گزارش کوتاهی در مورد اثرات یک بسته درمان خود مدیریتی بر روی رفتار کلیشه ای

We evaluated the effects of a self-management treatment package (SMTP) on the stereotypic behavior of an adolescent with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Latency to stereotypy was systematically increased in the training setting (academic) and the effectiveness of the SMTP was evaluated within a multiple-probe design across three generalization settings (vocational, meal/snack, leisure). Intervals were systematically increased from 3 min 30 s to 15 min in the training setting. Reinforcement was contingent on the absence of vocal and motor stereotypy for a prescribed interval within a differential reinforcement of the omission of behavior (DRO) paradigm. Following training, increases in latency to stereotypy were observed across generalization settings. Participant interview responses indicated social validity of the SMTP. Results are discussed with respect to possible mechanisms responsible for self-management behavior.

Self-management (SM) has been defined as the “personal and systematic application of behavior change strategies that result in the desired modification of one's own behavior” (Heward, 1987) and more broadly as “everything a person does to influence his or her own behavior” (Browder & Shapiro, 1985). A meta-analysis of SM procedures designed for behavior increase suggests the efficacy of SM procedures for individuals with autism (Lee, Simpson, & Shogren, 2007), including self-recording (recording one's own behavioral data), self-reinforcement (delivering reinforcement contingent on one's own behavior), and self-monitoring (operating devices that provide discriminative stimuli for one's own behavior). SM procedures have been successfully applied for the improvement of a variety of target behaviors for many individuals, including those with autism spectrum disorders (ASD) striving to increase independence from adults in support roles. Behaviors increased via SM procedures in this population have included academic behavior (Callahan & Rademacher, 1999), activity transitions (Newman et al., 1995), self-care (Lee, Poston, & Poston, 2007; Pierce & Schreibman, 1994), and social behavior (Koegel & Frea, 1993; Koegel & Koegel, 1990; Reinecke, Newman, & Meinberg, 1999; Stahmer & Schreibman, 1992). Behaviors for decrease have included stereotypy (Koegel & Koegel, 1990; Koegel, Koegel, Hurley, & Frea, 1992; Pierce & Schreibman, 1994; Stahmer & Schreibman, 1992) and disruptive behaviors (Lee, Poston, & Poston, 2007; Mancina, Tankersley, Kamps, Kravits, & Parrett, 2000). A wide variety of materials have been used for these purposes such as paper and pencil (Callahan & Rademacher, 1999; Koegel & Koegel, 1990; Lee, Poston, & Poston, 2007; Stahmer & Schreibman, 1992), stickers (Koegel & Koegel, 1990), tokens (Newman et al., 1995), wrist counters (Koegel et al., 1992), and rings on a dowel rod (Mace, Shapiro, West, Campbell, & Altman, 1986). Auditory stimuli have been used to signal the onset of self-recording or reinforcement delivery (Koegel & Koegel, 1990; Pierce & Schreibman, 1994). A limited number of studies have evaluated the effectiveness of SM procedures outside of the training setting. Stahmer and Schreibman (1992) demonstrated generalization of appropriate play skills outside of the original training setting in the absence of SM materials and treatment providers, while other studies have demonstrated successful generalization to additional settings (Koegel & Koegel, 1990; Koegel et al., 1992; Morrison, Kamps, Garcia, & Parker, 2001) and additional behaviors (Koegel & Frea, 1993; Pierce & Schreibman, 1994) via the continued application of SM procedures. Despite agreement in the literature on the effectiveness of SM procedures generally, the mechanisms responsible for behavior change remain largely unknown, specifically the differential effects of self-management components on behavior. Accuracy of self-recording, for example, has been found not to be pre-requisite for behavior change in the desired direction (e.g., Newman et al., 1995 and Reinecke et al., 1999). Mancina et al. (2000) reduced the stereotypic behavior of a 12-year-old girl with autism, applying self-management techniques in multiple-baseline design across tasks, finding accuracy of self-recording unrelated to reduction in stereotypy. The following research questions were posed in the current study, in light of the existing research on generalization and SM procedures in adolescents with autism spectrum disorders (ASD): First, could a small interval of the absence of stereotypy reinforced on a differential reinforcement of the omission of behavior (DRO) schedule be systematically increased to a socially significant level and generalized across settings? Second, could the participant independently implement the entire treatment package, including self-monitoring (in this investigation, starting the timer on a wristwatch and stopping the timer if stereotypy occurred) and self-reinforcement (pouring himself Diet Coke™ at the end of an interval without stereotypy)? Finally, would the participant consider this treatment package to be socially valid?

During initial baseline probe sessions in all settings, response latencies were short, ranging from 1 s to 1 min 29 s in the academic (training) setting, 1 s to 1 min 16 s in the leisure setting, and stable at 1 s in the meal/snack setting (see Fig. 1). Full-size image (30 K) Fig. 1. Latency from the onset of each DRO interval to the first instance of stereotypy in the training (academic) and probe (leisure, meal, and vocational) settings. Figure options When the SMTP was introduced in the academic setting, the target response latency was exhibited during the first session. Criterion performance (exhibiting the target response latency in two of three intervals within one session including the last interval) was exhibited in the third session, and the SMTP was withdrawn. Baseline probes in the training setting resulted in a decrease in response latency (range, 1–48 s). Baseline probes were also conducted in generalization settings, and response latencies remained at baseline levels in the vocational setting (range, 1–41 s), meal/snack setting (range, 20 s to 1 min 4 s), and in the leisure setting (range, 1–26 s). In the training setting, the first interval with the SMTP after each return-to-baseline consistently resulted in an immediate increase in the latency to stereotypy. Ned met criterion for decreasing the DRO on only two occasions (from 13 min to 8 min after Session 45, and from 15 min to 13 min after Interval 60), and reached criterion performance at the 15 min DRO after Interval 69. Generalization probes (SMTP materials present in the generalization settings, with a 15 min DRO) revealed greater effectiveness of the SMTP in the meal/snack setting (range, 9 min 20 s to 15 min) and leisure setting (range, 8 min 11 s to 15 min) than in the vocational setting (range, 7 s to 8 min). Ned exhibited the target response latency of 15 min during one interval in the leisure setting, and two intervals in the meal/snack setting. Following the generalization probes, the SMTP was applied throughout the day, across all environments (not shown in Fig. 1). One 15-min DRO interval was conducted each hour of the day, in which the absence of stereotypy was reinforced with 30 cm3 of Diet Coke™. Ned wore the watch around his wrist, and carried a re-sealable plastic bottle of Diet Coke™ with him (concealed in a sport-fanny pack). He accurately self-reinforced during all intervals in which he exhibited the target response latency. During the first two weeks, Ned's average latency to stereotypy was 9 min during meals and snacks, 11 min 15 s during leisure activities, 11 min 45 s during academic activities, 11 min 30 s in the context of domestic routines, 13 min 20 s in community settings, and 7 min 8 s in vocational settings. Following the first week of using the SMTP across his day, Ned was asked a series of questions to evaluate the social validity of this treatment. Ned's consistently positive responses included statements about his effort throughout the project being a good use of his time, that his decreased stereotypy was important to him, and that he felt proud of his accomplishments. When asked to describe how this new skill would help him, Ned replied, “I can concentrate better [at work],” “It will help me be more normal [in the community],” and, “It will help me do better in school, be a normal kid.”