Journal of Autism and Developmental Disorders

, Volume 41, Issue 10, pp 1330–1341 | Cite as

Effects of a Family-Implemented Treatment on the Repetitive Behaviors of Children with Autism

  • Brian A. Boyd
  • Stephen G. McDonough
  • Betty Rupp
  • Faraaz Khan
  • James W. Bodfish
Original Paper

Abstract

The restricted and repetitive behaviors of children with autism can interfere with family functioning as well as learning and socialization opportunities for the child. To date, neither pharmacological nor comprehensive behavioral treatments have been found to be consistently effective at significantly reducing children’s engagement in repetitive behaviors. We developed Family-Implemented Treatment for Behavioral Inflexibility (FITBI) to target the full variety of repetitive behaviors found in autism. For the current study, a therapist and parents of five children with autism (mean age = 48 months) co-implemented FITBI in a clinic setting over a 12-week treatment period. Using single case design methodology, significant reductions in repetitive behaviors were found for all participants and maintenance of treatment effects for 4 of 5 participants.

Keywords

Autism spectrum disorders Repetitive behaviors Treatment 

References

  1. Ahearn, W. H., Clark, K. M., MacDonald, R. P. F., & Chung, B. (2007). Assessing and treating vocal stereotypy in children with autism. Journal of Applied Behavior Analysis, 40, 263–275.PubMedCrossRefGoogle Scholar
  2. Azrin, N. H., Besalel, V., Jamner, J. P., & Caputa, J. N. (1988). Comparative study of behavioral methods of treating severe self-injury. Behavior Resident Treatment, 3, 119–152.Google Scholar
  3. Bishop, S., Reichler, J., Cain, A., & Lord, C. (2007). Predictors of perceived negative impact in mothers of children with autism spectrum disorders. American Journal on Mental Retardation, 112, 450–461.PubMedCrossRefGoogle Scholar
  4. Bodfish, J. W. (2004). Treating the core features of autism: Are we there yet? Mental Retardation and Developmental Disabilities Research Reviews, 10, 318–326.PubMedCrossRefGoogle Scholar
  5. Bodfish, J. W., Crawford, T. W., Powell, S. B., Parker, D. E., Golden, R. N., & Lewis, M. H. (1995). Compulsions in adults with mental retardation: Prevalence, phenomenology, and comorbidity with stereotypy and self-injury. American Journal of Mental Retardation, 100, 183–192.PubMedGoogle Scholar
  6. Bodfish, J. W., Symons, F. J., & Lewis, M. H. (1999). The Repetitive Behavior Scales (RBS). Western Carolina Center Research Reports.Google Scholar
  7. Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparison to mental retardation. Journal of Autism and Developmental Disabilities, 30, 237–243.CrossRefGoogle Scholar
  8. Boyd, B. A., Conroy, M. A., Mancil, G. R., Nakao, T., & Alter, P. (2007). Effects of circumscribed interests on the social behaviors of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1550–1561.PubMedCrossRefGoogle Scholar
  9. Boyd, B. A., McBee, M., Holtzclaw, T., Baranek, G. T., & Bodfish, J. W. (2009). Relationships among repetitive behaviors, sensory features, and executive functions in high functioning autism. Research in Autism Spectrum Disorders, 3, 959–966.PubMedCrossRefGoogle Scholar
  10. Boyd, B. A., Rupp, B., & Bodfish, J. W. (2010). Direct observation of repetitive behaviors in autism. Unpublished manual, University of North Carolina at Chapel Hill.Google Scholar
  11. Campbell, J. M. (2004). Statistical comparison of four effect sizes for single-subject designs. Behavior Modification, 28, 234–246.PubMedCrossRefGoogle Scholar
  12. Cuccaro, M. L., Shao, Y., Grubber, J., Slifer, M., Wolpert, C. M., Donnelly, S. L., et al. (2003). Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R. Child Psychiatry and Human Development, 34(1), 3–17.PubMedCrossRefGoogle Scholar
  13. Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20, 775–803.PubMedCrossRefGoogle Scholar
  14. Dawson, G., Rogers, R., Munson, J., Smith, M., Winter, J., Greenson, J. et al. (in press). Randomized, controlled trial of the Early Start Denver Model, a developmental behavioral intervention for toddlers with autism: Effects on IQ, adaptive behavior, and autism diagnosis. Pediatrics, published online. doi:10.1542/peds.2009-0958.
  15. Gabriels, R. L., Cuccaro, M. L., Hill, D. E., Ivers, B. J., & Goldson, E. (2005). Repetitive behaviors in autism: Relationships with associated clinical features. Research in Developmental Disabilities, 26, 169–181.PubMedCrossRefGoogle Scholar
  16. Gorman-Smith, D., & Matson, J. (1985). A review of treatment research for self-injurious and stereotyped responding. Journal of Mental Deficiency Research, 29, 295–308.PubMedGoogle Scholar
  17. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of symptom severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 693–705.PubMedCrossRefGoogle Scholar
  18. Green, V., Sigafoos, J., Pituch, K., Itchon, J., O’Reilly, M., & Lancioni, G. (2006). Assessing behavioral inflexibility in individuals with developmental disabilities. Focus on Autism and Developmental Disabilities, 4, 230–236.CrossRefGoogle Scholar
  19. Greenberg, J. S., Seltzer, M. M., Krauss, M. W., Chou, R. J., & Hong, J. (2004). The effect of quality of the relationship between mothers and adult children with disabilities: The mediating role of optimism. American Journal of Orthopsychiatry, 74, 14–25.PubMedCrossRefGoogle Scholar
  20. Holman, J., Goetz, E. M., & Baer, D. M. (1977). The training of creativity as an operant and an examination of its generalization characteristics. In B. C. Etzel, J. M. LeBlanc, & D. M. Baer (Eds.), New developments in behavior research, theory, method and application. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  21. Honey, E., McConachie, H., Randle, V., Shearer, H., & Couteur, A. S. (2008). One-year change in repetitive behaviours [sic] in young children with communication disorders including autism. Journal of Autism and Developmental Disorders, 38, 1439–1450.PubMedCrossRefGoogle Scholar
  22. Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single subject research to identify evidence-based practice in special education. Exceptional Children, 71, 165–179.Google Scholar
  23. Jenson, W. R., Clark, E., Kircher, J. C., & Kristjansson, S. D. (2007). Statistical reform: Evidence-based practice, meta-analyses, and single subject designs. Psychology in the Schools, 44, 483–493.CrossRefGoogle Scholar
  24. Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47, 611–620.PubMedCrossRefGoogle Scholar
  25. King, B., Hollander, E., Sikich, L., McCraken, J., Scahill, L., Bregman, J., et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior. Archives of General Psychiatry, 66, 583–590.PubMedCrossRefGoogle Scholar
  26. Koegel, R. L., & Covert, A. (1972). The relationship of self-stimulation to learning in autistic children. Journal of Applied Behavior Analysis, 5, 381–387.PubMedCrossRefGoogle Scholar
  27. Koegel, R. L., Firestone, P. B., Kramme, K. W., & Dunlap, G. (1974). Increasing spontaneous play by suppressing self-stimulation in autistic children. Journal of Applied Behavior Analysis, 7, 521–528.PubMedCrossRefGoogle Scholar
  28. Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., et al. (2010). Single-case designs technical documentation. Retrieved from What Works Clearinghouse website: http://ies.ed.gov/ncee/wwc/pdf/wwc_scd.pdf.
  29. Lam, K. S. L., & Aman, M. G. (2007). The Repetitive Behavior Scale—revised: Independent validation in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 855–866.PubMedCrossRefGoogle Scholar
  30. Lam, K. S. L., Holtzclaw, T. N., Baranek, G. T., & Bodfish, J. W. (2005). Early developmental patterns of repetitive behavior, aberrant behavior, and executive function deficits in autism spectrum disorders. Paper presented at thirty-ninth annual meeting of the Gatlinburg conference.Google Scholar
  31. Lam, K. S. L., Piven, J., & Bodfish, J. W. (2008). Evidence for three subtypes of repetitive behavior in autism that differ in familiarity and association with other symptoms. Journal of Child Psychology and Psychiatry, 49, 1193–1200.PubMedCrossRefGoogle Scholar
  32. Lewis, M. H., & Bodfish, J. W. (1998). Repetitive behavior disorders in autism. Mental Retardation and Developmental Disabilities Research Reviews, 4, 80–89.CrossRefGoogle Scholar
  33. Leyfer, O. T., Folstein, S., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.PubMedCrossRefGoogle Scholar
  34. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule. Los Angeles, CA: Western Psychological Services.Google Scholar
  35. Lounds, J., Seltzer, M. M., Greenberg, J., & Shattuck, P. (2007). Transition and change in adolescents and young adults with autism: Longitudinal effects on maternal well-being. American Journal on Mental Retardation, 112, 401–417.PubMedCrossRefGoogle Scholar
  36. Machado, A. (1989). Operant conditioning of behavioral variability using a percentile reinforcement schedule. Journal of the Experimental Analysis of Behavior, 52, 155–166.PubMedCrossRefGoogle Scholar
  37. Mercier, C., Mottron, L., & Belleville, S. (2000). A psychosocial study on restricted interest in high functions persons with pervasive developmental disorders. Autism, 4, 406–425.CrossRefGoogle Scholar
  38. Miller, N., & Neuringer, A. (2000). Reinforcing variability in adolescents with autism. Journal of Applied Behavior Analysis, 33, 151–165.PubMedCrossRefGoogle Scholar
  39. Mooney, E. L., Gray, K. M., & Tonge, B. J. (2006). Early features of autism: Repetitive behaviours [sic] in young children. European Child and Adolescent Psychiatry, 15, 12–18.PubMedCrossRefGoogle Scholar
  40. Napolitano, D. A., Smith, T., Zarcone, J. R., Goodkin, K., & McAdam, D. B. (2010). Increasing response diversity in children with autism. Journal of Applied Behavior Analysis, 43, 265–271.PubMedCrossRefGoogle Scholar
  41. Neuringer, A. (1986). Can people behave “randomly?” The role of feedback. Journal of Experimental Psychology: General, 115, 62–75.CrossRefGoogle Scholar
  42. Neuringer, A. (2004). Reinforced variability in animals and people: Implications for adaptive action. American Psychologist, 59(9), 891–906.PubMedCrossRefGoogle Scholar
  43. Newman, B., Tuntigian, L., Ryan, C., & Reinecke, D. (1997). Self-management of a DRO procedure by three students with autism. Behavioral Interventions, 12(3), 149–156.CrossRefGoogle Scholar
  44. Noldus. (1991). The observer. Wageningen, The Netherlands: Noldus Information Technology.Google Scholar
  45. Peters-Scheffer, N., Didden, R., Green, V. A., Sigafoos, J., Korzilius, H., et al. (2008). The behavior flexibility rating scale-revised (BFRS-R): Factor analysis, internal consistency, inter-rater and intra-rater reliability, and convergent validity. Research in Developmental Disabilities, 29, 398–407.PubMedCrossRefGoogle Scholar
  46. Piazza, C. C., Moes, D. R., & Fisher, W. W. (1996). Differential reinforcement of alternative behavior and demand fading in the treatment of escape-maintained destructive behavior. Journal of Applied Behavior Analysis, 29, 569–572.PubMedCrossRefGoogle Scholar
  47. Pierce, K., & Courchesne, E. (2001). Evidence for a cerebellar role in reduced exploration and stereotyped behavior in autism. Biological Psychiatry, 49, 655–664.PubMedCrossRefGoogle Scholar
  48. Piven, J., Harper, J., Palmer, P., & Arndt, S. (1996). Course of behavioral change in autism: A retrospective study high-IQ adolescents and adults. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 523–539.PubMedCrossRefGoogle Scholar
  49. Pryor, K. W., Haag, R., & O’Reilly, J. (1969). The creative porpoise: Training for novel behavior. Journal of the Experimental Analysis of Behavior, 12, 653–661.PubMedCrossRefGoogle Scholar
  50. Richler, J., Bishop, S., Kleinke, J., & Lord, C. (2007). Restricted and repetitive behaviors in young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 73–85.PubMedCrossRefGoogle Scholar
  51. Rutter, M. (1978). Diagnosis and definitions of childhood autism. Journal of Autism and Childhood Schizophrenia, 8(2), 139–161.PubMedCrossRefGoogle Scholar
  52. Schertz, H. H., & Odom, S. L. (2007). Promoting joint attention in toddlers with autism: A parent-mediated developmental model. Journal of Autism and Developmental Disorders, 37, 1562.PubMedCrossRefGoogle Scholar
  53. Scruggs, T. E., & Mastropieri, M. A. (1998). Summarizing single-subject research: Issues and applications. Behavior Modification, 22, 221–242.PubMedCrossRefGoogle Scholar
  54. Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland Adaptive Behavior Scales, second edition: Survey forms manual. Minneapolis, MN: Pearson, Inc.Google Scholar
  55. Strain, P. S., Kohler, F. W., & Gresham, F. (1998). Problems in logic and interpretation with quantitative syntheses of single-case research: Mathur and colleagues (1998) as a case in point. Behavioral Disorders, 24(1), 74–85.Google Scholar
  56. Szatmari, P., Georgiades, S., Bryson, S., Zwaigenbaum, L., Roberts, W., Mahoney, W., et al. (2006). Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry, 47(6), 582–590.PubMedCrossRefGoogle Scholar
  57. Turner, M. (1999). Annotation: Repetitive behavior in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, 40, 839–849.PubMedCrossRefGoogle Scholar
  58. Varni, J. W., Lovaas, O. I., Koegel, R., & Everett, N. (1979). An analysis of observational learning in autistic and normal children. Journal of Abnormal Child Psychology, 7, 31–43.PubMedCrossRefGoogle Scholar
  59. Wink, L. K., Erickson, C. A., & McDougle, C. J. (in press). Pharmacologic treatment of behavioral symptoms associated with autism and other pervasive developmental disorders. Current Treatment Options in Neurology.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Brian A. Boyd
    • 1
  • Stephen G. McDonough
    • 2
  • Betty Rupp
    • 3
  • Faraaz Khan
    • 1
  • James W. Bodfish
    • 3
  1. 1.Division of Occupational Science, Department of Allied Health SciencesUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.FPG Child Development InstituteUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Carolina Institute for Developmental DisabilitiesUniversity of North Carolina at Chapel HillChapel HillUSA

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