both conditioned activation and suppression, and both with and without problem behavior during the aversive event. In Study 2, individualized treatments involving differential reinforcement of alternative responses and stimulus fading were used to successfully reduce anxious responding in all four participants who displayed anxiety. These studies demonstrated a potentially useful means of assessing anxiety in individuals with autism which may not only help to measure anxious behavior and identify anxiety-provoking events, but may also lead to effective treatment.

Examining stereotypy in naturalistic contexts: Differential reinforcement and context-specific redirection.

This study examined stereotypy in naturalistic classroom contexts (i.e., academic programming, leisure skill acquisition) with differential reinforcement of contextually appropriate behavior (DRA). When stereotypy was problematic, redirection to the ongoing activity was provided. Contextually appropriate behavior and stereotypy were measured across all contexts prior to redirecting stereotypy to contextually appropriate behavior. Low levels of stereotypy were observed during the DRA in at least 2 contexts for all 5 participants. Context-specific redirection was added to the DRA if stereotypy persisted, and decreased stereotypy in 9 of the 10 evaluations. The results suggest that stereotypy might not be problematic in all contexts when DRA is present and redirection to contextually relevant appropriate behavior is an effective strategy.

Increasing item engagement and decreasing automatically reinforced problem behavior within a modified competing stimulus assessment.

A competing stimulus assessment (CSA) is commonly used to identify leisure items for use in treatments designed to decrease automatically reinforced problem behavior. However, this type of assessment may not yield useful information if participants do not readily engage with leisure items. The purpose of this study was to evaluate a modified CSA that included additional treatment components (i.e., prompting, prompting plus differential reinforcement of alternative behavior). The modified CSA identified the treatment components and leisure items that were most effective for increasing leisure-item engagement and decreasing problem behavior for each participant. Modified CSA outcomes maintained during an extended treatment analysis in a natural setting and when intervention components were faded.

Reducing Public Masturbation in Individuals With ASD: An Assessment of Response Interruption Procedures.

Individuals with autism may engage in sexual behavior at inappropriate times and/or in inappropriate places. The current study investigated the effects of response interruption and redirection (RIRD) and response interruption (RI) on public masturbation (PM) of children and adolescents with autism. Initial assessments showed that PM was maintained by automatic reinforcement. During the treatment evaluation phase, we compared RIRD and RI to determine whether either procedure was successful in decreasing the duration of PM. In the RIRD condition, contingent on the occurrence of any PM the participant completed physical activities involving both hands (e.g., moving chairs, touching toes). In the RI condition, the therapist interrupted all instances of PM using physical and verbal prompts (e.g., saying in a neutral tone, "Stop that" and moving hands away from genitals). Both procedures were effective in decreasing the duration of PM but RI required fewer resources and less time. Clinical implications and suggestions for future research are reviewed.

An analysis of treatment integrity of response interruption and redirection.

Response interruption and redirection has been shown to effectively decrease stereotypy, but its application outside an experimental setting has not been well studied. In Experiment 1, decreases in automatically maintained vocal stereotypy were obtained following treatment in a controlled setting for 3 participants diagnosed with autism spectrum disorder. Descriptive data on the consistency and accuracy of response interruption and redirection were then collected in the classroom setting. Results showed that the consistency of treatment implementation varied across participants and staff members. Failure to implement the treatment was the most common error. However, when response interruption and redirection was implemented, the components were generally carried out as prescribed. In Experiment 2, we conducted a parametric analysis in a controlled setting to test the impact of consistency errors on response interruption and redirection. The results indicated that response interruption and redirection was generally effective at 50% treatment implementation or higher. Furthermore, we observed treatment effects when 25% implementation sessions were interspersed with 100% treatment implementation sessions. Application of response interruption and redirection in light of previous studies and clinical implications are discussed.

Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism.

Increased severity of problematic daytime behavior has been associated with poorer sleep quality in individuals with autism spectrum disorder. In this work, we investigate whether this relationship holds in a real-time setting, such that an individual's prior sleep can be used to predict their subsequent daytime behavior. We analyzed an extensive real-world dataset containing over 20,000 nightly sleep observations matched to subsequent challenging daytime behaviors (aggression, self-injury, tantrums, property destruction and a challenging behavior index) across 67 individuals with low-functioning autism living in two U.S. residential facilities. Using support vector machine classifiers, a statistically significant predictive relationship was found in 81% of individuals studied (P < 0.05). For all five behaviors examined, prediction accuracy increased up to approximately eight nights of prior sleep used to make the prediction, indicating that the behavioral effects of sleep may manifest on extended timescales. Accurate prediction was most strongly driven by sleep variability measures, highlighting the importance of regular sleep patterns. Our findings constitute an initial step towards the development of a real-time monitoring tool to pre-empt behavioral episodes and guide prophylactic treatment for individuals with autism. Autism Res 2018, 11: 391-403. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We analyzed over 20,000 nights of sleep from 67 individuals with autism to investigate whether daytime behaviors can be predicted from prior sleep patterns. Better-than-chance accuracy was obtained for 81% of individuals, with measures of night-to-night variation in sleep timing and duration most relevant for accurate prediction. Our results highlight the importance of regular sleep patterns for better daytime functioning and represent a step toward the development of 'smart sleep technologies' to pre-empt behavior in individuals with autism.

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.

A comparison of momentary time sampling and partial-interval recording for evaluating functional relations.

In the current study, momentary time sampling (MTS) and partial-interval recording (PIR) were compared to continuous-duration recording of stereotypy and to the frequency of self-injury during a treatment analysis to determine whether the recording method affected data interpretation. Five previously conducted treatment analysis data sets were analyzed by creating separate graphic displays for each measurement method (duration or frequency, MTS, and PIR). An expert panel interview and structured criterion visual inspection were used to evaluate treatment effects across measurement methods. Results showed that treatment analysis interpretations based on both discontinuous recording methods often matched those based on frequency or duration recording; however, interpretations based on MTS were slightly more likely to match those based on duration and those based on PIR were slightly more likely to match those based on frequency.

An Assessment of Three Procedures to Teach Echoic Responding.

The research literature has revealed mixed outcomes on various procedures for increasing vocalizations and echoic responding in persons with disabilities (Miguel, Carr, & Michael The Analysis of Verbal Behavior, 18, 3-13, 2002; Stock, Schulze, & Mirenda The Analysis of Verbal Behavior, 24, 123-133, 2008). We examined the efficacy of an assessment procedure for identifying the most effective echoic teaching procedure to six students diagnosed autism spectrum disorder (ASD) and other developmental delays. The assessment procedure included a within-participant comparison of vocal imitation training (VIT), stimulus-stimulus pairing (SSP), and a mand-model procedure (MM). A functional analysis of the responses was conducted to determine whether responding was functionally an echoic or a mand. The results indicated that the assessment was effective in identifying a teaching procedure for five out of the six participants and that responding was established under echoic control. These outcomes support the efficacy of this assessment procedure for identifying effective echoic teaching procedures.

Behaviorally-determined sleep phenotypes are robustly associated with adaptive functioning in individuals with low functioning autism.

Despite sleep disturbance being a common complaint in individuals with autism, specific sleep phenotypes and their relationship to adaptive functioning have yet to be identified. This study used cluster analysis to find distinct sleep patterns and relate them to independent measures of adaptive functioning in individuals with autism. Approximately 50,000 nights of care-giver sleep/wake logs were collected on school-days for 106 individuals with low functioning autism (87 boys, 14.77 ± 3.11 years) for 0.5-6 years (2.2 ± 1.5 years) from two residential schools. Using hierarchical cluster analysis, performed on summary statistics of each individual across their recording duration, two clusters of individuals with clearly distinguishable sleep phenotypes were found. The groups were summarized as 'unstable' sleepers (cluster 1, n = 41) and 'stable' sleepers (cluster 2, n = 65), with the former exhibiting reduced sleep duration, earlier sleep offset, and less stability in sleep timing. The sleep clusters displayed significant differences in properties that were not used for clustering, such as intellectual functioning, communication, and socialization, demonstrating that sleep phenotypes are associated with symptom severity in individuals with autism. This study provides foundational evidence for profiling and targeting sleep as a standard part of therapeutic intervention in individuals with autism.

On the role of preference in response competition.

A duration-based preference assessment identified items that matched and did not match the sensory consequences hypothesized to maintain stereotypy. When evaluated in treatment, these items effectively competed with the occurrence of stereotypy, regardless of their sensory properties. It is suggested that relative preference, as measured in duration-based assessment, can be as significant as type of stimulation produced in interventions that reduce automatically reinforced problem behavior.

Teaching observational learning to children with autism.

Observational learning (OL) is critical for the acquisition of social skills and may be an important skill for learning in traditional educational settings. Although OL occurs during early childhood in the typically developing population, research suggests that it may be limited in children diagnosed with autism spectrum disorder (ASD). The purpose of the present study was to develop an assessment to test for the presence of OL across a variety of tasks. If OL was deficient, we sought to teach it by training specific skills. Six participants who had been diagnosed with ASD demonstrated deficits in OL. After an initial assessment, a multiple-probe design across OL tasks showed that training produced acquisition of these skills across multiple exemplars. After training, 5 of the 6 participants engaged in OL across multiple tasks and task variations, demonstrating generalization. For 1 participant, generalization of performance did not occur across tasks but did occur within task variations.

Recombinative Generalization of Tacts Through Matrix Training with Individuals with Autism Spectrum Disorder.

Foss (Journal of Experimental Psychology, 76, 450-459, 1968a; Journal of Experimental Psychology, 77, 341-344, 1968b) compared overlap and non-overlap instruction to promote recombinative response generalization using a matrix training procedure. In the present study, we used a similar set of procedures to teach tacting of kitchen items and prepositions (i.e., relational autoclitics) to three females ages 13-20, diagnosed with autism spectrum disorder. We taught some kitchen items/prepositions as tacts (e.g., "the strainer is to the right of the box") according to a non-overlap instructional sequence. Subsequently, we taught more combinations in an overlap instructional sequence. Each training procedure was followed by probes of untrained relations. Two participants demonstrated recombinative generalization of untrained combinations following the first non-overlap phase, while the third participant demonstrated some response generalization of untrained relations after a few additional training sequences. All three participants demonstrated generalized tacting of object components while two participants showed generalized tacting of preposition components.

Evaluating the Quality of Behavior Analytic Practitioner Training Programs.

Dixon and colleagues (2015) asserted that faculty research productivity is a key indicator of the quality of university programs that train future practitioners of behavior analysis. Based on their analysis of publications in select journals, the authors concluded that many faculty in such programs have published little to no research. Some alternative measures of both faculty research productivity and the quality of practitioner training programs are suggested here.

Increasing the efficiency of paired-stimulus preference assessments by identifying categories of preference.

A paired-stimulus preference assessment was conducted for 6 individuals with developmental disabilities. We selected stimuli that were representatives of 4 categories: chocolate, salty and crunchy, gummy, and fruit and vegetable. For all 6 participants, at least 3 of the 5 most preferred items came from the same category. On subsequent reinforcer assessments, items from the highest ranked preference category, some of which were included in the preference assessments and some of which were not, functioned as reinforcers. These findings suggest that after categories of preferred items are identified, clinicians may be able to identify reinforcers for some individuals without conducting additional assessments.

Using simultaneous presentation to increase vegetable consumption in a mildly selective child with autism.

A multiple baseline design was used to evaluate the effects of adding condiments on the consumption of previously rejected foods (vegetables). Adding condiments produced increased food acceptance across three food items. Data are discussed in relation to conditioned food preferences and establishing operations.

Persistence of stereotypic behavior: examining the effects of external reinforcers.

Basic research has shown that behavioral persistence is often positively related to rate of reinforcement. This relation, expressed in the metaphor of behavioral momentum, has potentially important implications for clinical application. The current study examined one prediction of the momentum metaphor for automatically reinforced behavior. Participants were 3 children who had been diagnosed with an autism spectrum disorder and who engaged in stereotypic behavior maintained by automatic reinforcement. Results suggested that stereotypic behavior was more resistant to disruption following periods of access to preferred stimuli delivered on a variable-time schedule than following periods without access to preferred stimuli. The implications of these findings for the treatment of automatically reinforced behavior are discussed.

Toward a behavioral analysis of joint attention.

Joint attention (JA) initiation is defined in cognitive-developmental psychology as a child's actions that verify or produce simultaneous attending by that child and an adult to some object or event in the environment so that both may experience the object or event together. This paper presents a contingency analysis of gaze shift in JA initiation. The analysis describes reinforcer-establishing and evocative effects of antecedent objects or events, discriminative and conditioned reinforcing functions of stimuli generated by adult behavior, and socially mediated reinforcers that may maintain JA behavior. A functional analysis of JA may describe multiple operant classes. The paper concludes with a discussion of JA deficits in children with autism spectrum disorders and suggestions for research and treatment.

Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism.

Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. Although several studies have identified behaviors that are possible indicators of best outcome, changes in performance are typically measured using norm-referenced standardized scores referencing overall functioning level rather than via repeated observational measures of autism-specific deficits (i.e., social behavior). In the current study, 83 children with autism (CWA), aged 1, 2 and 3 years, and 58 same-aged typically developing children (TDC) were directly observed in the areas of cognitive skills, joint attention (JA), play, and stereotypic behavior using a measure called the Early Skills Assessment Tool (ESAT; MacDonald et al., 2006). CWA were assessed at entry into an EIBI program and again after 1 year of treatment. Changes in performance were compared pre- and post-treatment as well as to the normative data by age. Results indicate significant gains on the ESAT across all age groups with the greatest gains seen in the children who entered treatment prior to their second birthday. Increases were seen on direct measures of JA, play, imitation and language while decreases were seen in stereotypy regardless of level of performance at entry into EIBI. The ESAT, a direct measurement tool, served as a sensitive tool to measure changes in autism symptomatology following EIBI treatment.