Vocal Stereotypy
Student A
Capella University
Vocal Stereotypy
Vocal stereotypy can be defined as any instance of nonfunctional speech that can include words or phrases that are not related to what is going on around the individual, or repetitive grunting, squealing, or babbling (Ahearn, Clark, & MacDonald, 2007). Stereotypic behaviors are a common feature in children who have been diagnosed with Autism Spectrum Disorder (ASD); stereotypic behaviors are any sort of repetitive and/or restricted movement or vocalization (Bulla & Frieder, 2017). Vocal stereotypy can be disruptive to a child’s life because it interferes with learning and social inclusion (Lanovaz & Sladeczek, 2011). Some researchers believe that vocal stereotypy is maintained by social reinforcements; however there are other researchers that believe that vocal stereotypy is not maintained by social reinforcements because vocal stereotypy typically persists even when social reinforcement is not present (Lanovaz & Sladeczek, 2011). Those that do not believe that vocal stereotypy is maintained by social reinforcement believe that vocal stereotypy functions for automatic reinforcement, or in other words that there is an internal reinforcing stimulation (Lanovaz & Sladeczek, 2011). Functional analyses have been utilized to determine the function of vocal stereotypy, and those that are found to function as automatic reinforcement are because the behavior happens when no one is around, and it is observed across all conditions (Lanovaz & Sladeczek, 2011). Throughout this paper five articles will be reviewed on vocal stereotypy, and will look into the methodologies used to treat vocal stereotypy, as well as experimental designs used.
Article 1
Overview
Researchers Bulla and Frieder (2017) wanted to look into the effectiveness of a self-management system that they called “Self-and-Match” system. The researchers wanted to review this system because it was commercially available intervention that allowed for the interventionist to individualize the intervention; this treatment was a self-management intervention that reinforced only appropriate behaviors, and accurate self-monitoring on vocal stereotypy that is displayed by participants (Bulla & Frieder, 2017).
Subjects and Setting
In the current study the participant was an 8 year old African American male name Zachery who had a previous diagnosis of autism spectrum disorder (ASD). Zachary received intensive services in an ASD classroom setting; Zachery exhibited vocal stereotypic behaviors that were disruptive to his peers in his classroom, and defined Zachery’s stereotypy behaviors as a vocalization, including nonsense sounds and words that were expressed in a repetitive manner, and were expressed in a volume that was louder than the conversational volume (Bulla & Frieder, 2017).
Design and Results
The researchers used a multiple baseline reversal design. During the baseline phase Zachery displayed vocal stereotypy 80% during the one minute intervals, and displayed vocal stereotypy 27% during the intervention where he could earn 4 tokens/stickers (Bulla & Frieder, 2017). The researchers noted that Zachery had difficulty engaging in his work when there were frequent interruptions, so the researchers extended the interval times (Bulla & Frieder, 2017). The results of the study suggested that a self-match system may be effective in decreasing vocal stereotypy in the intervention phase, but at the four month follow up the behavior had increased from the post intervention stage (Bulla & Frieder, 2017).
Internal, External, & Social Validity
The social validity was high for this research due to the fact that the vocal stereotypy was disrupting the class, the intervention is acceptable for the participant’s age, and the intervention showed to have success when implemented during the treatment conditions. External validity appeared to be low as the researchers did not mention having tried to generalize to others, or to other behaviors, or environments. In regards to internal validity, it appears that there might be a functional relationship between the self-match intervention and stereotypy behaviors. It is important to note that the researchers state that there were many limitations were present in this study and that in order to draw accurate conclusions more research should be conducted (Bulla & Frieder, 2017).
Article 2
Overview
The researchers Ahearn, Clark, and MacDonald (2007) conducted a study to assess and treat vocal stereotypy in children who were diagnosed with ASD. The researchers ruled out any children where social consequences were maintaining the vocal stereotypy, so that only children in which automatic reinforcement was maintaining the vocal stereotypy participated (Ahearn, Clark, & MacDonald, 2007). Since response blocking has been proven to be effective in decreasing behaviors that are maintained by automatic reinforcement, the researchers decided to use response interruption as the intervention to treat vocal stereotypy (Ahearn, Clark, & MacDonald, 2007).
Subjects and Setting
There were a total of four participants in this study, two boys and two girls, each of which was diagnosed with ASD and exhibited vocal stereotypy in which it disrupted their school day, and occurred at unacceptable levels when outside of the school setting (Ahearn, Clark, & MacDonald, 2007). Mitch was a 3 year old male whose vocal stereotypy was vocal approximations and noises, and he received services both clinical and educational in his preschool setting (Ahearn, Clark, & MacDonald, 2007). Peter was an 11 year old male who was a residential student, and his vocal stereotypy consisted of repeated words, approximations, and noises (Ahearn, Clark, & MacDonald, 2007). The two female participants were fraternal twins, Nicki and Alice who were 7 years old, and also residential students; Nicki’s vocal stereotypy consisted of repeated words, approximations, and noises, and Alice’s vocal stereotypy consisted of noises and some word approximations (Ahearn, Clark, & MacDonald, 2007). For this study all sessions took place in a small room that had a table and two chairs.
Design and Results
The researchers utilized the single phase alternating treatment design for each client when conducting the functional analysis, the conditions were play, alone, attention, and demand (). For the two male participants vocal stereotypy was exhibited the most frequent in the alone conditions, and for both girl participants there was high variability between each condition; the researchers were able to determine that the vocal stereotypy for each participant was not maintained by social consequences, but by automatic reinforcement (Ahearn, Clark, & MacDonald, 2007). For treatment the researchers used response interruption and redirection in an ABAB reversal design. Mitch displayed high frequency of vocal stereotypy in the baseline phase 1, then in the treatment phase 1 his vocal stereotypy dropped to low levels (Ahearn, Clark, & MacDonald, 2007). When Mitch returned to a baseline phase his vocal stereotypy increased to moderate levels, and then the vocal stereotypy dropped to nearly zero when treatment phase was reintroduced; Mitch’s appropriate vocalizations became more frequent when treatment was in place (Ahearn, Clark, & MacDonald, 2007). Peter displayed a moderate frequency of vocal stereotypy in the baseline phase 1, then in the treatment phase 1 his vocal stereotypy dropped to low levels (Ahearn, Clark, & MacDonald, 2007). When Peter returned to a baseline phase his vocal stereotypy had a decreasing trend but did not return to the original baseline levels, and then the vocal stereotypy decreased again in the treatment phase 2; Peter’s appropriate vocalizations became more frequent when treatment was in place (Ahearn, Clark, & MacDonald, 2007). Alice displayed high frequency of vocal stereotypy in the baseline phase 1, then in the treatment phase 1 her vocal stereotypy decreased (Ahearn, Clark, & MacDonald, 2007). When Alice returned to a baseline phase her vocal stereotypy increased to high levels, and then the vocal stereotypy decreased to low levels when treatment phase was reintroduced; Alice’s appropriate vocalizations became more frequent when treatment was in place, but were variable (Ahearn, Clark, & MacDonald, 2007).
Nicki displayed moderate to high frequency of vocal stereotypy in the baseline phase 1, then in the treatment phase 1 her vocal stereotypy dropped to low levels immediately (Ahearn, Clark, & MacDonald, 2007). When Nicki returned to a baseline phase her vocal stereotypy increased to moderate levels, and then the vocal stereotypy dropped to zero when treatment phase was reintroduced; Nicki did not display appropriate vocalizations in any condition (Ahearn, Clark, & MacDonald, 2007).
Internal, External, & Social Validity
Internal validity was displayed in this study as in each of the participants ABAB reversal design shows that there was a functional relationship between vocal stereotypy and response interruption and redirection, and that it was not a result of confounding variables. External validity was also displayed because the intervention was able to be applied to other participants and remained effective, so this shows that response interruption and redirection can be generalized to other participants. The study did not include any other settings or behaviors to generalize to. Social validity was also present in this study, as each of the participants behaviors were interrupting the ability to perform in school. This research study was beneficial to the children, as well as to the teachers and parents because it will help these children in school as well as with social interactions.
Article 3
Overview
The researchers Lanovaz, Rapp, Maciw, Pregent-Pelletier, Dorion, Ferguson, and Saade (2014) conducted this study to assess outcomes of different interventions with participants who had been diagnosed with ASD and displayed vocal stereotypy. The researchers note that most often response interruption and redirection are utilized by clinicians who are trying to reduce the frequency of vocal stereotypy in clients, but note that there are other interventions that can be utilized to reduce the frequency of vocal stereotypy (Lanovaz, et al, 2014). The researchers also looked to see what modifications can be made to interventions when the behavior was not reduced or produced other effects (Lanovaz, et al, 2014).
Subjects and Setting
In this study there were 12 participants that had been diagnosed with ASD and other developmental disabilities, all of the participants engaged in vocal stereotypy, and 5 out of the 12 participants also engaged in motor stereotypy (Lanovaz, et al, 2014). Each participant underwent the study in the setting that they typically engaged in vocal stereotypy. The participants were: Nicolas age 12, Zoe age 36, Kyle age 4, Morgan age 6, Lucas age 37, Ryan age 7, Yasmine age 63, David age 6, Jacob age 5, Eric age 4, Fred age 9, and Greg age 6 (Lanovaz, et al, 2014). Nicholas, Kyle, Ryan, Yasmine, Morgan, Zoe and Lucas were in the first experiment in which the intervention was non-contingent music and differential reinforcement of alternative behavior was used (Lanovaz, et al, 2014). Ryan, Yasmine, and David were in the second experiment in which the intervention was differential reinforcement of other behaviors was used; Zoe, Morgan, Jacob, Fred, Greg, and Eric were in the third experiment in which the intervention was adding prompts to increase appropriate behaviors (Lanovaz, et al, 2014).
Design and Results
The researchers used an alternating treatment design to compare the effects of non-contingent music and the differential reinforcement of incompatible behaviors (DRI); Nicolas reduced in frequency of vocal stereotypy when non-contingent music was implemented, but did not reduce the behavior when the DRA was present (Lanovaz, et al, 2014). For Zoe, the DRA was effective in reducing vocal stereotypy, but the non-contingent music did not appear to be effective in reducing her problematic behavior (Lanovaz, et al, 2014). Non-contingent music reduced vocal stereotypy in Kyle, whereas the DRA did not appear to be effective; Both DRA and non-contingent music decreased vocal stereotypy in Morgan but the DRA was more effective (Lanovaz, et al, 2014). For Lucas, non-contingent music reduced vocal stereotypy, but the DRA did not prove to be effective in reducing his behavior (Lanovaz, et al, 2014). Yasmine and Ryan did not have reductions in their vocal stereotypy when both interventions were implemented, so they were brought back to be included in the second experiment (Lanovaz, et al, 2014). The researchers used an alternating treatments design to compare the effects of the differential reinforcement of other behavior (DRO) with baseline, however they used an AB design for Yasmine because of Yasmine’s limited abilities (Lanovaz, et al, 2014). For the experiment for the DRO, David reduced his frequency of vocal stereotypy, but his functional play also remained low; for Ryan, the DRO reduced the frequency of vocal stereotypy, but for Yasmine the DRO did not reduce the frequency of vocal stereotypy and it did not increase Yasmine’s appropriate behaviors (Lanovaz, et al, 2014). The first experiment showed that non-contingent music was more effective than the DRA, and that adding prompts did not help in decreasing vocal stereotypy; in the second experiment the DRO was effective in reducing the behavior for two out of the three participants (Lanovaz, et al, 2014).
Internal, External, & Social Validity
Internal validity was assessed through interobserver agreement, and it was found that internal validity was demonstrated in the graphs because there appears to be a cause and effect between the intervention and behavior. External validity was demonstrated because the interventions were applied across a variety of participants, and therefore could be generalized to other individuals. The researchers indicate that other studies similar to theirs, state that these interventions are effective and can be generalized to other behaviors and settings (Lanovaz, et al, 2014). Social validity is demonstrated because the researchers state that it is important to investigate multiple interventions so that clinicians can see what treatments have been proven to be most effective when working with individuals with vocal stereotypy, and that it is important to understand that not all individuals will respond to the same treatment; the researchers also state that it is important in address stereotypy behaviors when they are present because it can be disruptive to the individual’s life, and it interferes with the individual’s ability to take part in society (Lanovaz, et al, 2014).
Article 4
Overview
Subjects and Setting
In the study conducted by Toper-Korkmaz, Lerman, and Tsami (2018), there were three participants, Nancy (6 years old), Areli (6 years old), and Bryan (4 years old), all of which had been diagnosed with autism spectrum disorder (ASD). All three participants had limited vocal imitation skills, and engaged in vocal stereotypy that was maintained by automatic reinforcement (Toper-Korkmaz, Lerman, & Tsami, 2018). Toper-Korkmaz, Lerman, and Tsami’s (2018) study took place at a university-base clinic in one of the therapy rooms; the therapy room had a one way observation window with a camera on the other side to record the sessions, the room contained two chairs and a table with a couple preferred items that had been identified as being a preferred item through the preference assessment.
Design and Results
Toper-Korkmaz, Lerman, and Tsami’s (2018) used a reversal design and a combined multielement (also known as alternating treatment design) design to see separate effects and combined effects of response interruption and redirection (RIRD) and the removal of a toy, as well as to examine the impact of response interruption and redirection sequence length on vocal stereotypy and appropriate vocalizations. Overall, the less intensive version of response interruption and redirection, with only a response to one demand was shown to be effective in reducing the amount of vocal stereotypy displayed by the participants (Toper-Korkmaz, Lerman, & Tsami, 2018).The researchers found that contingent toy removal was also effective in reducing vocal stereotypy. The researchers state that because sessions for these participants were short, in order to see long term effectiveness of response interruption and redirection with contingent toy removal, more research should be conducted (Toper-Korkmaz, Lerman, & Tsami, 2018).
Internal, External, & Social Validity
The mean interobserver agreement was 95% for vocal stereotypy, 98% for appropriate vocalizations, 98% for correct responses, and 97% for procedural integrity across participants indicating high internal validity. The external validity for this study was moderate because the generality of the researchers findings is limited, and is limited because this study was only conducted it in a clinical setting with leisure activities present. The researchers state that to increase external validity and generality of the study, more studies using the same method should be implemented in other settings such as schools where it is not as easy to provide leisure activities (Toper-Korkmaz, Lerman, & Tsami, 2018). Another limit to the study was that the sessions for each participant were brief (Toper-Korkmaz, Lerman, & Tsami, 2018). This study was able to be conducted across participants so that contributed to the external validity. Social validity was addressed by making the sessions shorter in time because historically response interruption and redirection interventions have been reported to be too time consuming, even though they were effective. Social validity was also addressed by increasing appropriate vocalizations across participants.
Article 5
Overview
The researchers Shillingsburg, Lomas, and Bradley (2012) state that there is a need for an intervention that allows for generalizing to other settings when vocal stereotypy is exhibited because of how detrimental the effects of vocal stereotypy can be for an individual. Shillingsburg, Lomas, and Bradley (2012) state that there has been research that has been conducted that exemplifies the importance of identifying competing responses as well as identifying a stimulus that matches the sensory reinforcement. The researchers look to see which of the two treatments that they implement is more effective in decreasing vocal stereotypy and if the treatments can be generalized to a classroom setting (Shillingsburg, Lomas, & Bradley, 2012). The two treatments that will be utilized in this study are non-contingent reinforcement with response cost and a token economy with a differential of reinforcement of other behaviors with a response cost (Shillingsburg, Lomas, & Bradley, 2012).
Subjects and Setting
This study consisted of one participant, Carl, who was a 12 year old male; Carl had a diagnosis of ASD, and attended a program that focused on his language delays (). Carl also attended public school and had been placed in an exceptional student educational classroom, and had an individualized education plan that allowed for Carl to engage in specials (physical education, art, music, media, etc.) with the regular education classes (Shillingsburg, Lomas, & Bradley, 2012). Carl was able to mand in one to six words for particular items, and was able to answer to wh- questions like who, what, where, when; Carl displayed vocal stereotypy in the form of loud vocalizations, and would disrupt his class as well as disrupt educational activities resulting in Carl not being allowed to be a part of the activities anymore (Shillingsburg, Lomas, & Bradley, 2012). Due to the level of disruption that was caused by Carl displaying vocal stereotypy, Carl was placed into a more restrictive classroom than what his level of intellectual function required him to be in (Shillingsburg, Lomas, & Bradley, 2012). The functional analysis and phases one and two of treatment were conducted in a therapy room, whereas phase three of treatment was conducted in the classroom setting (Shillingsburg, Lomas, & Bradley, 2012)
Design and Results
The researchers used an alternating treatment design to determine the function of behavior through a functional analysis; the researchers then used an ABAB reversal design for treatment phase one, and then for treatment phases two and three, an ABAB reversal design was used with a changing criterion design (Shillingsburg, Lomas, & Bradley, 2012). The functional analysis concluded that vocal stereotypy was maintained by automatic reinforcement. Phase 1 consisted of a baseline phase and of treatment which was a non-contingent reinforcement with response cost; Carl displayed high levels of vocal stereotypy in the baseline phase (Shillingsburg, Lomas, & Bradley, 2012). When treatment was introduced the levels of vocal stereotypy were high at first, but then decreased to almost a zero level; baseline was then placed back, and the vocal stereotypy rates increased to nearly the rates seen in the first baseline (Shillingsburg, Lomas, & Bradley, 2012). When treatment was reintroduced Carl’s rates of vocal stereotypy decreased to zero by the end of the treatment phase; however, when treatment was introduced with demands fading Carl’s vocal stereotypy increased back to baseline rates (Shillingsburg, Lomas, & Bradley, 2012). Phase 2 consisted of baselines and the treatment condition consisted of token economy and differential reinforcement of other behaviors with response cost; baseline phase showed high levels of behavior, and the first treatment condition Carl’s rates of behavior dropped to zero and remained low (Shillingsburg, Lomas, & Bradley, 2012). When baseline was reintroduced Carl’s rate of behavior increased, but not back to baseline levels; when treatment was reintroduced Carl’s rate of behavior remained low around zero, and when fading occurred Carl’s rate of behavior remained low (Shillingsburg, Lomas, & Bradley, 2012). Phase 3 was conducted in the classroom setting to see if token economy with the DRO and response cost remained effective in another setting. In the baseline phase Carl displayed high levels of vocal stereotypy in the classroom, but when treatment was introduced his rate of behavior dropped to low levels (Shillingsburg, Lomas, & Bradley, 2012). When baseline was reintroduced, Carl’s rates of behavior increase back to the previous baseline rates, and when treatment was reintroduced Carl’s rates of behavior dropped immediately and remained around zero (Shillingsburg, Lomas, & Bradley, 2012). Both the use of NCR with RC and TE with a DRO and RC were effective in reducing vocal stereotypy, but the use of TE with a DRO and RC was the most effective because it increased the time that was available for instructional learning as well as other academic activities (Shillingsburg, Lomas, & Bradley, 2012).
Internal, External, & Social Validity
Internal validity was assessed through interobserver agreement (IOA); for the functional analysis the IOA was 85.5%, for phase 1 the mean IOA was 100%, phase 2 the mean IOA was 99.8%, and for phase 3 the mean IOA was 73.4% (Shillingsburg, Lomas, & Bradley, 2012). The researchers state that the IOA for phase 3 was lower than the other phases because Carl’s volume when displaying vocal stereotypy had also decreased, and at times was difficult to discriminate when observing for Carl’s vocal stereotypy in the classroom (Shillingsburg, Lomas, & Bradley, 2012). The graphs in the study also show that there was a functional relationship between both treatments and Carl’s vocal stereotypy. External validity was exhibited when the researchers were able to apply the treatment to another setting (school) instead of just in the therapy room. Social validity was addressed because the researchers explain that Carl’s vocal stereotypy was so intense that he had to be placed in a classroom that did not correlate to his level of cognitive functioning, which could cause him to regress in his academics (Shillingsburg, Lomas, & Bradley, 2012).
Conclusion
Vocal stereotypy can greatly effect individuals who engage in it; vocal stereotypy effects the individual’s ability to interact with others, form relationships, and can affect the individual’s ability to learn when in classroom settings. Throughout this paper different studies were reviewed and different treatments were utilized across these studies when the behavior was maintained by automatic reinforcement, such as response interruption and redirection (RIRD), non-contingent music, differential reinforcements of incompatible behaviors (DRI), non-contingent reinforcement (NCR), token economy (TE), response costs, as well as differential reinforcement of other behavior. Overall, it appears that as clinicians we need to keep in mind that each individual is unique and each treatment needs to be individualized because not all individuals respond the same to the same interventions.
References
Last Ahearn, W. H., Clark, K. M., & MacDonald, R. P. F. (2007). Assessing and treating vocal stereotypy in children with autism. Journal of Applied Behavior Analysis, 40(2), 263-275. doi: 10.1901/jaba.2007.30-06
Bulla, A. J. & Frieder, J. E. (2017). Self-and-match system suppresses vocal stereotypy during independent work. Behavior Analysis: Research and Practice, 17(3), 274-285. Retrieved from: http://dx.doi.org.library.capella.edu/10.1037/bar0000063
Lanovaz, M. J., Rapp, J.T., Maciw, I., Pregent-Pelletier, E., Dorion, C., Ferguson, S., & Saade, S. (2014). Effects of multiple interventions for reducing vocal stereptypy: Developing a sequential intervention model. Research in Autism Spectrum Disorders, 8(5), 529-545. Retrieved from: https://doi.org/10.1016/j.rasd.2014.01.009
Lanovaz, M. J. & Sladeczek, I. E. (2011). Vocal stereotypy in individuals with autism spectrum disorders: A review of behavioral interventions. Sage Journals, 36(2), 146-164. Retrieved from: https://doi.org/10.1177/0145445511427192
Shillingsburg, M. A., Lomas, J. E., & Bradley, D. (2012). Treatment of vocal stereotypy in an analogue and classroom setting. Behavioral Interventions, 27(3), p. 151-163. Retrieved from: http://web.a.ebscohost.com.library.capella.edu/ehost/detail/detail?vid=4&sid=107a3ba5-6248-456e-a012-d2822c25d15d%40sessionmgr4008&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=2012-16404-003&db=psyh.
Toper-Korkmaz, O., Lerman, D. C., & Tsami, L. (2018). Effects of toy removal and number of demands on vocal stereotypy during response interruption and redirection. Journal of Applied Behavior Analysis, 51(4), 757-768. Retrieved from: http://dx.doi.org.library.capella.edu/10.1002/jaba.497
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