|Repetitive Responses: Treating Obsessive Compulsive and Stereotypic Behavior in Children With Autism Spectrum Disorders|
|Monday, May 27, 2019|
|11:00 AM–12:50 PM |
|Hyatt Regency West, Ballroom Level, Regency Ballroom A|
|Area: AUT/DDA; Domain: Translational|
|Chair: Marc J. Lanovaz (Université de Montréal)|
|Discussant: Mandy J. Rispoli (Purdue University)|
|CE Instructor: Jennifer Cook, M.S.|
Practitioners treating children diagnosed with autism spectrum disorder will inevitably encounter the problem of decreasing repetitive behavior. One form of repetitive behaviors are obsessive compulsive behaviors, and the paucity of research in this area leaves practitioners with few options. The first presentation will describe a randomized control trial involving 37 children to evaluate the effects of Functional Behavior-based Cognitive Behavior Therapy. The second presentation will suggest how the role of respondent and operant conditioning on obsessive compulsive behavior, and the implications for assessment and treatment. The third presentation will transition into a discussion on another commonly encountered form of repetitive behavior, stereotypy. Selections for stereotypy treatment may be context-specific; as such 5 children were assessed and treated to the extent necessary within an instructional setting. The fourth presentation extends stereotypy treatment into the home. Researchers in this study designed an iOS app, the iSTIM, and assessed the utility this app as a tool to be used by parents to treat stereotypy of their own children.
|Instruction Level: Intermediate|
|Keyword(s): OCD, repetitive behavior, stereotypy, treatment methods|
|Target Audience: |
Psychologists, Board Certified Behavior Analysts, Board Certified assistant Behavior Analysts, graduate students, teaching faculty
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) Discriminate between and identify the different types of repetitive behavior (2) Describe an appropriate assessment method that can be used for a specific type of repetitive behavior (3) Describe an appropriate treatment method that can be used for a specific type of repetitive behavior (4) Search the literature for unique approaches or methodologies for repetitive behavior|
A Blended Approach of Cognitive-Behavior Therapy and Applied Behavior Analysis for Obsessive Compulsive Behavior
|TRICIA CORINNE VAUSE (Brock University), Heather Yates (University of Manitoba), Nicole M. Neil (University of Western Ontario), Jan Frijters (Brock University), Grayzna Jackiewicz (Private Practice), Maurice Feldman (Brock University)|
Children with Autism Spectrum Disorder (ASD) frequently experience obsessions and compulsions similar to those specified in DSM-5 for Obsessive Compulsive Disorder (OCD) yet a paucity of research exists on treating these behaviours. Thirty-seven children (7 to 13 years old) received random assignment to a nine-week Functional Behavior-based Cognitive Behavior Therapy (Fb-CBT) or Treatment As Usual (TAU). Fb-CBT combines CBT (e.g., exposure and response prevention) and ABA elements (e.g., extinction, functional communication training and differential reinforcement) derived from functional behavioral assessment. Independent assessors administered measures pre- and post-treatment and at 6-months. Two primary outcome measures including the Repetitive Behavior Scale-Revised and the Children’s Yale-Brown Obsessive Compulsive Scale indicated statistically significant differences between groups, with large corrected effect sizes (Hedge’s g = 1.00 and 1.15, respectively). Time series parent report data corroborated these findings with two-thirds of treated behaviors in Fb-CBT showing a positive treatment response. This is the first known RCT to exclusively treat OCBs in children with high functioning ASD, and suggests that CBT with ABA components may be efficacious in decreasing OCBs and associated functional impairment.
|A Behavior Analytic Conceptual Framework for the Assessment and Treatment of Obsessive Compulsive Behaviors|
|EMILY GUERTIN (Brock University), Tricia Corinne Vause (Brock University), Jan Frijters (Brock University), Maurice Feldman (Brock University)|
|Abstract: A subset of repetitive behaviors in Autism Spectrum Disorder (ASD) including insistence on sameness, ritualistic behavior, and compulsions overlaps topographically with symptoms characteristic of Obsessive Compulsive Disorder. The overlapping symptoms often present a challenge in the literature for selecting how to assess and treat these behaviors. This presentation discusses the often-complex role that the function of an obsessive compulsive behavior (OCB) serves for an individual. Based on Mowrer’s (1951) two-factor theory of avoidance learning, both classical and instrumental learning processes can be involved in the development and maintenance of repetitive behaviors. Using behavioral models, four case examples from clinical treatment studies illustrate the influence of primary or multiple functions on obsessive compulsive behaviors in ASD, highlighting that the topography of the behavior alone may not indicate the function of the behavior (see Figure 1 for a clinical example of a multiply controlled behavior). Behavioral models describe the role of respondent and operant conditioning and ways that behavioral technologies can be integrated to enhance treatment efficacy. Methods of functional behavioral assessment including informant and observational methods and recommendations for incorporating assessment results in treatment are provided. Limitations and future directions for function-based treatment of OCBs in persons with ASD are discussed.|
To What Extent Do Practitioners Need to Treat Stereotypy During Academic Tasks?
|JENNIFER COOK (University of South Florida, Monarch House), John T. Rapp (Auburn University)|
Researchers frequently argue that a child’s engagement in stereotypy may compete with his ability to acquire academic skills, engage in appropriate social interactions, or both; however, few studies have directly tested these suppositions. We used a five-phase assessment to evaluate the extent to which behavioral interventions with a progressively greater number of components were necessary to decrease stereotypy and increase correct responding during academic instructions for five children diagnosed with autism spectrum disorders. For one participant, stereotypy decreased when instructors provided standard instruction without specific intervention for stereotypy. For two participants, stereotypy decreased when instructors provided standard instruction plus antecedent intervention for stereotypy with continuous music. For another participant, stereotypy decreased when instructors provided enhanced consequences for correct responding during standard instruction without either antecedent or consequent intervention for stereotypy. For the final participant, stereotypy decreased and correct responding increased when instructors provided standard instruction and consequent intervention for stereotypy.
Reducing Stereotypy in Children With Autism
|LYDIA TRUDEL (Université de Montréal), Marc J. Lanovaz (Université de Montréal), Isabelle Préfontaine (Université de Montréal)|
Children with autism spectrum disorder (ASD) often engage in stereotypy, which may interfere with social integration, adaptive functioning and learning. Unfortunately, many children with ASD do not have access to behavioral interventions that could effectively reduce engagement in stereotypy while improving appropriate behavior. To address this issue, we developed an iOS app, the iSTIM, designed to support parents in reducing stereotypy in their child with ASD. The purpose of our study was to evaluate the effects of the iSTIM when used by parents. More specifically, we tested the effects of the app with ten children with ASD between the ages of 3 to 12 years old within a noncurrent multiple baseline design. To date, four families have completed their participation in the study. The iSTIM reduced stereotypy in the four participants, but only increased functional engagement in one participant. The preliminary results suggest that the iSTIM may benefit from modifications to improve the clarity of the procedures of the intervention.