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

Brian A. Boyd, Ph.D.Maureen A. Conroy, Ph.D.

Peter J. Alter, M.Ed.University of Florida

October 15, 2005

DSM-IV, 1994; Ozonoff, 2004

What are Restricted Interests?

• “All encompassing topics or objects individuals with autism pursue with great intensity and focus”

• Also called:– Circumscribed interests– Obsessions– Compulsions– Special interests– Narrow interests

Epstein et al., 1985

What are RI (cont’d)?

• Considered to be a higher form of motoric, repetitive behaviors (e.g., hand-flapping)

Lower End: Stereotypy Higher End: Restricted Interests, Routines

Adams, 1998; Attwood, 1998; Ozonoff, 2004

Restricted vs. Preferred?

• How do you distinguish a highly preferred item from a restricted item?

• Share 5 characteristics– Idiosyncratic– Difficult to redirect child– Child is intensely focused on interest– Endure over a long period of time– Accumulation of mass amounts of

information

Ozonoff, 2004; South et al., 2005

Do RIs change over time?

• Sally Ozonoff asked a group of pre-teens and adolescents with Asperger’s and HFA about their RI

1. On average, they had 3-4 RI by that point in their lives

2. Sometimes they had more than one RI at the same time

3. Only repetitive behavior found to increase in severity over time

Lewis & Bodfish, 1998; Turner, 1999

Do all types of kids on the spectrum have RIs?• Mmmm…………………!!!!!!!!!• What we strongly think?• RIs are more prevalent for students who have HFA and are older• RIs maybe more common for children with Asperger’s syndrome vs. HFA

– Evidence is really mixed• RIs may differentiate kids with autism from other developmental

disorders

• What we know? We know more about lower forms of repetitive behaviors• Children with more severe autism engage in more stereotypy• Children with autism and MR engage in more stereotypy & self-injury• HFA also exhibit lower level repetitive behaviors

• To sum up:• We don’t know a lot about the relationship between functioning level and

repetitive behavior; in general, and in regards to RI, in particular

Turner, 1999

Why do students with autism have RIs?• Mmmmmmmmmm……………………

……• Mmmmmmmmmm……………………

…….• Lots of Theories

– Arousal theory– Executive Dysfunction theory– Perceptual Reinforcement hypothesis

Evans et al., 1997, 1999; Zohar & Felz, 2001

Do typically developing (TD) kids have RIs?• TD kids do engage in repetitive behaviors

(ritualistic and compulsive)

• Behaviors seem to peak between the ages of 2-5 (may be the same for kids with autism)

• In TD kids, we see them more during fear-inducing situations (e.g., new kid in classroom)

• TD kids engage in repetitive behavior to regulate or establish control over their environment

Ozonoff, 2004

What are some common RIs for students with autism?Most Common:

– Gadgets/devices/electronics– Power rangers/other action figures– Dinosaurs– Video games

Somewhat Common:– Fantasy/science fiction– Natural disasters– Disney characters– Letters/numbers

Least Common:– Mythology– Trains (other than Thomas)– License plates

Lovaas et al., 1987

Should we discourage RIs?• Repetitive behaviors are hard to extinguish

– It is hard to identify “what” is maintaining the behavior

– It is hard to replace the behavior if it is maintained by internal sensory consequences

– If RI is inappropriate for school, then make sure student knows when it is ok to talk about or engage with their interest

Adams, 1998; Charlop et al., 1990

Why should we encourage RIs?• Research studies have shown that using

their RI gradually decreases the amount of time children engage with that item– Provide children structured and expected

opportunities to engage with their RI

• Teaches kids a more functional and appropriate way to engage with their interest

Baker et al., 1998, 2000; Boyd, 2005

Can RIs be used to encourage social behavior?• Research suggests it can be used

to increase the amount of time children engage in peer-related social interactions

How do RIs encourage social behavior?• Students with autism appear to be

“motivated” to discuss or interact with RIs, either internally or externally

• Often they are motivated to engage in 1-sided conversations about them,

OR

• Play with the RI by themselves

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

Overview of RI Research Findings

• Interventions that utilized the RI of children with autism have increased their prosocial behaviors (e.g., on-task)– Only 2 studies have addressed the social behavior of children

with autism (Baker et al., 1998; Baker, 2000)

• Majority of studies used the RI as a consequence-based intervention– The child is given access to the RI after the occurrence of a

targeted behavior (Charlop et al., 1990; Charlop-Christy & Haymes, 1996; 1998)

• Studies also have used the RI as an antecedent-based intervention– The RI is used as an antecedent to set the occasion for the child’s

appropriate behavior (Adams, 1998)

• Primary problem associated with the RI literature– Paucity of studies examining the effects of RI – Lack of systematic identification of the RI

Research Questions

1. What is the effect of the presence of a restricted interest item in comparison to a less preferred item on the social behaviors of young children with autism spectrum disorders (ASD)?

2. What is the generalization effect of the presence of a restricted interest item and other tangible stimuli on the social behaviors of young children with ASD?

Method

• Inclusion Criteria• Preschool or elementary-aged children diagnosed

with an independently-obtained autism spectrum disorder

– Asperger syndrome, Autism, Pervasive Developmental Disorder-Not Otherwise Specificed (PDD-NOS)

• Use of at least 2-3 word utterances to express basic wants and needs

• Ability to initiate to peers’ social bids using gestural or verbal communication

• Display of low levels of appropriate or high levels of inappropriate social behaviors

• Display of high levels of engagement with or discussion of a RI tangible item

Study Participants

NameAge Diagnos

isSettin

gCARS score

Jason 5 PDD-NOS

Elementary

33.5mild

autism

Allen 5 PDD-NOS

Elementary

25.5 nonautist

ic

Jin 5 PDD-NOS

Preschool 32.5 mild

autism

Phases of Study

1. Assessment Phasea. Descriptive assessmentb. Preference assessment

2. Structural Analysis (SA) Phasea. Concurrent operant conditionb. Free operant condition

3. Generalization Phasea. Across settingsb. Across other tangibles

Assessment Phase

• Descriptive Assessment– Interview parents and teachers using Social Skills

Interview (Asmus et al., 2004) to identify their current levels of social behavior and RI

• For an item to be initially identified as the RI, two informants must independently identify that item

– Direct observation of participant using Social Skills Screening (Conroy et al., 2004)

• Data is taken on the percentage of intervals during a 10-min observation period the TC and classroom peers engage in social behavior across 3-5 classroom activities

• Identified activities within classroom context where participant exhibited highest & lowest % of social behavior to obtain a baseline measure

Assessment Phase

• Multiple Stimulus Preference Assessment (adapted from Roane et al., 1998)– Repeated presentation of 7 identified tangible

items found during descriptive assessment that the child engaged or played with, including the hypothesized RI tangible item

– Data was taken on the number of seconds the TC physically touched each item

– For an item to be verified as the RI, the TC must touch it for the longest duration of time for 2 out of 3 (67%) experimental sessions

– Identified a less preferred (LP) item by asking the TC

Assessment IOA

• Calculated using a point by point agreement ratio– Descriptive Assessment: IOA collected for

25-85% of sessions• Jason—Mean: 96% (range: 93-98%)• Allen—Mean: 99% (range: 96-100%)• Jin—Mean: 88% (range: 75-100%)

– Preference Assessment: IOA collected for 33% of sessions

• Jason, Allen, & Jin—Mean: 100%

Assessment Results

NameHighest % Social Behavior

Lowest % Social Behavior

Jason Blocks (33%)

Sensory play (6%)

Allen Outdoor play (18%)

Music (0%)

Jin Snack (16%)

Sensory play (5%)

NameRestricted Interest

Less Preferred

Jason Thomas the Train™

Magnets

Allen Thomas the Train™

Unifix cubes

Jin Construction trucks

Wooden blocks

Descriptive Assessment Preference Assessment

SA Phase:Experimental Procedures• SA phase (Concurrent & Free Operant

Conditions)– All sessions were 5-minutes in length– Each session was videotaped and coded using Tap-IT

software for Dell PDAs (Tapp, 2003)– Peer was instructed prior to each session to NOT

initiate to TC– Peer was instructed to always respond to TC

initiations • If peer failed to respond, therapist verbally

reminded him/her– All peers were typically developing classmates of the

TC

Concurrent Operant Procedures• Concurrent—purpose was to provide further

validation of the identified RI and to provide preliminary evidence of its effects on the display of participant social behavior – Procedural control—counterbalanced the peer holding the item

& the order the choices were given to the TC by the therapist

Peer 1 with RI or LP

Peer 2 with opposite item

TC stands on center line & chooses every 30-s

Concurrent Operant IOA

• Calculated using MOOSES software program (Tapp, 2002) – Each observer had to code the same

behavior within a +/- 5-second window of time; otherwise it was counted as an error

• IOA collected for 33% of sessions

• Percentage of intervals TC choose RI vs. LP: Jason, Allen, & Jin—Mean: 100%

Concurrent Operant Results: Choice of Tangible Items

0

10

20

30

40

50

60

1 2 3

0

20

40

60

80

100

120

1 2 30

20

40

60

80

100

120

1 2 3

% o

f 30

-sec

on

d i

nte

rval

s

Jason Allen Jin

RI

LP

Sessions

Concurrent Operant Results:Social Interactions

% o

f ti

me

Jason

0

5

10

15

20

25

30

35

1 2 3

LP

RI

Free Operant Procedures• Free operant—purpose was to provide a more

naturalistic play situation to evaluate the effect of the RI in comparison to the LP – Procedural control—randomly alternated the RI vs LP sessions &

randomly selected 1 peer from concurrent to participate

Peer with RI or LP

Duplicate of the RI or LP (no peer)

TC stands on center line & chooses at beginning of session only to play with the peer or alone with item

Free Operant IOA

• Calculated using MOOSES software program (Tapp, 2002) – Each observer had to code the same behavior within a

+/- 5-second window of time; otherwise it was counted as an error

• IOA collected for 26-36% of sessions

• Duration of social interactions: – Jason—Mean: 100% (range: 100%)– Allen—Mean: 98% (range: 97-100%)– Jin—Mean: 98% (range: 95-100%)

• Rate of initiations: – Jason & Allen—Mean: 100%– Jin—Mean: 83% (range: 67-100%)

Free Operant Condition:Social Interactions

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11

% o

f ti

me

Jason Allen Jin

Sessions

RI

LP

Free Operant Results:Mean Latency to First TC Initiation

Nu

mb

er

of

sec

on

ds

0

2

4

6

8

10

12

14

16

Restricted Less Preferred

0

20

40

60

80

100

120

Restricted Less Preferred

0

5

10

15

20

25

30

35

40

45

Restricted Less Preferred

*

Jason Allen Jin

*=TC did not initiate

Free Operant Results:Treatment Integrity

Name

RI LP

Jason 0.05/min 0-0.2/min

*

0.0/min

Allen 0.02min0-0.2/min*

0.0/min

Jin 0.04/min0-0.2/min*

0.02/min0-0.2/min*

Name

RI LP

Jason 1.0 1.0

Allen 0.89 0.88

Jin 1.0 No TC Initiation

s

Mean Rate of Peer InitiationsProbability of Contingent Peer Responses

* indicates the range

Indirect Comparison of Descriptive & Experimental Outcomes

NameDescriptive Assessment

Structural Analysis (RI)

Jason Blocks: M=33%

M=48%

Allen Outdoor play: M=18%

M=48%

Jin Snack: M=16%

M=27%

Generalization Procedures • Generalization—purpose was to

determine the extent to which the observed free operant effects generalized to another SETTING & other TANGIBLE ITEMS– Procedures same as Free Operant except

carried out in participants’ regular classrooms

– Experimenter randomly introduced two classroom toys to target child-peer dyad Peer from Free Operant participated

Generalization IOA

• Calculated using MOOSES software program (Tapp, 2002) – Each observer had to code the same

behavior within a +/- 5-second window of time; otherwise it was counted as an error

• IOA collected for 33-50% of sessions

• Duration of social interactions: – Jason—Mean: 99% (range: 99-100%)– Allen—Mean: 94% (range: 83-100%)– Jin—Mean: 92% (range: 98-100%)

Generalization Results:Social Interactions

Social Interactions

0

20

40

60

80

100

120

1 2 3 4 5 6

% of

time

0

10

20

30

40

50

60

1 2 3 4 5 6

Sessions

% of

time

Restricted Less Preferred Tangible 1 Tangible 2

Social Interactions

0

5

10

15

20

25

30

35

40

1 2 3 4

Sessions

% of

time

Tangible 1 Tangible 1 Tangible2 Tangible 2

Jason Allen Jin

Bugs

Peop

l

e

Books

Pegs

TrainsDinosaurs

Therapist PromptsTherapist Prompts

Therapist Prompts

Generalization Results:Treatment Integrity

RI LP OT

J

1.00 1.00 1.00

A

1.00 0.88 1.00

JN/A

N/A

1.00

Mean Rate of Peer InitiationsProbability of Contingent Peer Responses

RI LP OT

J0.1/min

0-.4/min*0.2/min0.2.min*

0.4/min0.2-.6/min*

A0.1.min

0-.2/min*0.1.min

0-2/min*0.1.min

0-.2/min*

J N/A

N/A1.2/min

0.8-1.6/min*

* indicates the range

Teacher Social Validity• At the conclusion of the generalization sessions for

each participant their teacher completed a Likert-type rating scale

1. How comfortable were they with the study?M=6 (R: 6)

2. How disruptive was the study?M=1 (R: 1)

3. Willingness to allow another child to participate?M=6 (R:6)

4. How useful was the information obtained from the study? M=5 (R: 4-6)

5. Overall, how would they rate the intervention? M=5 (R: 4-6)

Not at all (1) Very (6)

Expert Social Validity

• 1 expert in field of ASD, naïve to the researcher’s expectations, viewed randomly selected 5-min video clips of children in RI and LP sessions

1. How appropriate was child’s play?LP: M=2 RI: M=5

2. How inappropriate was child’s play?LP: M=5 RI: M=2

3. How often did the child play with the peer?LP: M=1 RI: M=5

4. Overall, do you think the child enjoyed playing with the peer?

LP: M=1 RI: M=5

Not at all (1) Very (6)

Conclusions• Children with ASD spent more time socially interacting

when play situation incorporated their RI vs LP tangible item

– RI acted as a setting event or establishing operation• Structural analysis served as a viable tool to examine the

antecedent effects of RI on the social behaviors of the participants

• Three-step process provided an effective method to validate the RI of participants:

1. Teacher & parent interviews2. Multiple stimulus preference assessment3. Concurrent operant conditions

• Generalization data were more variable– Therapist prompts had to be introduced to facilitate

generalization • Expert Social Validity data reflect clear differences in

behavior of participants in RI vs LP sessions

Potential Explanations of Results• Jason’s Undifferentiated Concurrent Operant Data

1. Stimulus Control Topography (SCT) Coherence Theory—posits that there is not always concordance between contingencies arranged by experimenter & the properties of a stimulus that eventually brings the participant’s behavior under stimulus control

2. Executive Dysfunction—posits that underlying neurological impairments affects the ability of individuals with ASD to inhibit prepotent behavioral responses & engage in alternative behaviors

• Variability in Generalization Data1. SCT Coherence Theory—competing stimuli in

generalization environment signal occasion for other available reinforcers

2. Use of Brief Reversal Design3. Difficulty isolating Antecedents occasioning &

Consequences maintaining social behavior in natural environment

Limitations & Future Research• Limitations

– Generalization concerns:• All children had some social skills prior to study• All children were verbal and on higher end of autism

spectrum• SAs were not conducted in the child’s natural

environment• Small sample size

• Future Research– Identify the function(s) RI serve for children with

ASD– Determine the specific stimulus conditions needed

for RI to serve as a setting event for social behavior in the regular classroom

– Address aforementioned generalization concerns

Practical Implications

• Research suggests a starting to place to tap social-motivation

• Practitioners can embed RI into structured cooperative games or tasks to promote child interaction and/or engagement

• Start sharing groups around child’s RI

Lord, 2002

Moving Beyond RI: Is it Possible?• Eventually kids may move on because

of development, they outgrow their interests

• 1 strategy to help kids move on:– Start a sharing group

• Different kids share their interests, including the child with autism

• Each child has to learn about the other person’s interest1. The child with autism learns that other people

have interests different than his or her own2. The child learns about other people’s interests3. The child learns to share talking and listening

time around their interest

Using RI to Encourage Social Interactions• 6 steps

1. Determine their RI

2. Establish a measurable social goal – Take into

account child’s play skills:– Development

al level of play

– Stage of play

Developmental level• Sensorimotor• Relational• Constructive• Dramatic• Games with rules

Stage of Play• Unoccupied• Onlooker• Solitary/independent• Parallel• Associative• Cooperative

Example of Direct (Preference) Assessment

Antecedent-based uses of RI (cont’d)3. Embed interest into cooperative games or

play activities– Take into account child’s skill level and

developmental abilities:– Can the child match pictures?– Can s/he sort objects?– Can s/he read?

4. Teach child how to play the game – Depends on child’s social & developmental

abilities• May need to teach skill in a 1:1 setting and

eventually integrate peers into activity• May be able to immediately introduce activity into a

small group activity (teacher may need to monitor)

Example of an Embedded RI Activity

Antecedent-based uses of RI (cont’d)5. Provide child structured and expected

opportunities to engage with RI game– Make sure game has a clear ending– Set limits for when child is allowed to engage with

game• Provide choice board• Daily picture or written schedule

6. Monitor the child’s progress

• Keep in mind that social relatedness is difficult for all kids (HFA or LFA) on the autism spectrum

Centers for Autism & Related Disabilities (CARD-UF), 2005

Example of a Choice Board

CARD, 2005

Example of a Daily Schedule

Written Schedule1. Center time2. Circle time3. Game Time 4. Small group,

reading time5. Game Time

Any Questions