Self-Stimulatory Behaviors

1. Self-Stimulatory Behaviors Presenters: Brittain Coleman, MA, BCBA Behavior Analyst Tracy Palm, MS, BCBA Executive Director Transformations Autism Treatment Center

2. What is a Self-stimulatory behavior? • Stereotypy or self-stimulatory behavior refers to repetitive body movements or repetitive movement of objects • Often observed in the following forms: • Visual • Auditory • Tactile • Vestibular • Taste • Smell

3. What do they look like? • Visual: • Staring at lights or ceiling fans • Repetitive blinking • Moving fingers in front of the eyes • Hand-flapping • Gazing at nothing in particular • Tracking eyes • Peering out of the corners of eyes • Lining up objects • Turning on and off light switches

4. What do they look like? • Auditory: • Vocalizing in the form of humming • Grunting, or high-pitched shrieking • Tapping ears or objects • Covering and uncovering ears • Snapping fingers • Making vocal sounds • Repeating vocal sequences • Repeating portions of videos, books or songs at inappropriate times

5. What do they look like? • Tactile: • Scratching or rubbing the skin with one’s hands or with another object • Opening and closing fists • Tapping surfaces with fingers • Vestibular: • Rocking front to back • Rocking side-to-side • Spinning • Jumping • Pacing • Taste: • Placing body parts or objects in one’s mouth • Licking objects • Smell: • Sniffing or smelling people or objects

6. What do they look like? • In extreme instances, self-stimulatory behaviors may take on the form of self-injurious behavior: • Head banging • Eye poking • Hand biting • Not all self-injurious behaviors are considered self-stimulating

7. Why do people engage in self-stimulatory behaviors? • THE REAL ANSWER?... No one really knows for sure

8. Hypotheses: • Hypotheses: • To calm themselves down • To receive some sort of sensory input they need • It releases opiate-like substances in the brain called beta-endorphins, which can produce either a euphoric or anesthetic effect • Provides an extra dose of internal stimulation for children with ASD who feel under-stimulated • Provides a feeling of tranquility for children who feel overstimulated • Children who are hyposensitive, or under-responsive to stimuli, may demonstrate the opposite effects: self-stimulatory behaviors may actually increase arousal

9. So what have we done for self-stimulatory behaviors? • Beginner Program: • This intervention will help an individual learn to do alternative behaviors and decrease their self stimulatory behaviors. • This intervention will allow the therapist/parent/caregiver etc. to assist the individual in decreasing their self stimulatory behavior • This intervention uses positive reinforcement to teach an individual how to discriminate between an appropriate vs inappropriate time to engage in self-stimulatory behaviors

10. When is the individual ready to do this type of program? • Does the child respond to multiple reinforcers? • Does the child use a token system successfully? • Does the child respond to delayed reinforcement? • What is the functioning level of the individual?

11. Materials Needed • Timer • Reinforcers • Token System

12. Steps to the intervention • Determine a baseline • How often is the person currently doing the behavior? • Pick your target time • This time should be slightly below the baseline time • Determine your master criterion • Typically 3-5 successful sessions • If the individual has more than 5 unsuccessful sessions then back the time down to the last previously successful time frame • Increase the time in small increments in the beginning to create opportunities for success

13. Steps to the Intervention cont. • Make the deal • Make sure to explain to the child what is expected and what the reward will be • Use a token system once the child is able to work for longer periods of time without primary reinforcers • Set the timer • Reward/Try Again • Increase the criterion as needed

14. What else do I need to teach? • Replacement behaviors • Determine the function for the behavior then you can determine an appropriate replacement behavior • Sensory/automatic • Weighted or textured clothes, etc. • Positive Reinforcement/ Attention • Asking for assistance, attention • Positive Reinforcement/ Access to Items or Activities • Manding for items/activities • Negative Reinforcement • Asking for a break • Asking for people to go away • Asking for something to stop

15. What does the data show? 11 year old boy, diagnosed with ASD

16. So what have I done for self-stimulatory behaviors? • Expanded Program: • An intervention that aims to help an individual learn how to control their own self stimulatory behaviors • An intervention that allows the therapist/parent/caregiver etc. to some control over the individual’s self-stimulatory behavior • An intervention that in a sense teaches an individual how to discriminate between an inappropriate time to engage in self-stimulatory behaviors

17. Participants • 2 participants • Both have an Autism diagnosis • Both males • Age: • Client #1: 6 yrs old • Client #2: 11 yrs old • Skill level: • Client #1: High functioning, able to understand some basic rules, some more complex language skills • Client #2: Low functioning, unable to understand basic rules, limited language skills

18. Topographies • Topographies: • Client #1: Vocal Stereotypy • Client #2: Hand-flapping, feet tapping, repetitive head movements • Often individuals who engage in frequent self-stimulatory behaviors engage in behaviors that are observed in a variety of topographies, therefore it is important to discuss and determine which or all of the behaviors are going to be targeted

19. What was involved? • This intervention is comprised of several different components: • Basic Stimulus Discrimination • Systematic Phases • Token Economy • Response Cost • Reinforcement • Self Management • Time Management Technology

20. Stimulus Discrimination • I utilized a basic red card and a basic green card to teach discrimination • Red card signifies the time the individual was not allowed to engage in self-stimulatory behavior(s) • Green card signifies the time the individual was allowed to freely engage in the targeted self-stimulatory behavior(s)

21. No Silly Noises Yay! Silly Noises OR OR Quiet Body Yay! Break Time Red Card Means: No Silly Noises • 08:00 Did I have a quiet voice? • Yes: Token No: Reset Timer & Tokens • 06:00 Did I have a quiet voice? • Yes: Token No: Reset Timer & Tokens • 04:00 Did I have a quiet voice? • Yes: Token No: Reset Timer & Tokens • 02:00 Did I have a quiet voice? • Yes: Token No: Reset Timer & Tokens • 00:00 Did I have a quite voice? • Yes: Token No: Reset Timer & Tokens

22. Systematic Phases • This intervention was designed to be implemented very carefully taking careful consideration of each step as progression (or lack there of) is made

23. Systematic Phases = break in the phases RCC= Red Card Condition VS= Vocal Stereotypy

24. Token Economy • It is essential that the individual be able to understand and navigate a token economy • If the individual has not yet been taught a token economy this needs to be the first step taken • Even if an individual does have a learning history with a token economy it is recommended to go back through the steps of pairing the tokens with reinforcers systematically • For the two clients that have used this method a token economy with five tokens was used • The number of tokens is not crucial

25. Response Cost • It was found that some degree of response cost was necessary for success • In the beginning taking away one token for a single incidence of self-stimulatory behavior was tried • However after assessment and consideration specifically for the two clients for which this intervention, it was determined removal of all of the tokens was the best approach

26. Reinforcement • Preference assessments prior to starting are necessary for success • Reinforcers are used as added incentive to continue to not engage in self-stimulatory behaviors, especially in the beginning phases • The ultimate reinforcer used is the ability to freely engage in the self-stimulatory behavior

27. Self-Management • This component is to aid in the success of the individual being able to utilize this intervention across a variety of settings • If the individual is able to maintain and manage it all by him/herself it increases the quality and quantity of learning that is possible • Throughout all of the phases of the intervention is it recommended to require the individual place their own tokens on the token board • Once the individual satisfies the criteria for the final phase you should then move to the maintenance phase

28. Maintenance Phase • The maintenance phase consists of the following: • Prompting the individual to: • Monitor the time • “Asking” or determining themselves whether or not they engaged in the behavior • If yes • Delivering their own tokens • If no • Not delivering a token • At this point elongating the time should be aversive enough • Systematically fading those prompts until the individual can independently maintain it all

29. Time Management Technology Used • Timer • A timer was used to indicate the end of the red and green card condition • The time was also used to monitor the increasing time to know when to deliver the tokens HOWEVER: If the resources are available: • A Motivaider is believed to be the better technology of choice for the following reasons: • Constant monitoring of time is not necessary • More discretion

30. Refresher on Participants • 2 participants • Both have an Autism diagnosis • Both males • Topographies: • Client #1: Vocal Stereotypy • Client #2: Hand-flapping, feet tapping, repetitive head movements • Age: • Client #1: 6 yrs old • Client #2: 11 yrs old • Skill level: • Client #1: High functioning, able to understand some basic rules, some more complex language skills • Client #2: Low functioning, unable to understand basic rules, limited language skills

31. Results • Yes means the individual successfully did not engage in vocal stereotypy during that time frame • No means the individual did engage in vocal stereotypy during that time frame

32. Results: Client #2 • During the sessions that have increased frequency of “no’s” the data also showed an increase in problematic behaviors • It was also noted that on during phases/sessions 3, 11, and 15 the clients mother reported the client not sleeping the night before

33. Questions? Contact Information: • Tracy Palm: Executive Directory • tracypalmaba@aol.com • Brittain Coleman: Behavior Analyst • BrittainColeman@gmail.com Transformations Autism Treatment Center (901)-231-2931