Pre-Session Satiation as a Treatment for Stereotypy During Group Activities.

511631 research-article2013 Rispoli et al.

BMO38310.1177/0145445513511631Rispoli et al.Behavior Modification

Article

Pre-Session Satiation as a Treatment for Stereotypy During Group Activities

Behavior Modification 2014, Vol. 38(3) 392–411 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0145445513511631 bmo.sagepub.com

Mandy Rispoli1, Síglia Hoher Camargo1, Leslie Neely1, Stephanie Gerow1, Russell Lang2, Fara Goodwyn1, and Jennifer Ninci1

Abstract Individuals with developmental disabilities may engage in automatically reinforced behaviors that may interfere with learning opportunities. Manipulation of motivating operations has been shown to reduce automatically maintained behavior in some individuals. Considering behavioral indicators of satiation may assist in identifying the point at which an abolishing operation has begun to effect behavior. The purpose of this study was to evaluate the effects of pre-session satiation of automatic reinforcement on subsequent levels of stereotypy and activity engagement during group activities for three males ages 5 to 13 years with developmental disabilities. Following functional analyses with analogue conditions, an alternating treatment design compared a pre-session access to stereotypy condition with a no-presession access condition prior to group activity sessions. Results indicated that pre-session satiation of the putative reinforcer produced by stereotypy was effective in decreasing stereotypy and increasing activity engagement during subsequent group activities for all participants. These findings add to the literature supporting the effectiveness of abolishing operations to decrease automatically maintained stereotypy.

1Texas 2Texas

A&M University, College Station, USA State University, San Marcos, USA

Corresponding Author: Mandy Rispoli, Texas A&M University, 4225 TAMU, College Station, TX 77843, USA. Email: [email protected]

Downloaded from bmo.sagepub.com at UNIV OF CONNECTICUT on June 9, 2015

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Keywords abolishing operation, stereotypy, automatically maintained behavior, autism Children with autism and other developmental disabilities are at an increased risk of engaging in stereotypy (MacDonald et al., 2007). When stereotypy is left untreated, children can experience social isolation and may be excluded from learning opportunities (Lanovaz, Robertson, Soerono, & Watkins, 2013). Unfortunately, stereotypy maintained by automatic reinforcement can be difficult to treat as the manipulation of social consequences may not influence the occurrence of stereotypy (Rapp, 2004; Rapp & Vollmer, 2005; Vollmer, 1994). Previous intervention research on stereotypy has typically produced mixed outcomes with most treatments showing short-term reductions in stereotypy (Rapp & Vollmer, 2005). Recently, research exploring treatments for stereotypy has begun to focus on the manipulation of motivating operations (MOs; Laraway, Snycerski, Michael, & Poling, 2003). A MO is defined as an event that changes the value of reinforcement and the frequency of behavior previously correlated with that reinforcement. Within this construct, there is the establishing operation (EO) which increases the value of the reinforcer and increases the frequency of behavior previously associated with that reinforcer, and the abolishing operation (AO) which decreases the value of the reinforcer and decreases the frequency of behavior previously correlated with that reinforcer. In particular, the manipulation of AOs has been shown to reduce stereotypy in some individuals with developmental disabilities (e.g., Lang et al., 2009). Previous literature investigating the manipulation of the AO has found subsequent decreases in stereotypy associated with the antecedent-based intervention. In a 2010 study, Chung and Cannella-Malone found that presession access to an AO condition led to a reduction in participants’ stereotypy during subsequent work sessions. Simmons, Smith, and Kliethermes (2003) also documented a reduction in their participant’s stereotypic hand mouthing behavior following the presentation of food on a fixed interval schedule, suggesting that food presentation acted as an AO for the mouthing behavior. AO manipulation has also extended to providing pre-session access to stereotypy (i.e., time to engage in stereotypic behavior without interruption) in an attempt to reduce subsequent engagement in stereotypy. In an effort to reduce stereotypy (i.e., object twirling), Rapp (2004) evaluated an AO procedure consisting of providing unrestricted access to stereotypy and environmental enrichment to a 10-year-old boy with Down syndrome and intellectual disability. Two sessions were held each day with the first session occurring without prior access to stereotypy and the second


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session occurring after the participant had unrestricted access to stereotypy. Although variable, overall results showed that stereotypy was lower during the second sessions, which followed unrestricted access to stereotypy, as compared with first sessions of the day. These findings suggest that providing pre-session access to stereotypy may have an abative effect on subsequent engagement in stereotypy. Vocal stereotypy has also been influenced by access to a matched and unmatched stimuli (Lanovaz, Fletcher, & Rapp, 2009; Rapp et al., 2013). In a 2009 study, Lanovaz et al. found immediate decreases in stereotypy during access to matched and unmatched stimuli for two of the three participants. However, the participants’ vocal stereotypy typically returned to baseline levels when access to matched and unmatched stimulation was removed. For one participant, engagement in stereotypy was reduced following the removal of the matched and unmatched stimuli. These mixed findings suggest that 10 min of access to matched or unmatched stimulation was not an AO for subsequent stereotypy. One possible explanation for these results may be that Lanovaz et al. (2009) provided access to matched or unmatched stimulation for a set period of time (10 min) and that time allotment may not have been enough to produce a state of satiation sufficient to abate the stereotypic behavior. This “paradoxical effect” of pre-session access has also been previously documented (Roantree & Kennedy, 2006). To ensure that an AO is in effect, Rapp and Vollmer (2005) suggested allowing access to reinforcement until the individual reaches a “switch point” (p. 532) or a point at which the individual’s responding patterns change. O’Reilly et al. (2009) demonstrated the utility of such a switch point for tangibly maintained challenging behavior by comparing behavioral indicators of satiation with time-based indicators of satiation. Behavioral indicators of satiation involve some change in behavior that occurs as the reinforcer maintaining the target behavior (e.g., stereotypy) begins to lose power. For example, the rate of stereotypy may begin to decrease or the topography may change. Behavioral indicators, as opposed to time-based approaches, have recently been utilized to signal that reinforcer power is waning (Lang et al., 2009; Lang et al., 2010; Rispoli, O’Reilly, Lang, et al., 2011; Rispoli, O’Reilly, Sigafoos, et al., 2011). Lang et al. (2010) evaluated the use of a behavioral indicator of satiation for decreasing subsequent engagement in stereotypy during play interventions for four young children with autism. Participants received an intensive one-on-one play intervention designed to increase functional play skills. Prior to the play intervention, participants were exposed to one of two conditions: pre-session access to stereotypy until the occurrence of a behavioral indicator of satiation, or no pre-session access to stereotypy. Results showed


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that stereotypy was lower during the play intervention sessions that followed pre-session satiation. This study highlights the potential utility of behavioral indicators of satiation to treat stereotypy in a highly controlled one-on-one setting. The purpose of the current study was to extend findings from previous research on the effects of pre-session satiation on automatic reinforcement as a treatment for subsequent engagement in stereotypy. Specifically, this study aimed to evaluate the effects of pre-session satiation on subsequent levels of stereotypy and activity engagement during group activities for three children with developmental disabilities.

Method Participants and Setting Three boys with developmental disabilities participated in this study. All participants were referred to this study for engagement in repetitive behaviors that were disruptive to group activities. Antonio was a 5-year-old Mexican American male diagnosed with autism. Antonio lived at home with his parents and two younger siblings. He attended a self-contained classroom for students with autism at a local public elementary school. Antonio was nonverbal and had no formal communication system, though he was being introduced to the Picture Exchange Communication System (PECS) at school. Antonio was referred to this study by his parents for engaging in repetitive high-pitched squealing vocalizations. All study phases took place in Antonio’s home after school. Jeff was a 12-year-old Caucasian male diagnosed with intellectual disability and seizure disorder. Jeff lived at home with his mother. He attended a self-contained classroom for students with intellectual disabilities at a local public middle school. Jeff had no functional speech or formal systematic means of communicating. Though Jeff had no spontaneous speech, he was able to make vocal approximations of single words in response to model prompts. Jeff was referred to this study by his teacher for engaging in repetitive banging of objects against surfaces. Jeff would repeatedly strike handheld objects against tables, chairs, and walls. According to Jeff’s teacher and based on classroom observation data, Jeff most often engaged in stereotypy with a 30-cm wooden cylinder to strike against surfaces. The teachers reported that the striking of the cylinder against surfaces was extremely disruptive to the class. Jeff’s stereotypy was therefore operationally defined as striking the wooden cylinder against a surface. All Jeff’s sessions took place in his special education classroom.


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Joel was a 4-year-old Caucasian male diagnosed with autism. He attended a university-supported autism clinic for 3 hr a day, 4 days a week. Joel also received daily one-on-one behavioral therapy in his home for 2 hr. He was able to spontaneously communicate using four- to six-word phrases. Joel was referred to this study by his mother for repetitively dropping/bouncing objects such as balls or small toys against the floor. This behavior often resulted in the destruction of the object being bounced and was considered inappropriate by the family. Due to the risk of property destruction and potential injury, stereotypy was operationally defined as dropping/bouncing a ball against the floor during all of Joel’s sessions. For all subsequent phases, stereotypy was defined as dropping or bouncing the ball against the floor. It was hypothesized that access to the ball produced stimulation similar to that produced by dropping other objects. All study phases took place at the university-supported autism clinic.

Dependent Variables and Response Measurement Data were collected by special education doctoral students trained in event recording procedures. Data were collected using paper-and-pencil in vivo for Jeff and Joel and through recorded videos of each session for Antonio. Data were collected on stereotypy using 10-s partial interval recording. Antonio’s stereotypy included vocalizations in the form of a squeak or squeal. Jeff’s stereotypy was defined as striking an object against a hard surface producing an audible sound from 60 cm away. Joel’s stereotypy was defined as bouncing or dropping an object to the floor. During the preference assessment (Antonio only), data were also collected on toy manipulation using 10-s partial interval recording. Toy manipulation was defined as the participant touching or interacting with the stimulus in any way. During the treatment evaluation phase of this study, data were also collected on activity engagement for all participants. Activity engagement was defined as being appropriately involved with the instructional materials or with other individuals present during the session. For example, activity engagement may include the participant looking at pictures in a book, placing a piece in a puzzle, drawing with a marker on paper, or interacting appropriately with another individual in the class. Activity engagement was measured using 10-s whole interval recording.

Interobserver Agreement (IOA) A second trained observer collected reliability data for at least 30% of sessions for each participant during each phase of the study. During the in vivo


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sessions, two observers were seated in the classroom and recorded data simultaneously and independently. During the video recorded sessions, two observers viewed the video and recorded data simultaneously and independently. IOA scores for stereotypy, toy manipulation (Antonio only), and activity engagement were calculated by dividing the total number of agreements for each dependent variable (defined as both observers agreeing on the occurrence or nonoccurrence of a behavior in a particular interval) by the total number of intervals and multiplying by 100%. Mean IOA for stereotypy across all participants and study phases was 96% with a range of 88% to 100%. Mean IOA for toy manipulation (Antonio) and activity engagement across all participants was 95% with a range of 75% to 100%.

Procedural Fidelity Procedural fidelity data were collected for at least 25% of sessions for each participant. A procedural task analysis (available from the first author upon request) was prepared for each study phase with the researcher behaviors defined operationally. Procedural fidelity was calculated by dividing the number of procedural steps completed correctly by the total number of procedural steps for that condition, and then multiplying by 100%. The combined mean procedural fidelity across all conditions of this study was 100%.

Procedures This study consisted of three phases: (a) functional analysis with analogue conditions, (b) single stimulus preference assessment (Antonio only), and (c) treatment evaluation. Functional analysis. Each participant’s stereotypy was assessed using functional analyses with analogue conditions conducted in a fashion similar to Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994). Five conditions were tested including contingent attention, contingent access to tangibles, contingent escape from demands, alone, and play (control). Functional analyses were conducted across 5 to 6 days for each participant with no more than six conditions conducted on a single day. Sessions were 5 min in length and occurred in a random sequence. In each condition, the object associated with stereotypy was in sight and within reach of Joel and Jeff. During the attention condition, the participant and researcher were seated at a table or on the floor with three to four toys present. The researchers provided 10 s of verbal and physical attention (e.g., pats on the back, hugs) following participant engagement in target stereotypy. During the tangible


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condition, 10 s of access to a specified toy was provided contingent upon stereotypy. Antonio’s toy was a light-up necklace and Jeff’s toy was a picture book. The toy was selected based on parental (Antonio) or teacher (Jeff) report of preference. A tangible condition was not tested with Joel as the absence of a tangible was incompatible with engagement in stereotypy (dropping objects to the floor). A tangible condition was conducted with Jeff as he would strike his hand against surfaces if an object were not available. In the demand condition, the researcher presented task demands taken from the participants’ individualized education program continuously using least to most prompting hierarchy. Demands for Antonio included handwriting, tracing, and receptively identifying pictures. Demands for Joel included answering “wh” questions and handwriting. Demands for Jeff included completing a sorting activity. Contingent upon stereotypy, the researcher removed all taskrelated materials and the participant was provided with a 10-s break from demands. During the alone condition, the participant was placed in an empty room without toys, leisure materials, or other individuals. No social interaction was provided though the researcher remained just outside the room out of sight to monitor participant safety and record engagement in stereotypy. The play condition was designed as a control in which the participant had continuous access to attention and toys and no demands were placed. The researcher did not respond to stereotypy during the play conditions. Preference assessment. A single stimulus preference assessment was conducted with Antonio to determine preferred stimuli that may compete with the reinforcement for vocal stereotypy. A trained doctoral student conducted the preference assessment according to the procedures described by Piazza, Adelinis, Hanley, Goh, and Della (2000). A total of six toys were assessed. Three of these toys made sounds and were hypothesized to be matched to the auditory reinforcement provided by Antonio’s stereotypy. These toys included a musical plastic camera, a device with a button that played a high-pitched squeak noise, and music played via a CD player. Three additional toys were assessed that were hypothesized to be unmatched to auditory reinforcement but provided other sensory consequences. These toys included a large exercise ball intended to provide kinesthetic stimulation, a light-up necklace intended to provide visual stimulation, and a stringy ball intended to provide tactile stimulation. Toys were presented one at a time in random order. Trials were 2 min in duration and each of the six toys was presented for 3 trials for a total of 18 trials. All trials took place in Antonio’s living room that included a couch, coffee table, and a television that was turned off. No other toys or leisure materials were present except for the target toy. Prior to beginning a trial, the


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researcher modeled interaction with the toy including activating lights or sound, and provided Antonio with brief access (i.e., 10 s) to the toy. Following this sampling procedure, the researcher placed the toy within half a meter of Antonio on the floor or table, and moved out of the room or out of sight. At this point the trial began and the participant’s vocal stereotypy and toy manipulation were observed. The musical camera was the toy associated with the lowest levels of vocal stereotypy (see the “Results” section and Figure 2) and was selected for use in the MO manipulation phase of the study. Treatment evaluation. Following the completion of the functional analyses and preference assessment, a MO manipulation was conducted using an alternating treatment design to compare the effects of two pre-session conditions on stereotypy and activity engagement during group activities. Prior to group activity sessions, participants were exposed to one of two pre-session conditions, pre-session access, or no pre-session access, in an alternating fashion. In the pre-session access condition, participants were provided unrestricted access to stimuli associated with stereotypy or hypothesized to match the function of stereotypy (musical camera for Antonio, wooden cylinder for Jeff, ball for Joel). In the no-pre-session access condition, participant access to these stimuli was prevented. Prior to the observation sessions in both conditions, teachers/parents were instructed to respond to stereotypy as they typically would, which involved interruption and verbal redirection. Pre-session access. During the pre-session access condition, the implementers (Antonio’s mother, Jeff and Joel’s teachers) presented the participants with stimuli hypothesized to evoke or match the function of stereotypy and verbally told participants to play with the stimulus. The implementer remained in the room but did not provide additional attention. If the participant rejected the stimulus, the implementer represented the item. To identify rejecting topographies, teachers or parents were queried regarding how the participant communicated that he no longer wanted an object. These topographies were then utilized in the pre-session access phase of the study. Rejection behaviors included walking away from the item or setting the item down without an attempt to retrieve it within 5 s (Antonio and Joel) or pushing the item away (Jeff). After the three of these rejections, the pre-session access condition was terminated and the participant immediately entered into the group activity session. Mean latencies to the behavioral criterion for satiation are presented in Table 1 for each participant. No-pre-session access. The purpose of the no-pre-session access condition was to function as a baseline against which pre-session access (satiation)


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Table 1. Time to Satiation. Participant Antonio Jeff Joel

M

Range

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could be compared. During the no-pre-access condition, participants did not have access to the stimulus associated with stereotypy for the entire day leading up to session. That is, Antonio did not have access to his musical camera, Joel did not have access to a ball, and Jeff did not have access to the wooden cylinder. Participants followed their typical daily routines leading up to the group activity session but no designated time for engagement in stereotypy was provided. Group activity sessions. Group activity sessions were implemented by Antonio’s mother, Jeff’s teacher, and Joel’s behavior therapist immediately following the pre-session conditions. Sessions were 15 min in length and occurred at the same time of day for each participant. Sessions consisted of three 5-min activities. Although the sequence of activities within the session was randomized, the activities and materials were held constant for each participant. During Antonio’s group activity sessions, Antonio, his mother, and two younger siblings (ages 14 months and 3 years) were seated at their kitchen table with activity-related materials placed on the table. Activities included building shapes and structures with modeling clay, coloring with paper and markers, and completing puzzles. This family time at the table was part of the family’s after school routine. Jeff’s sessions took place in the context of whole group instruction in his special education classroom. During group instruction, the classroom teacher was present at the front of the room and six to seven students were seated in chairs in a semicircle. Two paraprofessionals were seated behind the students. Specific activities included motor imitation, following along with books being read aloud, and completion of puzzles. Joel’s sessions took place during group instruction at the autism clinic. During group instruction, six children were seated on the floor with four behavior therapists seated behind them and one therapist providing instruction to the group. Specific activities included singing and performing corresponding movements to songs, listening to stories being read and answering questions regarding the story, and participating in a large group game, such as duck-duck-goose, follow the leader, or freeze dance.


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The participants’ parent (Antonio) or teacher (Jeff and Joel) modeled appropriate engagement with the materials/activities and presented demands to interact with the materials/activities approximately every 45 s. In addition, the parent or teachers provided the participant with attention in the form of praise or comments at least once every 60 s. These schedules approximated group instructional routines. However, during the group activity sessions, participant engagement in target stereotypy was ignored.

Results Functional Analysis Figure 1 presents the results of the functional analysis of stereotypy for all three participants. Antonio engaged in moderately high levels of stereotypy during all functional analysis conditions including attention (M = 45%; range = 7%-80%), demand (M = 41%; range = 7%-63%), play (M = 35%; range = 7%-77%), tangible (M = 38%; range = 30%-47%), and alone (M = 32%; range = 17%-43%) conditions. The level of stereotypy was undifferentiated across the five functional analysis conditions although an increasing trend in stereotypy was observed in the last three sessions of the attention condition. Jeff engaged in moderate levels of stereotypy across all conditions including attention (M = 45%; range = 27%-73%), demand (M = 34%; range = 3%-53%), play (M = 18%; range = 0%-50%), tangible (M = 10%; range = 3%-13%), and alone (M = 18%; range = 0%-47%). Following Session 15, Jeff seizure medication was altered, as denoted by the dotted vertical line. However, levels of stereotypy did not appear to be influenced by this medication change. Joel engaged in high but variable levels of stereotypy across all conditions including attention (M = 69%; range = 23%-97%), demand (M = 25%; range = 0%-50%), and play (M = 55%; range = 3%-93%), with the highest and most stable levels occurring in the alone condition (M = 93% of intervals; range = 83%-100%). These functional analysis results for all three participants suggest that stereotypy may have been automatically maintained.

Preference Assessment Figure 2 depicts the percentage of intervals in which Antonio engaged in vocal stereotypy and toy manipulation in the presence of each stimulus. The stimuli that provided auditory stimulation are presented on the left side of the figure and the stimuli which provided other sources of sensory stimulation are presented on the right. Across all matched stimuli, the mean level of vocal stereotypy was 11% of intervals (range = 3%-17%) and the mean level of toy


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manipulation was 37% of intervals (range = 0%-69%). Across all unmatched stimuli, the mean level of vocal stereotypy was 12% of intervals (range = 6%-21%). The mean level of toy manipulation with unmatched stimuli was


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Percentage of 10-s intervals with target behavior

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Figure 2. Preference assessment results for Antonio.

65% of intervals (range = 28%-100%). Antonio engaged with all stimuli except for the CD player. Antonio’s highest levels of toy manipulation occurred with the large yoga ball (100% of intervals), followed by the musical camera and the light-up necklace. Although vocal stereotypy occurred in the presence of all stimuli, it occurred the least in the presence of the musical camera. We selected the musical camera as the stimulus to be used during the MO manipulation due to its association with the lowest levels of vocal stereotypy and high levels of engagement. We hypothesized that the musical camera provided reinforcement that was matched to the sensory consequences obtained through vocal stereotypy.

MO Manipulation Figure 3 presents the results of the MO manipulation on stereotypy for all three participants. Overall, all three participants engaged in lower levels of stereotypy during group activities that followed the pre-session access to stereotypy and higher levels of stereotypy during group activities that followed the no-pre-session access to stereotypy condition. Antonio engaged in slightly lower levels of vocal stereotypy during group instruction following the presession access conditions (M = 9%; range = 0%-22%) as compared with the no-access conditions (M = 18%; range = 8%-31%). Jeff’s overall level of stereotypy during group activities was also lower following pre-session access to stereotypy (M = 11%; range = 0%-23%) as compared with


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no-pre-session access sessions (M = 26%; range = 10%-35%). Joel engaged in high levels of stereotypy following the no-access condition (M = 57%; range = 50%-66%). Following the pre-session access conditions, Joel


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engaged in low levels of stereotypy during group instruction (M = 13%; range = 2%-22%), though an increasing trend in stereotypy across sessions was observed. Smaller effects were noted for Antonio and Jeff. Figure 4 depicts the effects of the MO manipulation on activity engagement for Antonio in the upper panel, Jeff in the middle panel, and Joel in the bottom panel. Activity engagement was higher during group activities that followed the pre-session access to stereotypy conditions and lower in group activities that followed the no-pre-session access to stereotypy condition for all three participants. Antonio consistently engaged in higher levels of activity engagement following the pre-session access conditions (M = 88%; range = 74%-100%) as compared with the no-access conditions (M = 59%; range = 32%-89%). Similarly, Jeff’s activity engagement was higher during group activities, which followed the pre-session access condition (M = 66%; range = 42%-87%) as compared with the no-access condition (M = 48%; range = 25%-98%). Joel engaged in very high levels of activity engagement following the pre-session access to stereotypy condition (M = 92%; range = 87%-97%). His activity engagement was noticeably lower following the noaccess to stereotypy condition (M = 30%; range = 16%-44%).

Discussion The purpose of this study was to evaluate the effects of pre-session satiation on subsequent levels of stereotypy and activity engagement during group activities. Functional analysis results suggested that stereotypy was maintained by automatic reinforcement for all three participants. Participants were allowed pre-session access to stereotypy or were denied this access in an alternating fashion prior to group activities. Pre-session access conditions allowed participants to engage in unrestricted stereotypy or were provided with unrestricted access to matched stimulation (Antonio) until a predetermined behavioral criterion of satiation was achieved. Results showed that participants exhibited lower levels of stereotypy and higher levels of activity engagement during group activities following pre-session access to stereotypy. It should be noted that although pre-session access resulted in reductions in stereotypy for all three participants, these reductions were small for Antonio and Jeff. In addition, the systematically identified matched stimulus used within the pre-session satiation condition for Antonio appeared to have an abative effect on his stereotypy during subsequent group activities. The subsequent reduction of stereotypy during group activities following pre-session access is consistent with previous research in which unrestricted access to the putative reinforcer for challenging behavior is provided until a


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Figure 4. Motivating operation (MO) manipulation results on task engagement.


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behavioral criterion for satiation is reached (e.g., Lang et al., 2010; O’Reilly et al., 2009). It has been hypothesized that the subsequent reduction in challenging behavior is a result of an AO in which the value of reinforcement for challenging behavior is reduced along with the frequency of behavior previously correlated with this reinforcement (Rispoli, O'Reilly, Lang, et al., 2011). In the current study, the pre-session access to stereotypy may have also produced a state of satiation in which the value of automatic reinforcement was abolished and the frequency of stereotypy was abated. Both Jeff and Joel engaged in motor stereotypy in which they exhibited repetitive movements with their hands when provided an object that could be struck against surfaces (Jeff) or dropped to the floor (Joel). Pre-session access to stereotypy for these participants was fairly straightforward and involved providing them with an object. Antonio engaged in vocal stereotypy that was more difficult to evoke than motor stereotypy during pre-session access conditions. For this reason, we decided to provide Antonio with matched stimulation to create a state of satiation on vocal stereotypy. Interestingly, the preference assessment revealed that while Antonio preferred unmatched stimulation (yoga ball), access to matched stimulation (a sound-producing toy) produced an abative effect on vocal stereotypy. This preference for unmatched stimulation for stereotypy aligns with previous research (Lanovaz et al., 2009) and also supports data analysis of both preference and stereotypy during preference assessments of matched and unmatched stimuli (Piazza et al., 2000). More research into pre-session access to stereotypy is warranted given that previous research has found mixed results with respect to subsequent engagement in stereotypy (e.g., Lanovaz et al., 2009). Given the positive results in the current study, it is possible that the use of a behavioral criterion of satiation may increase the effectiveness of this intervention. In this study, we used the behavioral criterion of three rejections of the object associated with stereotypy to determine satiation. However, more research is needed to determine if satiation can be achieved with a lesser criterion (e.g., two rejections) or if some other criterion might offer better predictive utility. Activity engagement during group activities was higher overall for all participants following the pre-session access to stereotypy condition. This finding supports previous research on challenging behavior in which pre-session satiation on the putative reinforcer was associated with improvements in untargeted behaviors (e.g., Rispoli, O’Reilly, Sigafoos, et al., 2011). One possible explanation for the increase in activity engagement may be that with the reduced value of automatic reinforcement, participants were able to access novel communities of reinforcement from participating in the group activities. Thus, events such as teacher praise, peer attention, or interaction with


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materials may have functioned as reinforcement for task engagement when the value of automatic reinforcement was reduced thus creating a window in which these novel contingencies could be contacted. Although these results highlight the potential power of manipulation of MOs, more research is needed to elucidate the behavioral mechanisms responsible for the increase in activity engagement. There are several limitations to this study that should be addressed. This intervention required participants to be given unrestricted access to stereotypy prior to sessions. Allowing time for individuals to engage in stereotypy may not be feasible or acceptable for teachers or parents, particularly in group situations or under inflexible schedules. For instance, Joel’s time to satiation varied from 1 to 26 min. Given that pre-session satiation can require a considerable and variable amount of time, it may not be feasible in natural settings such as schools, the workplace, or home. In addition, although participants experienced increased activity engagement following presession satiation, the intervention resulted in smaller reductions in stereotypy for two of the three participants. Future research should gather data on the social validity of the magnitude of improvements from caregivers and service providers and examine the acceptability and feasibility of providing pre-session access to stereotypy. Future studies may also examine participant engagement in stereotypy during the pre-session access conditions in addition to subsequent engagement in stereotypy. The purpose of this study was to isolate and evaluate the effect of an MO manipulation on subsequent engagement in stereotypy. It is possible that the efficacy of this manipulation could be improved by combining pre-session access to stereotypy with other intervention procedures, such as differential reinforcement. Future research may consider examining treatment packages that contain pre-session access as well as other treatment components on stereotypy. The outcomes observed in this study provide several implications for practitioners. This study contributes to a growing body of research demonstrating that individualized antecedent manipulations intended to abolish the value of a reinforcer can have considerable clinical effects on levels of subsequent engagement and stereotypy (e.g., Lang et al., 2009; Lang et al., 2010). Systematically incorporating periods of free access to stereotypy in daily activities prior to group or inclusive activities may reduce the amount of supports and intervention needed in the group setting. Furthermore, this is a simple intervention that likely would not require extensive training to be implemented with fidelity. Future research should explore the use of MO manipulations implemented by natural change agents such as caregivers or teachers.


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Rispoli et al. Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author Biographies Mandy Rispoli, PhD, BCBA-D, is an assistant professor of special education in the Department of Educational Psychology at Texas A&M University. Her research explores the use of applied behavior analysis in the functional assessment and prevention of challenging behavior in children with intellectual and developmental disabilities. Síglia Hoher Camargo, PhD, is an assistant professor in the College of Education at University Federal de Pelotas, Brazil. Her research interest is related to strategies to


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facilitate inclusive education of children with autism spectrum disorders and other developmental disabilities. Leslie Neely, MEd, is a doctoral student in the Department of Educational Psychology at Texas A&M University. Her research evaluates the use of technology to improve behavioral services provided to children with developmental disabilities and their families. Stephanie Gerow, BS, is a doctoral student in the Department of Educational Psychology at Texas A&M University. Her area of research interest is decreasing challenging behavior in children with disabilities using antecedent and function-based behavioral interventions. Russell Lang, PhD, BCBA-D, is an assistant professor of special education in the Department of Curriculum and Instruction and the director of the Clinic for Autism Research Evaluation and Support at Texas State University. His research focuses on the use of applied behavior analysis to teach play skills and reduce challenging behavior in children with developmental and intellectual disabilities. Fara Goodwyn, MEd, BCBA, is a doctoral student in the Department of Educational Psychology at Texas A&M University. Her research interests are in video modeling and applied behavior analysis to support students with autism and developmental disabilities. Jennifer Ninci, MEd, BCBA, is a doctoral student in the Special Education Program in the Department of Educational Psychology at Texas A&M University. Her interests are in the uses of applied behavior analysis to prevent challenging behaviors and promote self-determination in individuals with intellectual and developmental disabilities.


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