Click here to Order a Custom answer to this Question from our writers. It’s fast and plagiarism-free.

1page summary on article attached. 




Stereotypy has been classified as repetitive behavior that does not serve any apparent function.
Two procedures that have been found to reduce rates of vocal stereotypy effectively are response
interruption and redirection (RIRD) and noncontingent access to matched stimulation (MS).
The purpose of the current study was to evaluate the effects of RIRD alone, MS alone, and MS
combined with RIRD. One participant’s results suggested similar suppressive effects on vocal
stereotypy across treatment conditions. For the second participant, a slightly greater suppression
of stereotypy was associated with MS þ RIRD. In addition, both participants emitted a greater
frequency of appropriate vocalizations in conditions with RIRD. Data suggest that the addition
of MS might facilitate the implementation of RIRD in applied settings.

Key words: autism, matched stimulation, response interruption and redirection, vocal

The term stereotypy is often used to classify
either motor or vocal repetitive behavior that
does not appear to serve an adaptive function
(Lovaas, Newsom, & Hickman, 1987). Al-
though stereotypy is not displayed exclusively
by individuals with disabilities, an increased
rate can be observed in this population,
especially in those diagnosed with autism
(American Psychiatric Association, 2005; Lewis
& Bodfish, 1998; Repp & Barton, 1980).
Stereotypy is typically targeted for reduction
given that it may interfere with learning,
compete with more functional responses, and
be socially stigmatizing (e.g., Durand & Carr,
1987; Koegel & Covert, 1972; Matson, Kiely,
& Bamburg, 1997; Repp & Barton, 1980).
Vocal stereotypy specifically may compete with

more adaptive forms of communication (e.g.,
mands) and also create disruptions for other
people in the social environment (e.g., Athens,
Vollmer, Sloman, & St. Peter Pipkin, 2008).

Lovaas et al. (1987) suggested that stereo-
typical responding functions to provide sensory
input to an individual. That is, it produces
automatic reinforcement. Stereotypic behavior
maintained by automatic reinforcement may be
more difficult to treat because one does not
have access to the exact source of reinforcement
(Vollmer, 1994). Despite these challenges,
interventions have emerged to treat automati-
cally reinforced stereotypy. Two of the recently
evaluated treatments are response interruption
and redirection (RIRD; e.g., Ahearn, Clark,
MacDonald, & Chung, 2007; Ahrens, Lerman,
Kodak, Worsdell, & Keegan, 2011; Duffy-
Cassella, Sidener, Sidener, & Progar, 2011;
Liu-Gitz & Banda, 2010; Miguel, Clark,
Tereshko, & Ahearn, 2009) and noncontingent
access to matched stimulation (MS; e.g.,
Lanovaz, Fletcher, & Rapp, 2009; Rapp,
2007; Taylor, Hoch, & Weissman, 2005).

Ahearn et al. (2007) evaluated RIRD with
four participants who displayed automatically
reinforced vocal stereotypy. During RIRD, the
experimenter interrupted the participants’ vocal
stereotypy and then redirected them to emit

This study is based on a thesis submitted by the first
author under the supervision of the second author to the
Psychology Department at California State University,
Sacramento in partial fulfillment of the requirements for
an MA degree in Psychology: Applied Behavioral
Analysis. Jessica Love is now at the University of Nevada,
Las Vegas. We thank Timothy Fechter for his assistance
with data collection and Tiffany Kodak for her editorial

Address correspondence to Caio Miguel, Department
of Psychology, California State University, Sacramento,
6000 J St., Sacramento, California 95819 (e-mail:

doi: 10.1901/jaba.2012.45-549



appropriate vocalizations such as answering
social questions. Results showed a decrease in
vocal stereotypy for all four participants and an
increase in the frequency of appropriate
vocalizations for three of four participants. In
a more applied extension, Liu-Gitz and Banda
(2010) evaluated teacher-implemented RIRD
in a natural classroom setting. Results showed
significant reductions in vocal stereotypy and
provided further evidence for the efficacy of
RIRD in school settings. Recently, Ahrens et al.
(2011) sought to isolate the mechanism that is
responsible for the effects of RIRD by imple-
menting a treatment integrity fading procedure
modeled after Lerman and Iwata (1996) and
Smith, Russo, and Le (1999). Results indicated
that reductions in vocal stereotypy followed a
pattern of responding indicative of positive

Because vocal stereotypy may occur quite
frequently, a high number of RIRD implemen-
tations may be required to achieve considerable
reductions in behavior, which may prevent
clinicians from adopting the procedure (Miguel
et al., 2009). This limitation may be circum-
vented by potentially decreasing the motivating
operation (MO) for engaging in stereotypy
through the presentation of stimuli that
produce the same hypothesized sensory conse-
quence as the problem behavior (Piazza,
Adelinis, Hanley, Goh, & Delia, 2000; Piazza
et al., 1998). The addition of these stimuli
(matched stimulation) to a treatment with
RIRD may be a more efficient approach than
RIRD alone, because decreasing the MO for
the products of stereotypy may result in fewer
implementations of RIRD. Piazza et al. (1998,
2000) investigated the effects of MS on pica,
saliva manipulation, hand mouthing, jumping,
and climbing, which were all maintained by
automatic reinforcement. Participants received
continuous access to items that produced either
the same (matched) or different (unmatched)
forms of stimulation. Results indicated a greater
reduction in the target behaviors for most
participants when they were given continuous

and noncontingent access to items that were
hypothesized to match the target behavior’s
sensory consequences.

Fisher, Lindauer, Alterson, and Thompson
(1998) also evaluated the effects of MS and
unmatched stimulation on stereotypic object
breaking plus tapping. Results indicated that
matched toys alone decreased stereotypy for one
of the two participants. Following the addition
of response blocking to MS for one participant,
rates of stereotypy further decreased and
appropriate manipulation of the matched toys
increased. Thus, previous literature on MS and
noncontingent reinforcement highlights the
potential benefits of supplementing a re-
sponse-blocking procedure with MS.

In light of the aforementioned findings, the
present investigation sought to evaluate whether
the use of MS would increase the effectiveness of
RIRD. By lowering the MO for the products of
stereotypy, the addition of MS could increase
the feasibility of implementing RIRD in school
or community settings if the inclusion of MS
decreases the number of times RIRD must be
implemented. In addition, the relative efficacy
of MS and RIRD treatment components were
evaluated both alone and as a treatment package.


Participants, Setting, and Materials
Participants were two children who had been

diagnosed with an autism spectrum disorder by
independent psychologists. Both participants
communicated vocally, could sit for a mini-
mum of 5 min in the absence of aggression
(e.g., hitting, kicking, punching) or self-injury
(e.g., scratching, hitting, biting him- or herself),
and engaged in vocal stereotypy that was at least
partially maintained by automatic reinforce-
ment, as determined by a functional analysis
(Iwata, Dorsey, Slifer, Bauman, & Richman,
1982/1994). Parents referred their children to
participate in the study because their children’s
vocal stereotypy was considered to be intrusive
in school or public settings.

550 JESSICA J. LOVE et al.

Ivan was an 8-year-old boy who vocally
communicated with others. He requested highly
preferred items using ‘‘I want —.’’ Ivan could
tact colors and numbers. His fine motor skills
were consistent with those of his typical peers.
We conducted sessions in his bedroom (2 m by
3 m), which contained a bed, a small table and
two chairs, various leisure items, and mirrored
closet doors. Ivan did not take any medications
throughout the duration of the study.

Troy was a 9-year old boy who requested
items using full sentences (e.g., ‘‘I want Elmo,
please’’). He could also tact colors and identify
numbers up to 30. Troy’s parents reported that
his general academic abilities were comparable
to his peers. Troy did not take any medication
for the duration of the study. We conducted
sessions in a treatment room (2 m by 3 m)
equipped with a table and two chairs, a bulletin
board, a video camera, and toys.

We conducted approximately three to four
sessions per day, 2 to 3 days per week with both

Response Measurement
Observers collected data on four dependent

variables for each participant: vocal stereotypy,
appropriate vocalizations, frequency of imple-
mentation of RIRD, and session length. For
Ivan, vocal stereotypy was defined as any
instance of noncontextual phrases or repetitions
of noncontextual words, phrases, or sounds. It
included noncontextual repetitions, defined as
at least two occurrences of phonemes (two or
more emissions of the same phoneme within a
5-s interval; e.g., ‘‘mm mm’’ or ‘‘na na na’’) or
phrases (e.g., ‘‘J is for jaguar’’), delayed
echolalia (e.g., ‘‘We go to the doctor first,
then Blockbuster’’), lip popping, and repeti-
tious sounds with a closed mouth (e.g.,
‘‘bbbbbb’’ sound with mouth closed and lips
vibrating). Sound effects in the absence of
appropriate toys (e.g., ‘‘shoo’’ or ‘‘vroom’’),
rhythmic breathing patterns (e.g., ‘‘huh huh
huh’’ or ‘‘heh heh heh’’), and noncontextual
repetitive blowing of air (e.g., blowing in the
absence of candles) were also included. Troy’s
vocal stereotypy was defined as any instance of

noncontextual or nonfunctional speech, includ-
ing rhythmic or patterned breathing (e.g., ‘‘huh
huh huh,’’ ‘‘heh heh heh,’’ or breathing inward
through pursed lips) and single phonemes (e.g.,
‘‘mmm’’). Repetitions of words, phonemes
(e.g., ‘‘kkk,’’ ‘‘tuh tuh tuh’’), or noncontextual
high-pitched squeals or squeaks, and reciting of
movie or videogame scripts were also included.

Ivan’s and Troy’s appropriate vocalizations
included mands for items, attention, or breaks
using the ‘‘I want —’’ frame and tacts that
included vocalizing the name of an item in its
presence (e.g., ‘‘tiger’’ in the presence of a tiger
figurine). For both participants, we did not
score repetitive mands (e.g., ‘‘I want break, I
want break’’) or tacts (e.g., ‘‘tiger, tiger’’) as
vocal stereotypy unless the phrase was non-
contextual (e.g., ‘‘crocodile, crocodile’’ when no
crocodile was present). Furthermore, the repet-
itive tact was considered appropriate and
contextual if the participant exhibited shared
interaction with the experimenter. For example,
if the participant looked at the tiger and looked
at the experimenter while saying ‘‘tiger’’ during
the second repetition of the word tiger, this
behavior was scored as appropriate. We scored
the above-mentioned examples of vocalizations
as appropriate because it was assumed that joint
attention with the experimenter during the
vocalization might have served a social func-
tion. Moreover, if a participant repeated the
same vocalization within 5 s (e.g., ‘‘I want
break, I want break’’), we scored only one
instance of an appropriate vocalization. RIRD
implementation was defined as the experiment-
er saying the participant’s name, the participant
complying with three vocal imitation demands
or social questions, and the experimenter
delivering praise (e.g., ‘‘Nice job talking’’).

We measured vocal stereotypy using duration
recording. To calculate the percentage of
stereotypy that occurred in each session, we
divided the total number of seconds the
participant engaged in vocal stereotypy by the
total number of seconds in the session (i.e., 300
s) and converted this number to a percentage.


Observers did not record data on vocal
stereotypy or appropriate vocalizations when
the experimenter implemented RIRD. Further-
more, the experimenter stopped the session
clock each time he or she implemented the
procedure to ensure that time spent imple-
menting RIRD was taken out of the 5-min total
session time.

Data on appropriate vocalizations and im-
plementation of RIRD were collected using
frequency recording and expressed as cumula-
tive frequency across sessions. At the conclusion
of the study, we calculated and compared the
average number of implementations of RIRD
per session during the conditions of MS þ
RIRD and RIRD alone for each participant. In
addition, averages for each condition were
compared across participants.

Interobserver Agreement
A second trained observer scored data

during at least 33% of all conditions by
watching the video footage. We calculated
agreement on occurrences of stereotypy
using a time-window analysis method
(Mudford, Martin, Hui, & Taylor, 2009),
which involved a second-by-second compar-
ison across the two observers for both
occurrence and nonoccurrence of stereotypy.
We scored an agreement if both observers
agreed that stereotypy occurred or did not
occur for a 1-s interval. We divided the
number of agreements by the number of
agreements plus disagreements and convert-
ed this number to a percentage. We also
calculated interobserver agreement for ap-
propriate vocalizations using the total agree-
ment method by comparing the cumulative
frequencies recorded by observers. The
smaller total from one observer was divided
by the larger total from the second
observer and this number was converted
to a percentage. Mean agreement for vocal
stereotypy and appropriate vocalizations was
96% (range, 89% to 100%) and 95%
(range, 84% to 100%), respectively. Mean
agreement for appropriate vocalizations was

Treatment Integrity
We collected treatment integrity on imple-

mentation of RIRD and MS during a portion
of sessions in each condition of the treatment
evaluation. Correct implementation of RIRD
was scored if the experimenter delivered RIRD
within 2 s of vocal stereotypy and ensured that
the participant complied with three consecutive
demands in the absence of stereotypy. We
calculated integrity during RIRD by dividing
the total number of correct implementations of
RIRD by the total number of opportunities to
implement RIRD in the session. The quotient
was converted to a percentage of overall
treatment integrity for the implementation of

Treatment integrity was also calculated
during conditions that included the delivery
of MS using 5-s partial-interval recording. An
interval was scored as containing MS if the toys
were making sounds at any time during the 5-s
interval. We divided the number of intervals
containing MS by the total number of intervals
for each session (i.e., 60) and converted the
result to a percentage to obtain an overall
percentage of integrity. Session percentages
were then added and averaged to yield a
percentage of overall integrity of MS for each

Across both participants, we evaluated treat-
ment integrity for implementation of RIRD
during 41% of sessions and for implementation
of MS during 36% of sessions. Treatment
integrity averaged 96% (range, 92% to 100%)
for RIRD and 99% (range, 93% to 100%) for


We conducted a stimulus preference assess-
ment, a functional analysis, RIRD probes, and a
matched stimuli assessment prior to the
experimental evaluation.

Preference Assessment
The experimenter conducted three sessions

of a multiple-stimulus without replacement
(MSWO) preference assessment for both
matched and unmatched toys based on proce-

552 JESSICA J. LOVE et al.

dures described by DeLeon and Iwata (1996).
Toys classified as ‘‘matched’’ were those that
made sound, and toys classified as ‘‘un-
matched’’ were toys that did not make sound.
The presence or absence of these toys was
planned for each condition, because vocal
stereotypy was hypothesized to be maintained
by auditory stimulation. Parents completed a
modified Reinforcer Assessment for Individuals
with Severe Disabilities (RAISD; Fisher, Piazza,
Bowman, & Amari, 1996) to identify some of
the items included in the preference assess-
ments. Along with the items identified via the
RAISD, the experimenter conducted an
MSWO to identify additional items. Two
preference assessments were conducted, one
for 10 toys that produced sound and one for 10
toys that did not produce sound. Thereafter,
one MSWO per day was conducted with the
seven top-ranked items. Depending on the type
of sessions conducted during a day, sometimes
the experimenter conducted two preference
assessments (one for matched and one for
unmatched). The toys that produced sound
were later tested (MS assessment) to see
whether they would compete with the auditory
product (i.e., automatic reinforcer) of vocal

Items identified for inclusion in functional
analysis sessions were highly and moderately
preferred toys that did not produce sound. The
use of these toys served to control for potential
suppressive effects that sound may have exerted
on stereotypy levels (e.g., Rapp, 2006, 2007).
Anecdotal observations indicated that the
highly preferred items used during sessions of
the functional analysis did not suppress stereo-
typy. The experimenter randomly selected four
items identified as moderately and highly
preferred from the daily MSWO for baseline
and treatment sessions to prevent potential
satiation effects.

Functional Analysis
We conducted a functional analysis of vocal

stereotypy according to procedures described by
Roscoe, Carreau, MacDonald, and Pence
(2008) and Athens et al. (2008). We rotated

among seven highly and moderately preferred
toys from the initial MSWO during sessions,
with three toys per functional analysis session
(that required toys). Toys were rotated to
prevent satiation. The toys included in the
previous session were not made available in
subsequent sessions unless the participant
requested an item or indicated sustained
preference (e.g., continually looking at the item
or reaching for it), in which case he received
access to it during the next session.

We conducted three conditions in the
functional analysis in a fixed order: no
consequence, attention, and demand. We
conducted twice as many no-consequence
sessions as demand and attention sessions,
because we hypothesized that stereotypy was
maintained by automatic reinforcement. An
extended no-consequence condition was con-
ducted for Ivan only, given that his perfor-
mance was low and undifferentiated during the
last few sessions of the multielement functional
analysis. Sessions lasted 5 min.

No consequence. Participants had continuous
access to two toys identified as moderately
preferred from the initial MSWO preference
assessment. We included moderately preferred
toys so that they would not compete with
stereotypy (Ahearn, Clark, DeBar, & Florenti-
no, 2005). The experimenter withheld social
interactions by sitting in a chair and looking
away from the participant. The person filming
the session was across from the participant and
also did not interact with him. No programmed
consequences were provided for appropriate

Attention. The participant and experimenter
sat in a room in which two moderately
preferred toys (that did not produce sound)
were available on a table. Contingent on vocal
stereotypy, the experimenter responded by
lightly touching the participant on the shoulder
and saying, ‘‘Don’t do that; it’s loud’’ or
‘‘Please be quiet.’’

Demand. The experimenter rotated the
presentation of four tasks similar to those
presented during the participant’s school or


day-treatment program. We selected unmas-
tered (e.g., less than 80% correct) and nonvocal
tasks based on caregiver report. Demands for
Ivan included hanging a shirt on a coat hanger,
tying a shoe, folding a shirt, and buttoning a
shirt. Demands for Troy included solving three-
digit multiplication problems, tying a shoe,
catching a ball, and putting pennies into a box
with one hand. The experimenter used a least-
to-most prompting hierarchy for all task
presentations. Contingent on stereotypy, the
experimenter said, ‘‘Okay, you don’t have to’’
and removed the task for 15 s. No programmed
consequences were provided for appropriate

MS Assessment
The purpose of this assessment was to

demonstrate that the items used in conditions
containing MS would suppress vocal stereoty-
py. We conducted the assessment using a
multielement design and rapidly alternated
among three conditions: baseline, toys with
sound, and toys without sound. We alternated
each baseline session with one of the toy
conditions to avoid carryover effects. During
Phase 1, we alternated between baseline sessions
and toys with sound (i.e., matched stimula-
tion). During Phase 2, we alternated between
baseline and toys without sound. Phase 1 was
then reinstated to replicate the effects of
matched toys. Each session lasted 5 min.

Baseline. The purpose of this condition was
to evaluate levels of vocal stereotypy in the
absence of toys and social interaction. The
experimenter sat in the room with the partic-
ipant but did not interact with him in any way.
No leisure items or materials were present.
Although sessions began with the participant
seated in a chair, he was free to move about the
room, and the experimenter did not redirect
him to sit.

Toys with sound. The purpose of this
condition was to measure levels of vocal
stereotypy in the presence of toys that produced
sound, because we wanted to determine
whether the auditory stimulation matched or

effectively substituted for the sensory conse-
quences typically produced by engaging in vocal
stereotypy (Rapp, 2007). Sessions included two
of four preferred items (identified in an
MSWO). Thus, we evaluated two sets of toys.
During the session, the participant sat at a table
or on the floor and had access to a set of toys.
Following 2 s without toy activation, the
experimenter manipulated the item to produce
auditory stimulation. This ensured consistent
delivery of MS throughout the condition. After
demonstrating that the presence of both sets of
toys reduced stereotypy, the experimenter
rotated the two sets during treatment condi-
tions that included MS.

Toys without sound. The purpose of this
condition was to evaluate vocal stereotypy levels
in the presence of toys that did not produce
sound. We used the same toys as those in the
toys-with-sound condition but removed the
batteries (Taylor et al., 2005). This condition
sought to isolate the effects of the sound
produced by the toys on vocal stereotypy.

RIRD Probes
Prior to treatment, an assessment probe was

conducted to identify appropriate vocal de-
mands for use during conditions containing
RIRD. Prior to the study, we conducted probes
of tasks that required vocalizations across two
different experimenters and two different
settings for a minimum criterion of 89%
accuracy. The results indicated that both
participants were most consistent and accurate
with vocal imitation of two-syllable words.

From a master list of 15 words, we created
three lists that contained 10 words and
randomly rotated these lists across all sessions
(lists available from the second author). We
used the same word lists for both participants
because of similar performances during the
RIRD probes. The experimenter presented all
words from the lists created during the probe
session. The purpose of these lists was to ensure
demand consistency across all experimenters.
The experimenter randomly determined the
order of words from each list by assigning

554 JESSICA J. LOVE et al.

numbers to each item and then drawing
numbers from a hat. The list was placed out
of the participant’s view. A different list was
used each day. Approximately three to four
sessions were conducted per day.

During all conditions, the participant had

access to two toys (matched or unmatched) and
had the opportunity to interact with the
experimenter. The experimenter smiled and
visually attended to the participant while he
played, but did not say anything unless the
participant emitted an appropriate vocalization.
For example, if the participant said, ‘‘Dino-
saur!’’ while playing with a dinosaur magnet,
the experimenter responded by saying, ‘‘You’re
right, that is a dinosaur! Nice talking!’’

Baseline and MS-alone conditions lasted
exactly 5 min. RIRD and MS þ RIRD
conditions were longer than 5 min depending
on the frequency of implementation of RIRD.
There was no session cap for conditions with

If the participant left his chair at any point
during a session in any condition, the
experimenter provided a gestural prompt by
pointing towards or tapping the seat of the
chair. If the participant complied with sitting
in the chair, the experimenter delivered praise.
If he did not sit within 5 s of the prompt, the
experimenter provided a vocal prompt,
‘‘[Name], sit down please.’’ Compliance re-
sulted in praise. If the participant did not
comply with the vocal prompt, the experi-
menter physically guided the participant back
to his chair by touching his back and walking
with him back to the chair.

The two toys included in baseline and
RIRD-alone sessions were identified as moder-
ately preferred from the preference assessment
and did not produce sound. We selected
moderately preferred toys because previous
research has shown that highly preferred items
(although unmatched in stimulation) could
occasion reductions in vocal stereotypy (Ahearn
et al., 2005). The participant had the oppor-

tunity to manipulate only one toy at a time. He
could gain access to the other toy by requesting
it. All conditions, with the exception of
baseline, included prompts to engage in a
mand if a participant was looking at a toy
(indicating interest) but did not ask for it.

To facilitate discrimination between MS þ
RIRD and RIRD-alone conditions, the exper-
imenter wore a blue shirt during sessions in
which matched stimulation was available
(paired with the MS þ RIRD and MS-alone
condition) and a black shirt during sessions in
which MS was not available (paired with the
RIRD-alone condition). The experimenter also
paired the instruction ‘‘We’re going to play
with toys that make noise’’ with the blue shirt.
With the black shirt, the experimenter paired
the instruction, ‘‘We’re going to play with quiet
toys.’’ During baseline, the experimenter wore
any color shirt other than blue or black and did
not provide any instructions.

Baseline. The participant had access to two
unmatched toys in a room with the experi-
menter. No programmed consequences were
provided contingent on vocal stereotypy. We
conducted at least three sessions or continued
conducting sessions until a steady state of vocal
stereotypy was observed. If a steady state was
not achieved within 10 sessions, then the next
condition was introduced. This was also the
criterion for introduction of all subsequent

MS þ RIRD. The procedures included those
described by Rapp (2007) for MS and Ahearn
et al. (2007) for RIRD. The participant had
continuous access to one of two toys that
produced auditory stimulation. The experi-
menter rotated the two sets of toys when
conducting more than one session per day. If
the participant stopped engaging with the toy
for longer than 2 s, the experimenter manipu-
lated the toy to produce sound. The experi-
menter activated the toy approximately five
times per session; however, in some sessions the
toy was never activated.


Contingent on vocal stereotypy, the experi-
menter removed the toy, interrupted the
participant’s stereotypy, and redirected the
participant by saying the boy’s name in a
neutral tone of voice before issuing a demand to
engage in a vocal response (as described by
Ahearn et al., 2007). The removal of the toys
during RIRD functioned both to increase the
likelihood of participants attending to demands
during RIRD and to increase the MO for the
emission of the request. If the toy produced
sound at the time of RIRD implementation,
the experimenter did not silence the toy. A
secondary observer stopped the session clock
during implementation of RIRD.

The vocal demands during RIRD were a
series of three vocal imitations of words (e.g.,
‘‘Troy say ‘hopscotch,’ say ‘binder,’ say …

Place your order now for a similar assignment and have exceptional work written by one of our experts, guaranteeing you an A result.

Need an Essay Written?

This sample is available to anyone. If you want a unique paper order it from one of our professional writers.

Get help with your academic paper right away

Quality & Timely Delivery

Free Editing & Plagiarism Check

Security, Privacy & Confidentiality