Self-Stimulatory BehaviorsPresenters:

Brittain Coleman, MA, BCBABehavior Analyst

Tracy Palm, MS, BCBAExecutive Director

Transformations Autism Treatment Center

What is a Self-stimulatory behavior?

• Stereotypy or self-stimulatory behavior refers to repetitive body movements or repetitive movement of objects

• Often observed in the following forms:– Visual– Auditory– Tactile– Vestibular– Taste– Smell

What do they look like?

• Visual: – Staring at lights or ceiling fans– Repetitive blinking– Moving fingers in front of the eyes– Hand-flapping– Gazing at nothing in particular– Tracking eyes– Peering out of the corners of eyes– Lining up objects– Turning on and off light switches

What do they look like?

• Auditory: – Vocalizing in the form of humming – Grunting, or high-pitched shrieking– Tapping ears or objects– Covering and uncovering ears– Snapping fingers– Making vocal sounds– Repeating vocal sequences – Repeating portions of videos, books or songs at inappropriate times

What do they look like?

• Tactile: – Scratching or rubbing the skin with one’s hands or with another object– Opening and closing fists– Tapping surfaces with fingers

• Vestibular: – Rocking front to back– Rocking side-to-side– Spinning– Jumping – Pacing

• Taste: – Placing body parts or objects in one’s mouth– Licking objects

• Smell: – Sniffing or smelling people or objects

What do they look like?

• In extreme instances, self-stimulatory behaviors may take on the form of self-injurious behavior:– Head banging– Eye poking– Hand biting

• Not all self-injurious behaviors are considered self-stimulating

Why do people engage in self-stimulatory behaviors?

• THE REAL ANSWER?...No one really knows for sure

Hypotheses:

• Hypotheses:– To calm themselves down

– To receive some sort of sensory input they need

– It releases opiate-like substances in the brain called beta-endorphins, which can produce either a euphoric or anesthetic effect

– Provides an extra dose of internal stimulation for children with ASD who feel under-stimulated

– Provides a feeling of tranquility for children who feel overstimulated

– Children who are hyposensitive, or under-responsive to stimuli, may demonstrate the opposite effects: self-stimulatory behaviors may actually increase arousal

So what have we done for self-stimulatory behaviors?

• Beginner Program:– This intervention will help an individual learn to do

alternative behaviors and decrease their self stimulatory behaviors.

– This intervention will allow the therapist/parent/caregiver etc. to assist the individual in decreasing their self stimulatory behavior

– This intervention uses positive reinforcement to teach an individual how to discriminate between an appropriate vs inappropriate time to engage in self-stimulatory behaviors

When is the individual ready to do this type of program?

• Does the child respond to multiple reinforcers?

• Does the child use a token system successfully?

• Does the child respond to delayed reinforcement?

• What is the functioning level of the individual?

Materials Needed

• Timer• Reinforcers • Token System

Steps to the intervention

• Determine a baseline– How often is the person currently doing the behavior?

• Pick your target time– This time should be slightly below the baseline time

• Determine your master criterion– Typically 3-5 successful sessions– If the individual has more than 5 unsuccessful sessions

then back the time down to the last previously successful time frame

• Increase the time in small increments in the beginning to create opportunities for success

Steps to the Intervention cont.

• Make the deal– Make sure to explain to the child what is expected and

what the reward will be– Use a token system once the child is able to work for

longer periods of time without primary reinforcers• Set the timer• Reward/Try Again• Increase the criterion as needed

What else do I need to teach?

• Replacement behaviors– Determine the function for the behavior then you can

determine an appropriate replacement behavior– Sensory/automatic

• Weighted or textured clothes, etc.– Positive Reinforcement/ Attention

• Asking for assistance, attention– Positive Reinforcement/ Access to Items or Activities

• Manding for items/activities– Negative Reinforcement

• Asking for a break• Asking for people to go away• Asking for something to stop

What does the data show?

Aug-09Sep-09Oct-09Nov-09Dec-09Jan-10 Feb-10Mar-10 Apr-10May-10Jun-100

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160

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Self Stimulatory Behaviors

Self Stimulatory Behaviors

Probe Seesions

Freq

uenc

y of

Uns

ucce

ssfu

l Int

erva

ls

11 year old boy, diagnosed with ASD

So what have I done for self-stimulatory behaviors?

• Expanded Program: – An intervention that aims to help an individual learn how

to control their own self stimulatory behaviors

– An intervention that allows the therapist/parent/caregiver etc. to some control over the individual’s self-stimulatory behavior

– An intervention that in a sense teaches an individual how to discriminate between an inappropriate time to engage in self-stimulatory behaviors

Participants

• 2 participants• Both have an Autism diagnosis• Both males• Age:

– Client #1: 6 yrs old– Client #2: 11 yrs old

• Skill level:– Client #1: High functioning, able to understand some basic

rules, some more complex language skills– Client #2: Low functioning, unable to understand basic rules,

limited language skills

Topographies

• Topographies:– Client #1: Vocal Stereotypy– Client #2: Hand-flapping, feet tapping,

repetitive head movements– Often individuals who engage in frequent self-

stimulatory behaviors engage in behaviors that are observed in a variety of topographies, therefore it is important to discuss and determine which or all of the behaviors are going to be targeted

What was involved?

• This intervention is comprised of several different components:– Basic Stimulus Discrimination– Systematic Phases– Token Economy– Response Cost– Reinforcement– Self Management– Time Management Technology

Stimulus Discrimination

• I utilized a basic red card and a basic green card to teach discrimination

• Red card signifies the time the individual was not allowed to engage in self-stimulatory behavior(s)

• Green card signifies the time the individual was allowed to freely engage in the targeted self-stimulatory behavior(s)

No Silly Noises

Quiet Body

OR

Yay! Silly Noises

OR

Red Card Means: No Silly Noises

1. 08:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens

2. 06:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens

3. 04:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens

4. 02:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens

5. 00:00 Did I have a quite voice?Yes: Token No: Reset Timer & Tokens

Yay! Break Time

Systematic Phases

• This intervention was designed to be implemented very carefully taking careful consideration of each step as progression (or lack there of) is made

Systematic PhasesPhase: Red Card Time Token Time

IntervalGreen Card

TimeCriteria for

Phase Change:1 10 seconds 2 seconds 10 min 3 RCC without

VS2 20 seconds 4 seconds 9 min 30 sec 3 RCC without

VS3 30 seconds 6 seconds 9 min 3 RCC without

VS6 1 minute 12 seconds 7 min 30 sec 4 RCC without

VS7 1 min 30 sec 18 seconds 7 min 4 RCC without

VS 8 2 min 24 seconds 6 min 30 sec 4 RCC without

VS17 8 min 1 min 36 sec 2 min 5 RCC without

VS18 9 min 1 min 48 sec 2 min 5 RCC without

VS19 10 min 2 minutes 2 min 5 RCC without

VS

= break in the phases RCC= Red Card Condition VS= Vocal Stereotypy

Token Economy

• It is essential that the individual be able to understand and navigate a token economy

• If the individual has not yet been taught a token economy this needs to be the first step taken– Even if an individual does have a learning history with a

token economy it is recommended to go back through the steps of pairing the tokens with reinforcers systematically

• For the two clients that have used this method a token economy with five tokens was used– The number of tokens is not crucial

Response Cost

• It was found that some degree of response cost was necessary for success

• In the beginning taking away one token for a single incidence of self-stimulatory behavior was tried

• However after assessment and consideration specifically for the two clients for which this intervention, it was determined removal of all of the tokens was the best approach

Reinforcement

• Preference assessments prior to starting are necessary for success

• Reinforcers are used as added incentive to continue to not engage in self-stimulatory behaviors, especially in the beginning phases

• The ultimate reinforcer used is the ability to freely engage in the self-stimulatory behavior

Self-Management

• This component is to aid in the success of the individual being able to utilize this intervention across a variety of settings

• If the individual is able to maintain and manage it all by him/herself it increases the quality and quantity of learning that is possible

• Throughout all of the phases of the intervention is it recommended to require the individual place their own tokens on the token board

• Once the individual satisfies the criteria for the final phase you should then move to the maintenance phase

Maintenance Phase

• The maintenance phase consists of the following:– Prompting the individual to:

• Monitor the time • “Asking” or determining themselves whether or not they

engaged in the behavior– If yes

» Delivering their own tokens– If no

» Not delivering a token» At this point elongating the time should be aversive

enough – Systematically fading those prompts until the individual

can independently maintain it all

Time Management Technology Used

• Timer– A timer was used to indicate the end of the red and

green card condition– The time was also used to monitor the increasing time to

know when to deliver the tokens

HOWEVER:If the resources are available:• A Motivaider is believed to be the better

technology of choice for the following reasons:– Constant monitoring of time is not necessary– More discretion

Refresher on Participants

• 2 participants• Both have an Autism diagnosis• Both males• Topographies:

– Client #1: Vocal Stereotypy– Client #2: Hand-flapping, feet tapping, repetitive head

movements• Age:

– Client #1: 6 yrs old– Client #2: 11 yrs old

• Skill level:– Client #1: High functioning, able to understand some basic

rules, some more complex language skills– Client #2: Low functioning, unable to understand basic rules,

limited language skills

Results

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190

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4

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14

Vocal Sterotypy

YesNo

Phase

Freq

uenc

y of

Yes

' and

No'

s in

eac

h ph

ase

• Yes means the individual successfully did not engage in vocal stereotypy during that time frame

• No means the individual did engage in vocal stereotypy during that time frame

Results: Client #2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

10

20

30

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60

Physical Self-Stimulatory Behaviors

YesNo

Phase

Freq

uenc

y of

Yes

' and

No'

s in

eac

h ph

ase

• During the sessions that have increased frequency of “no’s” the data also showed an increase in problematic behaviors

• It was also noted that on during phases/sessions 3, 11, and 15 the clients mother reported the client not sleeping the night before

Questions?

Contact Information:

• Tracy Palm: Executive Directory– tracypalmaba@aol.com

• Brittain Coleman: Behavior Analyst– BrittainColeman@gmail.com

Transformations Autism Treatment Center(901)-231-2931