Effects of Restricted Interests on the Social Behaviors of Children with Autism Spectrum Disorders

1. Brian A. Boyd, Ph.D. Maureen A. Conroy, Ph.D. Peter J. Alter, M.Ed. University of Florida October 15, 2005 Effects of Restricted Interests on the Social Behaviors of Children with Autism Spectrum Disorders

2. What are Restricted Interests? • “All encompassing topics or objects individuals with autism pursue with great intensity and focus” • Also called: • Circumscribed interests • Obsessions • Compulsions • Special interests • Narrow interests DSM-IV, 1994; Ozonoff, 2004

3. What are RI (cont’d)? • Considered to be a higher form of motoric, repetitive behaviors (e.g., hand-flapping) Lower End: Stereotypy Higher End: Restricted Interests, Routines Epstein et al., 1985

4. Restricted vs. Preferred? • How do you distinguish a highly preferred item from a restricted item? • Share 5 characteristics • Idiosyncratic • Difficult to redirect child • Child is intensely focused on interest • Endure over a long period of time • Accumulation of mass amounts of information Adams, 1998; Attwood, 1998; Ozonoff, 2004

5. Do RIs change over time? • Sally Ozonoff asked a group of pre-teens and adolescents with Asperger’s and HFA about their RI • On average, they had 3-4 RI by that point in their lives • Sometimes they had more than one RI at the same time • Only repetitive behavior found to increase in severity over time Ozonoff, 2004; South et al., 2005

6. Do all types of kids on the spectrum have RIs? • Mmmm…………………!!!!!!!!! • What we strongly think? • RIs are more prevalent for students who have HFA and are older • RIs maybe more common for children with Asperger’s syndrome vs. HFA • Evidence is really mixed • RIs may differentiate kids with autism from other developmental disorders • What we know? We know more about lower forms of repetitive behaviors • Children with more severe autism engage in more stereotypy • Children with autism and MR engage in more stereotypy & self-injury • HFA also exhibit lower level repetitive behaviors • To sum up: • We don’t know a lot about the relationship between functioning level and repetitive behavior; in general, and in regards to RI, in particular Lewis & Bodfish, 1998; Turner, 1999

7. Why do students with autism have RIs? • Mmmmmmmmmm………………………… • Mmmmmmmmmm…………………………. • Lots of Theories • Arousal theory • Executive Dysfunction theory • Perceptual Reinforcement hypothesis Turner, 1999

8. Do typically developing (TD) kids have RIs? • TD kids do engage in repetitive behaviors (ritualistic and compulsive) • Behaviors seem to peak between the ages of 2-5 (may be the same for kids with autism) • In TD kids, we see them more during fear-inducing situations (e.g., new kid in classroom) • TD kids engage in repetitive behavior to regulate or establish control over their environment Evans et al., 1997, 1999; Zohar & Felz, 2001

9. What are some common RIs for students with autism? Most Common: • Gadgets/devices/electronics • Power rangers/other action figures • Dinosaurs • Video games Somewhat Common: • Fantasy/science fiction • Natural disasters • Disney characters • Letters/numbers Least Common: • Mythology • Trains (other than Thomas) • License plates Ozonoff, 2004

10. Should we discourage RIs? • Repetitive behaviors are hard to extinguish • It is hard to identify “what” is maintaining the behavior • It is hard to replace the behavior if it is maintained by internal sensory consequences • If RI is inappropriate for school, then make sure student knows when it is ok to talk about or engage with their interest Lovaas et al., 1987

11. Why should we encourage RIs? • Research studies have shown that using their RI gradually decreases the amount of time children engage with that item • Provide children structured and expected opportunities to engage with their RI • Teaches kids a more functional and appropriate way to engage with their interest Adams, 1998; Charlop et al., 1990

12. Can RIs be used to encourage social behavior? • Research suggests it can be used to increase the amount of time children engage in peer-related social interactions Baker et al., 1998, 2000; Boyd, 2005

13. How do RIs encourage social behavior? • Students with autism appear to be “motivated” to discuss or interact with RIs, either internally or externally • Often they are motivated to engage in 1-sided conversations about them, OR • Play with the RI by themselves

14. How could RIs better be used to encourage social interactions? • Antecedent-based uses of RI • Consequence-based uses of RI

15. Overview of RI Research Findings • Interventions that utilized the RI of children with autism have increased their prosocial behaviors (e.g., on-task) • Only 2 studies have addressed the social behavior of children with autism (Baker et al., 1998; Baker, 2000) • Majority of studies used the RI as a consequence-based intervention • The child is given access to the RI after the occurrence of a targeted behavior (Charlop et al., 1990; Charlop-Christy & Haymes, 1996; 1998) • Studies also have used the RI as an antecedent-based intervention • The RI is used as an antecedent to set the occasion for the child’s appropriate behavior (Adams, 1998) • Primary problem associated with the RI literature • Paucity of studies examining the effects of RI • Lack of systematic identification of the RI

16. Research Questions • What is the effect of the presence of a restricted interest item in comparison to a less preferred item on the social behaviors of young children with autism spectrum disorders (ASD)? • What is the generalization effect of the presence of a restricted interest item and other tangible stimuli on the social behaviors of young children with ASD?

17. Method • Inclusion Criteria • Preschool or elementary-aged children diagnosed with an independently-obtained autism spectrum disorder • Asperger syndrome, Autism, Pervasive Developmental Disorder-Not Otherwise Specificed (PDD-NOS) • Use of at least 2-3 word utterances to express basic wants and needs • Ability to initiate to peers’ social bids using gestural or verbal communication • Display of low levels of appropriate or high levels of inappropriate social behaviors • Display of high levels of engagement with or discussion of a RI tangible item

18. Study Participants

19. Phases of Study • Assessment Phase • Descriptive assessment • Preference assessment • Structural Analysis (SA) Phase • Concurrent operant condition • Free operant condition • Generalization Phase • Across settings • Across other tangibles

20. Assessment Phase • Descriptive Assessment • Interview parents and teachers using Social Skills Interview (Asmus et al., 2004) to identify their current levels of social behavior and RI • For an item to be initially identified as the RI, two informants must independently identify that item • Direct observation of participant using Social Skills Screening (Conroy et al., 2004) • Data is taken on the percentage of intervals during a 10-min observation period the TC and classroom peers engage in social behavior across 3-5 classroom activities • Identified activities within classroom context where participant exhibited highest & lowest % of social behavior to obtain a baseline measure

21. Assessment Phase • Multiple Stimulus Preference Assessment(adapted from Roane et al., 1998) • Repeated presentation of 7 identified tangible items found during descriptive assessment that the child engaged or played with, including the hypothesized RI tangible item • Data was taken on the number of seconds the TC physically touched each item • For an item to be verified as the RI, the TC must touch it for the longest duration of time for 2 out of 3 (67%) experimental sessions • Identified a less preferred (LP) item by asking the TC

22. Assessment IOA • Calculated using a point by point agreement ratio • Descriptive Assessment: IOA collected for 25-85% of sessions • Jason—Mean: 96% (range: 93-98%) • Allen—Mean: 99% (range: 96-100%) • Jin—Mean: 88% (range: 75-100%) • Preference Assessment: IOA collected for 33% of sessions • Jason, Allen, & Jin—Mean: 100%

23. Assessment Results Descriptive Assessment Preference Assessment

24. SA Phase:Experimental Procedures • SA phase (Concurrent & Free Operant Conditions) • All sessions were 5-minutes in length • Each session was videotaped and coded using Tap-IT software for Dell PDAs (Tapp, 2003) • Peer was instructed prior to each session to NOT initiate to TC • Peer was instructed to always respond to TC initiations • If peer failed to respond, therapist verbally reminded him/her • All peers were typically developing classmates of the TC

25. Concurrent Operant Procedures • Concurrent—purpose was to provide further validation of the identified RI and to provide preliminary evidence of its effects on the display of participant social behavior • Procedural control—counterbalanced the peer holding the item & the order the choices were given to the TC by the therapist

26. Concurrent Operant IOA • Calculated using MOOSES software program (Tapp, 2002) • Each observer had to code the same behavior within a +/- 5-second window of time; otherwise it was counted as an error • IOA collected for 33% of sessions • Percentage of intervals TC choose RI vs. LP: Jason, Allen, & Jin—Mean: 100%

27. Concurrent Operant Results: Choice of Tangible Items % of 30-secondintervals Jason Allen Jin RI LP Sessions

28. Concurrent Operant Results:Social Interactions Jason % of time RI LP

29. Free Operant Procedures • Free operant—purpose was to provide a more naturalistic play situation to evaluate the effect of the RI in comparison to the LP • Procedural control—randomly alternated the RI vs LP sessions & randomly selected 1 peer from concurrent to participate

30. Free Operant IOA • Calculated using MOOSES software program (Tapp, 2002) • Each observer had to code the same behavior within a +/- 5-second window of time; otherwise it was counted as an error • IOA collected for 26-36% of sessions • Duration of social interactions: • Jason—Mean: 100% (range: 100%) • Allen—Mean: 98% (range: 97-100%) • Jin—Mean: 98% (range: 95-100%) • Rate of initiations: • Jason & Allen—Mean: 100% • Jin—Mean: 83% (range: 67-100%)

31. Free Operant Condition:Social Interactions Jason Allen Jin % of time RI LP Sessions

32. Free Operant Results:Mean Latency to First TC Initiation Jason Allen Jin Number of seconds *=TC did not initiate

33. Free Operant Results:Treatment Integrity Probability of Contingent Peer Responses Mean Rate of Peer Initiations * indicates the range

34. Indirect Comparison of Descriptive & Experimental Outcomes

35. Generalization Procedures • Generalization—purpose was to determine the extent to which the observed free operant effects generalized to another SETTING & other TANGIBLE ITEMS • Procedures same as Free Operant except carried out in participants’ regular classrooms • Experimenter randomly introduced two classroom toys to target child-peer dyad • Peer from Free Operant participated

36. Generalization IOA • Calculated using MOOSES software program (Tapp, 2002) • Each observer had to code the same behavior within a +/- 5-second window of time; otherwise it was counted as an error • IOA collected for 33-50% of sessions • Duration of social interactions: • Jason—Mean: 99% (range: 99-100%) • Allen—Mean: 94% (range: 83-100%) • Jin—Mean: 92% (range: 98-100%)

37. Generalization Results:Social Interactions Jason Allen Jin Therapist Prompts Therapist Prompts Therapist Prompts Books Trains Peop l e Dinosaurs Bugs Pegs

38. Generalization Results:Treatment Integrity Probability of Contingent Peer Responses Mean Rate of Peer Initiations * indicates the range

39. Teacher Social Validity • At the conclusion of the generalization sessions for each participant their teacher completed a Likert-type rating scale 1. How comfortable were they with the study? M=6 (R: 6) 2. How disruptive was the study? M=1 (R: 1) 3. Willingness to allow another child to participate? M=6 (R:6) 4. How useful was the information obtained from the study? M=5 (R: 4-6) • Overall, how would they rate the intervention? M=5 (R: 4-6) Not at all (1) Very (6)

40. Expert Social Validity • 1 expert in field of ASD, naïve to the researcher’s expectations, viewed randomly selected 5-min video clips of children in RI and LP sessions 1. How appropriate was child’s play? LP: M=2 RI: M=5 2. How inappropriate was child’s play? LP: M=5 RI: M=2 3. How often did the child play with the peer? LP: M=1 RI: M=5 4. Overall, do you think the child enjoyed playing with the peer? LP: M=1 RI: M=5 Not at all (1) Very (6)

41. Conclusions • Children with ASD spent more time socially interacting when play situation incorporated their RI vs LP tangible item • RI acted as a setting event or establishing operation • Structural analysis served as a viable tool to examine the antecedent effects of RI on the social behaviors of the participants • Three-step process provided an effective method to validate the RI of participants: • Teacher & parent interviews • Multiple stimulus preference assessment • Concurrent operant conditions • Generalization data were more variable • Therapist prompts had to be introduced to facilitate generalization • Expert Social Validity data reflect clear differences in behavior of participants in RI vs LP sessions

42. Potential Explanations of Results • Jason’s Undifferentiated Concurrent Operant Data • Stimulus Control Topography (SCT) Coherence Theory—posits that there is not always concordance between contingencies arranged by experimenter & the properties of a stimulus that eventually brings the participant’s behavior under stimulus control • Executive Dysfunction—posits that underlying neurological impairments affects the ability of individuals with ASD to inhibit prepotent behavioral responses & engage in alternative behaviors • Variability in Generalization Data • SCT Coherence Theory—competing stimuli in generalization environment signal occasion for other available reinforcers • Use of Brief Reversal Design • Difficulty isolating Antecedents occasioning & Consequences maintaining social behavior in natural environment

43. Limitations & Future Research • Limitations • Generalization concerns: • All children had some social skills prior to study • All children were verbal and on higher end of autism spectrum • SAs were not conducted in the child’s natural environment • Small sample size • Future Research • Identify the function(s) RI serve for children with ASD • Determine the specific stimulus conditions needed for RI to serve as a setting event for social behavior in the regular classroom • Address aforementioned generalization concerns

44. Practical Implications • Research suggests a starting to place to tap social-motivation • Practitioners can embed RI into structured cooperative games or tasks to promote child interaction and/or engagement • Start sharing groups around child’s RI

45. Moving Beyond RI: Is it Possible? • Eventually kids may move on because of development, they outgrow their interests • 1 strategy to help kids move on: • Start a sharing group • Different kids share their interests, including the child with autism • Each child has to learn about the other person’s interest • The child with autism learns that other people have interests different than his or her own • The child learns about other people’s interests • The child learns to share talking and listening time around their interest Lord, 2002

46. 6 steps Determine their RI Establish a measurable social goal Take into account child’s play skills: Developmental level of play Stage of play Developmental level Sensorimotor Relational Constructive Dramatic Games with rules Stage of Play Unoccupied Onlooker Solitary/independent Parallel Associative Cooperative Using RI to Encourage Social Interactions

47. Example of Direct (Preference) Assessment

48. Antecedent-based uses of RI (cont’d) 3. Embed interest into cooperative games or play activities • Take into account child’s skill level and developmental abilities: • Can the child match pictures? • Can s/he sort objects? • Can s/he read? 4. Teach child how to play the game • Depends on child’s social & developmental abilities • May need to teach skill in a 1:1 setting and eventually integrate peers into activity • May be able to immediately introduce activity into a small group activity (teacher may need to monitor)

49. Example of an Embedded RI Activity

50. Antecedent-based uses of RI (cont’d) • Provide child structured and expected opportunities to engage with RI game • Make sure game has a clear ending • Set limits for when child is allowed to engage with game • Provide choice board • Daily picture or written schedule • Monitor the child’s progress • Keep in mind that social relatedness is difficult for all kids (HFA or LFA) on the autism spectrum