Please, Stop the Flapping!
By Elizabeth Zeppernick, M.Ed, BCBA, LBA
When working with individuals with Autism Spectrum Disorder (ASD), it’s common for Board Certified Behavior Analysts to find themselves addressing stereotypy. Stereotypy is what we call repetitive movements and vocalizations. Sometimes this looks like jumping, hand flapping, body rocking or a repetitive vocalization that serves no apparent purpose. Stereotypy is often seen as a problem behavior as it can interfere with desirable social interactions and prevent the individual from engaging in learning opportunities. These behaviors can be stigmatizing and isolating.
At times the clinician may find this repetitive behavior is maintained by ‘automatic reinforcement’ or a self-stimulatory purpose. This means the behavior isn’t reinforced by those around the individual, making ignoring the behavior ineffective in reducing it. One common intervention includes a strategy to ‘response block’ or interrupt the stereotypy. The challenge of this intervention is it isn’t always practical in a home setting with other demands from the caregivers or in classrooms with other students. How does a caregiver or therapist safely and effectively block or interrupt a child who jumps forcefully up and down? How do we interrupt a loud and guttural humming noise that takes place for the majority of the day? An inconsistent and difficult intervention is likely one that is ineffective.
In response to the challenge of relying on response blocking, Hedquist and Roscoe (2019) compared other interventions to use when addressing stereotypy. The researchers worked with three teenage boys with ASD and moderate to severe stereotypy. Rather than using blocking techniques, the study compared two different types of interventions. First, they looked at how effective it was to reinforce or reward the participants during the times the stereotypy wasn’t occurring. This is called Differential Reinforcement of Other behavior (DRO). The second intervention entailed reinforcing the participant when an alternative, more productive behavior was taking place. This is called Differential Reinforcement of Alternative behavior (DRA). During the study they measured the occurrence of stereotypy as well as each student’s active task engagement.
The study found that while reinforcing the absence of the stereotypy (DRO) was effective in reducing stereotypy, it was reinforcing the alternative behavior (DRA) that led to the greatest increase in productivity and social significant engagement while simultaneously reducing the stereotypy. The positive effects of the intervention were maintained even when the schedule of reinforcement was thinned or, in other words, the student was given less reinforcement overtime.
The results of this study provide valuable insight into the interventions clinicians and caregivers should turn to when addressing stereotypy. Behavior Analysts know that we can’t ignore behaviors that are solely self-stimulatory in order to reduce them. We also know that interventions that are not implemented consistently and are unrealistic for the demands of a classroom and home setting are also often ineffective. By turning our focus to reinforcing or rewarding behaviors that are socially significant and productive, we are both reducing stereotypy when it is determined to be a problem behavior and increasing valuable skill sets. When caregivers provide insight into selecting the alternative tasks (vocational, educational, or social) the outcome of the intervention can be even more effective.
Source:
Hedquist, C.B., & Roscoe, E.M. (2019). A comparison of differential reinforcement procedures for treating automatically reinforced behavior. Journal of Applied Behavior Analysis, Advance online publication. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/jaba.561.
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