Running head: ANTECEDENT INTERVENTIONS FOR STEREOTYPY

Antecedent Interventions for Motor and Vocal Stereotypy - A Research Proposal

Mariah Bashir and Tracy Pham

University of British Columbia

ANTECEDENT INTERVENTIONS FOR STEREOTYPY 2

Antecedent Interventions for Motor and Vocal Stereotypy - A Research Proposal

Stereotypy is defined as restrictive, involuntary, non-reflexive and repetitive motor

movements and/or vocal responses, and is one of the core characteristics of Autism Spectrum

Disorder (Chebli, Martin, & Lanovaz, 2016; Lydon, Moran, Healy, Mulhern, & Young, 2017).

The prevalence of stereotypy in individuals with Autism Spectrum Disorder is 88%, which is the

highest prevalence rate compared to individuals diagnosed with other developmental disabilities

(Chebli et al., 2016). Motor stereotypy is presented in a wide range of forms, such as repetitive

hand movements, mouthing, body rocking and motor movements with and without objects, while

vocal stereotypy is presented as repetitive vocalizations, scripting and repetitive use of language

(Chebli et al., 2016; Lydon et al., 2017). Stereotypy is a socially significant behaviour to address

because stereotypy is usually viewed as socially inappropriate, stigmatizing, disruptive,

potentially dangerous to the individual or others and interferes with everyday life (Lee, Vargo, &

Poretta, 2018; Lydon et al., 2017). In a classroom setting specifically, engaging in stereotypy can

interfere with learning for the individual engaging in the stereotypy and for peers around them,

as well as impede development of social skills. In addition, this behavior can be stressful to the

classroom teacher/teaching assistant and parents.

Stereotypy has been shown to be maintained by all four functions: social reinforcement

(both positive and negative), tangible reinforcement, escape from demands, and automatic

reinforcement (Cunningham & Schreibman, 2008). However, there is an extensive amount of

research evidence for the sensory function of stereotypy, in which automatic reinforcement is

found to maintain the behaviour. A client of ours (LD) engages in motor stereotypy across his

entire day (e.g., when alone and with others, during play time and work time, and at home and

school). He runs objects through his fingers (e.g. beads, popcorn, cheerios, puzzle pieces), flaps
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 3

his hands, clap his hands, jumps up and down and taps the table with one finger. When he

engages in stereotypy, he is distracted, which impedes the acquisition of new skills and he is

unable to finish his meals. A functional behaviour assessment was completed to determine that

the motor stereotypy LD engages in is maintained by automatic reinforcement, as he engages in

the stereotypy throughout his entire day, whether he is alone or with another individual. LD is

significantly affected in all aspects and environments of his life, due to the disruptive nature of

the stereotypy (for him and those around him) and how the behaviour has impeded his social,

adaptive and academic gains.

A review of the literature provides a conceptual model for interventions focused on the

reduction or elimination of vocal and motor stereotypy. Some interventions found in the

literature to address stereotypy include differential reinforcement of other behaviour (DRO)

(Gehrman, Wilder, Forton, & Albert, 2017), incompatible behaviour (DRI) (Dickman, Bright,

Montgomery, & Miguel, 2012), response interruption and redirection (RIRD) (Pastrana, Rapp, &

Frewing, 2013), punishment (Maag, Rutherford, Wolchik, & Parks, 1986), and response

blocking procedures (Giles, St. Peter, Pence, & Gibson, 2012). However, some of these

strategies (i.e., RIRD, punishment, response bocking) focus on the introduction and manipulation

of intrusive consequences. Although these procedures are often effective in reducing or

eliminating stereotypy, there are many reasons as to why antecedent interventions would be a

better long-term solution and why we propose investigating the use of an antecedent intervention

in the reduction of vocal and motor stereotypy.

One primary concern about these intrusive consequence strategies is that they are not

easily applied to the classroom setting (Lydon et al., 2017) due to the limited resources available.

For example, one client of ours engages in stereotypy on average every 10 seconds. It is highly
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 4

unlikely that a teacher or Education Assistant would be able to reliably block (i.e., response

blocking) every instance of his motor stereotypy and/or redirect him to other appropriate

alternative behaviours (i.e., RIRD).

Another limitation is the use of consequence strategies is that it can be difficult to

pinpoint or manipulate the specific source of reinforcement for individuals who engage in

automatically maintained stereotypy in order to match the sensation felt by that individual

(Lerman & Rapp, 2006). For example, if an individual engages in frequent automatically

maintained motor stereotypy (i.e. flapping) during class work, it would be difficult to identify an

alternative replacement behaviour that would match this sensation, yet presenting itself as a more

appropriate alternative behavior that is less distracting from the task at hand.

Antecedent interventions are socially valid and “less resource-intensive” than the more

intrusive consequence strategies (Lydon et al., 2017). Without the use of punishment or response

blocking procedures, antecedent interventions are more acceptable because they involve

implementing preventative measures. In addition, if these preventative measures are

implemented consistently and are effective in reducing or eliminating stereotypy, the behaviour

is less likely to require invasive physical and/or vocal interruption and redirection,

thus requiring less resources and time.

Some antecedent interventions found in the literature include the application of

antecedent physical exercise (Lee et al., 2018), Inhibitory Stimulus Control Procedures (ISCP)

(Lydon et al., 2017), Matched Stimulation with contingent and noncontingent access to preferred

items (offering the same source of reinforcement as the stereotypy) (Piazza, Adelinis, Hanley,

Goh, & Delia, 2000), removing or reducing antecedent events that trigger stereotypy (Green &

Freed, 1993), and self-management (Koegel & Koegel, 1990).

ANTECEDENT INTERVENTIONS FOR STEREOTYPY 5

To specifically address automatically maintained stereotypy, ISCPs has been shown to be

an emerging intervention for reducing automatically maintained stereotypy in individuals, ages

4-18 with autism (Lydon et al., 2017).To qualify ISCPs as evidence based, more research needs

to be conducted with this population. Therefore, we propose to study the functional relation

between ISCPs with DRO and the reduction of automatically maintained stereotypy. The

existing ISCPs research often combines ISCPs with intrusive consequences (i.e. response

blocking, physical restraint) and it is uncertain what component of the intervention resulted in

the change in stereotypy. Punishment or reinforcement techniques are often integrated with

ISCPs to establish stimulus control; however, the main goal of ISCPs is to then bring stereotypy

under the control of a specific stimulus only (without the use of punishment or reinforcement).

After removing these additional restrictive and possibly resource intensive procedures, ISCPs

offer a more attractive and socially valid option to consequence-based interventions. If the

stimuli controlling the stereotypy is a naturally occurring stimuli (e.g., specific people, locations

and activities), ISCPs become a more practical option. Although in this present study we will

not be combining an ISCP with intrusive consequences, external positive reinforcement will be

provided contingent on the absence of stereotypy during table work (DRO). The external positive

reinforcement will then be faded to a more natural form of reinforcement, with the hopes of

enhancing the stimulus control between the discriminative stimuli and stereotypy.

Research Question

This proposed study would investigate the question: Is there a functional relation

between Inhibitory Stimulus Control Procedures (ISCP) combined with Differential

Reinforcement of Other Behaviour (DRO) and a reduction in motor and vocal stereotypy

maintained by automatic reinforcement, with students with Autism in the classroom setting? If
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 6

stereotypy decreases significantly during academic tasks or activities within the classroom, the

results would suggest that ISCPs offer a less intrusive and more practical option of intervention

for addressing frequent automatic stereotypy in the classroom.

Method

Participants

One student from an elementary school (from grades Kindergarten to 7) in the Lower

Mainland will be selected to participate in this study. The student will need to have a diagnosis

of Autism Spectrum Disorder and engage in frequent (40-80% of their day) vocal and/or motor

stereotypy. Specifically, the stereotypy the student engages in will need to be maintained by

automatic reinforcement.

The potential participant will be recruited for the initial screening process by sending out

informed consent forms to Applied Behaviour Analysis agencies in the Lower Mainland, which

will be distributed to their elementary aged clients and their families. The consent forms will

inquire permission for a functional analysis (FA) to be performed on elementary aged students

diagnosed with Autism Spectrum Disorder, who engage in vocal and/or motor stereotypy that

interfere with learning in a classroom setting. The FA will determine the function of the

stereotypy for each individual, and a participant who engages in stereotypy (that does not cause

self-harm) maintained by automatic reinforcement will be randomly chosen to partake in the

study.

The parents or guardians of the participants selected for the initial screening process will

be provided with consent forms outlining all roles and responsibilities of the participant for the

assessments and research study, and will be required to sign before any further interaction. The

participants will then undergo a trial-based functional analysis (FA) in the participant’s
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 7

classroom setting; this is a variation of FA that allows for the assessment to occur under more

naturalistic conditions as long as confounding influences are minimized for brief periods of time

(Iwata & Dozier, 2008). The trial-based FA will be conducted by the researchers in a classroom

setting in accordance with the procedures outlined by Bloom and colleagues (Bloom, Iwata,

Fritz, Roscoe, & Carreau, 2011).

Assessment conditions will be embedded as probe trials throughout classroom routines

and opportunities to conduct trials will arise naturally throughout the day. Attention, tangible,

demand, and ignore conditions (and the control for each condition) will be conducted 3 times

each, for 2 minutes each time, intermittently across the day.

One participant from the independent Functional Assessments, will be randomly chosen

to partake in the study. A consent form outlining all roles and responsibilities will be provided to

the chosen student’s school principal, teachers, and Education Assistant(s), and will be signed

and returned before any further interaction.

Settings

The selected student’s classroom will be the setting where data collection will occur and

intervention will be implemented. Implementation of Inhibitory Stimulus Control Procedures

will occur during work time at the table. Observations will also take place in the natural setting

of the classroom, during table work.

Measurement

Dependent Variables. The overall goal of this study is to decrease motor and/or vocal

stereotypy. Vocal stereotypy will be defined as any audible vocalizing of non-functional or non-

contextual speech. Some examples of vocal stereotypy topographies includes singing, humming,

repetitive sounds and reciting phrases that are unrelated to the current activity. Some non-
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 8

examples include answering a question, responding to a demand or repeating a demand given.

Motor stereotypy will be defined as non-functional or non-contextual repetitive movements.

Some examples of motor stereotypy topographies will include hand flapping, body rocking, arm

waving, or finger tapping. Some non-examples include jumping off a stair, playing with a toy as

intended, and waving hello to a peer.

Social Validity. A social validity questionnaire will be created to inquire about the

viability, importance and acceptability of using ISCPs and DRO to intervene on the vocal and/or

motor stereotypy the target student is engaging in. The questionnaire will be given to the

student’s parents, classroom teacher, EA(s), principal and parents. Depending on the cognitive

level of the student, a social validity questionnaire may be given to the student as well, ensuring

any adaptations are made on the questionnaire in order for him or her to fully comprehend the

questions asked.

Measurement Procedures. The unit of measurement will be the percent of intervals in

which the participant(s) demonstrate(s) motor and/or vocal stereotypy. Prior to intervention, a

brief interview and direct observation will be conducted to determine the individualized length of

interval for partial interval data recording. Interval length will vary on an individual basis

depending on how often the participant engages in stereotypy. The Education Assistant (EA)

will record data for occurrences and non-occurrences of motor and/or vocal stereotypy during

direct observation of in-seat work within the classroom, using a partial interval recording

procedure.

Data collection will be designated to three separate times of the day; these will be times

that the teacher has identified as the “most problematic” in terms of vocal and/or motor

stereotypy. The Education Assistant (EA) will be responsible for collecting these data during a
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 9

ten-minute period of table work. During the ten-minute period, the EA will record the occurrence

or non-occurrence of motor and/or vocal stereotypy within 30-second intervals of time. If the

participant engages in motor and/or vocal stereotypy at any point during the 30-second interval,

this will be recorded as an occurrence (+). If the participant does not engage in motor or vocal

stereotypy for the entire interval, this will be recorded as a non-occurrence (-). The EA will use

an interval timer as reference, and will record a + (occurrence) or - (non-occurrence) on a paper

data sheet during a 5-second break/gap between each 30-second interval. Although inserting this

5-second gap between intervals may result in less data, this is more acceptable than inaccurate

data recordings (Ledford & Gast, 2018). At the end of the 10-minute period, the EA will convert

the raw data into a percentage of intervals in which occurrences occurred (# of intervals in which

occurrences of stereotypy occurred/ total # of intervals ´ 100).

During intervention conditions, we will measure treatment fidelity. Treatment fidelity

will be defined as independent and correct implementation of the procedures outlined in the

intervention. We will collect treatment fidelity by using a checklist outlining the steps in the

intervention procedure and ensure each step is being performed as written and in the correct

order. We will aim for a treatment fidelity of 100%.

Inter-observer Agreement

The Teaching Interaction Procedure (TIP) will be used to train educational assistants on

how to conduct the ISCP intervention as well as how to use partial interval recording to collect

data on the participant engaging in stereotypy. The procedure for TIP will be followed as

outlined by Leaf and colleagues (Leaf et al., 2015). TIP includes 6 important steps to

implementation: label and identify skill to be taught, explain why the trainee is learning the skill,

skill is broken down into substeps and the trainee identifies each step, trainer provides examples
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 10

and non-examples of the skill/correct and incorrect ways to carry out the skill, role play, and

feedback. Training will continue until trainee reaches 90% accuracy in regards to procedure

implementation and data collection.

Interval-by-interval interobserver agreement (IOA) (also known as point-to-point

agreement) will be used to calculate IOA, wherein both observers agree on the occurrence or

non-occurrence of behaviour in each interval. Two trained graduate students will conduct the

IOA observations for 30% of baseline, treatment and follow-up sessions. The IOA observations

will be conducted at the same time baseline and treatment sessions are being performed. An

agreement will be scored when both observers record either the occurrence or non-occurrence of

vocal and/or motor stereotypy during the same interval. Interval agreement on the occurrence of

stereotypy will be calculated by using the following formula: (agreements) divided by

(agreements plus disagreements) × 100 %. Adequate IOA will be identified as 80% across two

consecutive observations. IOA will be completed once per week, and it will be required that this

level of agreement is maintained over the span of the intervention. If IOA drops below 80%, a

TIP booster session will be provided to identify and fix mistakes.

Design

An A-B-A-B withdrawal design will be used to assess the effectiveness of the Inhibitory

Stimulus Control Procedure (ISCP) combined with a differential reinforcement of other

behaviour (DRO) on the reduction of motor and vocal stereotypy in a student with ASD in the

classroom setting. A withdrawal design was chosen due to the ability of withdrawing the ISCP

and DRO intervention. The chosen participant will be an individual who engages in vocal and/or

motor stereotypy that does not inflict self-harm, therefore, it is ethical to remove the intervention

in the hope that stereotypy returns to baseline level. The design will have five phases, A-B-A-B,
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 11

and follow up (2-4 months later). Across both intervention phases and follow up phase, there will

be two data pathways; one will be for stereotypy in the presence of a red card, and one will be

for stereotypy in the presence of a green card.

Research Procedures

Preparation. After a participant has been selected from the screening process and

consent has been given by the school team and the child’s parents or guardians, a multiple

stimulus without replacement (MSWO) preference assessment will be conducted with the

participant in the classroom to identify potential reinforcers that can be used for the DRO

procedure. The preference assessment procedure will be performed as outlined by Carr and

colleagues (Carr, Nicolson, & Higbee, 2000). Data sheets for partial-interval recording of the

participant’s stereotypy will be created as well as data sheets to collect IOA. Interval timers will

be obtained to assist the educational assistant(s) and IOA observers in their collection of data

both individually and in tandem during IOA sessions. Two 3-inch by 5-inch visual cue cards

(one red, one green) will be created as the ISCP visual cues for the intervention phases.

Baseline Phases. Table work during baseline will be performed in a classroom setting. The

participant will be asked to complete table work as he/she normally would, without any cue cards

shown. The teacher and educational assistant will be asked to give instructions as he or she usually

would. The number of data points collected for baseline phases will be between 3 and 5 points

(until baseline is stable). The EA will collect baseline data during the three most problematic times

of the day (as identified by the EA and/ or teacher), for 10 minutes each time.

Intervention Phases. An Inhibitory Stimulus Control Procedure (ISCP) combined with a

DRO procedure will be applied to individuals with Autism Spectrum Disorder within the natural

classroom environment, and teachers/educational assistants will be trained to be the sole

ANTECEDENT INTERVENTIONS FOR STEREOTYPY 12

implementers of this procedure. ISCP is an antecedent intervention that begins with

discrimination training to teach the individual when reinforcement is and is not available. A

discriminative stimuli (SD) is present when the individual is allowed to engage in the

stereotypy/automatic reinforcement is available, and is not present when the individual is not

allowed to engage in the stereotypy/automatic reinforcement is not available (S). Our hypothesis

is that stereotypic behavior will decrease to near zero levels during times in which the

discriminative stimuli is not present. Two examples of discriminative stimuli mentioned in the

review written by Lydon and colleagues (2017), is a coloured wristband worn by the participant,

and a cue card/visual present within view. When either of these were present, the individual was

allowed to engage in his or her current rate of stereotypy.

In this study, we will include the wristband and cue cards/visuals as the discriminative

stimuli, with each being applied to half of the participants. The purpose of applying two different

forms of discriminative stimuli, is to increase the external validity of the ISCP intervention.

Students would learn that during table work, stereotypy will not be acceptable/automatic

reinforcement will not be available, whereas during breaks, stereotypy is acceptable/automatic

reinforcement in the form of stereotypy will be available. The absence of stereotypy during table

work will be reinforced by external reinforcement (DRO) rather than automatic reinforcement

(stereotypy). This external reinforcer will be gradually faded to a more natural form of

reinforcement.

The procedures performed in the intervention phases will be similar to those conducted

by Haley, Heick, and Luiselli (2010). Prior to starting the intervention, a brief 5-minute pre-

instructional session will be conducted to teach the participant to discriminate which times will

be appropriate for him or her to engage in stereotypy (green card present) and which times will
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 13

be inappropriate for him or her to engage in stereotypy (red card present). This pre-instructional

session may be taught vocally and/or with visuals, depending on the learning needs of the

participant.

When seated at the table, each visual cue card will be presented for 5 minutes out of the

10-minute intervention sessions and the order the cards shown will be randomly assigned and

counterbalanced during the intervention sessions. When the red card is on the table, the

participant will be provided access to a highly desired item (according to the preference

assessment performed earlier) as soon as the 30-second interval has ended if he or she does not

engage in any stereotypy within the interval. When the green card is on the table, the participant

will be allowed to engage in stereotypy without any consequences. The number of data points

collected for intervention phases will be between 5 and 8 points (until the data is stable). The EA

will collect intervention data during the three most problematic times of the day (as identified by

the EA and/ or teacher), for 10 minutes each time.

Follow-up. Follow-up will be performed 2 months after the second intervention phase

has stabilized. The number of data points collected for intervention phases will be between 1 and

3 points. The EA will collect the follow-up data during at least one of the three most problematic

times of the day (as identified by the EA and/ or teacher), for 10 minutes each time.

Anticipated Results

Baseline

During the baseline phase, we anticipate that the percentage of motor and/or vocal

stereotypy will be high (ranging between 40 and 85% of intervals), as shown in Figure 1. This
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 14

prediction is based on our screening criteria that requires the individual to be engaging in highly

frequent motor and/or vocal stereotypy across his or her day.

Intervention

During both intervention phases in which ISCP and DRO are implemented, we anticipate

that the percentage of motor and/or vocal stereotypy will be low (ranging between 10 to 30% of

intervals), as shown in Figure 1. This prediction is based on previous research conducted by

Haley, Heick, and Luiselli (2010), that show ISCP strategies are effective in decreasing motor

and vocal stereotypy in a child with autism. Furthermore, according to Weston, Hodges, and

Davis (2018) in their literature review, DRO can improve challenging behavior in individuals

with ASD, and is a much more effective intervention when combined with other procedures as a

treatment package.

Follow-up

Although our follow-up phase will take place 2 months after the intervention phase has

completed, we anticipate the results to remain at a low level with a steady trend, as shown in

Figure 1. This prediction is based on the results of the review written by Leaf and colleagues

(2015), in which 4 of the 8 studies using the Teaching Interaction Procedure model for training

implementers showed highly effective maintenance levels, with the remaining 4 showing

moderately effective maintenance levels. This suggests that the Teaching Interaction Procedure

model for training, has long lasting effects on implementation fidelity for trainees.

Social Validity

We anticipate that our results from the social validity questionnaire will suggest

acceptance by the participant and/ or family members, along with all school personnel. This

prediction is based on a number of factors: Our goal of reducing motor and/or vocal stereotypy is
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 15

important due to the current interference with learning. Although the intervention is complex and

may be time consuming in the beginning, we predict that the teacher and EA will be accepting of

the intervention due to the thorough training received via the Teaching Interaction Procedure

model and increased interval length over time after improvement in behavior. As a result of the

participant engaging in low to near zero rates of motor and/or vocal stereotypy during in-seat

work, there will be less disruption in class, and less interference with his or her learning.
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 16

References

Bloom, S. E., Iwata, B. A., Fritz, J. N., Roscoe, M. E., & Carreau, A. B. (2011). Classroom

application of a trial-based functional analysis. Journal of Applied Behavior Analysis,

44(1), 19-31.

Carr, J. E., Nicolson, A. C., & Higbree, T. S. (2000). Evaluation of a brief multiple-stimulus

preference assessment in a naturalistic context. Journal of Applied Behavior Analysis,

33(3), 353-357.

Chebli, S. S., Martin, V., & Lanovaz, M. J. (2016). Prevalence of stereotypy in individuals with

developmental disabilities: A systematic review. Review Journal of Autism and

Developmental Disabilities, 3, 107-118.

Cunningham, A. B., & Schreibman, L. (2008). Stereotypy in autism: The importance of function.

Research in Autism Spectrum Disorders, 2, 469-479.

Dickman, S. E., Bright, C. N., Montgomery, D. H., & Miguel, C. F. (2012). The effects of

response interruption and redirection (RIRD) and differential reinforcement on vocal

stereotypy and appropriate vocalizations. Behavioral Interventions, 27, 185 - 192.

Gehrman, C., Wilder, D. A., Forton, A. P., & Albert, K. Comparing resetting to non-resetting

DRO procedures to reduce stereotypy in a child with autism. Behavioral Interventions, 32,

242-247.
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 17

Giles, A. F., St. Peter, C., Pence, S. T., & Gibson, A. B. (2012). Preference for blocking or

response redirection during stereotypy treatment. Research in Developmental Disabilities,

33, 1691-1700.

Green, L., Freed, D. E. (1993). The substitutability of reinforcers. Journal of the Experimental

Analysis of Behavior, 60, 141-158.

Haley, J. L., Heick, P. F., & Luiselli, J. K. (2010). Use of an antecedent intervention to decrease

vocal stereotypy of a student with autism in the general education classroom. Child and

Family Behavior Therapy, 32(4), 311-321.

Iwata, B. A., & Dozier, C. L. (2008). Clinical application of functional analysis methodology.

Behavior Analysis in Practice, 1(1), 3-9.

Koegel, R. L., & Koegel, L. K. (1990). Extended reductions in stereotypic behavior of students

with autism through a self-management treatment package. Journal of Applied Behavior

Analysis, 23, 119-127.

Leaf, J. B., Townley-Cochran, D., Taubman, M., Cihon, J. H., Oppenheim-Leaf, M. L.,

Kassardjian, A., … Pentz, T. G. (2015). The teaching interaction procedure and behavioral

skills training for individuals diagnosed with autism spectrum disorder: A review and

commentary. Review Journal of Autism and Developmental Disorders, 2(4), 402-413.

Ledford, J. R., & Gast, D. L. (2018). Single case research methodology- Applications in special

education and behavioral sciences (3rd ed.). New York, NY: Routledge.
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 18

Lee, J., Vargo, K. K., & Poretta, D. L. (2018). An evaluation of the effects of antecedent exercise

type on stereotypic behaviors. Journal of Developmental and Physical Disabilities, 30,

409-426.

Lerman, D., & Rapp, J. (2006). Antecedent assessment & intervention for stereotypy. In J.

Luiselli (Ed.), Antecedent assessment & intervention: Supporting children & adults with

developmental disabilities in community settings (pp. 125-146). Baltimore, MD: Brookes

Publishing Co.

Lydon, S., Moran, L., Healy, O., Mulhern, T., & Young, K. E. (2017). A systematic review and

evaluation of inhibitory stimulus control procedures as a treatment for stereotyped behavior

among individuals with autism. Developmental Neurorehabilitation, 20(8), 491-501.

Maag, J. W., Rutherford, R. B., Wolchik, S. A., & Parks, B. T. (1986). Brief report: Comparison

of two short overcorrection procedures on the stereotypic behavior of autistic children.

Journal of Autism and Developmental Disorders, 16, 83–87.

Pastrana, S. J., Rapp, J. T., & Frewing, T. M. (2013). Immediate and subsequent effects of

response interruption and redirection on targeted and untargeted forms of stereotypy.

Behavior Modification, 37, 591-610.

Piazza, C. C., Adelinis, J. D., Hanley, G. P., Goh, H. L., & Delia, M. D. (2000). An evaluation of

the effects of matched stimuli on behaviors maintained by automatic reinforcement.

Journal of Applied Behavior Analysis, 33, 13-27.

ANTECEDENT INTERVENTIONS FOR STEREOTYPY 19

Weston, R., Hodges, A., & Davis, T. N. (2018). Differential reinforcement of other behaviors to

treat challenging behaviors among children with autism: A systematic and quality review.

Behavior Modification, 42(4), 584-609.

ANTECEDENT INTERVENTIONS FOR STEREOTYPY 20

Figures

100 Intervention Intervention Follow-

Baseline (ISCP & Baseline (ISCP & up
90 DRO) DRO)
Percentage of motor and/or vocal stereotypy

80

70

60

50

40

30

20

10

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Sessions

Figure 1: Hypothetical data for percentage of motor and/or vocal stereotypy during implementation
of an Inhibitory Stimulus Control Procedure (ISCP) and differential reinforcement of other behavior
(DRO).
ANTECEDENT INTERVENTIONS FOR STEREOTYPY 21

Appendix A. Timeline

Week 1 - • Conduct literature search related to motor and vocal stereotypy, ISCPs
Week 4 and DRO
• Define research question
• Prepare draft of thesis proposal
• Get approval of thesis topic from supervisor and committee members
• Complete thesis proposal
• Submit application to ethical review board

Week 5 - • Refine thesis and methodology

Week 9 • Write literature review
• Obtain and incorporate feedback from ethical review board
• Create working references list
• Revise and resubmit ethical review application

Week 10 - • Write screening criteria

14 • Write description of study letter for participant recruitment
• Write parent consent form
• Write school personnel consent form
• Select ABA organizations in Lower Mainland and send description of
study letter
• Send and obtain signed consent forms to students’ parents

Week 15-19 • Conduct trial-based FA with the students we received consent for from
recruitment
• Randomly choose one participant that fits screening criteria (based on
FA results)
• Contact the chosen student’s principal and send description of study
letter to school
• Send and obtain signed consent forms to school personnel
• Check out the classroom to determine set up for intervention
• Collect social validity measures from principal, teachers, EA(s), parents
and student

Week 20 - • Implement Teaching Interaction Procedure (TIP) with

21 implementers/teachers as our training model
• Begin baseline data collection with target student
• Conduct IOA in the middle of baseline phase
• Provide booster TIP session if needed
• Meet with supervisor to discuss implementation progress

Week 22-23 • Implement intervention

• Conduct IOA and treatment fidelity in the middle of intervention phase
• Provide booster TIP session if needed

Week 24-25 • Implement baseline phase again

ANTECEDENT INTERVENTIONS FOR STEREOTYPY 22

• Conduct IOA in the middle of intervention phase

• Provide booster TIP session if needed
• Collect social validity measures from principal, teachers, EA(s), parents
and student

Week 26-27 • Implement intervention

• Conduct IOA and treatment fidelity in the middle of intervention phase

Week 28-29 • Begin writing up results

Week 35-36 • Conduct follow-up

• Conduct IOA during follow-up phase
• Collect social validity measures from principal, teachers, EA(s), parents
and student

37-38 • Discuss with supervisor and collaborators

• Prepare results and discussion section

39-41 • Share draft of manuscript with supervisor

• Discuss feedback and revise

42-44 • Complete manuscript

45-46 • Select peer review journal

47-50 • Write draft of article to submit for publication in peer review journal
• Submit to supervisor for feedback on article draft
• Revise and send to peer reviewed journal for publication