| Identify a strategy that may be effective in this scenario. | When describing the treatment to caregivers or staff, what would you tell them to expect as far as implementation and outcomes? | What are the possible clinical obstacles you may encounter? |
|---|---|---|
| Choice-making intervention for restrictive behaviors (Fisher et al., 2019) | Choice making reduces restrictive behaviors and its easier to implement at home. | At times training staff to implement choice is difficult |
| Augmented competing stimulus assessment (Hagopian et al., 2020) | Caregivers and staff can expect the treatment to be implemented consistently across daily routines using clearly defined procedures, such as antecedent strategies, reinforcement of appropriate vocal behavior, and planned responses to vocal stereotypy. Initial implementation may require increased prompting and monitoring, and a temporary increase in the behavior may occur as the client adjusts to the intervention. With consistent implementation and data-based adjustments, vocal stereotypy is expected to decrease over time, while functional and appropriate vocalizations increase, leading to improved engagement and learning opportunities. | Possible clinical obstacles when addressing vocal stereotypy may include inconsistent implementation across caregivers or staff, limited treatment fidelity, and difficulty maintaining intervention strategies in naturalistic or highly stimulating environments. Additional challenges may include competing automatic reinforcement maintaining the behavior, variability in motivation, and initial resistance to alternative or replacement behaviors. These factors may temporarily limit progress and require ongoing training, monitoring, and data-based adjustments to ensure effective outcomes. |
| Response interruption and redirection (RIRD) | automatically reinforced BX is hard to stop | The child's reactions. School policies, teacher disagreement. |
| Augmented competing stimulus assessment (Hagopian et al., 2020) | We’ll be testing and refining competing items so they actually suppress vocal stereotypy during table work and self-care, not just replace it with distraction. Expect more structure during those times and gradual improvement in focus, not an overnight fix. | Finding stimuli that reduce stereotypy without pulling attention away from instruction can be tricky, and effects may not generalize right away. Staff consistency and timing (using it only at critical moments) will matter a lot. |
| Response interruption and redirection (RIRD) | They should expect that Cyrus will show resistance to the treatment and perhaps even show an increase in the intensity of his resistance until new patterns of behavior can be established. | We may encounter more disruptive behavior, aggression, SIB, and work refusal. This may be more of an issue if Cyrus is in a classroom setting. |
| Response interruption and redirection (RIRD) | ||
| Response interruption and redirection (RIRD) | During important learning times, we’ll briefly interrupt the vocal sounds and redirect Cyrus to focus on his work or respond appropriately. This helps him stay engaged so he can learn new skills. Outside of these times, he’ll still have access to things that help him regulate. | Increased restrictiveness, Treatment integrity, Generalization |
| Choice-making intervention for restrictive behaviors (Fisher et al., 2019) | slow and steady progress, not overnight | caregivers' unwillingness to try the intervention |
| Augmented competing stimulus assessment (Hagopian et al., 2020) | ||
| Response interruption and redirection (RIRD) | Although it is a restrictive intervention, I think it would be a good starting point. RIRD can be faded and other techniques can be used in the future (DRA) based on the reduction in stereotypy. | It would require consistent attention from his technicians or caregivers and the attention may become a reinforcer that maintains the stereotypy. |
| Response interruption and redirection (RIRD) | Consistency is key in immediately interrupting stereotypy and have the questions ready for redirection | Difficult to response block vocal stereotypy; redirection in form of question may be challenging and does not guarantee a response. Needing to identify intraverbal skills and how complex for the client to be successful in responding. |
| Response interruption and redirection (RIRD) | Every time Cyrus engages in vocal stereotypes, you must interrupt the behavior and redirect Cyrus to an alternative response, and if he comply, reinforce immediately | the caregiver needs more training to implement the intervention |
| Response interruption and redirection (RIRD) | I would describe the intrusiveness of the treatment | little social validity from client or stakeholders, increased emotional responding when stereotypic behavior is interrupted |
| Choice-making intervention for restrictive behaviors (Fisher et al., 2019) | ertre | |
| Competing stimulus | should expect to provide frequent prompting and redirecting | finding the right competing stimulus that works for the client |
| Choice-making intervention for restrictive behaviors (Fisher et al., 2019) | The idea is to offer choices such as a different sound, a movement, or a communication tool, that the child can use if the vocalizing is making things harder for them in that moment. | Intervention not as effective as expected, extraneous and confounding variables. |
| Response interruption and redirection (RIRD) | We will have to be very attentive and focused on Cyrus during this procedure so we can help him focus on learning the skills we´re teaching in those moments. Cyrus´s stereotypy will likely decrease while the procedure is being run and during those times only, which, is our goal. | Having to train and correct incorrect procedural fidelity. |
| Response interruption and redirection (RIRD) | Give 3 topographically similar responses (things for child to say) | noncompliance |
| Choice-making intervention for restrictive behaviors (Fisher et al., 2019) | ||
| Response interruption and redirection (RIRD) | Conduct a preference and reinforcement assessment to identify naturally occurring reinforcers or to pair and find engaging activities. | I am a firm believer in not stopping stimming as it provides input, but the goal is to make it more functional and find replacement behaviors. |
| FA screening for automatically-reinforced behavior (Querim et al., 2013) | ||
| FA screening for automatically-reinforced behavior (Querim et al., 2013) | ||
| Response interruption and redirection (RIRD) | Have small easy demand statements and reinforcement prepared. | The reinforcement may not be potent enough to be successful. |
| Competing stimulus | items are identified that decrease the occurrence of the target behavior. These are presented during times in which a reduction in target behavior is most valuable. | identifying effective items |
| Intervention for perseverative speech (Kuntz et al., 2020) | ||
| Identify a strategy that may be effective in this scenario. | When describing the treatment to caregivers or staff, what would you tell them to expect as far as implementation and outcomes? | What are the possible clinical obstacles you may encounter? |
