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ment program to reduce stereotypic (repetitive) behav- iors. Four children diagnosed with autism were referred because of high frequency of stereotypic behaviors (e.g., arm flapping, finger flexing, humming, nonsense vocal- izations). After self-management procedures were taught, stereotypic behaviors decreased to zero levels for all chil- dren, however, the two children with vocal stereotypies required a longer period of self-management before de- creases were noted. Similarly, Stahmer and Schreibman (1992) investigated the effects of self-management pro- cedures for a variety of target behaviors including in- creasing appropriate play skills, and reducing stereotypic behaviors of three children with autism. Participants were 7 to 13 years old and were referred for treatment by their parents due to destructive and obsessive behavior with toys in unsupervised settings. Appropriate play increased for all three children during treatment, fading, posttreat- ment, and follow-up observations and self-stimulatory behavior decreased to zero levels. Results from these studies indicated the successful use of self-management to reduce inappropriate behaviors (R. L. Koegel & Koegel, 1990), to increase schedule following (Newman, Buffington, O’Grady, Poulson, & Hemmes, 1995), and

INTRODUCTION

Self-management procedures, as reported in the literature, have incorporated components of self- assessment, self-recording, and self-reinforcement (R. L. Koegel & Frea, 1993). Applications of self-management to children with autism have evolved from procedures to (a) improve on task behaviors of children with retarda- tion, learning disabilities, and behavior disorders; and (b) to decrease disruptive, inappropriate, or stereotypic behaviors (Gardner, Clees, & Cole, 1983; L. K. Koegel, Koegel, Hurley, & Frea, 1992; Reese, Sherman, & Shel- don, 1984; Shapiro, McGonigle, & Ollendick, 1980; Stah- mer & Schreibman, 1992). In an exemplary study, R. L. Koegel and Koegel (1990) assessed whether children with autism could be taught to use a self-management treat-

Brief Reports

Brief Report: Reduction of Inappropriate Vocalizations for a Child with Autism Using a Self-Management Treatment Program

Catherine Mancina,1 Melody Tankersley,2 Debra Kamps,1,4 Tammy Kravits, 1

and Jean Parrett3

Self-management procedures that incorporate elements of self-assessment, self-recording, and self-reinforcement have reduced stereotypic (i.e., repetitive) behaviors in children with autism in clinical settings. This study examined the effects of a self-management program used to re- duce high rates of inappropriate vocalizations (e.g., humming, tongue clucking, perseverative and echolalic words/phrases) in a 12-year-old girl having autism served in a public school classroom. When self-management was applied to inappropriate vocalizations in a multiple- baseline design during leisure, prevocational, and reading tasks, the occurrence of vocaliza- tions decreased. Implications for teaching these procedures in classroom settings are discussed.

KEY WORDS: Self-management procedures; autism; inappropriate vocalization.

Journal of Autism and Developmental Disorders, Vol. 30, No. 6, 2000

1 University of Kansas, Kansas City. 2 Kent State University, Kent, Ohio. 3 Kansas City, Kansas Public Schools, Kansas City. 4 Address all correspondence to Debra M. Kamps, Juniper Gardens

Children’s Project, 650 Minnesota Avenue, 2nd floor, Kansas City, Kansas 66101.

to increase social behaviors (R. L. Koegel & Frea, 1993; Stahmer & Schreibman, 1992).

The purpose of the present study was to extend the literature on classroom-based self-management procedures. The investigation examined the effects of self-management procedures for a 12-year-old girl di- agnosed with autism and moderate mental retardation. Three inappropriate behaviors were identified for the participant (i.e., vocalizations, facial movements, body movements); however, self-management proce- dures were applied to only one behavior (i.e., vocal- izations) and collateral effects were observed for the others. Because studies indicated that the reduction of vocalizations requires longer durations of treatment in children with autism (R. L. Koegel & Koegel, 1990), the amount of time required to teach the self- management procedures and the levels to which tar- get behaviors decreased were investigated.The present study, therefore, focused on the reduction of vocaliza- tions with effects noted for (a) change in the target be- havior, (b) change in collateral behaviors, (c) the treatment effects across tasks, (d) the accuracy of the student’s self-recording, and (e) time required to teach the procedures.

METHOD, STUDY 1

Participant and Settings

Target student.The participant, Keri, a 12-year- old African American girl, was diagnosed with autism and moderate mental retardation. Keri attended sum- mer school in a self-contained, special education classroom located in an urban, elementary school set- ting. On the Wecshler Intelligence Scale for Children (Wecshler, 1974), Keri scored a 46 on the perfor- mance subtest. No information concerning her verbal subtest was provided. Her estimated full IQ range was between 42 and 55. She read sight words and simple sentences, had good verbal comprehension, and re- sponded correctly to yes/no questions. She indepen- dently participated in prevocational and leisure activities. Of primary concern to her teacher was her verbal behavior. Keri’s verbal communication (two- to-three-word phrases) was continuously interrupted by noises (humming, whistling, tongue clucking); and per- severative vocalizations. She also exhibited stereotypic body and facial movements. Assessments and inter- views indicated that these behaviors were primarily maintained by sensory stimulation. Keri’s teachers re- ported that her vocalizations were very disruptive, and interfered with her academic and social learning. Keri

600 Mancina, Tankersley, Kamps, Kravits, and Parrett

was most attentive in quiet environments with one-to-one teaching situations.

Treatment Providers/Observers.All three indi- viduals who participated in this study including the first author, a research associate, and a doctoral student had at least 5 years experience using behavioral techniques to teach children with autism, behavior disorders, and/or other developmental disabilities. Treatment providers also served as observers for the study.

Setting. The experimental sessions were con- ducted in a special education classroom (20 × 40 m), located in a public school, 4 to 5 days a week. Sessions lasted 5 minutes each. Four to six sessions were con- ducted every morning within a 3-hour period. Keri fol- lowed her regular morning schedule of activities with self-management sessions conducted during typical tasks (i.e., leisure, prevocational, and reading). Keri was seated at her own desk located in the back of the classroom. One treatment provider and one observer sat in chairs placed on each side of her, and five stu- dents were also working at individual desks.

Dependent Variables and Measurement

Dependent Variable/Target Behavior.The ob- server recorded occurrence or nonoccurrence of three categories of behavior: (a) vocalizations, (b) facial movements, (c) and body movements during 10-second intervals for 5 minutes. Occurrence of self-injurious be- havior within 10-second intervals was also recorded. The occurrence of vocalizations was identified as the tar- get behavior, however, all three behaviors were mea- sured to examine collateral effects of the self-management procedures. Vocalizations were defined as (a) noises such as humming, whistling, tongue clucking, and (b) perse- verative (repeated) and echolalic words or phrases. Fa- cial movements were recorded as any nonfunctional movements of the face including exaggerated eye blinks, rolling eyes, noncontextual smiling, tongue pro- trusions, and raising and lowering of eyebrows. Body movements were defined as any nonfunctional body movements including hand and finger manipulations, stomping feet, head butts, elbow jabs, and head jerks. Any occurrence of self-injury, such as hand biting or hitting her head, was recorded.

Observations.Data were collected by the treat- ment providers. They randomly rotated between teach- ing and supervising the self-management procedures and recording the data. Data were collected using a 10- second whole interval recording procedure to record the occurrence or nonoccurrence of (a) target vocal- izations, (b) facial movements, (c) and body move-

ments. When a self-injurious behavior was observed, the observer placed a circle around the interval to in- dicate the occurrence of a self-injurious behavior. Data were recorded during leisure, prevocational, and read- ing tasks. Data were not taken during self-reinforcement (see Procedures).

Reliability. Interobserver reliability was collected for each behavior during baseline and treatment phases, for 38% (n = 36) of all sessions, using video- tapes of sessions. The primary observer and the treat- ment provider viewed the tapes simultaneously, while scoring independently. An agreement was scored if both observers recorded a “+” or when both recorded a “−” for each behavior in an interval. Reliability was measured by calculating the number of agreements be- tween the two observers divided by the number of agreements and disagreements, multiplied by 100. The mean percentage of reliability for vocalizations was 95% (R = 63–100%), 87% (R = 63–100%) for facial movements, and 89% (R = 75–100%) for body move- ments.

Experimental Design and Procedures, Study 1

A multiple-baseline design (Kazdin, 1984) across tasks was used to teach Keri to use self-management procedures. Occurrences of the inappropriate vocal- izations and collateral behaviors were recorded during experimental conditions: baseline (A) and treatment phases (B). Treatment (self-management) was only ap- plied to inappropriate vocalizations, as the teacher de- termined this to be the most problematic behavior.

Baseline (A).Data were collected during Keri’s participation in leisure, prevocational, and reading tasks, as included in her IEP and presented to her by the class- room teacher. Baseline data were collected over 11 days for the leisure task, 20 days for the prevocational task, and 32 days for the reading task, Leisure task materials included coloring and sticker books, drawing boards, memory match games, photograph albums, and puzzles. Prevocational materials/activities included sorting, stamping, and collating items. Materials used during the reading tasks included flash cards, worksheets, and the student’s Edmark® reading book.

Treatment Phases (B).Self-management proce- dures, adapted from a training manual by R. L. Koegel, Koegel, and Parks (1990), were implemented first dur- ing leisure tasks followed by, prevocational, and read- ing tasks. The treatment procedures incorporated the use of (a) the same classroom materials as used in baseline tasks, (b) self-management materials, and (c) the teach- ing of self-management including: identification of be-

Reduction of Inappropriate Vocalizations 601

haviors, self-recording, self-reinforcement, independent use of the program, and assessing student accuracy.

Teaching the self-management programtook place in Keri’s summer school classroom. Self-management materials served as stimuli for Keri to perform the self–management procedures and included a Timex dig- ital watch with a repeat alarm to signal 10-second in- tervals, self-recording sheets (i.e., a sheet of paper with 12 empty boxes with the words “quiet” and “noisy” written beside them), visual prompts (i.e., 4 inch × 6 inch quiet card), and reinforcers. Keri was taught to correctly identify her target behavior (i.e., vocaliza- tions) through modeling. The treatment provider mod- eled quiet and noisy behavior, asked Keri “Was I quiet or noisy?” (with gestures toward cards with the words quiet and noisy), reinforced correct responses and cor- rected errors. When Keri responded correctly during 8 of 10 trials for five consecutive sessions, Keri was then required to model quiet and noisy behavior in 8 of 10 trials (emphasis on quiet behavior), for three consecu- tive sessions (emphasis on quiet).

Keri was then taught to assess target behavior using the self-recording sheet. Training and continued practice followed the instruction (i.e., “Get ready, show me quiet.”) and an instruction to record in the quiet box (or noisy box). Once Keri consistently marked the box that described the behavior she was modeling, she was taught self-recording using the watch, with initial intervals of 5 seconds, as the longest observed dura- tion that Keri could work, play, or sit without dis- playing the target behavior (vocalizations). The watch was started when the treatment provider gave the in- struction to work quietly (“Get ready. Show me quiet when you color.”). When the watch beeped, the treat- ment provider stopped the watch, and Keri was asked “Were you quiet or noisy?”. When Keri responded (“quiet” or “noisy”) she was instructed to check that particular box (e.g., “That’s right. You were quiet. Check the quiet box.”). If Keri was incorrect in her re- sponse, she was verbally corrected and instructed to mark the appropriate box. Keri often said the word “quiet” during the interval. This was considered an ap- propriate verbalization. During intervals when Keri was noisy, the treatment provider prompted her to be quiet (e.g., “That’s noisy. Show me quiet. That’s bet- ter. That’s quiet.”).

After Keri could successfully self-record her be- haviors when signaled by the watch, she was taught self-reinforcement.Before presentation of each new self-recording sheet, a variety of rewards (e.g., pop- corn, cereal, stickers, raisins,) were shown to Keri. Keri was instructed to (a) select six small rewards (six

602 Mancina, Tankersley, Kamps, Kravits, and Parrett

in the interval beeps from 5 seconds to 10 seconds. The prompt-fading sequence was faded to, “Were you quiet or noisy?,” to “Check it,” and finally to a gestural prompt (a point to the paper). Also, verbal prompts to be quiet during the interval were only given during the intervals after Keri was noisy, and prompts were tied to the self-management procedure and materials. Cri- teria for implementation to the second (third) task was completion of the self-management steps, successful in- crease to 10-second intervals, and decreases in vo- calizations to 50% or less of the intervals for five sessions.

pieces of cereal, popcorn, raisins), (b) write the name of the reward at the top of the self-recording sheet, and (c) put the rewards on her desk above her self- recording sheet. Edibles were earned for quiet boxes. She was instructed to do the same for the one “spe- cial” reward (tape player, sticker, soda, or several pieces of the smaller rewards), which she selected to earn for reaching performance criteria (3 of 6 quiet intervals, then 4 of 6).

Teaching independence in self-recordingfollow- ing successful self-management, consisted of (a) gradual fading of verbal prompts, and (b) an increase

Fig. 1. Percentage occurrence of vocalizations during leisure, prevocational, and reading tasks for Study 1.

Results and Discussion

Overall the target behavior, vocalizations, decreased while collateral behaviors, facial and body movements, showed variable changes with minimal generalization of effects (Fig. 1 and Table I). During all tasks, the occur- rence of vocalizations, facial movements, and body movements ranged from 80–100% during baseline. Dur- ing the treatment phase for leisure tasks (28 sessions), self-management decreased vocalizations to 50% of the intervals or less after 18 sessions. When self-management was applied during prevocational tasks, the vocalizations decreased to less than 50% occurrence after four sessions, and continued to decrease to 20% occurrence or less. Dur- ing reading tasks, the occurrence of vocalizations once more decreased below 50% occurrence within the first three sessions of self-management.

Though vocalizations remained below 50% oc- currence, facial and body movements continued to occur at higher rates than the target behavior. As de- picted in Table I (means by condition, and last five ses- sions of treatment), no change in facial movements occurred following treatment for vocalizations during leisure tasks, with some generalization of effects to final sessions during prevocational and reading tasks. Limited generalization was noted in the occurrence of body movementsfollowing treatment for vocalizations. Keri’s self-injurious behavior was recorded during baseline and intervention. A total of 49 instances of self-injury were noted during sessions. The frequency was similar during baseline and treatment.

Results from Self-Management Procedures

Keri’s accuracy in self-recording her quiet and noisy behavior was recorded during treatment phases (5 sessions for leisure tasks, 3 sessions for prevocational

Reduction of Inappropriate Vocalizations 603

tasks, and 4 sessions for reading tasks). She averaged 85% accuracy per session with a range of 78–92%. The initial teaching of the self-management steps required 6 days of intensive instruction for an average of 3 hours a day, with training continuing during the leisure tasks until Keri’s vocalizations decreased to 50% occurrence or less. Keri required 2 days of teaching before vocal- izations decreased to 50% occurrence during the prevo- cational tasks, and required only 1 day of teaching during reading. While vocalizations decreased, she did not reach independence, still needing verbal and gestural prompts to use the program.

STUDY 2: SELF-MANAGEMENT WITH THE TEACHER AS TREATMENT PROVIDER

A continuation of self-management was conducted with Keri in Study 2, beginning in the fall term with in- corporation of the following procedures: (a) training the classroom teacher as treatment provider in the self-man- agement procedures, (b) lengthening the duration of the interval for quiet behavior, (c) increasing the number of intervals on the self-recording sheet, (d) gradually fad- ing verbal prompts to increase independence, (e) fading tangibles to natural reinforcers, and (f) fading the prox- imity and presence of the treatment provider.

Participant, Setting, Design, and Procedures

The teacher, a paraprofessional, and five students with autism, were present in the classroom. The class- room teacher had 11 years of teaching experience in special education classroom settings. Self-management procedures were implemented during scheduled class- room tasks involving leisure, prevocational, and read- ing activities, as in Study 1. Self-management procedures were conducted approximately 20–30 minutes a day, four to five times a week.

Dependent Measures and Design.Dependent mea- sures were identical to those in Study 1 with the same definitions for the target and collateral behaviors. Oc- currence of inappropriate vocalizations, facial and body movements were recorded during continuous 10-second observations for 5-minute sessions. Observers for Study 2 included the first author and a research assistant with 9 years of teaching experience with children with autism. Reliability was computed for 9% of the data files (14 of 137 sessions). Mean agreement was 91% (R = 83–100%) for vocalizations, 83% (R = 52–100%) for facial movements, and 80% (R = 67–100%) for body movements. A multiple-baseline design was used to evaluate treatment effects across tasks.

Table I. Means for Facial and Body Movement, Self-Injurious Behavior Across Conditions During Study 1

Task Baseline Treatment for vocalizations

Mean percentage occurrence—Facial Movements Leisure 89 83 (87, final 5 sessions) Pre-Voc 92 74 (68, final 5 sessions) Reading 94 84 (73, final 5 sessions)

Mean percentage occurrence—Body Movements Leisure 83 84 (79, final 5 sessions) Pre-Voc 87 79 (82, final 5 sessions) Reading 95 89 (81, final 5 sessions)

Frequency of self-injurious behavior Leisure 0.250 0.285 (0.00, final 5 sessions) Pre-Voc 0.060 0.625 (0.00, final 5 sessions) Reading 0.176 0.100 (0.20, final 5 sessions)

Baseline. Baseline observations occurred during Keri’s regular leisure, prevocational and reading tasks with the same materials used in Study 1 and no self- management procedures.

Self-Management Procedures.In Study 2, the role of the treatment provider was transferred to the class- room teacher. Teacher training included (a) task analy- sis of each component of self-management procedures, (b) videotaped examples of the student using self-man- agement procedures, (c) modeling of prompting and self- management procedures by the first author, and (d)

604 Mancina, Tankersley, Kamps, Kravits, and Parrett

monitoring and feedback concerning her performance as treatment provider for 5 days of training. Once the teacher training was completed, self-management pro- cedures identical to those used in Study 1 were imple- mented: (a) identification of target behavior, (b) recording of the target behavior, (c) self-recording using the watch, and (d) self-reinforcement.

During the treatment phase, the number of self- recording boxes per page was increased from 6 to 10. The duration of intervals ranged from 10–40 seconds, and was variable throughout all treatment phases. If Keri

Fig. 2. Percentage occurrence of vocalizations during leisure, prevocational, and reading tasks for Study 2.

Reduction of Inappropriate Vocalizations 605

exhibited vocalizations and was not successful (i.e., did not earn a reward using the self-management procedures) on three consecutive self-recording sheets, the duration of the interval was lowered. Also, the number of suc- cessful (i.e., quiet) intervals required to receive a reward was increased to 8 of 10 quiet intervals.

In Study 2, limited independence with self-man- agement procedures was obtained. Verbal prompts and gestural prompts were faded; however, Keri frequently required gestural prompts toward the end of the ses- sions. Because Keri continued to require prompts to re- main on-task, proximity by the treatment provider was limited to the area within the classroom.

Results and Discussion

In Study 2, vocalizations decreased, facial move- ments remained unchanged, and body movements de- creased. As depicted in Figure 2, baseline levels of vocalizations were high (76–97%), with a decrease to 41% occurrence in the first treatment session, and con- tinued decreases to near zero levels. Self-management during prevocational tasks decreased vocalizations to below 20% after the first treatment session, with zero levels during several sessions of the treatment phase. During reading, vocalizations decreased to lower lev- els; however, the decrease was variable, ranging from 0–60% occurrence. An increase in final sessions ap- peared to be related to task difficulty. Facial movements showed some variability but continued to occur at higher rates than vocalizations. Body movements de- creased to lower levels during treatment for vocaliza- tions, indicating some generalization of treatment effects. Self-injurious behavior was somewhat lower

during the Study 2 period, except during frustrating tasks (see Table II).

GENERAL DISCUSSION

Similar to positive findings in prior research (e.g., R. L. Koegel & Koegel, 1990; Reese, Sherman, & Shel- don, 1984), self-management was highly effective in decreasing inappropriate vocalizations. In general, treatment effects were slower during the initial program (Study 1, Task 1) with quicker results for the second and third tasks and during Study 2. In addition, both teachers reported that Keri was much quieter with more appropriate behavior when using the self-management program. Generalization of treatment effects were noted for one of two collateral behaviors. Though the findings were encouraging, a limitation was that Keri did not learn complete independence, nor were procedures able to be faded within the period of study. Larger changes in tar- get and collateral behaviors may have been obtained with (a) the use of behavioral programming to address behav- iors such as noncompliance, (b) an augmentative com- munication system, and (c) programs to increase social competencies. Longer treatment may also be necessary for students with (a) lower cognitive ability, (b) high rates of challenging behaviors, rates, and (c) a long his- tory of behaviors with insufficient interventions (R. L. Koegel, Koegel, Van Voy, & Ingham, 1988).

ACKNOWLEDGMENT

This research was supported by the Office of Spe- cial Education and Rehabilitation Services, U.S. De- partment of Education, Grant H023C00024 to the University of Kansas.

REFERENCES

Gardner, W. I., Clees, T. J., & Cole, C. L. (1983). Self-management of disruptive verbal ruminations by a mentally retarded adult. Applied Research in Mental Retardation, 4, 41–58.

Kazdin, A. E. (1984). Behavior modification in applied settings (3rd ed.). Homewood, IL: Dorsey.

Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D. (1992). Im- proving social skills and disruptive behavior in children with autism through self-management. Journal of Applied Behavior Analysis, 25, 341–354.

Koegel, R. L., & Frea, W. D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. Jour- nal of Applied Behavior Analysis, 26, 367–377.

Koegel, R. L., & Koegel, L. K. (1990). Extended reductions in stereo- typic behavior of students with autism through a self-manage- ment treatment package. Journal of Applied Behavior Analysis, 23, 119–128.

Table II. Means for Facial and Body Movements, Self-Injurious Behavior Across Conditions During Study 2

Task Baseline Treatment for vocalizations

Mean percentage occurrence—Facial Movements Leisure 71 72 (62, final 5 sessions) Pre-Voc 84 82 (89, final 5 sessions) Reading 83 80 (78, final 5 sessions)

Mean percentage occurrence—Body Movements Leisure 71 52 (35, final 5 sessions) Pre-Voc 82 66 (58, final 5 sessions) Reading 85 74 (59, final 5 sessions)

Frequency of self-injurious behavior Leisure 0.000 0.090 (0.00, final 5 sessions) Pre-Voc 0.000 0.000 (0.00, final 5 sessions) Reading 0.420 1.500 (2.80, final 5 sessions)

606 Mancina, Tankersley, Kamps, Kravits, and Parrett

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Shapiro, E. S., McGonigle, J. J., & Ollendick, T. (1980). An analy- sis of self-assessment and self-reinforcement in a self-managed token economy with mentally retarded children. Applied Re- search in Mental Retardation, 1, 227–240.

Stahmer, A. C., & Schreibman, L. (1992). Teaching children with autism appropriate play in unsupervised environments using a self-management treatment package. Journal of Applied Be- havior Analysis, 25, 447–459.

Wechsler, D. (1974). Manual for the Wechsler Intelligence Scale for Children-Revised. San Antonio: Psychological Corp.

Koegel, R. L., Koegel, L. K., & Parks, D. R. (1990). How to teach self-management skills to people with severe disabilities: A training manual. Unpublished manuscript, University of Cali- fornia, Santa Barbara.

Koegel, R. L., Koegel, L. K., Van Voy, K., & Ingham, J. C. (1988). Within-clinic versus outside-of-clinic self-monitoring of artic- ulation to promote generalization. Journal of Speech and Hear- ing Disorders, 53, 392–399.

Newman, B., Buffington, D. M., O’Grady, M. A., Poulson, C. L., & Hemmes, N. S. (1995). Self-management of schedule following in three teenagers with autism. Behavior Disorders, 20, 190–196.

Reese, R. M., Sherman, J. A., & Sheldon, J. (1984). Reducing agi- tated-disruptive behavior of mentally retarded residents of com-

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