Analysis of self-recording in self-management interventions for stereotypy

Article (PDF Available)inJournal of Applied Behavior Analysis 45(1):55-68 · March 2012with49 Reads
DOI: 10.1901/jaba.2012.45-55 · Source: PubMed
Abstract
Most treatments for stereotypy involve arrangements of antecedent or consequent events that are imposed entirely by a therapist. By contrast, results of some studies suggest that self-recording, a common component of self-management interventions, might be an effective and efficient way to reduce stereotypy. Because the procedure typically has included instructions to refrain from stereotypy, self-recording of the absence of stereotypy, and differential reinforcement of accurate recording, it is unclear which element or combination of elements produces reductions in stereotypy. We conducted a component analysis of a self-management intervention and observed that decreases in stereotypy might be attributable to instructional control or to differential reinforcement, but that self-recording per se had little effect on stereotypy.
ANALYSIS OF SELF-RECORDING IN SELF-MANAGEMENT
INTERVENTIONS FOR STEREOTYPY
J
ENNIFER N. FRITZ
UNIVERSITY OF HOUSTON–CLEAR LAKE
BRIAN A. IWATA
UNIVERSITY OF FLORIDA
NATALIE U. ROLIDER
KENNEDY KRIEGER INSTITUTE
ERIN M. CAMP
AUTISM CONCEPTS
AND
PAMELA L. NEIDERT
UNIVERSITY OF KANSAS
Most treatments for stereotypy involve arrangements of antecedent or consequent events that are
imposed entirely by a therapist. By contrast, results of some studies suggest that self-recording, a
common component of self-management interventions, might be an effective and efficient way
to reduce stereotypy. Because the procedure typically has included instructions to refrain from
stereotypy, self-recording of the absence of stereotypy, and differential reinforcement of accurate
recording, it is unclear which element or combination of elements produces reductions in
stereotypy. We conducted a component analysis of a self-management intervention and observed
that decreases in stereotypy might be attributable to instructional control or to differential
reinforcement, but that self-recording per se had little effect on stereotypy.
Key words: stereotypy, functional analysis, self-management, self-recording, instructions,
differential reinforcement
______________________ _________________________________________________________
Stereotypy consists of a large collection of
chronic, repetitive behaviors that are considered
maladaptive and disruptive to learning. Stereo-
typy commonly is observed in individuals with
intellectual disabilities and also is one of the
main diagnostic criteria for autism (American
Psychiatric Association, 2000). Although many
topographies of stereotypy have been observed
(body rocking, hand flapping, bizarre vocaliza-
tions, etc.), the common feature of all these
behaviors is that they seem to persist indepen-
dent of social consequences.
A number of interventions have been shown
to be effective in decreasing stereotypy (see
Rapp & Vollmer, 2005, for a review). Many stud-
ies have examined reinforcement-based pro-
cedures, such as noncontingent access to items
that compete with stereotypy (NCR; Horner,
1980), differential reinforcement of alternative
behavior (DRA; Mulick, Hoyt, Rojahn, &
Correspondence regarding this a rticle should be
addressed to Jennifer N. Fritz, University of Houston–
Clear Lake, 2700 Bay Area Blvd. Box 112, Houston,
Texas 77058 (e-mail: fritzj@uhcl.edu).
doi: 10.1901/jaba.2012.45-55
This research was supported in part by a grant from the
Florida Agency on Persons with Disabilities. We thank
Michelyn Butler and Carrie Dempsey for their assistance
in conducting the study. We also thank Donald Stehouwer
and Timothy Vollmer for their helpful comments on an
earlier version of the manuscript.
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2012, 45, 55–68 NUMBER 1(SPRING 2012)
55
Schroeder, 1978), or differential reinforcement of
otherbehavior(DRO;Repp,Dietz,&Speir,
1974;Ringdahletal.,2002).Otherstudieshave
examined interventions that attenuate the rein-
forcement available for stereotypy, such as in-
creasing the amount of effort required to engage
in stereotypy (Irvin,Thompson,Turner,&
Williams, 1998) or decreasing the sensory input
produced by stereotypy (Rincover, Cook, Peoples,
& Packard, 1979). When these interventions are
ineffective, punishment-based strategies, such as
overcorrection (Foxx & Azrin, 1973) or response
blocking (Lindberg, Iwata, & Kahng, 1999),
represent alternative strategies. It is important to
note that all of these interventions involve ante-
cedent or consequent events imposed entirely by
a therapist.
By contrast, a small body of research has
examined one component of self-management
interventions, namely, self-recording, as a thera-
peutic intervention for stereotypy. Although the
mechanisms by which self-management interven-
tions produce behavior change have been the
subject of some disagreement (Nelson & Hayes,
1981), the intervention has been shown to be
effective in increasing, as well as decreasing, the
frequency of a wide range of target behaviors
exhibited by individuals with intellectual disabil-
ities (Harchik, Sherman, & Sheldon, 1992).
R. L. Koegel and Koegel (1990) reported the
use of a self-management intervention to de-
crease stereotypy exhibited by four children and
adolescents with autism. All subjects engaged in
multiple topographies of stereotypy, and, al-
though a functional analysis was not conducted,
the authors noted that these behaviors ‘‘did not
appear to serve any function other than to
provide sensory input’’ (p. 120). During base-
line, consequences for stereotypy were similar to
those delivered by subjects parents and teachers,
which typically included reprimands or redirec-
tion to other tasks. Following baseline, subjects
were taught to record whether a therapist
modeled occurrences or nonoccurrences of
stereotypy. After the discrimination was ac-
quired, a self-management intervention was
implemented, during which the therapist deliv-
ered instructions to refrain from engaging in
stereotypy and delivered reinforcers when sub-
jects accurately recorded the absence of stereoty-
py. Results showed that the intervention de-
creased all subjects’ stereotypy, even though
subjects only recorded the absence of stereotypy
accurately (mean accuracy, 93%). By contrast,
accuracy of ‘‘recording’’ the occurrence of
stereotypy (not marking in the box following
intervals in which the subject engaged in
stereotypy) averaged only 39%.
Shabani, Wilder, and Flood (2001) replicat-
ed the R. L. Koegel and Koegel (1990)
procedures with an individual who engaged in
body rocking and found that the intervention
was effective in reducing body rocking to zero
across two settings. In addition, zero levels of
body rocking were maintained after the rein-
forcement schedule was thinned from an initial
interval of 10 s to 17 to 20 min.
Although subjects’ self-recording of their
behavior played a prominent role in the R. L.
Koegel and Koegel (1990) and Shabani et al.
(2001) studies, the direct influence of self-
recording on stereotypy is difficult to determine
because instructions to refrain from stereotypy
were delivered, and reinforcers were delivered
only for accurately recording the absence of
stereotypy. Thus, it is possible that other variables,
such as instructional control or the DRO
contingency alone, in addition to or instead of
self-recording, might have produced reductions in
the subjects’ stereotypy. The purpose of this study
wastoconductacomponentanalysisoftheself-
management intervention described by R. L.
Koegel and Koegel and by Shabani et al. to
identify the variables that are responsible for
producing reductions in stereotypy exhibited by
individuals with autism.
METHOD
Subjects, Target Behaviors, and Setting
Three individuals who attended a day
program for adults with intellectual disabilities
56 JENNIFER N. FRITZ et al.
(Aaron and Earl) or a special education school
(Curtis) participated. All subjects had bee n
diagnosed with autism and engaged in
stereotypy frequently th roughout the day. In
addition, all subjects communicated vocally,
followed multiple-step instructions, were able
to read, and had no physical impairments that
interfered with their ability to perform the
self-recording response. Subjects were includ-
ed in the study if results of a functional
analysis indicated that their stereotypy was
maintained by automatic (sensory) reinforce-
ment, and this was true for the first three
subjects identified for inclusion. Aaron was
a 40-year-old man who engaged in head
weaving (repeated head movement in a side-
to-side motion) that interfered with his abil-
ity to attend to tasks and disrupted social
interactions. E arl and Curtis engaged in
bizarre vocalizations. Earl was a 49-year-old
man whose vocalizations consisted of loud
noises, repetitive mumbling, and speech not
directed to another person. Curtis was a 12-
year-old boy whose vocalizations consisted of
high-pitched squealing or other vocalizations
not directed to another person and unrelated
to any ongoing events. Earl’s and Curtis’s
bizarre vocalizations were disruptive to others
and interfered with t heir ability to engage in
appropriate social interactions. Sessions were
conducted in a room away from others at the
day program or the school.
Response Measurement and Reliability
The study was conducted in two phases that
consisted of a functional analysis of stereotypy
followed by a component analysis of the self-
management intervention. Trained observers
used handheld computers to collect data on
the percentage of 10-s intervals in which
stereotypy occurred. Reliability was assessed
for at least 20% (range, 20% to 78%) of
sessions during each condition of the functional
analyses and component analyses for all sub-
jects. Agreement percentages for interval data
were calculated by dividing the number of
intervals in which both observers scored the
occurrence or nonoccurrence of the behavior by
the total number of intervals in the session and
multiplying by 100%. Interobserver agreement
for all subjects’ stereotypy averaged 95% (range,
48% to 100%); scores below 70% were ob-
tained in two sessions only.
Observers also collected data on subjects’
accurate or inaccurate self-recording of their
behavior (as well as on Aaron’s accurate
copying of words) during the component
analysis of the self-management interve ntion.
Reliabilit y was calculated for frequency data by
dividing session time into continuous 10-s
inte rvals and comparing observer s’ records
on an interval-by-interval basis. The smaller
number of resp onses in each interva l was
divided by the larger; these fractions then were
summed across the session and multiplied by
100%. Interobserver agreement for all subjects’
accurate self-recording, as well as for Aaron’s
word copying, averaged 96% (range, 77% to
100%) in these phases. Interobserver agree-
ment for all subjects’ inaccurate self-recording
(and word copying) averaged 99% (range, 86%
to 100%).
PHASE 1: FUNCTIONAL ANALYSIS
Functional analyses of each subject’s stereo-
typy were conducted in a multielement design
using methods similar to those described by
Iwata, Dorsey, Slifer, Bauman, and Richman
(1982/1994). Sessions lasted 10 min and were
conducted in an observation room (Aaron and
Earl) or a classroom (Curtis) that contained
relevant session materials. Each subject was
exposed to three test conditions (alone or
ignore, attention, and demand) and a control
condition (play). The alone (or ignore) condi-
tion was alternated with all other conditions in
a 2:1 ratio to allow more frequent observa-
tion of subjects’ stereotypy in the absence of
programmed social consequences.
During the alone condition (Aaron and Earl),
the subject was alone in a room without access
SELF-RECORDING OF STEREOTYPY 57
to any leisure or edible items. During the ignore
condition (Curtis), the subject was seated in a
secluded area of a classroom without access to
any leisure or edible items, and no consequences
were delivered for stereotypy. Other individuals
in the room were engaged in varied activities
and were instructed to avoid eye contact and
interaction with Curtis in any manner during
sessions. During the attention condition, the
subject was seated or standing in a room with
the therapist and had access to moderately
preferred leisure items. At the start of session,
the therapist informed the subject that she had
‘‘work to do’’ and that they could talk later. The
therapist then engaged in other tasks and
ignored the subject, except to deliver a brief
reprimand (e.g., ‘‘Stop making that noise.’’)
contingent on the occurrence of stereotypy.
During the demand condition, the subject was
seated at a table next to the therapist. The
therapist presented academic or vocational tasks
using a three-step prompting sequence (vocal,
model, and physical prompts) throughout the
session and delivered praise as a consequence for
compliance. Contingent on the occurrence of
stereotypy, the therapist removed the task
materials and turned away from the subject
for 30 s. During the play condition, the subject
was seated or standing in the room with the
therapist and had free access to at least two
highly preferred leisure items. The therapist
interacted with the subject at least once every
30 s and whenever the subject initiated inter-
action. No consequences were delivered follow-
ing stereotypy.
Three patterns of responding were consid-
ered indicative of maintenance by automatic
reinforcement: (a) higher levels of stereotypy
during the alon e (or ignore) condition
compared to all other conditions, (b) undif-
ferentiated levels of stereotypy a cross all
conditions with maintenance of stereotypy in
the alone or ignore condition, or (c) high
levels of stereoty py in all conditions except the
play condition.
PHASE 2: COMPONENT ANALYSIS
OF THE SELF-MANAGEMENT
INTERVENTION
The purposes of this phase were to replicate
systematically the self-management intervention
described by R. L. Koegel and Koegel (1990)
and Shabani et al. (2001) and to determine
which components of the procedure were
responsible for observed reductions in stereoty-
py. All sessions lasted 10 min, and a reversal
design was used to evaluate the relative effects of
the procedures on subjects’ stereotypy.
Prior to the start of the component analysis, a
paired-stimulus preference assessment (Fisher
et al., 1992) was conducted with all subjects to
identify a highly preferred edible item (one
selected on 80% or more trials) to be used as a
reinforcer during training and intervention
sessions. Based on the assessment, Cheetos were
selected for Aaron, Fritos were selected for Earl,
and Slim Jims were selected for Curtis.
All subjects were exposed to the following
conditions: (a) baseline, (b) self-recording train-
ing, and (c) differential reinforcement of accurate
self-recording (DR [accurate]). Based on the
subject’s performance during these conditions,
additional conditions were conducted to provide
a component analysis of the self-recording in-
tervention. The rationale and procedural details
for these conditions are provided in the results
section.
Baseline
The subject and a therapist were seated next
to each other at a table, and no other materials
were present. The therapist did not interact
with the subject at any time and did not deliver
any consequences following occurrences of ste-
reotypy. In other words, these sessions were
similar to the ignore condition of the functional
analysis.
Training the Self-Recording Response
Following baseline and prior to the start of
the DR (accurate) phase, the subject was taught
58 JENNIFER N. FRITZ et al.
to discriminate between occurrences and non-
occurrences of his stereotypy. Before each
training session, the therapist described the
training procedure to the subject using a script
similar to the following:
[Subject’s name], watch what [model’s name] does.
Sometimes [model’s name] will be head weaving
[i.e., the target stereotypic behavior, which the
model demonstrated at this time], and you will
need to mark the ‘‘head weaving’’ box [the therapist
pointed to the stereotypy box on the self-recording
sheet]. And sometimes [model’s name] will be sitting
still [i.e., not engaging in stereotypy, model
demonstrated sitting still and quiet], and you will
need to mark the ‘‘sit still’’ box [the therapist pointed
to the no-stereotypy box on the self-recording sheet.]
If you record correctly, you will get a [highly
preferred edible item].
During training sessions, the model per-
formed the subject’s particular topography of
stereotypy during five occurrence trials and sat
quiet and still during five nonoccurrence trials.
Trials lasted 10 s, and trial types (occurrence
and nonoccurrence) were presented in random
order. Before each trial, a timer was set for 10 s.
When the timer sounded, the therapist prompt-
ed the subject to record the model’s behavior as
an occurrence or nonoccurrence of stereotypy
(e.g., ‘‘Did she head weave or sit still? Make a
mark.’’). The subject indicated whether stereo-
typy was or was not modeled by placing a mark
in the corresponding box on a self-recording
sheet.
Each self-recording sheet contained two boxes,
one under the heading ‘‘Head Weaving’ (Aaron)
or ‘‘Inappropriate Talk’’ (Earl and Curtis) to
correspond to the occurrence of stereotypy, and
the other under the heading ‘‘Sit Still’’ (Aaron) or
‘‘Quiet’’ (Earl and Curtis) to correspond to the
absence of stereotypy. Each box type was affixed
to a different brightly colored paper to aid the
subjects in discriminating between the two types
of boxes.
Following an accurate recording of the
occurrence or nonoccurrence of stereotypy, the
therapist delivered praise plus the edible item. If
the subject recorded inaccurately (marked that
stereotypy occurred when it had not been
modeled or vice versa), the therapist delivered
feedback (e.g., ‘‘No, she was sitting still.’’) and
physically guided the subject to place a mark in
the correct box. If the subject did not place a
mark in either box following the model, the
therapist delivered a second verbal prompt to
record (e.g., ‘‘Did she head weave or sit still?
Write it down.’’). If the subject recorded
accurately following either prompt, the thera-
pist delivered praise plus an edible item. If the
subject again did not record or recorded
inaccurately, the therapist provided feedback
and physically guided the subject to place a
mark in the correct box on the self-recording
sheet but did not deliver praise or the edible
item.
Training continued until the subject accu-
rately recorded the model type after the first or
second verbal prompt on 90% or more of the
trials or until the total training session time
equaled 1 hr, whichever came first. If the
subject did not acquire the recording response
after 1 hr of training, additional training
components were added until the subject was
able to record the model type accurately. These
additional components included (a) shortening
the model duration from 10 s to 5 s, (b)
implementing overcorrection following incor-
rect responses, in which the subject was guided
physically to record correctly three times
following an incorrect recording, (c) interspers-
ing one model of the occurrence of stereotypy
within nine models of the nonoccurrence of
stereotypy and vice versa, and (d) showing 10-s
video clips of the subject either engaging in
stereotypy or engaging in other appropriate
behaviors.
Differential Reinforcement (Accurate)
Although subjects had recorded a model
either engaging or not engaging in stereotypy
during training, they had not recorded their
own behavior. Thus, DR (accurate) was de-
signed to teach subjects to record occurrences
and nonoccurrence of their own stereotypy
accurately. During these sessions, the therapist
SELF-RECORDING OF STEREOTYPY 59
and subject were seated at a table in the session
room. A timer, self-recording sheets, writing
utensils, and the edible reinforcers were placed
on the table. The self-recording sheets were
identical to the sheets used during training.
At the start of each session, the therapist set
the timer for 30 s and instructed the subject to
record his behavior accurately to receive
reinforcement when the timer sounded. When
the timer sounded, the subject was asked to
place a mark in the appropriate box on the self-
recording sheet to indicate whether or not he
had engaged in stereotypy at any time during
the interval. If the subject placed a mark in the
correct box (in the occurrence box if the subject
engaged in stereotypy or in the nonoccurrence
box if the subject had not engaged in
stereotypy), the therapist delivered praise (e.g.,
‘‘Good job recording.’’) plus one edible item.
The therapist did not comment on whether the
subject had engaged in stereotypy during DR
(accurate) sessions. Accurate self-recording of
the occurrence or nonoccurrence of stereotypy
resulted in reinforcer delivery in this condition
to evaluate directly the effects of self-recording
per se on levels of stereotypy.
If the subject did not record the occurrence
or nonoccurrence of stereotypy within 3 s of the
timer sounding, the therapist delivered a verbal
prompt for the subject to record his behavior
(i.e., ‘‘You need to record correctly.’’). If the
subject placed a mark in the correct box, the
therapist delivered praise plus the edible item. If
the subject did not comply within 3 s or
recorded incorrectly, the therapist physically
guided the subject to place a mark in the
appropriate box but did not deliver praise or an
edible item. Prompts were delivered following
no response to increase the probability that each
subject would acquire and perform the self-
recording response during this condition. Once
recording was completed, regardless of accuracy,
the timer was reset for 30 s.
Prompt fading. After a subject independently
recorded his stereotypy with 80% or greater
accuracy for two consecutive sessions, the
therapist increased the latency from the timer
sounding to the delivery of the verbal prompt
by 2 s. This prompt delay was increased by 2 s
following each session with 80% or greater
accurate and independent self-recording until
prompts no longer were required.
Schedule thinning. If low levels of stereotypy
were observed, the self-recording interval was
increased by 50% of its previous value. In other
words, depending on the subject’s level of
stereotypy in this or subsequent conditions, the
reinforcement schedule was thinned as follows:
30 s, 45 s, 70 s, and so on.
RESULTS
Figure 1 shows results of the subjects’
functional analyses. Aaron (top) engaged in
higher levels of stereotypy in the alone
condition than in all other conditions. Earl
(middle) engaged in variable levels of stereotypy
in all conditions. Curtis (bottom) engaged in
variable levels of stereotypy in all test conditions
and relatively low levels in the play condition;
however, he continued to engage in variable
levels of stereotypy during consecutive ignore
sessions. These patterns of responding, although
somewhat different, indicated that subjects’
stereotypy was not differentially sensitive to
social contingencies and most likely was
maintained by automatic reinforcement.
Figure 2 shows results obtained during
treatment conditions. Because each subject
experienced a different set of conditions to
provide a component analysis of the self-
recording intervention following the DR (accu-
rate) condition, procedural descriptions and
results are presented separately for each subject.
Aaron
Aaron engaged in variable levels of head
weaving during the initial baseline condition.
Prior to the start of the DR (accurate)
condition, he achieved 100% accuracy in
recording the occurrence and nonoccurrence
of stereotypy in one training session. His
60 JENNIFER N. FRITZ et al.
stereotypy subsequently decreased immediately
to zero during the DR (accurate) condition,
when reinforcers were delivered for accurate
self-recording regardless of stereotypy. A return
to baseline resulted in an increase in stereotypy.
Because the DR (accurate) condition contained
implicit instructions to refrain from stereotypy
(the words ‘‘Sit Still’’ were written on the self-
recording sheet) plus the self-recording activi-
ty, we delivered instructions to refrain from
stereotypy but substituted an irrelevant activity
(copying an unrelated word on an index card)
during the next condition (control activity).
The purpose of this condition was to determine
whether instructional control and the availabil-
ity of an alternative activity, rather than self-
recording, might have been responsible for
observed reductions in Aaron’s stereotypy in
the preceding condition.
Prior to the start of each control-activity
session, the therapist instructed Aaron to sit still
and explained that reinforcers would be earned
if he correctly copied one word from a stack of
index cards onto a piece of paper with the words
‘‘Sit Still’’ printed across the top. Aaron then
was given writing utensils, and the timer was
set. When the timer sounded, the therapist
delivered praise and an edible item if Aaron
accurately copied a word from an index card
onto the paper. None of the words in the stack
of index cards pertained to stereotypy or the
self-recording intervention, and no consequenc-
es were delivered contingent on stereotypy in
this condition. In other words, reinforcers were
delivered for accurately copying the irrelevant
word regardless of whether Aaron engaged in
stereotypy during the interval.
During the control-activity condition, Aar-
on’s stereotypy decreased immediately to near-
zero levels. Similar effects were observed in the
final baseline and control-activity sequence:
Aaron engaged in high levels of stereotypy
during baseline, engaged in near-zero levels of
stereotypy, and copied words with 100%
accuracy at the end of every interval during
the final control-activity condition.
Earl
Earl engaged in high, stable levels of
stereotypy during baseline. Prior to the DR
(accurate) condition, he learned to perform the
self-recording response with 90% accuracy in
three sessions. His stereotypy decreased during
the first session of the DR (accurate) condition
but then returned to baseline levels. It is
interesting to note that he accurately recorded
occurrences of stereotypy during this condition.
DRO plus self-recording was implemented
next and closely replicated the original proce-
dures used by R. L. Koegel and Koegel (1990)
and Shabani et al. (2001). The purpose of this
condition was to determine whether a contin-
gency for accurately self-recording the absence
Figure 1. Functional analysis results for Aaron’s head
weaving, Earl’s bizarre vocalizations, and Curtis’s
bizarre vocalizations.
SELF-RECORDING OF STEREOTYPY 61
Figure 2. Results of the component analysis of the self-management intervention on Aaron’s, Earl’s, and Curtis’s
stereotypy (STPY). Filled circles represent stereotypy, open squares represent accurate self-recording, and open triangles
(Aaron only) represent accurate copying of irrelevant words. Numbers near data points denote the interval value (in
seconds) for self-recording (all subjects), DRO (Earl and Curtis), or copying a word (Aaron only). Unless otherwise noted,
subsequent conditions began with the last interval value of the preceding condition. DR 5 differential reinforcement.
62 JENNIFER N. FRITZ et al.
of stereotypy would be effective in reducing it.
Prior to the start of each session, the therapist
told Earl that reinforcers could be earned by
refraining from engaging in stereotypy and
accurately recording the absence of stereotypy.
Earl had access to writing utensils and self-
recording sheets that contained only one box.
This sheet was identical to the side of the DR
(accurate) sheets for the nonoccurrence of
stereotypy (the box was labeled ‘‘Quiet’’ and
was affixed to the same brightly colored paper as
in the DR [accurate] condition). When the
session began, the therapist set the timer for
30 s. Each time the tone sounded, the therapist
delivered praise (e.g., ‘‘Good job being quiet.’’)
plus one edible item if Earl had not engaged in
stereotypy and had marked the self-recording
sheet. If he engaged in stereotypy at any time
during the interval and did not mark the self-
recording sheet, the therapist delivered praise
(e.g., ‘‘That’s right; you were making noise.’’)
but not an edible item. Finally, if Earl engaged
in stereotypy at any time during the interval but
marked the self-recording sheet, the therapist
delivered verbal feedback (e.g., ‘‘No, you were
making noise.’’) and did not deliver an edible
item. During this condition, the self-recording
interval was thinned from 30 s to 70 s.
Introduction of DRO plus self-recording
(reinforcement only for accurately recording
the absence of stereotypy) resulted in reductions
in Earl’s stereotypy to near-zero levels. It was
unclear, however, whether self-recording was
necessary to maintain low levels of stereotypy;
therefore, the self-recording component was
removed during the subsequent DRO-only
condition.
Prior to the start of each DRO session, the
therapist told Earl that reinforcers could be
earned only for the absence of stereotypy. When
the session began, the therapist set the timer for
70 s (the last value of the recording interval in
previous conditions). Each time the tone
sounded, the therapist delivered praise plus
one edible item if he had not engaged in
stereotypy at any time during the interval. If he
had engaged in stereotypy, the therapist deliv-
ered feedback (‘‘No, you made this noise:
[modeled stereotypy].’’) and did not deliver an
edible item at the end of the interval.
Low levels of stereotypy were maintained
when the self-recording component was re-
moved in the DRO-only condition and re-
mained low when the DR (accurate) condition,
which previously had been ineffective, was
reinstated. Thus, Earl’s data suggested that
DRO per se was effective in decreasing ster-
eotypy but that exposure to either DRO plus
self-recording or to DRO alone might have
accounted for the absence of stereotypy when
the DR (accurate) condition was reinstated. To
determine whether his recent reinforcement
history influenced responding during the DR
(accurate) condition, a different history was
established by reinforcing accurate recording of
occurrences of stereotypy during a DR (stereo-
typy) condition.
PriortothestartofeachDR(stereotypy)
session, the therapist told Earl that reinforcers
could be earned by engaging i n stereotypy and
accurately recording i ts occurrence. He had
access to writing utensils and self-recording
sheets that contained only one box. This sheet
was i dentical to the side of the DR (accurate)
sheets for the occurrence of stereotypy (the box
was labeled ‘‘Inappropriate Talk’’ and was
affixed to the same brightly colored paper as
in the DR [accurate] condition). When the
session began, the therapist set the timer for
70 s. Each time the tone sounded, the
therapist delivered pr aise plus an edi ble item
if Earl engaged in stereotypy and mar ked the
self-recording sheet. If he d id not engage in
stereotypy and d id not mar k the self -rec ordin g
sheet, the therapist delivered praise but not a n
edible item. Finally, if Earl did not e ngage in
stereotypy and marked the self-recording
sheet, the therapist delivered feedback (e.g.,
‘‘No, you were quiet.’’) and did not deliver an
edible item.
SELF-RECORDING OF STEREOTYPY 63
During the DR (stereotypy) condition, Earl
accurately recorded the occurrence of stereotypy,
and his stereotypy increased to near-baseline
levels. The DR (accurate) condition then was
reinstated, and his behavior was similar to that
observed during the initial DR (accurate)
condition. In other words, he accurately recorded
occurrences of stereotypy and engaged in it
frequently. Earl’s final conditions, DRO plus
self-recording followed by DR (accurate), repli-
cated the sequence to which he was exposed
initially, and similar results were obtained. To
determine if this apparent historical influence
might have lasting effects, a follow-up session was
conducted 1 month after the termination of data
collection and resulted in both accurate recording
and the complete absence of stereotypy.
Curtis
Curtis engaged in variable levels of stereotypy
during baseline. Prior to the DR (accurate)
condition, numerous sessions and several vari-
ations of the training procedures were required
before he learned to perform the self-recording
response consistently with 90% accuracy.
Ultimately, he learned to self-record by watch-
ing 10-s video clips of himself engaging or not
engaging in stereotypy; however, 52 training
sessions had been conducted before he met the
mastery criterion. Implementation of the DR
(accurate) condition had no effect on his
stereotypy, although he learned to record its
occurrence accurately.
Next, DRO plus self-recording was imple-
mented (procedures were similar to those used
for Earl). Stereotypy gradually decreased during
this condition but subsequently increased to
baseline levels when the DR (accurate) condi-
tion was reinstated. These results were different
than those observed for Earl, and, despite the
extended duration of his DRO plus self-
recording condition, it was possible that
additional exposure to DRO plus self-recording
might result in therapeutic maintenance during
a subsequent DR (accurate) phase. Therefore,
we repeated the DRO plus self-recording
condition and observed reductions in stereoty-
py, but these reductions again failed to be
maintained when DR (accurate) was reinstated.
Given these results, Curtis’s final condition
consisted of DRO only, without the self-
recording component, which resulted in low
levels of stereotypy that were maintained even as
the DRO interval was thinned from 30 s to
5 min.
DISCUSSION
Results of previous studies (R. L. Koegel &
Koegel, 1990; Shabani et al., 2001) indicated
that a self-management intervention that con-
sisted of instructions, self-recording, and rein-
forcement for the absence of stereotypy effec-
tively decreased the frequency of stereotypy;
however, the influence of self-recording per se
was not examined. Results of this study
indicated that self-recording was unnecessary
for (Aaron) or ineffective in (Earl and Curtis)
reducing any of the subjects’ stereotypy. More
specifically, reductions in stereotypy were
produced by instructional control and access
to an alternative activity (Aaron), a recent
history of reinforcement for accurately record-
ing the absence of stereotypy (Earl), or the
DRO reinforcement contingency itself (Curtis).
Aaron’s data indicated that self-recording was
not responsible for reductions in his head
weaving. In fact, simply instructing Aaron to
refrain from stereotypy and providing an
alternative activity at least every 30 to 45 s
was sufficient to reduce his stereotypy to zero
immediately. This effect was established during
the control-activity condition in which near-
zero levels of stereotypy were observed when
instructions were delivered to refrain from
stereotypy and reinforcers were delivered for
copying an irrelevant word at the end of the
interval. Although the relative influence of
instructional control and access to the control
activity in suppressing stereotypy cannot be
determined from the data, features of the self-
recording materials (i.e., the words ‘‘Sit Still’’
64 JENNIFER N. FRITZ et al.
written over one box) might have functioned
as an instruction to refrain from stereotypy
throughout the interval. In addition, results of
his functional analysis suggested that simply
providing access to any alternative activity
might be effective in reducing Aaron’s stereo-
typy, because he engaged in stereotypy most
often during the alone condition when no
materials were present.
Similarly, self-recording per se was not
effective in reducing Earl’s stereotypy, in that
he continued to engage in high levels of bizarre
vocalizations during the initial DR (accurate)
condition when reinforcers were delivered for
accurate self-recording (whether or not stereo-
typy occurred). It was only following a history
with the DRO contingency that reinforcement
for accurate self-recording was effective in
maintaining low levels of stereotypy, as was
demonstrated in subsequent exposures to the
DR (accurate) condition. Most relevant was the
DR (stereotypy) followed by DR (accurate)
sequence in which, following a history of
reinforcement for accurately recording the
occurrence of stereotypy, he continued to do
so when the occurrence of stereotypy no longer
mattered. These results suggest that, for some
individuals, a particular history of reinforce-
ment for the absence of problem behavior
might be necessary before self-recording inter-
ventions can be used to maintain low levels of
behavior. Newman, Tuntigian, Ryan, and
Reinecke (1997) evaluated procedures similar
to those used in the DRO plus self-recording
followed by DR (accurate) sequence of Earl’s
component analysis and showed that a ‘‘self-
reinforcement’’ intervention following a history
of DRO maintained reductions in the problem
behaviors of three individuals with autism. The
experimenters delivered tokens contingent on
the absence of problem behavior in the first
intervention phase. In the second phase,
subjects were prompted to take a token
following an interval in which they did not
engage in problem behavior. In the last phase,
subjects were permitted to take tokens indepen-
dently at the end of the interval. In light of Earl’s
results, it is possible that, without the preceding
history of DRO, the self-reinforcement interven-
tion used in the Newman et al. study might not
have been sufficient to produce reductions in the
subjects’ problem behaviors.
Finally, Curtis’s results showed that DRO
was necessary to produce reductions in his
bizarre vocalizations, in that accurate self-
recording in the DR (accurate) phases never
resulted in low levels of stereotypy. Further-
more, DRO alone (without self-recording) was
effective in maintaining low levels of stereotypy,
even during interval durations up to 5 min.
Results of this study also suggest that self-
recording interventions designed to reduce
problem behaviors can be difficult to imple-
ment. First, teaching the self-recording response
might require a significant time investment.
Curtis, for example, required over 5 hr of
training before an effective procedure was
identified to bring the self-recording response
under discriminative control of his own behav-
ior. Difficulties in teaching individuals with
autism to self-record their behavior accurately
also have been reported in other studies. For
example, Mancina, Tankersley, Kamps, Kravits,
and Parrett (2000) reported that it took
approximately 18 hr of instruction before a
young girl with autism was able to perform
the self-recording response (as part of a self-
management intervention) to decrease her
inappropriate vocalizations. Conversely, this
training might be justified for some individuals
as a maintenance procedure following a history
of DRO, as suggested by Earl’s results. The
prerequisite skills or subject characteristics
necessary to produce these effects are not clear,
however, because some studies have shown that
self-management can be effective as a mainte-
nance procedure for some individuals (Newman
et al., 1997) but not for others (Santogrossi,
O’Leary, Romanczyk, & Kaufman, 1973).
Future research might attempt to identify the
SELF-RECORDING OF STEREOTYPY 65
prerequisite skills or subject characteristics that
are predictive of successful self-management
interventions for problem behavior exhibited by
individuals with autism.
Sustained reductions in problem behaviors
also might require continuous monitoring of
the client’s behavior such that reinforcers can be
delivered (a) contingent on a target response
(e.g., accurate self-recording), as was the case for
Earl in the DR (accurate) condition; or (b) for
the absence of problem behavior, as was the case
for Curtis during the final DRO intervention.
This finding is not unique to the present study;
Mancina et al. (2000) also reported that their
subject never learned to perform the self-
management intervention independently, in
spite of continued prompting and reinforce-
ment throughout the study. Even when self-
recording can be acquired and can be shown to
produce reductions in problem behavior, fre-
quent monitoring of the subject’s behavior is
still needed (Gross & Wojnilower, 1984). For
example, Freeman and Dexter-Mazza (2004)
evaluated a self-recording intervention to de-
crease the off-task and disruptive behavior of
one typically developing adolescent. They
found that self-recording was not sufficient to
reduce problem behavior unless a classroom
aide continuously monitored the subject’s
behavior and delivered reinforcers contingent
on 80% or better accuracy in self-recording. If
frequent monitoring of the individual’s behav-
ior is necessary to produce and maintain
reductions in problem behaviors, clinicians
may wish to consider simpler strategies for
reducing problem behaviors, such as establish-
ing stimulus (or instructional) control over
appropriate behavior, using standard DRO
procedures to decrease problem behaviors, or
teaching more adaptive replacement behaviors
(appropriate leisure skills) via DRA.
It remains unknown, however, whether self-
recording has any advantages over DRO alone
in terms of efficiency of initial behavior
suppression, maintenance during reinforcement
schedule thinning, or generalization across
settings. Previous research has produced mixed
results regarding the effectiveness of DRO as
a sole intervention for behavior maintained by
automatic reinforcement (e.g., Piazza, Fisher,
Hanley, Hilker, & Derby, 1996; Shore, Iwata,
DeLeon, Kahng, & Smith, 1997); however,
DRO alone was effective in reducing stereotypy
in this study, even at lengthy DRO intervals
(300 s). It is possible that discriminative
properties of the self-recording materials might
promote these effects, because research already
has demonstrated that stimulus control over
stereotypy can be established using punishment
procedures (Doughty, Anderson, Doughty,
Williams, & Saunders, 2007; Rapp, Patel,
Ghezzi, O’Flaherty, & Titterington, 2009;
Woods, 1983). Alternatively, statement of the
reinforcement contingency (instructions) might
have contributed to the effectiveness of DRO in
this study. For example, Ringdahl et al. (2002)
showed that an intervention that consisted of
DRO plus a statement of the reinforcement
contingency was effective in reducing the
stereotypic hand flapping of an individual with
mild mental retardation and a seizure disorder
and that reductions were maintained as the
DRO interval was thinned to 600 s. Future
research might examine the potential stimulus
control aspects of self-recording plus DRO,
which might make it more advantageous as an
intervention for stereotypy than DRO alone.
Finally, we must emphasize the fact that our
findings and conclusions are limited to situa-
tions in which self-recording is used to decrease
problem behavior. Self-recording has been used
to strengthen or maintain a variety of adaptive
responses exhibited by individuals with intel-
lectual disabilities (see Harchik et al., 1992, for
a review), including work productivity (Chris-
tian & Poling, 1997), social skills (L. K. Koegel,
Koegel, Hurley, & Frea, 1992), and appropriate
toy play (Stahmer & Schreibman, 1992). For
example, Stahmer and Schreibman taught three
children with autism to play appropriately with
66 JENNIFER N. FRITZ et al.
various toys using prompting, DRA, and a self-
management intervention. Self-management
materials were faded gradually from the training
setting, and the subjects were observed in other
settings to determine whether appropriate toy
play would be maintained and collateral
reductions in stereotypy would be observed.
They found that the intervention was effective
in increasing appropriate play and decreasing
stereotypy, and that these effects were main-
tained in the training and generalization settings
after the self-management materials were faded
gradually. Thus, it is possible that adaptive
behaviors continue to occur when self-recording
interventions are withdrawn, presumably be-
cause these behaviors contact naturally occur-
ring reinforcement contingencies. Similar ef-
fects might not be obtained when the focus of
treatment is response suppression, however, if
self-recording does not compete effectively with
reinforcement that maintains problem behavior.
REFERENCES
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders (4th ed., text
rev.). Washington, DC: Author.
Christian, L., & Poling, A. (1997). Using self-manage-
ment procedures to improve the productivity of adults
with developmental disabilities in a competitive
employment setting. Journal of Applied Behavior
Analysis, 30, 169–172.
Doughty, S. S., Anderson, C. M., Doughty, A. H.,
Williams, D. C., & Saunders, K. J. (2007).
Discriminative control of punished stereotyped be-
havior in humans. Journal of the Experimental Analysis
of Behavior, 87, 325–336.
Fisher, W., Piazza, C. C., Bowman, L. G., Hagopian, L. P.,
Owens, J. C., & Slevin, I. (1992). A comparison of two
approaches for identifying reinforcers for persons with
severe and profound disabilities. Journal of Applied
Behavior Analysis, 25, 491–498.
Foxx, R. M., & Azrin, N. H. (1973). The elimination of
autistic self-stimulatory behavior by overcorrection.
Journal of Applied Behavior Analysis, 6, 1–14.
Freeman, K., & Dexter-Mazza, E. T. (2004). Using self-
monitoring with an adolescent with disruptive class-
room behavior: Preliminary analysis of the role of adult
feedback. Behavior Modification, 28, 402–419.
Gross, A. M., & Wojnilower, D. A. (1984). Self-directed
behavior change in children: Is it self-directed?
Behavior Therapy, 15, 501–514.
Harchik, A. E., Sherman, J. A., & Sheldon, J. B.
(1992). The use of self-management procedures
by people with developmental disabilities: A brief
review. Research in Developmental Disabilities, 13,
211–227.
Horner, R. D. (1980). The effects of an environmental
‘‘enrichment’’ program on the behavior of institu-
tionalized profoundly retarded children. Journal of
Applied Behavior Analysis, 13, 473–491.
Irvin, D. S., Thompson, T. J., Turner, W. D., &
Williams, D. E. (1998). Utilizing increased response
effort to reduce chronic hand mouthing. Journal of
Applied Behavior Analysis, 31, 375–385.
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E.,
& Richman, G. S. (1994). Toward a functional
analysis of self-injury. Journal of Applied Behavior
Analysis, 27, 197–209. (Reprinted from Analysis and
Intervention in Developmental Disabilities, 2, 3–20,
1982)
Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D.
(1992). Improving social skills and disruptive behav-
ior in children with autism through self-management.
Journal of Applied Behavior Analysis, 25, 341–353.
Koegel, R. L., & Koegel, L. K. (1990). Extended
reductions in stereotypic behavior of students with
autism through a self-management treatment package.
Journal of Applied Behavior Analysis, 23, 119–127.
Lindberg, J. S., Iwata, B. A., & Kahng, S. W. (1999). On
the relation between object manipulation and stereo-
typic self-injurious behavior. Journal of Applied
Behavior Analysis, 32, 51–62.
Mancina, C., Tankersley, M., Kamps, D., Kravits, T., &
Parrett, J. ( 2000). Bri ef report: Reducti on of
inappropriate vocal izat ions for a child with autism
using a self-management treatment program. Journal
of Autism and Developmental Disorders, 30,
599–606.
Mulick, J. A., Hoyt, P., Rojahn, J., & Schroeder, S.
(1978). Reduction of a ‘‘nervous habit’’ in a
profoundly retarded youth by increasing toy play.
Journal of Behavior Therapy and Experimental Psychi-
atry, 9, 381–385.
Nelson, R. O., & Hayes, S. C. (1981). Theoretical
explanations for reactivity in self-monitoring. Behav-
ior Modification, 5, 3–14.
Newman, B., Tuntigian, L., Ryan, C. S., & Reinecke,
D. R. (1997). Self-management of a DRO procedure
by three students with autism. Behavioral Interven-
tions, 12, 149–156.
Piazza, C. C., Fisher, W. W., Hanley, G. P., Hilker, K., &
Derby, K. M. (1996). A preliminary procedure for
predicting the positive and negative effects of
reinforcement-based procedures. Journal of Applied
Behavior Analysis, 29, 137–152.
Rapp, J. T., Patel, M. R., Ghezzi, P. M., O’Flaherty,
C. H., & Titterington, C. J. (2009). Establishing
stimulus control of vocal stereotypy displayed by
young children with autism. Behavioral Interventions,
24, 85–105.
SELF-RECORDING OF STEREOTYPY 67
Rapp, J. T., & Vollmer, T. R. (2005). Stereotypy I: A
review of behavioral assessment and treatment.
Research in Developmental Disabilities, 26, 527–547.
Repp,A.C.,Dietz,S.M.,&Speir,N.C.(1974).
Reducing stereotypic responding of retarded per-
sons by the differential reinforcement of other
behavior. American Journal of Mental Deficiency, 79,
279–284.
Rincover, A., Cook, R., Peoples, A., & Packard, D.
(1979). Sensory extinction and sensory reinforcement
principles for programming multiple adaptive behav-
ior change. Journal of Applied Behavior Analysis, 12,
221–233.
Ringdahl,J.E.,Andelman,M.S.,Kitsukawa,K.,
Winborn, L. C., Barretto, A., & Wacker, D. P.
(2002). Evaluation and treatment of covert stereoty-
py. Behavioral Interventions, 17, 43–49.
Santogrossi, D. A., O’Leary, K. D., Romanczyk, R. G.,
&Kaufman,K.F.(1973).Self-evaluationby
adolescents in a psychiatric hospital school token
program. Journal of Applie d Behavior A nalysis, 6,
277–287.
Shabani, D. B., Wilder, D. A., & Flood, W. A. (2001).
Reducing stereotypic behavior through discrimination
training, differential reinforcement of other behavior,
and self-monitoring. Behavioral Interventions, 16,
279–286.
Shore, B. A., Iwata, B. A., DeLeon, I. G., Kahng, S., &
Smith, R. G. (1997). An analysis of reinforcer
substitutability using object manipulation and self-
injury as competing responses. Journal of Applied
Behavior Analysis, 30, 21–40.
Stahmer, A. C., & Schreibman, L. (1992). Teaching
children with autism appropriate play in unsupervised
environments using a self-management treatment
package. Journal of Applied Behavior Analysis, 25,
447–459.
Woods, T. S. (1983). The selective suppression of a
stereotypy in an autistic child: A stimulus control
approach. Behavioural Psychotherapy, 11, 235–248.
Received December 24, 2008
Final acceptance October 27, 2011
Action Editor, Jeffrey Tiger
68 JENNIFER N. FRITZ et al.
    • "First, a third of the studies included a self-monitoring component. As demonstrated by Fritz et al. (2012), when DRO is implemented with self-monitoring, it is likely that the decrease in stereotypy is attributable, at least in part, to differential consequences for engaging in self-monitoring. Therefore, it is not clear whether DRO is equally effective for individuals who cannot monitor their own engagement in stereotypy (Rapp & Lanovaz, 2016; Tiger, Fisher, & Bouxsein, 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: We conducted a series of studies on multiple forms of repetitive behavior displayed by four children with autism spectrum disorder. Study 1 showed that each participant’s highest probability repetitive behavior persisted in the absence of social consequences, thereby meeting the functional definition of stereotypy. Study 2 showed that preferred, structurally matched stimulation decreased each participant’s targeted (highest probability) stereotypy, as well as their non-targeted (lower probability) stereotypy. Study 3 showed that for three participants, non-contingent access to preferred stimulation decreased immediate and, to some extent, subsequent engagement in targeted and non-targeted stereotypy. For the fourth participant, non-contingent access to preferred stimulation decreased immediate engagement in the targeted stereotypy, but increased subsequent engagement in non-targeted stereotypy; this subsequent increase was attenuated by reducing the duration of access to the preferred stimulus. Study 4 showed that a trial-based differential reinforcement of other behavior (DRO) procedure systematically increased the period of time for which the targeted stereotypy was not displayed for three of three participants. In addition, results showed that the participants’ non-targeted stereotypy either decreased or was unchanged when DRO was provided for the targeted stereotypy.
    Full-text · Article · Jun 2016
    • "Second, as previously noted, some of the aforementioned studies implemented DRO procedures in conjunction with self-monitoring procedures (e.g., Nuernberger et al., 2013 ; Ringdahl et al., 2002 ). Nevertheless, results from a study by Fritz et al. ( 2012 ) suggest that when DRO is used in conjunction with self-monitoring procedures, decreases in stereotypy are likely attributable to reinforcement contingencies (e.g., the omission of stereotypy or engagement in alternative behavior ). Third, studies for which researchers were able to demonstrate consistent reductions in stereotypy with DRO schedules of 5 min or longer typically included participants with developed academic repertoires (e.g., individuals who could write, follow instructions, or both). "
    [Show abstract] [Hide abstract] ABSTRACT: This chapter provides an overview of behavior analytic procedures for assessing and treating stereotypical behavior that is exhibited by individuals diagnosed with autism and intellectual disabilities. First, the chapter begins with a functional definition of motor and vocal stereotypy. Second, the chapter briefly reviews the epidemiology of stereotypy and other repetitive behaviors. Third, the chapter outlines criteria for evidence-based treatments and then describes several antecedent- and consequent-based interventions with strong, moderate, or no evidence in the literature. Fourth, the chapter outlines the application of stimulus control procedures, which are behavioral interventions with emerging empirical support for decreasing stereotypy during instructional periods. Finally, the chapter concludes with an overview of a model for treatment selection and progression.
    Chapter · Jan 2016 · Behavior Modification
    • "%, range = 96.28– 96.28 %). Fritz et al. (2012) used a combination of discrimination training, self-monitoring, and differential reinforcement to decrease motor and vocal stereotypy in three participants aged 12–40 years (m=33.67 years). "
    [Show abstract] [Hide abstract] ABSTRACT: Stereotyped, repetitive, ritualistic, obsessive, and compulsive behaviors are a common feature for many individuals with autism, and multiple topographies of such behavior exist. Previous reviews have discussed treatments for stereotypy and repetitive behaviors; however, to date, none have systematically evaluated the efficacy of such treatments. An abundance of treatments based on the principles of applied behavior analysis exist within the literature; however, many assume that stereotypy is maintained by automatic reinforcement. The current review aimed to evaluate the efficacy of treatments for stereotypy across disciplines including behavioral, pharmacological, and sensory-based therapies. Furthermore, this review compares the efficacy of function-based and nonfunction-based treatments for stereotypy.
    Full-text · Article · Jun 2014
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