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Evaluating and Treating Stereotypy

Evaluating and Treating Stereotypy. Presented by Melania Brown, B.S. University of Houston – Clear Lake. Agenda. What is stereotypy? Why does it happen? How do we treat it?. What is stereotypy?. Behavior that is repetitive and seems to serve no purpose Everyday examples:

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Evaluating and Treating Stereotypy

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  1. Evaluating and Treating Stereotypy Presented by Melania Brown, B.S. University of Houston – Clear Lake

  2. Agenda • What is stereotypy? • Why does it happen? • How do we treat it?

  3. What is stereotypy? • Behavior that is repetitive and seems to serve no purpose • Everyday examples: • Foot tapping while waiting • Pen clicking at a meeting • Leg shaking while watching presentation

  4. What is stereotypy? • Problem examples: • Hair twirling • Body rocking • Jumping • Mouthing • Vocal stereotypy • Hand flapping

  5. When is stereotypy a concern? • When it interferes with daily life • Missed learning opportunities • Teachers can’t get/keep attention • Missed social interactions • Peers may avoid • May not respond to greetings • Prohibits engaging in other activities

  6. Why does it happen? Behavior  Reinforcement  More behavior • 3 main sources of reinforcement • Social positive- Reprimands, redirection • Social negative- Getting out of a situation • Automatic- Self-stimulation • Most common cause of stereotypy

  7. Why does it happen? • Test • Observe behavior during down time • How much stereotypy? • Observe behavior during play time • How much stereotypy? • Less stereotypy during play likely automatically reinforced • No difference consult a BCBA

  8. How do we treat stereotypy? Least Intrusive Most Intrusive • Environment enrichment • Provide app. access to stim. • Teach play skills and reinforce • Blocking • Response interruption and redirection (RIRD)

  9. Environment Enrichment • Add to the environment more sources of reinforcement • Identifying toys • Paired-stimulus (Vollmer et al., 1994) • Highly pref. items less stereotypy • Less pref. items more stereotypy • Pref. alone does not indicate potential decrease in behavior

  10. Environment Enrichment • Competing stimulus assessment (Ringdahl et al. 1997) • How often engage in stereotypy, object manipulation, or both

  11. How Do We Take Data

  12. Practice • Behavior: Hand clapping • Definition: Hands come in contact loud enough to produce a sound

  13. Melania’s Results

  14. EE/ Alternative Access to Stimulation • Try to identify source of reinforcement • Hand flapping • Physical stimulation of moving hand • Visual stimulation of moving hand • Sensation of air moving

  15. EE/ Alternative Access to Stimulation • Example (Rapp, 2007) • Behavior- Vocal Stereotypy • Item 1: Toy blocks (different consequence) • Item 2: CD player (same consequence)

  16. Using Environment Enrichment • Provide free access to the chosen toys • Appropriate way to get stimulation • Makes stereotypy unnecessary • Replace toys before satiation (boredom) • Rotate toys • Identify new toys as needed

  17. Test Your Understanding • Blaire’s mom is concerned about Blaire’s body rocking. She would like to enrich the environment. Should she present: • A. Blocks to build with • B. A teddy bear to hold • C. A rocking chair to sit in

  18. Test Your Understanding • Blaire’s mom knows to use a rocking chair, but now she wonders when she should present the chair. Should she present it: • A. when body rocking starts • B. before body rocking starts

  19. Test Your Understanding • The rocking chair was working so well, but lately it seems that body rocking is happening more frequently and Blaire doesn’t sit in the chair. What should Blaire’s mom do? • A. Give up • B. Find new items

  20. Teach Play Skills • Show the child how to manipulate toys • Model playing • Help your child play • Reinforce appropriate play • Praise! Edibles! Tickles! Smiles!  Lots of good things will make play fun • Give breaks, too

  21. Teach Play Skills • Least-to-Most prompting • Tell- verbal cue or gesture • Show- demonstration • Help- hand over hand

  22. Test Your Understanding • Tony’s teacher wants to give Tony an appropriate way to access the sensation he gets when hand flapping. He thinks the reinforcing sensation is the air on the face. What should he present? • A. hand-held fan • B. a toy train • C. a book

  23. Test Your Understanding • Tony is not playing with the fan and keeps hand flapping. What should his teacher do? • A. Try another item • B. Teach play skills • When Tony starts playing what should his teacher do?

  24. Blocking • Most likely a necessary component • When behavior begins, gently stop it • Examples • Hand flapping: Gently move hands down • Mouthing: Place hand a few inches in front of mouth so nothing can get in • Body rocking: Stand behind student and gently hold shoulders

  25. Blocking • Does not require restraint • Behavior can still happen • No more sensory reinforcement  Decrease in behavior

  26. Test Your Understanding • Jill has tried enriching the environment and other less intrusive interventions and wants to block the sensory reinforcement of her son’s hand clapping. What could she try?

  27. Review of Reinforcement • Enrich environment • Provide access to alternative stimulation • Use items that produce same consequence • Teach play skills • May need to block stereotypy

  28. Response Interruption and Redirection (RIRD) • Response interruption • Stereotypy starts interrupt! • Redirection • Stereotypy starts interrupt! present a series of easily completed tasks praise compliance!

  29. Test Your Understanding • Billy’s humming is interrupting class, and it needs to decrease soon. What should his teacher try first? • A. RIRD • B. blocking • C. enriching the environment

  30. Test Your Understanding • Billy’s teacher has tried to use less intrusive interventions, but it hasn’t worked. When Billy starts humming, his teacher interrupts him by calling his name. She wants to redirect him. • What could she do? • A. Give him motor instructions • B. Give him vocal instructions

  31. References • Ahrens, E. N., Lerman, D. C., Kodak, T., Worsdell, A. S., & Keegan, C. (2011). Further evaluation of repsonse interruption and redirection as treatment for stereotypy. Journal of Applied Behavior Analysis, 44, 95-108. • Piazza, C. C., Fisher, W. W., Hanley, G. P., Hilker, K., & Derby, K. M. (1996). A preliminary procedure for predicting the positive and negative e!ects of reinforcement-based procedures. Journal of Applied Behavior Analysis, 29, 137-152. • Rapp, J. T. (2007). Further evaluation of methods to identify matched stimulation. Journal of Applied Behavior Analysis, 40, 73-88. • Rapp, J. T., Miltenberger, R. G., Galensky, T. L., Ellingson, S. A., & Long, E. S. (1999). A functional analysis of hair pulling. Journal of Applied Behavior Analysis, 32, 329-337. • Ringdahl, J. E., Vollmer, T. R., Marcus, B. A., & Roane, H. S. (1997). An analogue evaluation of environmental enrichment: The role of stimulus preference. Journal of Applied Behavior Analysis, 30, 203-216. • Vollmer, T. R., Marcus, B. A., & LeBlanc, L. A. (1994). Treatment of self-injury and hand-mouthing following inconclusive functional analyses. Journal of Applied Behavior Analysis, 27, 331-344.

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