An Evaluation of a Treatment Package Consisting of

Discrimination Training and Differential Reinforcement with

Response Cost and a Social Story on Vocal Stereotypy for a
Preschooler with Autism in a Preschool Classroom

Amanda P. Laprime, Gretchen A. Dittrich

Education and Treatment of Children, Volume 37, Number 3, August 2014,

pp. 407-430 (Article)

Published by West Virginia University Press

DOI: https://doi.org/10.1353/etc.2014.0028

For additional information about this article

https://muse.jhu.edu/article/552406

Access provided at 29 Mar 2019 14:19 GMT from Idaho State University
 EDUCATION AND TREATMENT OF CHILDREN Vol. 37, No. 3, 2014

An Evaluation of a Treatment Package

Consisting of Discrimination Training and
Differential Reinforcement with Response Cost
and a Social Story on Vocal Stereotypy for a
Preschooler with Autism in a
Preschool Classroom
Amanda P. Laprime and Gretchen A. Dittrich
Simmons College

Abstract
The purpose of the study was to evaluate the use of a treatment package com-
prised of a social story, discrimination training, and differential reinforcement
with response cost on the vocal stereotypy of one preschooler diagnosed with
an autism spectrum disorder. The study took place in a preschool classroom
of a public school and was implemented by the classroom teacher and staff.
A changing criterion design was employed to evaluate experimental control.
The results of this study demonstrated a clear decrease in vocal stereotypy as
compared to baseline.
Keywords: Vocal Stereotypy, Response Cost, Differential Reinforcement,
Changing-Criterion Design

A defining characteristic of autism spectrum disorders (ASDs)

involves repetitive vocalizations or body movements, otherwise de-
fined as stereotyped behavior (American Psychiatric Association,
2000). Rapp and Vollmer (2005) conducted a review of the literature
and concluded that the majority of stereotypic behaviors are main-
tained by automatic reinforcement. Skinner defined verbal behav-
iors as “behavior reinforced through the mediation of other persons”
(1957, p.2). Though repetitive vocal responses may topographically
appear to be verbal, if the consequences maintaining such responses
are not mediated by a listener, they then could instead be defined as
vocal stereotypy maintained by automatic reinforcement. Vaughn and
Michael (1982) defined automatic reinforcement as a contingency not
mediated by a listener. Therefore, vocal stereotypy may be maintained

This study was conducted by the first author in partial fulfillment of the requirements
for the Ph.D. degree in behavior analysis at Simmons College. We thank the staff at the
LABBB Collaborative for their dedication and hard work with their students and this
study.
Address correspondence to Amanda Laprime, Department of Behavior Analysis, Sim-
mons College, 300 Fenway, Boston, MA 02115; e-mail: aplaprime@gmail.com

Pages 407–430
408 LAPRIME and DITTRICH

by the sensory byproduct it produces (Ahearn, Clark, MacDonald, &

Chung, 2007). Because the reinforcing consequence cannot always be
separated from the response, stereotypic behaviors may be difficult to
extinguish. Vocal stereotypy is especially problematic in that the audi-
tory product of the response is often challenging to block or place on
sensory extinction. In addition, stereotypy may often persist when the
individual is alone or void of social contingencies (Falcomata, Roane,
Hovanetz, Kettering, & Keeney, 2004; Iwata, Dorsey, Silfer, Bauman,
& Richman, 1982,1994; Rincover, 1978).
Based on the difficulty of separating the auditory byproduct of
vocal stereotypy and the response itself (i.e., the movement of the vo-
cal musculature), behavior change of vocal stereotypy achieved by
sensory extinction may be attributed to punishment contingencies and
not extinction (Ahearn et al., 2007). Ahearn and colleagues evaluated
the efficacy of a punishment contingency on reducing vocal stereoty-
py with response interruption and redirection. The participants were
given vocal demands contingent on any instance of vocal stereotypy,
which effectively reduced responding for all four participants (Ahern
et al., 2007). Rapp and colleagues (Rapp, Patel, Ghezzi, O’Flaherty, &
Titterington, 2009) extended the literature on mild punishment proce-
dures by assessing whether vocal stereotypy could be brought under
stimulus control of arbitrary stimuli. Their results demonstrated that
vocal stereotypy was suppressed in the presence of a red card after
the implementation of the response cost contingency when the card
was present. The authors concluded that the negative punishment
procedure was effective at establishing the red card as a discrimina-
tive stimulus related to punishment (SDP) by being paired with both
positive and negative punishment (Rapp et al., 2009).
Researchers have also examined the effects of negative punish-
ment on vocal stereotypy; specifically, response cost was found to be
effective at reducing vocal stereotypy in individuals with ASDs. Fal-
comata and colleagues (2004) compared noncontingent reinforcement
(NCR) and NCR with response cost to decrease vocalizations main-
tained by automatic reinforcement. Initially, levels of vocalizations
decreased moderately during the NCR conditions, but with the addi-
tion of a response cost in which a Walkman© was removed contingent
on vocal stereotypy, responding decreased to near zero levels for the
participant (Falcomata et al., 2004).
Previous studies have also employed response cost procedures
with token boards (Kostinas, Scandley, & Luiselli, 2001; Truchlicka,
McLaughlin, & Swain, 1998). During this procedure, tokens, which
function as conditioned reinforcers, are removed contingent upon
the occurrence of a target response. At the end of a predetermined
VOCAL STEREOTYPY 409

amount of time, remaining tokens can be exchanged for a backup re-

inforcer (Cooper, Heron, & Heward, 2007). For example, Kostinas and
colleagues (2001) employed a response cost procedure with a token
system in which the participant was given 15 tokens at the start of
each day. Contingent upon the occurrence of a perseverative verbal-
ization, a token was removed. By the end of the day, if at least one
token remained on the board, a preferred snack was delivered. Re-
sults demonstrated a decrease in perseverative vocalizations for the
one participant (Kostinaset al., 2001). In a similar study, Truchlicka
and colleagues (1998) decreased errors during spelling exams and
increased accuracy in spelling performance in three participants fol-
lowing implementation of a token-based response cost system. Fur-
thermore, the authors concluded that the token economy with the
response cost component was en effective intervention for use in edu-
cational settings, such as a middle school.
Social stories have also been used in conjunction with response
cost and token board systems (Kuttler, Myles, & Carlson, 1998). So-
cial stories describe a situation and the contingencies related to de-
sired responses for that situation. The contingencies are described
in a manner by which they are easily understood by the person for
whom the social story was written (Grate & Garand, 1993). Social sto-
ries were demonstrated to increase the effects of contingencies related
to token economies (Kuttler et al., 1998). Additionally, social stories
are often recommended not as a behavior change agent, but instead
to help facilitate a better social understanding of the contingencies
related to improvements in behavior and functioning in social situ-
ations (Kokina & Kern, 2010). The American Psychiatric Association
(2000) has suggested that social stories may address the need for
predictability for children with autism in social situations and that
visually cued instruction that may be more discernable than verbal
instructions (Quill, 1997). This may be additionally important in situ-
ations such as public school settings, where students may not have
constant support and are required to share their teachers. In a meta-
analysis conducted by Kokina and Kern (2010) on the use of social
stories, the authors found that 21% of the participants in studies that
employed social stories included preschoolers, while 60% of the par-
ticipants were elementary aged. The majority of the studies surveyed
utilized social stories which focused on a reduction of inappropriate
behaviors and an increase in social skills (Kokina & Kern, 2010). The
research on social stories have described their effects as potentially ef-
fective, at best (e.g., Ali & Frederickson, 2006; Rust & Smith, 2006), yet
they are often viewed positively by teachers and parents as a feasible
and effective intervention (Smith, 2001). However, meta-analytic data
410 LAPRIME and DITTRICH

suggest that they social stories are often utilized in conjunction with
behavior change procedures leading to difficult with determining the
isolated effects of social stories on behavior alone (Kokina & Kern,
2010). While response cost systems with token boards and social sto-
ries have been demonstrated to be effective at decreasing behaviors,
such as precursors to tantrum behavior, perseverative vocalizations,
and calling out in the classroom (Kostinas et al., 2001; Kuttler et al.,
1998), to date, the efficacy of a treatment package utilizing these meth-
ods has not been evaluated with vocal stereotypy in a public school
classroom.
When evaluating methods to decrease behavior, reinforcement-
based procedures, either alone or in conjunction with punishment
procedures, may be considered. For example, differential reinforce-
ment interventions have been empirically demonstrated to mitigate
the negative side effects of punishment or extinction procedures
(Catania, 1997). However, the combination of punishment procedures
with differential reinforcement has been demonstrated to be more ef-
fective at reducing problematic behavior than differential reinforce-
ment alone (Buckley & Newchok, 2005; Kostinas et al., 2001). Differ-
ential reinforcement of low rates of behavior (DRL), first described by
Fester and Skinner (1957), effectively reduced disruptive behaviors in
individuals with disabilities, including but not limited to requests for
teacher attention (Austin & Bevan, 2011), stereotypy (Singh, Dawson,
& Manning, 1982), and physical and verbal aggression (Alderman
& Knight, 1997). A DRL procedure involves the delivery of positive
reinforcement contingent uponthe frequency of a target behavior oc-
curring less than or equal to a predetermined limit during a specified
period of time (Deitz, 1977). A DRL procedure is often used when be-
haviors occur too often to be susceptible to other reinforcement con-
tingencies (e.g., differential reinforcement of other behavior; Martin
& Pear, 2010).
Kostinas and colleagues (2001) compared the effects of a DRL
procedure to a DRL with a response cost procedure on perseverative
verbal behavior in an adult diagnosed with obsessive-compulsive dis-
order. Results demonstrated that the DRL with response cost proce-
dure produced greater reductions in perseverative speech than the
DRL procedure alone (Kostinas et al., 2001). The authors concluded
that DRL alone did not effectively reduce perseverative verbaliza-
tions, and that the absence of inappropriate responses may be the re-
sult of the participant avoiding negative consequences (i.e., the loss
of a token), rather than accessing positive reinforcement (Kostinas
et al., 2001). Though the authors did not discuss the function of the
problem behavior, in the case of behaviors maintained by automatic
VOCAL STEREOTYPY 411

reinforcement, it may be difficult to either substitute a functionally

equivalent reinforcer or find a reinforcer that will compete with the
byproduct of stereotypy when using differential reinforcement alone
(Falcomata et al., 2004).
The purpose of the current study was to extend the literature on
establishing SDP control of vocal stereotypy using arbitrary stimuli and
a DRL with a token-based response cost procedure. A social story was
used to describe the contingencies in place during the experimental
sessions. All experimental sessions were conducted within a public
school environment, with public school staff implementing the pro-
cedures.
Method

Participant and Setting

David was a 4-year-old male who had been diagnosed with
an autism spectrum disorder. He had been diagnosed at the age of
2-years-old. One year prior to the study, the Early Intervention De-
velopmental Profile (Rogers et al., 1981) had been administrated to
David. His social emotional skills were scored at the age equivalent
of 33 months, self-care 25 months, cognition was scored at 30 months,
perceptual fine motor was 24 months, gross motor was 32 months,
receptive language was 24–31 months, and expressive language was
scored at 26 months. The most recent speech and language testing was
conducted during the study. Results from the Clinical Evaluation of
Language Fundamentals® preschool second edition (Semel, Wiig, &
Secord, 2008) suggested that David had a receptive language index of
61 (which was 2 standard deviations below the mean), and the results
of the Peabody Picture Vocabulary Test fourth edition (Lloyd & Dunn,
2007) yielded a score of 74 (which was also 2 standard deviations from
the mean).
He had been nominated for the study by his classroom teacher
and mother due to the high rate of vocal stereotypy at both school and
home. David attended an integrated preschool classroom in a pub-
lic elementary school. Four to six other students with developmental
disabilities attended his classroom five days per week. During two
of the five days the classroom was integrated with neurotypical pre-
schoolers. The classroom included one special education teacher and
three classroom assistants. The special education teacher had taught
in a preschool classroom for children with autism for 11 years and
had a master’s of science in intensive special needs at the time of the
study. She had taken post-masters classes in Applied Behavior Anal-
ysis (ABA) after completing her degree. The other three classroom
412 LAPRIME and DITTRICH

assistants had a range of education from a high school diploma to

an associates and bachelor’s degree. They had been working for 6 to
14 years with children with developmental disabilities. None of the
classroom assistants had any classes or specific training in ABA other
than workshops intermittently provided by their employer.
All sessions were conducted in the preschool classroom through-
out the school day. The classroom included three individual student
work areas divided by partitions, a circle area comprised of a rug and
individual seats, and three tables, each identified by their shape and
color. Sessions were conducted by the classroom assistant or teacher
who was working with David for that period of time, and the class-
room assistant or teacher also worked with one or two other students
while running the experimental sessions. The study was conducted
from September through February of the academic school year, ex-
cluding programmed school breaks and weekends.
Response Measurement and Data Collection
Vocal stereotypy was defined as any instance in which David
engaged in non-contextual vocal word or sound output for three con-
secutive seconds. An example included, David verbally repeating the
plot of a television show during lunch while looking at his food. A
non-example included if David responded to a question, attempted
to ask a question, or engaged in contextual or non-contextual vocal
output when making eye contact with an adult.
Partial interval recording (Johnston & Pennypacker, 1980) data
were collected during two to four experimental sessions per day. Per-
centage of intervals in which vocal stereotypy occurred was calcu-
lated by dividing the number of intervals in which vocal stereotypy
occurred by the total number of intervals and multiplying by 100 per-
cent. Intervals were between 1 to 2 min in length for a total of 5 to
10 min depending on the experimental condition. The length of the
intervals was determined at the onset of the experiment after the re-
sults of the descriptive assessment demonstrated a high frequency of
vocal stereotypy with little to no breaks in between episodes. While
average frequency was not formally recorded, a 1 min session was
determined to be the initial interval to evaluate if such a measure
was representative of the overall occurrence of vocal stereotypy and
was determined to be feasible for the staff in terms of data collection.
The total session time was determined based on two criteria, first,
sessions would start at small enough intervals so David would access
reinforcement frequently, second, the total session duration was long
enough to be effective while being manageable for implementation by
classroom staff.
VOCAL STEREOTYPY 413

100
Percentage of Intervals in which Vocal Stereotypy Occured

90

80

70

60

50

40

30

20

10

0
Group PT Snack Choice Story Music Circle Lunch Cooking 1:1 OT Art
Work Group
Activity

Figure 1. Average percentage of 1 min intervals during a 5 min session where

vocal stereotypy occurred across classroom activities during descriptive as-
sessment.

Experimental Design
A changing conditions design (Kazdin, 1982) with an embed-
ded changing criterion design (Weis & Hall, 1971) was employed to
evaluate the effects of discrimination training and differential rein-
forcement of low rates (DRL) of behavior with response cost on vocal
stereotypy. Criterion was initially set at 80% based on baseline lev-
els of responding. The criterion was increased by 20% systematically
when David engaged at or below criterion specific levels of respond-
ing for two consecutive sessions. In order to demonstrate a functional
relationship the criterion was increased to a previously attained level
and then systematically decreased again.
Descriptive Assessment
Antecedent, behavior, consequence (Bijou & Baer, 1963) data
were recorded by the classroom behavioral consultant prior to the
beginning of the study during targeted weekly observations. Each ob-
servation occurred for approximately 30 min. The classroom staff col-
lected daily data on (a) percent of intervals in which vocal stereotypy
occurred for up to five 5 min sessions, (b) the activity (Figure 1), and
(c) the day of the week (Figure 2). An analysis of these variables was
414 LAPRIME and DITTRICH

100
Percentage of Intervals in which Vocal Stereotypy Occured

90

80

70

60

50

40

30

20

10

0
Monday Tuesday Wednesday Thursday Friday

Day of the Week

Figure 2. Average percentage of 1 min intervals across 5 min sessions where

vocal stereotypy occurred across days of the week.

conducted in order to develop a hypothesis regarding environmental

events that potentially maintained vocal stereotypy. The results of the
assessment suggested that vocal stereotypy was maintained by posi-
tive automatic reinforcement. This conclusion was made for the fol-
lowing reasons: (a) teachers reported that no consequence appeared
to result in an increase or decrease in the occurrence of the behavior,
and that when left alone, David was likely to engage in continuous
vocal stereotypy; (b) responding was variable with no clear trend
throughout the assessment (see Figure 3), and no clear patterns in re-
sponding among days, activities, or time; and (c) responding occurred
at lower levels during activities in which there were other auditory
stimuli present (see Figure 1).
At the onset of the study, the behavioral consultant met with
the guardian and the teacher to determine goals for the intervention.
Goals identified were as follows: 1) the intervention would begin
with the criterion set so that David could contact reinforcement (i.e., 5
min sessions comprised of 1 min intervals), and 2) the session length
would be systematically increased to 10 min total duration(comprised
of five 2-min intervals). The terminal duration was set to approximate
the duration of work sessions in kindergarten, to which David was
transitioning the following year.
VOCAL STEREOTYPY 415

Baseline DRL/RC
5 min 7.5 min 10
min
100

90 C1

80

70 C2
Percentage of Intervals

60

50 C3 C5

40

30 C4 C6 C8

20

10
C7

1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151 161 171

Sessions

Figure 3. Percentage of intervals in which vocal stereotypy occurred during

baseline (BL) and treatment (DRL/RC) across 1 min intervals during 5 min ses-
sions, 1.5 min intervals during 7 min sessions, and 2 min intervals during 10
minute sessions. Arrows indicate criterion (C=criterion) levels on the graph.
C1 represents 80% of intervals, C2 represents 60% of intervals, C3 represents
40% of intervals, C4 represents 20% of intervals, C5 represents 40% of inter-
vals, C6 represents 20% of intervals, C7 represents 0% of intervals, and C8
represents 20% of intervals.

Staff Training
The classroom teacher and assistants were trained to implement
all experimental conditions by the classroom behavioral consultant
who was also the primary experimenter of the study. During the first
phase of training, the consultant reviewed the written behavior plan
of implementation procedures with the teacher and assistants. In the
second phase, the behavioral consultant modeled the implementation
of the experimental conditions for the staff in vivo. In the third phase,
each staff was individually observed implementing the experimental
conditions and then given immediate feedback. The classroom teach-
er and staff were required to go through the training sequence prior to
running the experimental procedures.
416 LAPRIME and DITTRICH

Procedures
General Procedures. Across all experimental conditions, class-
room teachers and staff were instructed to implement the treatment
procedures two to four times per day. The frequency was determined
based on teacher reports of how often they could implement the pro-
cedures, based on staffing and the number of students in the class-
room (which changed at times).
David’s school day was broken up into activities in which there
were no specified programmed consequences for vocal stereotypy
and activities in which programmed consequences were imple-
mented following the occurrence of vocal stereotypy. The teacher
and classroom assistants met with the behavioral consultant to de-
termine these activities. Playground, choice time, and free play were
isolated as times when David was allowed to engage in vocal stereo-
typy without the occurrence of a programmed consequence. Circle,
small group activities, lunch, snack, and individual work time were
determined to be times when vocal stereotypy competed with other
desired responses, and it was therefore targeted for decrease utilizing
the treatment package.
It was determined that changes in criteria would be communi-
cated to the classroom staff by the behavioral consultant after an anal-
ysis of the current data. The behavioral consultant was scheduled to
be in the classroom one to two times per week. For this reason, David
may have met criteria and then remained in that phase of the study
until the next time the behavioral consultant was in the classroom for
consultation. Therefore, the number of days in a particular phase of
the study was variable.
Baseline. The baseline condition occurred throughout the entire
school day. During baseline, staff redirected David to have a quiet
voice (via verbal instruction paired with a finger put to the lip) con-
tingent on any instance of vocal stereotypy. The social story, token
board, and bracelets were not utilized during baseline.
Discrimination training. The no programmed consequence condi-
tion was labeled the green condition, and a green circle was placed
on the classroom schedule for those activities in which there would
be no programmed consequence for vocal stereotypy. The DRL/RC
condition was identified as the red condition, and the activities that
resulted in the programmed consequence for vocal stereotypy were
labeled with a red circle on the classroom schedule. The red and green
colors were to serve as conditional stimuli associated with differen-
tial consequences. In addition, the labels on the schedules served as
prompts for the classroom staff regarding which experimental con-
dition to run. It was determined that during some designated red
VOCAL STEREOTYPY 417

activities it was not feasible for the red condition to be implemented

due to insufficient staffing; therefore, during these times the green
condition was implemented. It is important to note that the red and
green designations were a guide for classroom staff, but the red con-
dition did not occur for every occurrence of a red activity, due to
staffing issues.
At the start of any scheduled activity in the classroom, the staff
instructed David on the condition specific contingency and provided
him with the corresponding social story (Appendix B). At any time
during the day in which the classroom staff did not run the red condi-
tion, they implemented the green condition.
The DRL/RC condition was comprised of three phases. The pur-
pose of the phases was to systematically increase the amount of time
in which the treatment package was implemented while systematical-
ly decreasing the amount of intervals in which David could engage in
vocal stereotypy. The first phase was implemented to establish stimu-
lus control of vocal stereotypy across 5 min sessions. The purpose of
the second and third phases was to systematically increase the dura-
tion of time in which he was not engaging in vocal stereotypy. Within
the first and second phase, the number of intervals in which David
could engage in vocal stereotypy and receive contingent reinforce-
ment was systematically decreased (i.e., the DRL). The purpose of the
third phase was to evaluate if low levels of vocal stereotypy could be
maintained across a longer session duration.
DRL and response cost (DRL/RC). At the start of the condition, the
social story (Appendix B) was given to David and he was instructed
to read it aloud. Simultaneously, a red wristband or watch was put on
David’s wrist to signal the onset of the red condition. Staff presented
a token board filled with five tokens and a prize box filled with pre-
viously identified preferred items. The timer was set for the phase
specific interval and started. If at any point during the interval David
engaged in vocal stereotypy, the staff showed him the token board
and removed a token. They then prompted a quiet voice by holding a
finger up in front of their lips and counting to three, and repeated this
procedure until David remained quiet for three consecutive seconds.
Instructions were reintroduced regarding the contingency in place. If
David engaged in vocal stereotypy at any other time during the same
interval, the staff redirected him one time by holding a finger up in
front of their lips.
At the end of the condition specific time, if David had kept the
criterion specific number of tokens, the green condition was imple-
mented and he was given access to the prize box and all tangibles
in the box for a predetermined reinforcement time. If David did not
418 LAPRIME and DITTRICH

100
Percentage of Intervals in which Vocal Stereotypy Occured

90

80

70

60

50

40

30

20

10

0
Baseline Phase 1: Phase 1: Phase 1: Phase 1: Phase 2: Phase 2: Phase 2: Phase 3:
Criterion 1 Criterion 2 Criterion 3 Criterion 4 Criterion 5 Criterion 6 Criterion 7 Criterion 8

Experimental Condition

Figure 4. Average percentage of intervals where vocal stereotypy occurred

across experimental conditions.

have the specified number of tokens remaining on the token board,

the contingency for reinforcement was described. If the program was
going to be run immediately again, the red condition continued; if
the program could not be run again, the green condition was imple-
mented.
Phase 1. During phase 1 of the DRL/RC, all sessions were com-
prised of five 1 min intervals for a total of a 5 min session. Contingent
on meeting the criteria, reinforcement time was 1 min. The phase began
with a predetermined criterion of 80% or less of intervals with vocal
stereotypy (C1). Once this criterion was met, the criterion decreased to
60% or less of intervals with vocal stereotypy (C2). Upon meeting this
criterion, the criterion decreased to 40% or less of intervals with vocal
stereotypy (C3). The next two criteria changes involved a decrease to
20% or less of intervals with vocal stereotypy (C4) and a reversal back
to 40% or less of intervals with vocal stereotypy (C5).
Phase 2. During phase 2 of the DRL/RC, all sessions were com-
prised of five 1.5 min intervals for a total of a 7.5 min session. Con-
tingent on meeting the criteria, reinforcement time was 1–2 min. The
phase began with a predetermined criterion of 20% or less of intervals
with vocal stereotypy, and once this was met, the criterion was de-
creased to 0% or less of intervals with vocal stereotypy.
VOCAL STEREOTYPY 419

Phase 3. During phase 3 of the DRL/RC, all sessions were com-

prised of five 2 min intervals for a total of a 10 min session. Contingent
on meeting the criteria, reinforcement time was 2–3 min. The criterion
for this phase was 20% or less of intervals with vocal stereotypy.
No programmed consequence. At the start of the no programmed
consequence condition, the social story (Appendix B) was given to
David and he was instructed to read it aloud. Simultaneously, a green
wristband or watch was put on David’s wrist to signal the onset of
the green condition, and David was instructed of the condition spe-
cific contingency. There was no programmed consequence for any in-
stance of vocal stereotypy.
Interobserver Agreement
Interobserver agreement (IOA) was collected for 25% of sessions.
The behavioral consultant simultaneously recorded occurrences of
vocal stereotypy independent of the classroom staff. Data were com-
pared to identify the number of agreements and disagreements IOA
was calculated by dividing the number of agreements by the sum of
agreements and disagreements and multiplying by 100 to determine a
percentage. Agreement was 97% (range of 60% to 100%). The low data
point at 60% occurred during session 16 of baseline, when the behav-
ioral consultant recorded repeated occurrences of vocal stereotypy
during only one interval, but the classroom staff recorded the repeat-
ed occurrences of stereotypy as occurring across consecutive intervals
(i.e., although the repeated stereotypy occurred during the same in-
terval, the staff recorded each instance in a new interval). Feedback
on data collection was given to the staff following the recording error.
Recording errors were not observed during any subsequent observa-
tions, nor with any other classroom staff; therefore, additional train-
ing was not conducted.
Social Validity
Social validity was assessed with a 7-point Likert scale consist-
ing of 10 questions and a brief open-ended comments section (Ap-
pendix A). The form was adapted from the Treatment Acceptability
Rating Form-Revised (TARF-R; Reimers & Wacker, 1988). David’s
guardian, teacher, classroom staff, and home-based behavioral con-
sultant recorded data on social validity at the end of the study.
Results
Experimental conditions. The results of the baseline condition and
DRL/RC are shown in Figures 3 and 4. During baseline, David’s vo-
cal stereotypy occurred at moderate levels during recorded sessions,
420 LAPRIME and DITTRICH

averaging 60% of five 1 min partial intervals. When discrimination

training and DRL/RC was implemented, vocal stereotypy stabilized
with little variability at 56% of five 1min partial intervals on average
in criterion 1 of phase 1. Criterion increases resulted in decreases in
vocal stereotypy to 37% of five 1 min partial intervals on average in
criterion 2 of phase 1, 26% of five 1 min partial intervals on average in
criterion 3 of phase 1, and 15% of five 1 min partial intervals on aver-
age in criterion 4 of phase 1. When the criterion was decreased vocal
stereotypy increased to 28% of five 1 min partial intervals on aver-
age in criterion 5 of phase 1.A return to the previous criterion and an
increase in the duration of the session resulted in a decrease in vocal
stereotypy to 12% of five 1.5 min partial intervals on average in crite-
rion 6 of phase 2. The last criterion increase resulted in an additional
decrease in vocal stereotypy to 10% of five 1.5 min partial intervals on
average in criterion 7 of phase 2. A return to the previous criterion and
an increase in the duration of the session resulted in a slight decrease
in vocal stereotypy to 8% of five 2 min partial intervals in criteria 8 of
phase 3 (see Figure 3 and Figure 4).
Social validity. Results from the social validity assessment (Ap-
pendix A) indicated that staff rated the procedures as a socially ac-
ceptable way to decrease vocal stereotypy (mean of 5 out of 5 possible
points), while being easy to implement (mean of 4.5 out of 5 possible
points), and minimally intrusive to the participant (mean of 4.75 out
of 5 possible points). The raters also indicated that the procedures
resulted in an improved rate of appropriate vocalizations both dur-
ing (mean of 5 out of 5 possible points) and outside of session (mean
of 4.75 out of 5 possible points respectively), and did not result in
adverse side effects for the participant (mean of 5 out of 5 possible
points).
Discussion
In the current study, discrimination training paired with a
DRL/RC contingency effectively reduced the occurrence of automat-
ically reinforced vocal stereotypy in a public school preschool class-
room. The results of the intervention were achieved across a time pe-
riod of 5 months, demonstrating the efficacy of the intervention. The
results of the current study were similar to those of previous studies
(e.g., Falcomata et al., 2004; Rapp et al., 2009) and suggested that re-
sponse cost and discrimination training effectively reduced vocal
stereotypy. In addition, these procedures could be implemented in
a setting that was not experimental, with less experimental con-
trol, and still result in substantial reductions in interfering problem
behaviors.
VOCAL STEREOTYPY 421

Although there was some variability in the data, overall, the

contingent removal of a token paired with the opportunity to earn a
prize box for low rates of vocal stereotypy was effective at reducing
vocal stereotypy, even when the intervention was not implemented
the same number of times daily. It appeared that the presence of the
red bracelet enhanced the discrimination of the contingency when the
DRL/RC was in effect; therefore, the red bracelet came to exert SDP
control over vocal stereotypy. Rapp and colleagues (2009) suggested
that establishing SDP control might be useful in educational settings
because it may result in a teacher or trainer needing to provide fewer
consequences to maintain low levels of problem behavior. While the
current study did not record data on vocal stereotypy in the presence
of the red bracelet without the DRL/RC contingency, low levels of re-
sponding were maintained across 10 min sessions (Figure 3). These
data support that establishing stimulus control of automatically main-
tained problem behavior in the presence of arbitrary stimuli and not
teachers, may reduce the need for intensive teacher supports to main-
tain low levels of responding in educational settings.
Additionally, the red bracelet may have come to exert SD control
over other responses that resulted in social positive reinforcement;
therefore, in the presence of the red bracelet, positive tangible rein-
forcement (i.e., prize box) for behaviors other than vocal stereotypy
may have competed with the hypothesized automatic reinforcement
derived from the vocal stereotypy. Teacher reports indicated that to-
ward the end of the study, David occasionally refused the prize box
and asked to engage in the current activity and continue to wear the
red bracelet (i.e., restart the response cost). One hypothesis is that by
reducing the interference of vocal stereotypy, other activities in the
classroom became conditioned reinforcers. Alternatively, the tokens
themselves may have become conditioned reinforcers and keeping
them may have been as reinforcing as earning the prize box, thus sup-
porting the role of tokens as mediating reinforcement to the ultimate
reinforcer.
Teacher reports also indicated that there were days when David
engaged in vocal stereotypy and then asked the teachers for the red
bracelet. The response product of vocal stereotypy may have become
aversive due to being paired with the response cost contingency dur-
ing the DRL/RC condition. Previous researchers (i.e., Rappet al., 2009;
Lerman & Vorndran, 2002) demonstrated that verbal reprimands be-
came effective punishers after being paired with a response cost. A
similar effect may have occurred in the current study, except that the
response product of the vocal stereotypy may have become an effec-
tive punisher after the systematic pairing with the response cost.
422 LAPRIME and DITTRICH

The results of the current study contributed to the literature re-

garding effective treatment of vocal stereotypy in several ways. First,
outcomes replicated and extended the results of previous research
(i.e., Falcomata et al., 2004; Rapp et al., 2009) which demonstrated
the effectiveness of establishing SDP control via a negative punish-
ment procedure. Second, the current data demonstrated the utility of
employing differential reinforcement of low rates of behavior (DRL)
paired with mild punishment procedures to decrease automatically
maintained problem behavior that was not susceptible to other dif-
ferential procedures due to initial high rates of response. Lastly, the
current procedures were implemented throughout the day in a public
school preschool classroom. The classroom was integrated two days
per week and staffed by individuals with minimal experience with be-
havior analysis, and no experience conducting research. The obtained
data suggested that the current procedures were not only effective
but could be implemented in a natural environment without exten-
sive training in behavior analysis or research methods.
Anecdotal reports suggested that David’s vocal verbal behav-
ior increased in the classroom. Though no formal data were collected,
during observations David consistently used full sentences to tact the
occurrence of classroom events, intraverbals to answer questions, and
mands for attention. The DRL/RC contingency was also implemented
by David’s guardians in the home and community, and they reported
similar effects as the current study.
Several limitations to the current study should be noted. First,
a formal functional analysis was not conducted; therefore, other vari-
ables may have maintained David’s vocal stereotypy. Future studies
should ensure a function-based treatment prior to employing punish-
ment procedures. Second, criterion changes did not occur immedi-
ately after David met criterion for the phase. The experimenter was
only available to visit the classroom one to two times per week. Based
on this schedule, the phase was changed when the experimenter was
able to go into the classroom, score the data, and then inform the class-
room staff of the next phase. This resulted in some phases where Da-
vid met criterion and remained in the phase for many consecutive
sessions (e.g., criterions 5 and 8), or met criterion but then remained in
the phase and variable responding occurred (e.g., criterions 1, 2, 3, 4,
6, and 7). While it is unclear if the delayed criterion change influenced
response variability, substantial changes were evident, demonstrating
that the procedures were efficacious in a less controlled environment.
An additional limitation to the current study was that two
students with developmental disabilities joined the classroom dur-
ing the second phase of the study. Variability in those data may be
VOCAL STEREOTYPY 423

attributed to less sessions daily as well as increases in staff to stu-

dent ratios. Regardless, responding continued to remain at low lev-
els, suggesting that the intervention was one that would not require
constant staff attention to be successful. Another limitation was that
the green condition was implemented when David earned the prize
box and items that were hypothesized to evoke vocal stereotypy such
as Thomas the Tank Engine© were put into the prize box and not
available throughout the day. Previous studies (i.e., Charlop, Kurtz,
& Casey, 1990) have evaluated the effects of using automatically rein-
forced problem behavior as a reinforcer in differential reinforcement
programs. The hypothesis that vocal stereotypy may also have been a
reinforcer for low rates during the red condition was not evaluated in
this study but may warrant further investigation as an independent
variable. Additionally, the number of red and green sessions were not
held constant daily. While red sessions did occur two to four times
daily, there was no specific schedule; rather, session implementation
was based on the classroom staff having the opportunity to run the
program. Therefore it is unclear as to how many sessions were neces-
sary to establish and maintain SDP control of vocal stereotypy. Lastly,
vocal stereotypy was not measured in the green condition; therefore,
it is unclear if vocal stereotypy remained the same when not under
SDP control of the red bracelet or decreased across all conditions. If
data were recorded during the green condition and there was a de-
crease in responding compared to baseline, it would suggest that the
classroom itself came to exert some SDP control of vocal stereotypy.
If vocal stereotypy remained at the same levels in the green condi-
tion as in baseline, reductions during the red condition may also be
attributed to an abolishing operation in effect (Laraway, Syncerski,
Michael, & Poling, 2003). David was able to engage in behaviors that
produced automatic reinforcement at other times before and after the
onset of the red condition (i.e., during any time he wore the green
bracelet); therefore, he may have temporarily satiated on the response
product of vocal stereotypy, resulting in a momentary decrease in
the value of such reinforcement and reducing the occurrence of vocal
stereotypy.
An additional limitation was that David’s guardians were im-
plementing the system in the home and community. Reports from
the guardian and home-based behavioral consultant suggested that,
within the home and community settings, the intervention remained
at the beginning phases (i.e., 5 min sessions with 1 min intervals)
and that the procedures may have been altered slightly due to the
parents’ needs in the home and community. This may have pro-
duced a confound in two ways: 1) changing contingencies may have
424 LAPRIME and DITTRICH

mitigated some of the effects in the classroom, increasing variability

in vocal stereotypy and requiring that David contact the contingen-
cies in the classroom before coming under control of the classroom-
specific contingencies in place, and 2) the effects of the intervention
may have been artificially increased, and generalization across dif-
ferent staff and settings in the school may have been due to expo-
sure to the contingencies in locations and with persons outside of the
school, suggesting that some programming for generalization was in
fact occurring.
The results of the current study provided many areas that war-
rant further investigation. First, future research should evaluate if
changes in responding would remain suppressed without the token
system and only the presence of the red bracelet. Second, the occur-
rence of appropriate vocalizations should be measured. Previous re-
search (i.e., Ahearn et al., 2007; Rapp et al., 2009) found that there were
increases in appropriate vocalizations along with decreases in vocal
stereotypy when implementing punishment procedures for vocal ste-
reotypy. Future researchers should also compare the effects of estab-
lishing stimulus control with arbitrary stimuli (i.e., the red bracelet) or
stimuli in the environment that may naturally come to exert stimulus
control (i.e., the classroom activity or location). For example, when
one walks into the library, there is SDP control over the volume of one’s
voice due to a history of punishment from the librarian in the library.
One research question would be to evaluate generalization and sup-
pression of vocal stereotypy over time with naturally occurring stim-
uli being paired with the DRL/RC contingency as compared to the red
bracelet or some other arbitrary stimulus. Lastly, it should be evalu-
ated if the green condition is necessary for the development of strong
SDP control. The results of the current study have many implications
for practitioners, in terms of assessing and treating vocal stereotypy in
an applied setting, with classroom staff implementing the procedures.
The treatment package was developed based on the literature but also
addressed desired outcomes reported by the guardian and teacher
and the available resources of the behavioral consultant, the teacher,
and the classroom staff.
In the current study, David’s vocal stereotypy was brought
under control of the colored bracelets, with the addition of a cor-
responding response cost system and social story. While effective,
the intervention was implemented at various times per day with
different staff, and across multiple settings within the school. Re-
sults demonstrated that the effects of the intervention were general-
ized without direct training and that the effects were maintained
throughout vacations, during days with fewer sessions, and without
VOCAL STEREOTYPY 425

constant oversight by a graduate-level behavioral clinician. Further-

more, results suggested that a DRL with response cost procedure
may be an effective way to reduce behaviors maintained by auto-
matic reinforcement, without the use of extinction-based procedures
or the side effects typically associated with punishment procedures.
It remains imperative that behavioral consultants work with guard-
ians, teachers, and classroom staff to develop efficacious interven-
tions that can be successfully implemented with intermittent over-
sight from the consultant.
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VOCAL STEREOTYPY 429

Appendix A

Social Validity Scale

Token System + Red Bracelet
After implementing the procedures or watching the implemen-
tation of the procedures in the classroom, please answer all questions
honestly and to the best of your ability. His will help to interpret the
overall social validity of the study for future reference.

1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree,

5 = strongly agree

1. I like the token system + red bracelet procedure. 1  2  3  4  5

2. I think this procedure was easy to implement. 1  2  3  4  5

3. I am satisfied with my students/child’s response

1  2  3  4  5
to the procedure.

4. The token system + red bracelet reduced my stu-

1  2  3  4  5
dent/child’s vocal stereotypy during the session.

5. I thought the token system + red bracelet proce-

1  2  3  4  5
dure was intrusive.

6. The token system + red bracelet program was a

socially appropriate intervention for my student/ 1  2  3  4  5
child.

7. I think token system + red bracelet training re-

sulted in an improved rate of appropriate vocal- 1  2  3  4  5
izations during the session.

8. I think token system + red bracelet resulted in

an improved rate of appropriate vocalizations out- 1  2  3  4  5
side of the sessions.

9. My child/student will benefit in the long run

1  2  3  4  5
from the procedures implemented in this study.

10. I think token system + red bracelet training

produced negative emotional reactions in my stu- 1  2  3  4  5
dent/child.

Please feel free to write in any additional comments regarding the

study here:
430 LAPRIME and DITTRICH

Appendix B
Red Condition Social Story:

Green Condition Social Story: