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Behavioral Interventions

Behav. Intervent. 25: 7787 (2010)


Published online 15 December 2009 in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/bin.297

A REPLICATION OF THE RIRD STRATEGY TO DECREASE


VOCAL STEREOTYPY IN A STUDENT WITH AUTISM

Lan Liu-Gitzy and Devender R. Banda*,z


Department of Educational Psychology & Leadership, Texas Tech University, Texas, USA

This study was conducted to decrease vocal stereotypy in a student with autism. Results of functional
analysis indicated that vocal stereotypy was maintained by automatic reinforcement. We used the
Response Interruption and Redirection (RIRD; Ahearn, Clark, & McDonald, 2007) strategy to decrease
the vocal behavior. An ABAB design was used. Results indicated that the RIRD intervention success-
fully reduced the target behavior. Results are discussed and implications for practice are provided.
Copyright # 2009 John Wiley & Sons, Ltd.

INTRODUCTION

Stereotypy refers to any repetitive or invariant behavior that serves no apparent


social function (Rapp, Vollmer, Peter, Dozier, & Cotnoir, 2004). Typical stereotypy
may range from simple to complex forms of behavior. Common examples include
hand apping, body rocking, toe walking, spinning objects, snifng, echolalia,
running objects across ones peripheral vision, etc. Some more complex forms of
stereotypy include insisting on sameness of a ritual or routine, such as repeatedly
lining cars or blocks (Cunningham & Schreibman, 2008). Stereotypic behaviors occur
in a wide variety of developmental disabilities (e.g., mental retardation [MR], autism,
severe and multiple disabilities), psychiatric disorders (e.g., schizophrenia, obsessive
compulsive disorder), and neurological conditions (e.g., Parkinson disease,
Sydenham chorea, Tourette syndrome), but the occurrence in individuals with
autism is considerably greater when compared with individuals with MR (Bodsh,
Symons, Parker, & Lewis, 2000). A comparison study by Matson et al. (1996) showed
75% of the subjects in the autistic-MR group received scores above the cutoff on the

*Correspondence to: Devender R. Banda, Department of Educational Psychology and Leadership, College of
Education, PO Box 41701, Texas Tech University, Lubbock, TX, 79409, USA. E-mail: devender.banda@ttu.edu
y
Doctoral student in special education in the Department of Educational Psychology & Leadership.
z
Assistant professor of special education in the Department of Educational Psychology & Leadership.

Copyright # 2009 John Wiley & Sons, Ltd.


78 L. Liu-Gitz and D. R. Banda

stereotypy subscale of the Diagnostic Assessment for Severe Handicaps-II (DASH-II;


Matson, 1995) compared to only 7% of the subjects in the non-autistic-MR group. In
another study, McDonald et al. (2007) compared the differences in frequency and
duration of stereotypy between autistic children and their age-matched typical peers.
Results indicated that vocal stereotypy was comparatively higher in the group of
children with autism than it was in the group of typical children and was highest in the
group of 4-year olds with autism.
Stereotypic behavior in children with autism and other developmental disabilities
often persists until adulthood, and greatly reduces the childs time for learning and
interacting with his/her environment. Most importantly, stereotypy is socially
stigmatizing and can signicantly limit the already limited social interactions
between individuals with autism and their surroundings. Stereotypy is one of the most
frequent targets of behavioral intervention in children with autism (Cunningham &
Schreibman, 2008), yet is also one of the most difcult behaviors to change (LeBlanc,
Patel, & Carr, 2000; Vollmer, 1994).
Investigators in some studies viewed vocal stereotypy as a developmental
milestone. For example, Sherer and Schreibman (2005) found that a behavioral prole
with a low frequency of non-vocal stereotypy and a high frequency of vocal
stereotypy predicted the highest positive responses to naturalistic language training,
behavioral intervention, and pivotal response training in young children with autism.
It is known that both typical children and children with autism develop echolalia, a
form of vocal imitation before developing functional speech. Vocal stereotypy could
very well be the indicator of a childs development on the path to functional speech,
instead an idiosyncratic, abnormal behavior. A study by Ward, Pamela, Osnes, and
Partington (2007) reported the use of vocal stereotypic behavior of two children with
severe language developmental delay to increase echolalia. The investigators paired
vocal stereotypic sounds with positive reinforcement and increased the childrens
echolalia from near 0 to 90100%, under the theory that vocal stereotypy might be
viewed as a childs developmental milestone instead of an aberrant behavior. These
studies suggest that vocal stereotypy can lead to development of functional speech
when appropriate environment and intervention are provided.
It is generally agreed that functional analysis is the most reliable method used to
generate and test hypotheses about the variables that maintain an aberrant behavior
(Iwata, Dorsey, Slifer, Bowmen, & Richman, 1994/1982). Typically, one or more of
four possible functions maintain stereotypic behaviors: positive social reinforcement
(e.g., praise, attention), negative social reinforcement (e.g., escape, avoidance),
positive non-social reinforcement (e.g., automatic reinforcement), and negative non-
social reinforcement (e.g., escape from sound, touch, or other environmental
conditions) (Cunningham & Schreibman, 2008). Stereotypic behaviors may also
have mixed functions among social and non-social reinforcement contingencies

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
RIRD and vocal stereotypy 79

(see Durand & Carr, 1987; Kennedy, Meyes, Knowles, & Shukla, 2000; Vollmer,
Marcus, Ringdahl, & Roane, 1995).
Several behavioral strategies exist to modify stereotypic behaviors. Vollmer (1994)
summarized the treatment strategies of stereotypy into four types: (1) manipulation of
establishing operations (Vollmer & Iwata, 1991; Weeks & Gaylord-Ross, 1981), (2)
sensory extinction (Dorsey, Iwata, Reid, & Davis, 1982; Rincover, 1978), (3)
differential reinforcement (Cowdery, Iwata, & Pace, 1990; Wacker et al., 1990), and
(4) punishment (Friman & Hove, 1987; Linscheid, Iwata, Ricketts, Williams, &
Grifn, 1990; Rapp & Vollmer, 2005). Recently, Ahearn, (2007) studied the vocal
stereotypic behaviors of four children with autism and reported a successful treatment
strategy called the Response Interruption and Redirection (RIRD) in a clinical setting
for the rst time. Vocal stereotypy in all four children decreased to substantially lower
level than the baseline, and three of the four children exhibited appropriate
communication behaviors. The RIRD intervention involves an adult (teacher,
therapist) delivering a series of vocal demands that are within the childs repertoire.
The vocal demands are issued contingent on the onset of the vocal stereotypy and
continuously presented until the child responds for three consecutive compliances
without an occurrence of vocal stereotypy. Meanwhile, the childs compliance to
vocal demand yields social praise from the adult (Ahearn et al.). The RIRD strategy
combines both response blocking and differential reinforcement strategies into one
procedure and is suited for intervention in children with some verbal abilities. The
primary purpose of the current study was to replicate the RIRD strategy developed by
Ahearn and colleagues with a young student with autism who displayed vocal
stereotypic behavior in a school setting.

METHOD

Participant
Dylan was a 10-year-old male with autism who attended a special education
classroom. Dylan was described as having frequent repetitive stereotypic behaviors
and temper tantrums, inappropriate socialization and play, and signicant
communication impairment. On the Developmental Prole II (DPII; Alpern, Boll,
& Shearer, 1980), he had moderate to signicant developmental delays across all
areas. His speech was intelligible when he did not engage in vocal stereotypy. He
could read at a 1st grade level based on teacher reports and school benchmark
assessments. He was frequently sick due to cold or u and was given cold medicines at
home. Consequently, he often was drowsy or sleepy at school. Additionally, he was on
Clonidine to control hyperactivity.

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
80 L. Liu-Gitz and D. R. Banda

The classroom teacher reported that Dylan consistently displayed vocal stereotypy
and was consequently moved from a general to a special education setting. His vocal
behaviors ranged from high pitched yelling or whining to whistling, laughing,
making burping noises, and making blowing sounds. The teacher was concerned that
Dylans frequent vocal behaviors disrupted typical classroom instruction and limited
inclusion opportunities with peers. Previously, the teacher had tried to ignore,
reprimand, and differentially praise appropriate verbalizations. However, the
interventions did not yield observable long-term effects on his behavior. The teacher
requested the help of a university-based autism center to decrease his vocal
stereotypy.

Setting and Trainer


All observations and treatments were conducted in the special education classroom
(10 m  10 m). The classroom was managed by the lead teacher and a co-teacher.
Also, in the classroom were ve children with disabilities including autism, MR, and
multiple disabilities. The classroom was divided into group activity, downtime,
independent work, and computer areas. Dylans classroom teacher implemented the
intervention.

Dependent Variable and Data Collection


Dylans target behavior was dened as any instance of vocalization that was non-
contextual or non-functional. Each instance of vocal behavior audible within 4 m was
recorded as an incidence. Data were collected using a 10 s partial interval recording
method. Each session consisted of 5 min of observation (30 intervals). Using a stop
watch, the observers recorded if the behavior occurred anytime during the 10 s
interval. The per cent intervals with problem behavior of each session was
calculated as the number of intervals with problem behavior divided by total intervals
(30) multiplied by 100.

Functional Analysis
A multi-element design was used to assess the functions of the target behavior
across four conditions: (a) attention, (b) demand, (c) ignore, and (d) free play (Iwata
et al., 1982/1994). During the attention condition, the teacher gave Dylan a task to
complete (e.g., reading a 1st grade level story and then answering questions or lling
in the blanks) and only gave him attention when he displayed the target behavior (e.g.,

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
RIRD and vocal stereotypy 81

Dylan, dont do that, or Its time to work, no whining.). During the demand
condition, the teacher gave Dylan a demanding task to complete (e.g., the reading task
described before or a math work sheet that required independent work). When he
displayed the target behavior, the teacher removed the task and told him to take a
break, waited 30 s, then re-presented the task until he displayed target behavior
again. During the ignore condition, the teacher gave Dylan a task to complete but
totally ignored the target behavior. During free play condition, no demands were
made. He was allowed access to his favorite toys and preferred objects. He was also
free to talk to any teachers in the room. Each condition was presented randomly once
per day for 5 min. Sessions were conducted at similar times through the day, three to
5 days per week. Figure 1 indicates the results of functional analysis. Results revealed
little variation across the four conditions, indicating that the problem behavior was
possibly maintained by automatic reinforcement. Based on the results of functional
analysis, we opted to implement the RIRD intervention (Ahearn et al., 2007) to
decrease the vocal stereotypy in Dylan.

Design
An ABAB reversal design was used to determine the effectiveness of the RIRD
strategy. Baseline and intervention sessions were conducted during the same
classroom activities (guided work at Dylans desk or round table) at least three to ve
times in a week. All treatment sessions were conducted by the classroom teacher.

Figure 1. Dylans vocal stereotypic behaviors across four conditions.

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
82 L. Liu-Gitz and D. R. Banda

Baseline
During baseline, the teacher was instructed to interact with Dylan as she normally
did during day to day activities. Typically, the teacher redirected Dylan or verbally
instructed him not to whine or make inappropriate vocalizations during the class.

The RIRD Intervention


The RIRD method (Ahearn et al., 2007) was implemented by the teacher to
decrease Dylans vocal stereotypy. When Dylan displayed appropriate verbalization
by using intelligible words to express himself, the teacher praised him by saying Nice
job asking! or I like it when you use your pretty voice. If Dylans verbalization was
requesting tangibles or activities, the teacher would say: I like you to use your words
to ask. You may have it later (or at specic time). When Dylan displayed the target
behavior, the teacher would immediately interrupt him and redirect him by asking
him a series of questions. More specically, the teacher would rst state Dylans name
to gain his attention, then she would ask him questions. The criteria for selecting
which question to ask were based on whether, (a) Dylan had demonstrated that he
could easily answer the question, and (b) the context of the question were related to
Dylans interests and favorites. Since Dylan liked topics related to weather,
swimming, and the movie Toy Story, such questions included Dylan, what is the
weather today?, What do we do during the summer?, and Who do you like in Toy
Story? As soon as Dylan responded with intelligible words, he was verbally praised
(e.g., good job answering). After two or three verbal responses from Dylan, the
teacher gently reminded him to nish his work. Every time the teacher started RIRD,
the observer stopped the timer; after the teacher prompted Dylan to return to his task,
the observer started the timer again. Therefore, the 5 min interval reected the length
of the baseline interval.

Interobserver Agreement
A trained graduate student in special education independently collected data for a
total of 30% sessions. During the sessions, both observers were seated within 5 m
from Dylan. A session started when the primary observer signaled the second
observer. Both observers used the same timer which indicated elapsed time and
independently recorded the presence or absence of the problem behavior on separate
data sheets. Interobserver agreement was calculated as the ratio of agreements to the
total recorded incidence (agreements plus disagreements) multiplied by 100%.
Average agreement was 95% (range 77100%).

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
RIRD and vocal stereotypy 83

Procedural Integrity
Procedural integrity was collected for 30% of all treatment sessions. Procedural
integrity was rated according to the procedural checklist developed prior to the
intervention. An independent observer rated Yes when the procedure conformed to
the protocol and rated No for the specic items in the protocol that were not
followed. The procedural integrity was 100%.

Social Validity
The Intervention Rating Prole-15 (IRP; Martens & Witt, 1982) was completed by
the classroom teacher at the conclusion of the study. The teacher rated agree for 12
of 15 items in the IRP. For the item, This intervention is consistent with those I have
used in classroom settings, she rated disagree. For the items I liked the procedure
used in this intervention, and Most teachers would nd this intervention suitable for
the behavior described, she rated slightly agree. Overall, the teacher was very
positive about the intervention and agreed that it improved the students behavior.

RESULTS

Figure 2 shows the results of Dylans vocal stereotypy during baseline and
intervention conditions. In the initial baseline phase, Dylan exhibited vocal

Figure 2. Per cent of occurrences of Dylans vocal stereotypic behavior during baseline and treatment
conditions.

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
84 L. Liu-Gitz and D. R. Banda

stereotypy during 41% of intervals. Although the baseline recording period


revealed a trend of increasing frequency of the targeted behaviors, both the
experimenter and the classroom teacher agreed that the data was representative of
what they had observed in the classroom. Due to limited number of school days
remaining in the study period, the intervention was started without further
delay. During the RIRD intervention, the behaviors decreased from 41% to 10%
of intervals. Dylans target behaviors increased to 51% of occurrence during return to
baseline. When the RIRD was reintroduced, Dylans behavior decreased to 9% of
intervals. In addition, the teacher indicated that Dylans appropriate vocalizations had
improved. During the 5 min intervention sessions, the teacher only used RIRD no
more than twice, and the target behavior generally dropped to zero percent
occurrences. Overall, the results indicate that the RIRD was effective in reducing the
target behavior.

DISCUSSION

This study demonstrated that the RIRD intervention was very effective in reducing
Dylans vocal stereotypy. During the intervention, Dylan was able to complete his
required academic work with minimum resistance. Furthermore, Dylans teacher
indicated that he was less resistant to academic tasks. Also, the RIRD increased
Dylans appropriate verbal expression, which was one of his educational goals. Due to
Dylans high functioning communication skills, the intervention was easily
implemented by the classroom teacher.
The RIRD intervention may have served to extinguish vocal stereotypy and to
differentially reinforce incompatible behavior (DRI) at the same time (Ahearn et al.,
2007). In a study, Lerman and Iwata (1996) concluded that punishment was the
operative mechanism in decreasing the behavior. However, Ahearn et al. (2007) point
out that the signicance of the RIRD lies more on its effectiveness on the target
behavior and less on the distinction of its operative mechanisms. By asking questions
related to Dylans favorite topic, the teacher blocked his inappropriate vocal
stereotypic behaviors and provided opportunities for him to respond with appropriate
vocal behaviors. The RIRD strategy may also have been successful because it
provided Dylan with social attention from the teacher and a temporary escape from
the task demand.
Functional analysis of vocal stereotypy in individuals with autism typically
resulted in undifferentiated patterns between the behavior and the social environment
in a majority of the reported studies (Ahearn et al., 2007; Graff, Lineman, Libby, &
Ahearn, 1999; Kennedy et al., 2000; Taylor, Hoch, & Weissman, 2005). Although the

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
RIRD and vocal stereotypy 85

majority of such studies concluded that the behaviors were maintained by sensory-
related reinforcement, Kennedy and colleagues cautioned that the causes of
stereotypy in individuals with are complex, and that it is less important to presume
association between response and behavioral function for treatment purposes. The
present study found similar response patterns as in the studies mentioned above.
Although both teacher and paraprofessional of the classroom reported high
association between Dylans behavior and demand, the functional analysis could
not disassociate one condition from another, even after extensive data collection
during functional analysis. Such effects may be the result of carryover effects from
multi-element design, as discussed by LeBlanc et al. (2000) and Vollmer, Iwata,
Duncan, and Lerman (1993). It is also possible that Dylans behavior was driven by
multiple functions other than sensory reinforcement alone (Kennedy et al., 2000), but
the functional analysis data could not support such a presumption. As an intervention
strategy, the RIRD was able to address multiple functions and decrease vocal
stereotypy in the participant.
Previous studies indicate that vocal stereotypy could be a stage of a child
development before the development of functional speech (Sherer & Schreibman,
2005; Ward et al., 2007). When a child has a need to express but lacks appropriate
language skills, he/she may resort to using inappropriate vocal behavior. In the
present study, the RIRD strategy may have allowed the teachers to provide
opportunities for the child to vocally express appropriate behavior by teacher
attention and temporary escape from the task demand.
A limitation of the study is that the initial baseline showed an upward trend of
Dylans behavior. Previous observations and teacher reports both indicated that there
were variations in the intensity of his behavior due to unidentied factors
(environmental variables). Therefore, the researchers decided that the baseline was
representative of the levels of target behavior. The second baseline also reected this
uctuation of intensity which supports the validity of the initial baseline. Another
limitation is that we chose partial interval recording to obtain the data (10-s interval),
which is slightly different than momentary time sampling, a method used by the
RIRD investigators (Ahearn et al., 2007). The difference lies in whether one counts
the occurrence of the behavior anytime during the interval or only at the end of the
interval. In this study, a large window of 10-s interval may have resulted in a less
accurate estimate of the target behavior. Future researchers could use shorter intervals
(5 s or less) to obtain more accurate data.
This study extends the initial study by using RIRD in an educational setting rather
than a clinical setting (Ahearn et al., 2007). The study also demonstrates the use of
functional analysis in a natural setting and contributes to the growing body of
literature on functional assessment. Future researchers may wish to explore the
feasibility of using RIRD in general education settings.

Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin
86 L. Liu-Gitz and D. R. Banda

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Copyright # 2009 John Wiley & Sons, Ltd. Behav. Intervent. 25: 7787 (2010)
DOI: 10.1002/bin