Operant Innovations Monthly 004 | Stereotypy Q&A | Dr. Bill Ahearn

Shauna Costello (00:01):

You're listening to operant innovations. The podcast brought to you by ABA technologies. This month, we're talking with dr. Bill Ahearn and answering some questions that we received from social media and an email blast. So please welcome dr. Ahearn. We are here with dr. Bill Ahearn who recently, well, within the last six months, came down to Florida and recorded a new updated CE course for us on stereotypy and also anxiety behaviors with some of the more recent research that he's done to update a previous course that he did for us, but there's still a lot of questions regarding stereotypy and what it is. And there's always the big debate on, you know, should you get rid of stereotypical behaviors and when should you get rid of stereotypical behaviors or try to decrease those behaviors and increase more socially significant behaviors. And so he's agreed to answer some of those questions for us today. So welcome.

Dr. Bill Ahearn (01:09):

Hi Shauna. It's nice to talk to you

Shauna Costello (01:11):

And thank you for being here. And so we have some questions from social media and also from some emails and some that I threw in there or elaborated on as well. I guess we'll jump right in and ask, you know, what is stereotypy and what qualifies or what qualifies as stereotypy?

Dr. Bill Ahearn (01:33):

Well, that's a perfect starting point when we're talking about stereotypy to look at, you know, how it is that we define stereotypy, how we distinguish it from other similar sorts of behavior. Stereotypy has traditionally been referred to in the psychiatric literature as nonfunctional movements and vocalizations that are repetitive in nature as a behavior analyst, working primarily with individuals with autism, stereotypy, restricted interests and repetitive behavior, stereotypy being one of those, you know, repetitive behaviors that we're interested in, more working with individuals with autism stereotypy as a defining characteristic as something that we're very familiar with when we're working with this population, one of the problems with the traditional psychiatric definition of stereotypy, the nonfunctional part of it is that that's not particularly satisfying to a behavior analyst or anybody interested in behavior and learning as to how it is. We should characterize a particular type of response.

Dr. Bill Ahearn (02:51):

Stereotypy has long been thought in Hebrew analytics circles to be maintained by the sensory consequences, engaging stereotypic behavior produces. And we'll talk a little bit more about that in a minute when when we sort of gravitate towards that, but the types of behavior that we generally been into this this category of stereotypy involve things that are repetitive motor movements. They can involve hand movements like hand flapping. They can be gross motor movements like I'm rocking the body or weaving one's head and shoulders. Stereotypic vocalizations are generally distinguished by them having an auditory quality being produced by an individual and being non-communicative that non-communicative non-communicative part has been debated, debated a little bit here and there, but there seems to be very little evidence that the vast majority of the individuals that have been worked with by behavior analysts have stereotypy that is sensitive to social consequences. There are certainly a small percentage, but stereotypy then are these repetitive movements and, or vocalizations that occur in individuals of all types. We see it in typically developing individuals, but we see it occurring at higher levels in individuals with intellectual and developmental disorders. And we see it occurring most prominently in individuals with autism.

Shauna Costello (04:43):

And I know that you had mentioned that, you know, maybe one of the potential reasons why individuals engage in stereotypical behaviors and some people who might be listening to this, that aren't behavior analysts might be like, Oh, you're talking about like tics or something along those lines. And I think, what do you think about the word tic versus how we, how a behavior analyst might define a stereotypical?

Dr. Bill Ahearn (05:12):

Right. Well, you know, one of my favorite things to say to students is your opinions are meaningless. Facts are much more important. And so my my personal experience with tics has really been wide ranging. I have a number of members of my family that have experienced a tic disorder, either trans in, in a transient fashion or in a more lifelong type of situation. I have a nephew that has Tourette's syndrome. I'm also encountered tics and lots of individuals that have other neurodevelopmental impairment and a tic, what distinguishes a tic and on the medical and psychiatric literature from stereotypy is that tics are usually referred to as as involuntary. So they are more reflex like then then stereotypy, which is voluntary it's it's operant behavior. In fact, there is a healthy debate we could have from the beginning of one behavior applied behavior analysts in particular started studying stereotypically as to whether or not we had a good idea as to whether stereotypic behavior was operant in nature or not operant in nature.

Dr. Bill Ahearn (06:33):

But the more evidence that we've gathered over time, it certainly seems to be the case that stereotypy is operant behavior and the kind of operant behavior it is, is automatically reinforced behavior. Whereas a tic is something that is much more, meflexive, like, as I mentioned, and there are generally, I think, four types of tic disorders that are now classified in the, mn the revised version of the, hSM-IV, mhey're transient tic disorders. Umnd the kinds of tics that we see are similar in category. There are motor tics and there are, muditory or phonic tics, mhat, mnvolve some, home sound property to them. But a transient tic disorder generally is something that's observed to occur for at least four weeks, but less than a year. Whereas chronic disorder, a tic disorder is something where there is either a single tic or multiple motor and phonic tics.

Dr. Bill Ahearn (07:41):

Usually not both categories together for a chronic disorder either motor or a phonic. And it's present for more than a year Tourette's syndrome is characterized by both motor and phonic tics being present for more than a year's period of time. Then there's a tic disorder, not otherwise specified where the criteria really don't meet any of the other categories. So this is sort of the catchall other category, but tics in and of themselves are things that we oftentimes see developing in young children four or five, six or so years of age. And oftentimes these tics don't last past childhood unless they're of the chronic Tourette's type and when they, they do persist beyond childhood there are a lot of different opinions as to as to what should be done with tics and should they be treated and generally tics if they're interfering for the individual there are there strategies that can be used?

Dr. Bill Ahearn (08:58):

There are talk therapies that have been developed, but most I think from a behavioral perspective, we would categorize these or the terminology that we've used for it is habit reversal, but in the grand scheme of things, it is operant behavior that is incompatible with the tech and is something that we help to teach the individual to engage in, in those situations, in which they would like to control those texts. So tics and stereotypy are really different things. In fact, one of the important diagnostic moves was to remove the word stereotypy or stereotype from the definition of tics to make it a little less confusing for the medical medical community when they encounter these, and to be able to distinguish between stereotypy that we've seen in individuals with developmental disorders, particularly autism versus tics that we see in individuals with tic disorders, the tic disorder the, the etiology is even less clear than the etiology of autism, although it is thought that there's a very strong genetic component to tics as there is with autism. But the mechanisms of abnormal neuro development are probably very different.

Shauna Costello (10:28):

That's a great, great way to distinguish between the tics and the stereotypical behaviors. And I know that you mentioned that with the stereotypical behaviors, that a lot of the times, you know, they are automatic and sometimes, you know, I've run into when I'm supervising. Some people might just be like, Oh, it's stereotypy, it's automatic. So is there, I mean, what kinds of assessments should people be running on these stereotypical behaviors, you know, to see if they are, you know, if they are straight, automatically reinforced or if there is some social aspect to it as well?

Dr. Bill Ahearn (11:07):

Well, it really depends on a purpose. What kind of an assessment and how long an assessment we would want to invest our time and resources. As a clinician, when I encounter a stereotypy, whether stereotypy is something that we consider as a treatment target is usually, you know, something that we determine based on a number of factors, are there other more severe categories of problem behavior that the individual presents with, like self-injurious behavior? If, so then we generally are not going to spend much time assessing or attempting to treat stereotypic behavior when we have self-injurious behavior or aggressive behavior or other more severe forms of problem behavior. But if stereotypy is interfering in socialization or during times in which we're attempting to teach functional skills then we may benefit from having a focused approach on how we can make appropriate behavior more probable and stereotypy less probable, but we'll get, we'll get there in a few minutes because you are asking about assessment.

Dr. Bill Ahearn (12:27):

So as part of that process as to developing the intervention the assessment strategy that I would typically recommend in a, in a clinical environment is something that we refer to as an alone screen. You might provide the, the individual with the opportunity to engage in stereotypic behavior by setting up the environment such that there's nothing else to do. And in those situations, if we see a lot of stereotypic behavior we might want to occasionally probe some of the other standard functional analysis, you know, conditions where we have a a strong feeling that because of the literature stereotypic behavior serves an automatic reinforcement function, that is the sensory consequences produced by engaging in stereotypy are what maintains stereotypy. We want, I think to be comfortable with the fact that stereotypy is not maintained by attention, because if then there's anything that we do.

Dr. Bill Ahearn (13:39):

And, and treatment that involves prompting a reinforcement, we might be making the problem worse. So we might want to probe as to whether or not stereotypically sensitive to attention as a reinforcer. And this is something that we can do during an alone screen. We generally run three or four alone or no interaction sessions where we have impoverished environment, not much going on, no access to materials, unless the individual's interfering, stereotypical behavior is with materials. And see whether or not the behavior tends to persist in that condition with occasional probes of of other conditions like the attention condition and and the demand conditional where stereotypy might be sensitive to escaping from, or avoiding aversive tasks. So generally that alone screen involves infrequent probes of the attention and the demand condition two or three for every three to five or so of the alone no interaction sessions.

Dr. Bill Ahearn (14:49):

So that's what I would recommend from a clinical perspective. From a research perspective, I have a little bit of a different purpose to the assessments that I choose. When I first started working with individuals with stereotypy, we were concentrating on vocal stereotypy. And at that point in time, there was not as much compiled evidence that stereotypical behavior was indeed automatically reinforced. So we were conducting the standard water functional analysis, where we were using the alone, the demand and the attention condition, as well as the play control condition. And in those early days the vast majority of the functional analyses we completed provided us with fairly decent evidence, that behavior seemed to be maintained by automatic reinforcement and was not likely sensitive to social consequences. And if it was sensitive to social consequences, one of the more frequent outcomes we saw with our students that we were working with was that stereotypy was least likely to occur in the demand condition, because there was something else to do.

Dr. Bill Ahearn (16:05):

And completing demands was associated with reinforcement and the school environment for these individuals. So we oftentimes saw much lower levels during the demand condition. We occasionally would not have great separation between the alone condition and the play play control condition. And over time we sort of moved away from that standard functional analysis to more of the alone screen, because the preponderance of evidence was suggesting automatic reinforcement with there being not a great amount of evidence, that behavior was sensitive to other reinforcers like attention, however right about 2015, 2016 the Kennedy Krieger research group head of a Louis Gobain started to publish some really interesting work on on automatically reinforced self injurious behavior. And they suggested that perhaps the standard functional analysis when self-injurious behavior is automatically reinforced, if there is differentiation between the alone or no interaction condition and the control condition, the play condition that, that is predictive, that automatically reinforced self-injurious behavior would be responsive to environmental stimulation of other kind, meaning that we could see a redirection of the response repertoire. If we provide access to activities that the individual is likely to engage in, or at least prompt and reinforce engaging in those alternative activities. So we've moved back to doing the standard functional analysis to determine whether or not stereotypy when we conduct a functional analysis that differentiation that we see during the functional analysis, whether it is predictive of of the treatment outcome. So, you know, long extended answer. But generally from a clinical perspective, I think a, an alone screen would be something that would be most appropriate.

Shauna Costello (18:20):

Well, and I like that you give both sides because there is a research side to it, but then there is there, there also is the clinical application side of it. And I think with you describing the alone screen with some of the other probes in there, it makes it much more approachable for a lot of those clinical behavior analysts in their everyday work. And it really pulls out the important parts, because I mean, I, you know, I've even read that if you want to go further into, depending on what the stereotypical behavior is, you can do even, you know, like break the break, the depending on what it is, break it down even further. But I think that that's a really good assessment tool for clinical behavior analyst to look into. And I mean, you even mentioned in there when you were talking about it, one of the other questions that was asked and a question that I see very frequently on social media is do all stereotypical behaviors need to be decreased. And I know that you, I know that I have my opinions on this. And I've seen other people's opinions on this as well. And I know that this is one of the areas that behavior analysis still kind of, you know, clinical behavior analysis still kind of gets thing done sometimes is that there's this overgeneralization that all behavior analysts want to always get rid of all stereotypical behaviors. So what are you, what is your opinion on stereotypical behaviors?

Dr. Bill Ahearn (20:01):

My thoughts on stereotypy really come from what it is we know about stereotypy, if an individual engages in stereotypic behavior and it is like the vast majority of other people who engage in stereotypic behavior. And so I can maintain by some form of automatic positive reinforcement. So if stereotypy is something that somebody prefers to engage in. It's not hurting themselves, it's not hurting anybody else. There should be some time in the day in which it's okay to do that. So should we be looking to eliminate stereotypy? My my clinical opinion is elimination is not really a goal of stereotypy, stereotypy is something that occurs with typically developing individuals. It certainly may interfere in certain social situations. It might make it less likely that someone will be accepted in the social world, if they're engaging in high levels of stereotypic behavior.

Dr. Bill Ahearn (21:09):

But I would as I would assume, most advocates for persons with autism be hoping that the world would be more accepting of, of differences. But that said there are times in which automatically reinforced behavior is probably not acceptable from social perspective. So it would be great to be able to teach individuals the skills they need to be independent in the community. And when there are those times in which someone needs to be engaging in prosocial behavior then it's good that we have a focus on teaching them the skills that they need to be independent in the world. If that means that we're also teaching them to not engage in stereotypy at those particular points in time. Well then maybe that's part of the, you know, nuance of how we are crafting our, in our treatments to the individuals and the situations in which those individuals find themselves. But no, I want to harken back to the fact that if it's something that somebody likes to do, they're not going to be in social situations where it's stigmatizing all the time. There should be some time in the day in which yes, if they like to do that, it's not hurting them or anybody else, they should be able to engage in that behavior. Just like, you know, we would expect any member of society, who's doing something that is legal and enjoyable. Something that we would encourage them to spend their time doing.

Shauna Costello (22:58):

Exactly. And I fully agree with you. And I know that there are some we'll get to, I know I want to talk some more about like interventions and stuff that you've worked on and seen. But also there's some questions about, you know, what causes stereotypy, you know, when do these usually show up?

Dr. Bill Ahearn (23:20):

It just so happens that we've been working on a, on a project where we are doing developmental screens of infants who have a sibling with an autism diagnosis. And one of the things that we're looking for are, do we see some early markers of autism and an infancy early development. And if so can we provide some very early intervention to help the the individual learn in the environments that they need to be learning in and to be attending to aspects of the social world that are going to be very important for them to to attend to as they, as they age and they're developing other behavior. So obviously one of the things that we're looking for in these young children is stereotypy stereotypy can start to develop and an early infancy, we're talking a few months of age and there is not a ton of work with this population, but I think there will be some better answers to this because many groups are now sort of gravitating towards working with this you know, so-called high risk population siblings that have a diagnosis of autism children that are born into that family are at at least a 10 fold increase likelihood of themselves having an autism diagnosis.

Dr. Bill Ahearn (25:08):

So if we study this population, I think we're going to be able to develop some better answers to when does this start to develop, but we've done work with typically developing children at one year of age at two years of age, at three years of age, four years of age. And we see stereotypy occurring with typically developing children at these ages. So it's at least by age one, probably much earlier, you know, two, three, four months that these responses start to develop. There have been a couple of studies that also suggest the presence of early stereotypic behavior may be indicative that self-injurious behavior may develop in the individual that is very tentative data, but it's also concerning. If we see stereotypy, is it more likely that we're going to see self injurious behavior? That's probably a pretty good bet given that stereotypy is one of the hallmark characteristics of autism as a disorder and many individuals with autism go on to develop self injurious behavior.

Shauna Costello (26:20):

Well, and I liked that you mentioned the studies with the siblings, because I know that I've I've, this was years ago, but, and this family had the means to, but they had one child with autism and they had a younger child on top of that. And they decided to, like, there wasn't a diagnosis or anything yet, but they decided to enroll their other child, their second child in the, in the behavior analytic services as well before they even had anything. They're like, Nope, we're just, we're going to enroll our second child as well. And like I said, not all families are able to do that. But I think it's really cool to see that, you know, there is this research going on and there are a lot more people going into these different types of research fields to look at this. And I know that not all of these will probably be in, you know, JABA or behavior analysis and practice or any of those. What are some of the other journals that if people are interested in looking into that they could find some of the stuff. And

Dr. Bill Ahearn (27:26):

Well I think a good place to start is a Google scholar search. If you're you're interested and this high risk population, siblings of individuals with an autism diagnosis, there are a number of researchers that are looking into these you know, these populations very explicitly. One of the places that I suggest somebody with more of a behavior analytic bent might want to go to directly, if we're talking about a specific journal outlet, the J D D at the journal of autism and developmental disorders is a pretty good clearing house. I would say it is most likely the flagship journal for autism research. If we were to categorize it as such the the work that we're currently doing is something that we've also disseminated at at Alba at APA and a number of regional and state conferences.

Dr. Bill Ahearn (28:38):

So we're interested in sharing this information, but ultimately the goal of or, or at least our goal. I know that some of the psychiatric and psychological researchers most likely be of you know, different perspectives when it comes to what their goal is. They may be more interested in looking at these signs of autism in early an early development, but also are focused on what then happens as that individual continues to show those symptoms of autism, where from a clinical applied behavior analytic perspective, we're interested in, you know, getting the person to be as independent in the community. And oftentimes that will involve, you know, us intervening in ways that will make it less likely that those types of signs of autism will remain present. So our goal in this early research has developed to develop assessments whereby we can identify autism before, or by six months of age, so that we can go in and provide some intensive intervention to prepare the child for a preschool and elementary school to the point where they are going to be independent and not needing any supports of services later on.

Dr. Bill Ahearn (30:08):

So our goal is to, you know, get early intervention in there for those that need it. And it is also the case that we're going to be working to try to advocate for those autism diagnoses occurring at at early ages or perhaps a provisional diagnosis especially for those individuals that are at are a high risk of developing autism. Can we do something to keep the social development on track for them so that they can have as independent of a life in the community at large as possible?

Shauna Costello (30:50):

That's wonderful. So one thing that I like to always make sure to reiterate is that with all of this research going on and not everybody has access to all of these journals or a database where they can get access to these journals, one thing that people might be a little bit, I don't want to say scared, but kind of scared to do is to reach out to authors. And I know if you reach out to the authors, typically, they'll be very happy to share their research with you. Especially in our field. I know that I've had a wonderful time reaching out to you and to a ton of the other, you know, big names in the field to ask them about podcasts, research, other interesting topics to me, this and that. And even stuff that I haven't had been able to get access to, you know, I reached out and they're like, yeah, here, here you go. So that's always something to do as well, that if there is research that's going on, that you want access to, to make sure that you are reaching out to those authors and asking because

Dr. Bill Ahearn (32:00):

Yes, I'm always happy to, to share what we're doing. In our research group, and most of what I have developed with my students in terms of treatment where in the context in which stereotypy's problematic are pretty readily available. And a number of places besides journal outlets the redirection strategies that we've developed have sort of propagated themselves in many different locations on the internet. There's a clearing house of information on best practices. I believe it's referred to as the national professional development center on autism something or other like that has developed modules on best practices and autism treatment. Response interruption redirection is one of those. Although when we start to talk a little bit more about intervention, redirection isn't necessarily where I would recommend anybody to start having a good learning environment where there are the appropriate supports and consequences for appropriate behavior that will help support there being more desirable behavior and the environments in which we're looking for, you know, prosocial behavior or academic learning of one sort or another that is generally our, our first approach.

Dr. Bill Ahearn (33:41):

And I've really had a nice experience with this particular line of work because many other research groups have contributed quite a lot to our understanding of this and more diversity in terms of different researchers and research groups and locations throughout the country in different settings, in which intervention has been provided, more confidence. We have that those strategies are giving us, you know, what in fact are the best practices.

Shauna Costello (34:14):

And I mean, you said you do it, you segue right into the last question I had for you though, a question I said, we'd come back to are the common interventions for stereotypic behaviors. And I know this connects directly to the CE that you have come and recorded for us. But what are some of the common interventions that people should be, you know, making sure that they're up to date on and, you know, becoming more familiar with.

Dr. Bill Ahearn (34:42):

Well, since you mentioned CES, I'll give my first sort of a take on this to behavior analysts out there. And if you find that stereotypic behavior is is interfering with an individual that you're working with, my suggestion is that you don't suck as a behavior analyst by that. What I mean is that you have an idea of the repertoire of the individual that you're working with, what the skills are that they have, what their skill deficits are relative to other children, their age other adults, their age, should they be adults and that you are working towards teaching them the skills they need to be independent in the community by providing appropriate prompting and reinforcement for those appropriate behaviors. That is the first line intervention. So when I say don't suck as a behavior analyst, what we really, as a behavior analyst when we're tackling socially meaningful problems have to bring to the table is an analysis of what are the motivating variables for the problems that we see, what are the motivating variables that should be there for the appropriate behavior that we're attempting to, to teach the individual.

Dr. Bill Ahearn (36:04):

And because we have, you know, both of those pieces, it's really important that we spend a lot of time on providing for a good learning environment so that we're supporting those appropriate that we would like to see in those situations, in which stereotypy is problematic. We want to have a good focused approach to teaching those skills that are necessary. And there are a variety of them in the in the event that are recorded for you folks. I spent a lot of time talking about the different contexts in which we are studying whether stereotypy is problematic and what the skills are we're attempting to produce. We right now have been focusing on communication skills and and other responses that are appropriate when the individual is alone or when they're with other people. So when we're focusing on, when somebody is left to their own devices, well, stereotypy might be okay in that situation, but we also want to make sure that we're providing individuals the opportunity to engage in age appropriate and by age appropriate.

Dr. Bill Ahearn (37:24):

I mean, at least starting with developmental age appropriate and attempting to move towards age, age appropriate leisure skills so that we're teaching the individual to do those sorts of things that people normally do when they're on their own. And and spending a little less time worrying about whether or not stereotypy is occurring in those situations and social situation for really attempting to teach the the skills that are necessary when are interacting with, with other people. So there oftentimes lots of prompts and and reinforcers that we're embedding within those situations to provide not only the, the the skills that are necessary when interacting with others, but also help to provide the appropriate motivation until we get to the point in time where the automatic reinforcers that are maintaining social behavior are there because the individual's behaviors contacted how reinforcing them can be to interact with others.

Dr. Bill Ahearn (38:33):

So when we look at that initial approach, it's making sure that we have a good, solid applied behavior analytic objective for those skills that we're going to teach, that we have good teaching methods to to produce the skills that we're attempting to produce along with good reinforcers to maintain those appropriate responses. Whereas when that's not enough, redirection is is a strategy that we have found to be very effective. So that second piece, the response interruption and redirection that I've spent an awful lot of time with my colleagues developing ways of making it less likely that stereotypy is going to occur in those situations, in which it's problematic. We have a number of different kinds of redirection techniques that we have found to be effective. They're detailed and the two events that I've recorded for you folks there.

Dr. Bill Ahearn (39:50):

But in a nutshell, redirection is something that we aim to have it be contextual and as unintrusive as possible. The original study that we publish in JABA in 2007, showed that when we asked individuals to engage in vocal responses that were in the repertoire that they engaged in and independently and frequently in other situations. So we would ask them social questions redirecting their stereotypic behavior. We had a great deal of success in decreasing stereotypy in those situations in which stereotypy was interfering over time, we have gravitated towards a more specific analysis of the different contexts in which we encounter stereotypy and determine those in which we can let stereotypy happening because it's not interfering or problematic. And those in which it is interfering and problematic and tailor our interventions to those situations in which stereotypy is problematic and attempt to redirect the individual back to the task that we're working on at the point in time, in which we're encountering stereotypy, that's interfering.

Shauna Costello (41:18):

And this is a good place for me to, like you had mentioned plug your CE events that you did come down and do for us. And there's only so much that, you know, we can talk about on a podcast in such a short period of time, but you have done a couple CE events for us on this topic. Specifically, one was stereotypy, there are no easy answers. And then just recently you did an updated one called repetitive behavior, autisms, stereotypy, and anxiety supporting adaptive behavior is the answer. And I just want to plug those because you do a very good job of going even further in depth about the research, the history behind it, what it is, how to address it. And a lot of the supports you've been talking about throughout our talk today. And you even, I, one thing I like about the newer version as well is the videos that you gave, you actually give videos and show what it looks like as well. So are there any other types of interventions or assessments or questions that you've heard from people that you've liked that you would like to answer while I have you here?

Dr. Bill Ahearn (42:41):

Let me start with the comprehensive approach that we have. My my research group that has been focused on stereotypy. We as a research group have a number of tools that we use before we bring an individual into an experiment that oftentimes are very informative and helpful for us. One of the things that we have in our bag of tricks is we attempt to identify what activities and individual likes to engage in, what are the play or leisure you know, activities that an individual will spend their time doing and provide them uninterrupted, independent access to these activities so that we can see they engaging in them and a functional manner. Do they engage in stereotypic behavior during these times? Do we see any other problem behavior surrounding these particular activities?

Dr. Bill Ahearn (43:59):

So we do something that's very similar to what is in the published literature referred to as a competing stimulus assessment. So we identified a number of different kinds of activities each refer to as a stimulus, and we provide at least three minutes of access to the activity across three different samplings of that. And we usually expose an individual somewhere between 10 and 20 activities to, to gauge what their skill levels are. If we see a lot of item contact, but stereotypic manipulation of objects, oftentimes the focus of our intervention strategy is what happens if we teach these these individuals that we're working with, how to engage functionally with these particular items. So we would prompt functional engagement and then provide them access to the, to the activities independently. If we're not seeing a lot of functional engagement at that point in time, we might throw on reinforcement of some sort starting with, you know, maybe hitting five or 10 seconds worth of functional engagement, providing a reinforcer, and then extending out our criteria and our leaning their reinforcement, so that we get more and more functional engagement in those particular activities.

Dr. Bill Ahearn (45:28):

So competing stimulus activity is something that is always part of our process of working with them individual where stereotypy is problematic. We also do a number of other types of preference assessments. We usually do edible preference assessments for those individuals for whom edibles are reinforcers. We oftentimes will work, particularly if we're going to try to build social interaction skills, we'll do social stimulus preference assessments, so that we can identify social stimulate that serve or reinforcing function and use those in teaching the social skills that we're working with, because those are the kinds of reinforces that are going to be there naturally for social behavior. So we go in there and do those kinds of assessments. And we look specifically for the components of the skills that we're attempting to teach. For instance, if we're teaching social interaction we are going to, you know, try to make sure that we have eye contact conversation skills, volleys of going back and forth in those turn-taking situations such that we're producing the vocal motor responses that are, that occurred during those interactions in a way that is meeting that individual's skill level.

Dr. Bill Ahearn (46:50):

We sometimes also test out different redirection strategies to see if one is better than another. So there have been a number of studies that have shown motor redirection can be very effective for both vocal and motor stereotypy. Vocal redirection also can be effective for both vocal and motor stereotypy. But there are individual differences. We may find that we have better treatment effects with motor redirection than we do with vocal redirection or vice versa. And if so, we try to embed that into our our general treatment approaches when we're crafting the interventions that are gonna work best for an individual. So there are I think a number of standard behavior, analytic assessments that BCBAs out, they're going to have plenty of experience with that. We'll also usefully inform them developing ways of of dealing with stereotypy. And finally, I really do like to spend some time just observing the individual and whatever their natural environment is to get a good sense for what are the variety of stereotypic behaviors that we're going to see. And we always interview caregivers specifically to determine are there those responses that are more or less concerning, and if we have those that are more concerned than others, and we're going to concentrate on the more important response classes rather than attempting to catch everything

Shauna Costello (48:35):

Right. And I think that that's a key point to make because like I've mentioned before that this is still a critique that I'm seeing, you know, over the whole internet of people.

Dr. Bill Ahearn (48:51):

I just want to comment on the take, because I think that when that critique is made for stereotypic behavior I understand from an ethical perspective, why if an individual chooses to do something, they should have the right to do that if it's not hurting them or anybody else. So I think that's appropriate context within our discussion of, of stereotypy and what we should and shouldn't do. But I think the same logic applies in just about every situation in which a behavior analyst is, is encountering behavior. Putting together a reinforcement contingency and teaching pro social skills is something that we should always have an eye towards. What what are we doing if we're attempting to to teach a particular skill? And we're using some contrived reinforcers, are we going to need to use those contrived reinforcers for the rest of this person's life?

Dr. Bill Ahearn (50:00):

Just like, you know, a clear cut situation. If we have an individual self-injurious behavior, that's placing them a life threatening situation. Of course, we're going to do whatever we can to go in there and develop an effective intervention strategy. Should that intervention strategy involve some form of positive punishment? Well, I sure don't want start there. If that's the only effective thing that we can do, and we need to make an ethical decision as to is the, the continued occurrence of self-injury more problematic for this individual, then exposing their behavior to some kind of a punishment contingency. That's an ethical decision that should be made not by any one clinician in isolation. It should be made by a team of individuals should include the person if they are if they are capable of consenting to intervention of, of that type, but in the long run, even if we choose to initially use a positive punishment strategy, our goal should be to get rid of that as soon as we possibly can so that we no longer need to have that in place, because it's never acceptable to have that kind of strategy in place for an individual's lifetime.

Dr. Bill Ahearn (51:30):

That's my opinion.

Shauna Costello (51:31):

Yeah. And I fully agree as well.

Dr. Bill Ahearn (51:34):

So that leaves us with we should not suck as a behavior analyst,

Shauna Costello (51:38):

Right? We should not. Yes. We should not suck as a behavior analyst. I know that, you know, I, I mean, I'd be lying if I said that I didn't find myself, you know, when I was practicing in the clinical realm that I didn't find myself getting dull. Sometimes I did, I could feel it sometimes. Cause you know, there's that work life balance and trying to make sure that you're not getting burnt out. But use your teammates, use research, see what's out there, go to conferences, talk to other individuals in the field that are outside of your area, see what they're doing. And yes, to, to quote Bill Ahearn, don't suck as a behavior analyst. That's my main takeaway from today. So yeah. Is there anything else that you want to cover? I know you went into that about a lot of it and I'm very happy to have you and your expertise. Talk to me today about stereotypy, because this is still a set of behaviors that eludes people, so

Dr. Bill Ahearn (52:41):

Sure. The only thing that really didn't get into that I did in fact get into an in the second event that I recorded for you guys, where we were talking about anxiety and automatically negatively reinforced behavior, is there are some instances in which we encounter stereotypy, like ear plugging and ear flapping, where it seems like the individuals decreasing the, you know, noise that present in the ambient environment, that those kinds of responses, and perhaps other responses may be indicative of automatic negative reinforcement, meaning the individuals escaping from some type of aversive stimulation. If that's the case, we really want to have a different approach for automatic negative reinforcement. We want to analyze what is aversive about the environment. And can we teach the individual ways of of removing the aversiveness of the environment or removing themselves from the aversiveness of the environment I've worked with so many individuals with that ear plugging and ear flapping, kind of a response where we either teach them to request, to leave a noisy environment or to access noise canceling headphones, or to access some individuals actually really don't like those noise canceling headphones and they prefer just some alternative auditory stimulation, like listening to music as a, as a means of making the environment less versus so automatic negative reinforcement when it's suspected as something that we might want to have a very different treatment treatment approach to.

Dr. Bill Ahearn (54:39):

And if individuals are interested in that, the second recording might be helpful for them because the kinds of approaches that we've used with individuals with autism, who we suspected were anxious are applicable in those types of situations.

Shauna Costello (55:00):

Yeah. And that's really neat too, to kind of, you know, just think about, because I know that we talked about the functions and yes, it can be, you know, automatically reinforced, but what type are they escaping? Are they gaining something? Yeah. So that's something really interesting to think about. Alright, well, thank you so much for talking about stereotypy with us. And I always, like I said, I know I already plugged them, but if you want to learn more from, from Dr. Ahearn, his CE events are absolutely phenomenal. And please go watch them. But if you, I mean, are you willing if anybody has questions too, I know that you kind of mentioned it before, but if anybody has questions for them to reach out to you as well.

Dr. Bill Ahearn (55:46):

Sure they should email me bahearn@nccc.org. And I am very happy to answer any questions. Sometimes you just need to wait a little while for me to get through all my emails, because sometimes there are emergencies and sometimes there aren't.

Shauna Costello (56:05):

Right. But just knowing that you know, that the, our community has, has access to you and your knowledge and your experiences is phenomenal. So I'll make sure to include your email in the podcast description. But thank you so much for talking with us today.

Dr. Bill Ahearn (56:20):

Well, thank you too, Shauna. Happy new year. And look forward to speaking to you again soon.

Shauna Costello (56:26):

Thank you for listening to operant innovations. If you are interested in learning more from dr. Ahearn, please see the links in the description and they will send you to his continuing education courses. And of course, if you have any questions, feedback, or suggestions, please feel free to reach out to us at operantinnovations@abatechnologies.com.