ALISON KING VIRGINIA COMMONWEALTH UNIVERSITY SEDP 711: DOCTORAL SEMINAR IN SINGLE SUBJECT DESIGN FALL 2015 Article Analysis: Changing Criteria

Purpose The purpose of this study was to evaluate a treatment package consisting of discrimination training, a social story, and differential reinforcement with response cost on vocal stereotypy for a preschooler diagnosed with Autism. Vocal stereotypy is repetitive vocal responses that are maintained by automatic reinforcement characterized as the sensory byproduct.

Research Question/IV/DV Not outright stated in the article. DV and IV were easily identified. DV - Vocal stereotypy defined as any instance of non-contextual vocal word or sound output for three consecutive seconds (ex. TV show talk). IV - discrimination training and differential reinforcement of low rates (DRL) of behavior with response cost (RC)

Subject David – 4 year-old diagnosed with ASD at age of 2 CELF – P – receptive language index = 61 PPVT-4 = standard score of 74 Nominated by teacher and mother due to high rate of vocal stereotypy at school and at home.

Setting Integrated preschool in public school 5 days per week with children who have developmental disabilities 2 of the 5 days integrated with typically developing peers One special education teacher and three classroom assistants Behavioral consultant in class 1-2 days per week (researcher)

Design Changing conditions design with an embedded changing criterion design Changing Conditions: increase the duration of sessions and intervals  Phase One: Five 1 minute intervals for a total of a 5 minute session. Reinforcement time was 1 minute.  Phase Two: 1.5 minute intervals for a total of a 7.5 minute session. Reinforcement was 1-2 minutes.  Phase Three: Five 2 minute sessions for a total of a 10 minute session. Reinforcement time was 2-3 minutes.

Design continued Changing Criterion: percentage of intervals with vocal stereotypy Phase 1: Criterion 1 – 80% or less; C2 – 60% or less; C3 – 40% or less; C4 – 20% or less; C5 – reversal back to 40% or less Phase 2 –C6 – 20% or less; C7 – 0% Phase 3 –C8 - 20% or less. No programmed consequence condition (green) Intervention condition of DRL/RC (red)

Intervention Antecedent, behavior, consequence data were recorded by the classroom behavioral consultant prior to the beginning of the study and during weekly observations of 30 minutes. Data collection = partial interval recording; 2 -4 experimental sessions per day; percentage of occurrence was calculated

Intervention continued Daily data collection on percent of intervals in which vocal stereotypy occurred for up to 5 minute sessions, the activity, and the day of the week in order to analyze environmental conditions that may maintain vocal stereotypy. Vocal stereotypy maintained by positive automatic reinforcement. No consequence increased or decreased the behavior. More likely to engage in vocal stereotypy when left alone and occurred at lower levels when there were other auditory stimuli present.

Intervention continued No consequences for vocal stereotypy - playground, choice time, play time (more socially acceptable) Consequences (intervention) activities – circle time, small group, lunch, snack, individual work time Baseline – given verbal redirection (quiet voice)

Baseline

Intervention continued Start of scheduled activity, David instructed on condition specific contingency with corresponding social story (i.e. red or green condition). Given matching wristband. Token board with 5 tokens and a prize box with preferred items, timer set. Engaged in vocal stereotypy, staff showed him token board and removed a token. Finger to their lips and counted to three until he remained quiet for 3 seconds. If he had a predetermined number of tokens left at the end of condition specific time, green condition was then implemented and he was given access to the prize box for a predetermined amount of time.

Social Stories

Data Analysis/Results Decrease in vocal stereotypy in all phases as compared to baseline. Phase 1 – C1 – 56%; C2 – 37%; C3- 26%; C4- 15%; C5 – 28%  Note that C5 was when criteria was reversed back to 40% or less Phase 2 – C6 – 12%; C7 – 10% Phase 3 – 8%

Data Analysis/Results

IOA – calculated for 25% of sessions with 97% agreement. No statistical information given. Criteria for changing the criteria – meeting criteria on 2 consecutive sessions.

Limitations Formal functional analysis not being conducted so other variables may have impacted his vocal stereotypy. Criterion changes were not made until the behavioral specialist was able to come into the classroom, score the data, and then inform the staff of the changes. The number of times the intervention was implemented per day varied. The intervention was also in place at home. There was no data taken on the amount of vocal stereotypy during the green phases.

Strengths/Weaknesses Social validity – scored high on measure adapted from the Treatment Acceptability Rating From- Revised; 7 point Likert scale consisting of 10 questions with open ended comments section. Completed by guardian, teacher, staff, home-based behavioral consultant at the end of the study. Socially acceptable – 5 of 5; Easy to implement – 4.5 out of 5; minimally intrusive – 4.75 of 5; no adverse side effects – 5 of 5; Improvement during (5 of 5) and outside of intervention (4.75 of 5).

Strengths/Weaknesses Red bracelet may have exerted control over other responses resulting in positive social reinforcement and prize box thereby competing with hypothesized reinforcement for decreases in vocal stereotypy. Intervention not implemented the same number of times per day. The home-behavior specialist and guardian implemented program at home and David stayed in the beginning phases.

Future Directions The researchers speculated that these procedures could be implemented in non-experimental settings with less control and result in decreases in target behaviors. More research is needed to determine if the suppression of vocal stereotypy will continue with just the use of the red bracelet. Occurrence of appropriate vocalizations should be measured. The researchers suggested pairing the suppression of vocal stereotypy with DRL/RC and naturally occurring stimuli or if the green condition is necessary.