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6/11/2017
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GregoryP.HanleyPh.D.,BCBA‐D
AddressingStereotypyTheImportanceofaBalancedApproach
tothisCoreSymptomofAutism
Formoreinformationandmaterials,goto:
www.practicalfunctionalassessment.com
PersonsdiagnosedwithAutism
oftenengageinrepetitiveacts
thatappeartoservenofunction
Theseactsarecollectivelyreferredtoas
stereotypy
duetotheformalsimilarityoftheacts
andtheperiodicitywithwhichtheyareemitted
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HFA = High functioning autism
LFA =Low functioning autism
DLD = Developmental language disorder
NALIQ = Non‐autistic low IQ
Stereotypycanservedifferentfunctions
FromHanley,Iwata,andMcCord,JABA,2003,p.166
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Stereotypyisusuallymaintainedby
sensory(automatic)reinforcement)
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
whenitinterfereswithattemptstoteachskillsorconcepts
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WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
whenitinterfereswithsocialinteractions
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
whentheprohibitionofstereotypyresultsinmoreseriousproblembehavior
(DeLeon etal.,2011)
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• Threeteenagers– Jon,Patrick,&Edward
• Stereotypy– Handflapping,fingertappingorflicking,bodyrocking,mouthing,eyepressing,earholding
Someapplicationsofthemodel
Jon
Jon
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Edward
Alterconsequenceofstereotypyviablocking
Conclusion:Stereotypypersistedorworsened
Why?• Interpretationoffunctionalpropertiesofstereotypywasincorrect
• Onlysawearlystageofextinction• Arenotremovingallreinforcers (therewereintegritybreaches)
• Motivationtoproduceautomaticreinforcementwashighwithnootherwaytoproducesimilarreinforcers
CriticalStep:AdddifferentialreinforcementtostrengthensomedesirablebehaviorSeethesestudiesforthesuccessfultreatmentofstereotypyviadifferentialreinforcement
Charlop,Kurtz,&Casey(1990)JABA
Hanley,Iwata,Thompson,&Lindberg(2000)JABA
Wolery,Kirk,&Gast (1985)JADD
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Jon
Edward
Patrick
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Thetreatment–
activitiesprompting(teaching)
blockingwhile teachingearnedaccesstostereotypy
canthenbeusedtoteachmorecomplexplayskills
Somequestions
Isthisahumanetreatment?
Arestaffwillingtoimplementthesetreatments?
Doesthepersonwithstereotypylikeorloathethistreatment?
Table 2
Questions and Results of the Social Validity Questionnaire Responses
Questions Mean (range)1. Do you think that the treatment that involved prompting engagement, blocking stereotypy, and differentially reinforcing engagement with 30 s access to the participant’s own stereotypy was acceptable?
7.0
2. Do you think that the amount of behavior change was acceptable and sufficient?
6.6 (6 - 7)
3. I feel that the overall goals of this treatment were acceptable, appropriate and important for the individual.
6.6 (5 - 7)
4. I would recommend this treatment package to other therapists/providers that are attempting to decrease motor stereotypy and increase age-appropriate play skills.
6.8 (6 - 7)
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Similarinquiry,differentrespondent:Whichtreatmentdideachteenagerprefer?
Orange
Purple
Light Blue
Hot Pink
Royal Blue
White Pink
Teal
% S
elec
ted
0
10
20
30
40
50
60
70
80
90
100
Colors
Jon
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10
Trials
12 24 36 48 60 72 84 96 108 120 132 144 156 168 180
Cu
mul
ativ
e #
of S
elec
tion
s
0
4
8
12
16
20
24
28
32
36
40
44
No Differential Consequences for Selections
Differential Consequences for Selections
Jon
Pink Blocking only Light Blue Activities only Royal Blue Tx Package
Link Colors Correlated Treatments
(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)(11)(12)(13)
(Sessions)
(14)(15)(16)(17)(18)(19)(20)
No Differential Consequences for Selections
(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)
Blocking OnlyPink Card
Light Blue Card
Royal Blue Card
FR-1
Activities Only
Activities, Blocking, andContingent Access to Stereotypy
Initial Links Terminal Links
Contingency:
Trials
12 24 36 48 60 72 84 96 108 120 132 144 156 168 180
Cu
mul
ativ
e #
of S
elec
tion
s
0
4
8
12
16
20
24
28
32
36
40
44
No Differential Consequences for Selections
Differential Consequences for Selections
Jon
Pink Blocking only Light Blue Activities only Royal Blue Tx Package
Link Colors Correlated Treatments
(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)(11)(12)(13)
(Sessions)
(14)(15)(16)(17)(18)(19)(20)
No Differential Consequences for Selections
(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)
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Trials
6 12 18 24 30 36 42 48 54 60
Cu
mu
lati
ve #
of
Sele
ctio
ns
0
2
4
6
8
10
12
14
16
No Differential Consequences for Selections
Differential Consequences for Selections
Patrick
(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)
(Sessions)
No Differential Consequences for Selections
Pink Blocking onlyYellow Activities only
Link Colors Correlated Treatments
Green Tx Package
Trials
12 24 36 48 60 72 84 96 108 120 132 144 156 168
Cu
mu
lati
ve #
of
Sele
ctio
ns
0
4
8
12
16
20
24
28
32
36
40
44
No Differential Consequences for Selections
Differential Consequences for Selections
Edward
Blue Tx Package
Green Blocking Only Orange Activities Only
Link Colors Correlated Treatments
(1) (2) (5)(3) (4) (6) (7) (8) (9)(10)
(Sessions)
(11)(12) (13)(14) (15)(16)
No Differential Consequences for Selections
(17)(18) (19)(20) (21)(22) (23)(24) (25)(26) (27)(28)
ResultsSummary
Noonepreferredblockingonly
Nooneavoidedthetreatmentwithallthreecomponents
Twoofthreepreferredthetreatmentwithallthreecomponents
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Whyapreferenceforthistreatment?
Preferenceforcontingencies?
SomeTake‐HomePoints
Don’tassumefunction
Testforsensitivitytosocialreinforcers first;see:
SomeTake‐HomePoints
Itisimportanttorecognizethenecessityandinsufficiencyofblockingasatreatmentforstereotypy
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SomeTake‐HomePoints
Immediatetreatmentgoalisnotelimination ofstereotypy
Moreappropriategoalishavingitoccurinacceptableplacesandatacceptabletimes
Canwesimplyobtainstimuluscontroloverstereotypy?
Yes– butthenotionofacontingencyisimportantheretoo.
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Obtainingstimuluscontrolofstereotypy
S-S-
Stereotypy is blocked
S+S+
Stereotypy is allowed
Multipleschedule• S‐:stereotypyblocked• S+:stereotypyallowed
• ChangeoverbetweenS‐ andS+ componentsistime‐based
Chainedschedule• S‐:stereotypyblocked• S+:stereotypyallowed
• ChangeoverbetweenS‐ andS+ componentsiscontingentonperformance
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
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15
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
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Okay,butdideitheryieldstimuluscontroloverstereotypy?
0
50
100
S-S+
0
50
100
Chained
0
50
100
0
50
100
Multiple
0
50
100
0
50
100
Chained
10 20 30 400
50
100
Max
10 20 30 40 500
50
100
Multiple
Molly
Sessions
Lat
ency
to
ster
eoty
py(%
tim
e el
apse
d)L
aten
cy t
o en
gage
men
t(%
tim
e el
apse
d)
0
50
100
S-S+
0
50
100
Chained
0
50
100
0
50
100
Multiple
0
50
100
0
50
100
Chained
10 20 30 400
50
100
Max
10 20 30 40 500
50
100
Multiple
Molly
Sessions
Lat
ency
to
ster
eoty
py(%
tim
e el
apse
d)L
aten
cy t
o en
gage
men
t(%
tim
e el
apse
d)
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0
50
100
S-S+
0
50
100
Chained
0
50
100
0
50
100
Multiple
0
50
100
0
50
100
Chained
10 20 30 400
50
100
Max
10 20 30 40 500
50
100
Multiple
Molly
Sessions
Lat
ency
to
ster
eoty
py(%
tim
e el
apse
d)L
aten
cy t
o en
gage
men
t(%
tim
e el
apse
d)
Okay,butdideitheryieldstimuluscontroloverstereotypy?
Yes– Thechainedschedule.
Thenotionofacontingencyisimportantheretoo.
Dochildrenprefer
time‐basedalternation(multipleschedules)
or
behavior‐basedalternation(chainedschedules)?
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18
3 6 9 12
0
2
4
6
8
10
MultipleChainedExtinction
Max
Free choice
Cum
ulat
ive
sele
ctio
ns
3 6 9 12 15
0
2
4
6
Molly
Free choice Forced choice Free choice
Trials
Thesechildrenpreferredbehavior‐basedalternation(chainedschedules)
Whentreatingstereotypyarewemissingsomeimportantopportunities?
Canweaddresstheothercoredeficitsofautism(languageandsocial)whileaddressingstereotypy?
Canweallowthechildmorecontroloverwhereandwhentoengageinstereotypy?
Canwemakethetreatmentmoreflexiblesoitfitsintoeverydaylifealittlebetter?
Ithinkwecan.
NewAlternative:Skill‐BasedTreatmentPermission/Check‐inbasedmodelinwhichcommunication,toleration,andcontextuallyappropriatebehaviorsarestrengthened(Hanley,Jin,Vanselow,&Hanratty,JABA,2014)
1. Teachchildtorequestaccesstostereotypy(viablockingandcontingentaccesstostereotypy)
2.Teachchildtotoleratedenialsofmands forstereotypy(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypy)
3.Teachchildtoengageincontextuallyrelevantbehavior(viaprompting,blockingandcontingent,intermittent,andunpredictableaccesstostereotypy)
6/11/2017
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Slaton&Hanley(2016)
• Contingentvs.noncontingentaccess
S-S-
Stereotypy is blocked
S+S+
Stereotypy is allowed
contingent: performance occurs
contingent: performance occurs
noncontingent: time elapses
noncontingent: time elapses
Slaton&Hanley(2016)
• Whataboutpermission‐basedaccess?
S-S-
Stereotypy is blocked
S+S+
Stereotypy is allowed
mand for stereotypy
yesno
Hanley,Jin,Vanselow,&Hanratty(2014)
• Skill‐basedtreatmentforsocially‐mediatedPB
Functional communicationrequest (FCR)
DeniedTolerance
response (TR)Variable amount of work/play
Compliance
Reinforcement
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Hanley,Jin,Vanselow,&Hanratty(2014)
• Skill‐basedtreatmentforsocially‐mediatedPB
Functional communicationrequest (FCR)
DeniedTolerance
response (TR)Variable amount of work/play
Compliance
ReinforcementGranted
Hanley,Jin,Vanselow,&Hanratty(2014)
• Skill‐basedtreatmentforsocially‐mediatedPB
Functional communicationrequest (FCR)
DeniedTolerance
response (TR)Variable amount
of workCompliance
ReinforcementGranted
20%
Hanley,Jin,Vanselow,&Hanratty(2014)
• Skill‐basedtreatmentforsocially‐mediatedPB
Functional communicationrequest (FCR)
DeniedTolerance
response (TR)Variable amount of work/play
Compliance
ReinforcementGranted
20%
60%
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21
Thecurrentstudy
• Combinationofbothtreatmentpackages
S-S-
Stereotypy blocked
Mand for stereotypy
20%
20%Denied
Tolerance response
Variable work/play
Comp.60%
S+S+
Stereotypy is allowed
15 – 45 seconds
Participants
Name Age Diagnosis Communication Work tasks
Grant 7 Autism 1‐2 word phrases Numbers, letters, sight words, pictures, matching
Milo 12 Autism 1‐3 word phrases Match and identify objects, pictures, numbers, letters;
short ADL tasks
Marco 21 Autism 1‐3 word phrases Leisure and time management on iPad
Participants:stereotypytopographies
Grant Milo Marco
• Hand flapping• Finger wiggling• Object flapping• Clapping• Holding objects to eyes and rotating
• Hand flapping• Tapping on teeth• Rubbing or poking face• Finger play• Shaking objects• Tapping work materials
• Pacing or galloping• Jumping• Tapping body, furniture• Hair twirling• Knuckle cracking
6/11/2017
22
Baseline
• Alone– Confirmthatstereotypypersistsintheabsenceofsocialconsequences
• InstructionalBL– Emulatethefinaltreatmentcontextnominatedbytheteam– Noconsequencesforstereotypy– ForMilo:10worktrials(S‐)followedby15‐30saccesstostereotypy(S+)• Repeatfor5min
0
25
50
75
100
0
5
10
15
20BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
Instructional Baseline Tasks
• Match pictures in an array of 6• Match letters in an array of 6• Match numbers in an array of 6• Identify (touch) pictures in an array of 6• Sort objects in an array of 3• Unpack backpack• Put on shirt (over his current shirt)
0
25
50
75
100
0
5
10
15
20BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
FCT
• 10 trial sessions• Simple FCR: “play please”• Complex FCR: “Can I play please?”• Immediate vocal model, faded within session• All FCRs were immediately granted• Criteria: 3 consecutive sessions with optimal FCRs
and stereotypy at 5% or less during S‐
6/11/2017
23
0
25
50
75
100
0
5
10
15
20BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
Tolerance Response Training
• 10 trial sessions• FCR granted on 4 trials, denied on 6 trials• Tolerance response following denial: “Okay”• Immediate vocal model, faded within session• Criteria: 3 consecutive sessions with optimal FCRs
and TRs, and stereotypy at 5% or less during S‐
0
25
50
75
100
0
5
10
15
20BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
Response Chaining
• 10 trial sessions• 2 trials: FCR produced the S+• 2 trials: TR produced the S+• 6 trials: compliance with work produced the S+• Criteria: 3 consecutive sessions with 80% accuracy (or
100% for 2), optimal FCRs and TRs, and stereotypy at 5% or less during S‐
0
25
50
75
100
0
5
10
15
20BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
Level Task Demandrange
Total demands
Field size
1 Match pictures 1 ‐ 3 12 3
2 +Letters, numbers 1 ‐ 3 12 3
3 (Same) 1 ‐ 6 18 3
4 (Same) 1 ‐ 10 27 3
5 (Same) 1 ‐ 10 27 4
6 (Same) 1 ‐ 10 27 5
7 (Same) 1 ‐ 10 27 6
8 +Sort objects 1 ‐ 10 27 6
9 +ADLs 1 ‐ 10 27 6
10 +Identify pictures 1 ‐ 10 27 6
6/11/2017
24
0
25
50
75
100
0
5
10
15
20BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
0
25
50
75
100
0
2
4
6
8
10
S-S+M
otor
ster
eoty
py%
of
com
pone
nt
0
5
10
15
20 S- duration (min)
0
10
20
30
40
*
FCR
per
min
0
5
10
15
20
0
4
8
12
16
20
TR
per
min
0
2
4
6
8
10
10 20 30 40 50 600
25
50
75
100
0
20
40
60
80
Grant
1 2 3 4 5
Acc
urac
y (%
)
20 40 60 80 1000
5
10
15
201 2 3
Marco
# demands
Sessions
Discriminationindex
• ProportionofstereotypythatoccurredduringS+• Expressedasadecimal
– 0.7– 1.0=discriminatedresponding– 0.5=indiscriminateresponding
6/11/2017
25
0.0
0.2
0.4
0.6
0.8
1.0
0
2
4
6
8
10
0.0
0.2
0.4
0.6
0.8
1.0
0
5
10
15
20
20 40 60 80 1000.0
0.2
0.4
0.6
0.8
1.0
0
5
10
15
20
Sessions
Mot
or s
tere
otyp
y di
scri
min
atio
n in
dex
Grant
Milo
Marco
S- duration (m
inutes)
0.0
0.2
0.4
0.6
0.8
1.0
Grant Milo Marco
BaselineTreatment
Dis
crim
inat
ion
inde
x (a
vg)
0.0
0.2
0.4
0.6
0.8
1.0
0
2
4
6
8
10
0.0
0.2
0.4
0.6
0.8
1.0
0
5
10
15
20
20 40 60 80 1000.0
0.2
0.4
0.6
0.8
1.0
0
5
10
15
20
Sessions
Voc
al s
tere
otyp
y di
scri
min
atio
n in
dex
Grant
Milo
Marco
S- duration (m
inutes)
SocialValidity
Question Grant Milo Marco
Thetreatmentthatinvolvedteachingarequestforstereotypy,teachinganappropriateresponsetothedenialofthatrequest,andteachingtheindividualtocompleteanincreasingnumberofdemandsbeforeearningaccesstostereotypywasacceptable.
7 7 7
Theamountofbehaviorchange(i.e.,theeffectsoftreatment)wasacceptableorsufficient.
6 7 6
Theoverallgoalsofthistreatmentwereacceptable,appropriate,andimportantfortheindividual.
7 7 6
Iwouldrecommendthistreatmentpackagetoothertherapistsorproviderswhoareattemptingtodecreasestereotypyandincreaseappropriateengagement.
7 7 7
1=highlydisagree 7=highlyagree
6/11/2017
26
NextStep
Evaluategenerality oftheskill‐basedtreatmentindifferentcontextsandwhenappliedunderlongerperiodsbyrelevantteachersandcaregivers
Evaluatetreatmentwhenappliedtovocalstereotypyandother“there’sabettertimeandplaceforthat”behaviors
HandmouthingScriptingMasterbationInteractive,imaginativeplay
FinalTake‐HomePoints
Treatmentforstereotypycan(should?)be….
function‐based
comprehensive
involveastrong,intermittent,andunpredictablecontingencytoinhibitstereotypyanddosomethingelsecontextuallyappropriateinordertoengageinstereotypy
Goodluckwithallthatyoudoforallwhoyouteachandprovidecare
Formoreinformationgoto:www.practicalfunctionalassessment.com
Contactinfo.:GregoryP.Hanley,Ph.D.,BCBA‐D
PsychologyDepartmentWesternNewEnglandUniversity
1215WilbrahamRoadSpringfield,Massachusetts01119
