Using Response Interruption and Redirection to Reduce Vocal Stereotypy

Abstract

Response interruption and redirection, commonly referred to as RIR, is an evidence-based intervention that has been demonstrated to quickly reduce moderate to high levels of vocal stereotypy in children with autism spectrum disorder. The RIR intervention is a simple, three-step procedure that can be embedded in classroom instruction with minimal planning. This column describes the procedure and provides a troubleshooting guide to aid practitioners in effectively implementing the RIR behavior management strategy.

Keywords

autism disabilities interventions behaviors effective instruction strategies

Response interruption and redirection, commonly referred to as RIRD (Ahearn, Clark, MacDonald, & Chung, 2007) or RIR (Wong et al., 2014), is an intervention that has been demonstrated to quickly reduce moderate to high levels of vocal stereotypy in children with autism spectrum disorder (ASD). The RIR procedure involves interrupting the vocal stereotypy behavior of a student by asking the student a question or placing a verbal demand that has a high probability of an accurate response and reinforcing the student’s response. It has been identified as an evidence-based practice for students with ASD (Wong et al., 2014). The RIR procedures have been shown to be effective with students who have some functional language and who respond easily to demands for vocal responses. This intervention has been used to reduce vocal stereotypy in home (Lanovaz & Sladeczek, 2012), clinic (Cook, Rapp, Gomes, Frazer, & Lindblad, 2014), and school (Ahearn et al., 2007) settings. Lydon, Healy, O’Reilly, and McCoy (2013) identified 10 studies that investigated the use of RIR as an intervention for vocal stereotypy in children with ASD across 20 children between the ages of 3 to 11 years of age (Ahearn et al., 2007; Ahrens, Lerman, Kodak, Worsdell, & Keegan, 2011; Casella, Sidener, Sidener, & Progar, 2011; Colon, Ahearn, Clark, & Masalsky, 2012; Dickman, Bright, Montgomery, & Miguel, 2012; Liu-Gitz & Banda, 2013; Love, Miguel, Fernand, & LaBrie, 2012; Miguel, Clark, Tereshko, & Ahearn, 2009; Schumacher & Rapp, 2011).

Stereotypic Behavior

Stereotypic behavior can be defined as any repetitive motor (e.g., hand flapping, twirling) or vocal (e.g., repeating words or phrases, humming) response that typically serves no communicative or social function and is reinforced by the sensory stimulation it produces (Rapp & Vollmer, 2005). Stereotypic behavior often occurs during the development of many young children including those who are developing typically (Foster, 1998). Many individuals have engaged in repetitive behaviors at some point in their lives (e.g., twisting hair, rubbing thumb across finger pads); however, repetitive behaviors in individuals with ASD are more persistent, intense, and significantly more difficult to interrupt.

Typically, stereotypy is decreased or replaced by other appropriate behaviors as one develops and the stereotypic behaviors do not inhibit learning or socializations. This is not the case for many students with ASD. Based on parent report, 85% of children and adolescents with ASD have atypical, repetitive vocalizations or speech (Lanovaz & Sladeczek, 2012). The persistent engagement in stereotypic behaviors by individuals with ASD often interferes with academic learning and socialization (Martinez & Betz, 2013). Stereotypic behaviors may also result in their stigmatization and exclusion from school and community environments (Reed, Hirst, & Hyman, 2012).

Characteristics of Students With Autism Spectrum Disorder

Students diagnosed with ASD, even those with high functioning ASD, often exhibit delays in communication and social skills. Stereotypic behavior is one of the prominent characteristics of the disability (Bodfish, Symons, Parker, & Lewis, 2000). The deficits in communication and social skills and the presence of stereotypic behaviors often hinder these students’ interactions with peers. Stereotypic behaviors, in particular, may severely affect students’ academic learning and social skill development, both essential to positive school outcomes (Liu-Gitz & Banda, 2010). Students who display vocal stereotypy often have difficulty participating in social activities and experience limited social inclusion (Lanovaz & Sladeczek, 2012). In addition, vocal stereotypy also tends to interfere with and reduce a student’s time spent on learning and social interactions across settings (Liu-Gitz & Banda, 2010). Students who display these behaviors typically continue to do so throughout adolescence and adulthood, which can have a significant impact on their post–high school opportunities (Schall & McDonough, 2010).

Interventions

A variety of interventions have been used to minimize the occurrence of repetitive vocalizations, such as (a) providing alternative access to sensory stimulation that maintains behavior (Piazza, Adelinis, Hanley, Goh, & Delia, 2000), (b) providing access to dissimilar forms of sensory stimulation (Ahearn, Clark, DeBar, & Florentino, 2005), (c) enriching the environment by providing noncontingent access to music or sound producing toys (Lanovaz, Sladeczek, & Rapp, 2011), (d) providing contingent access to matched stimulation using differential reinforcement of other behavior (DRO; Taylor, Hoch, & Weissman, 2005), and (e) verbal reprimands and response blocking (Rapp, 2006, 2007). Results from these interventions have been mixed.

Although many of these interventions have resulted in reductions in vocal stereotypy and some in increases in appropriate vocalizations, some disadvantages have been noted in the literature. Disadvantages of environment enrichment strategies include (a) reduction of time available for instructional activities when noncontingent reinforcement of music or toys is administered and (b) satiation of music or toys, reducing the effectiveness of this intervention over time (Lanovaz et al., 2011). The literature indicates that DRO has not always been effective in decreasing stereotypic responding (Ahearn et al., 2007). In addition, the DRO procedure does not teach the student an alternative appropriate communicative response to replace the stereotypy. Verbal reprimands and response blocking have been shown to actually increase the stereotypic behavior over time (Rapp, 2006). In fact, during response blocking, a decrease in one automatically reinforced behavior, such as vocal stereotypy, often results in an increase in another automatically reinforced behavior, such as motor stereotypy (Lerman, Kelley, Vorndran, & Van Camp, 2003).

Response Interruption and Redirection

The RIR procedures consist of two primary components: (a) interrupting stereotypic behavior (either motor or vocal) immediately upon its occurrence and (b) redirecting the student to other appropriate behaviors (Martinez & Betz, 2013). Blocking a stereotypic vocal behavior by issuing a demand that requires a vocal response results in an appropriate vocalization that is incompatible with the vocal stereotypy. This is often accomplished by the teacher selecting prompts that are highly likely to elicit a verbal response from the student, such as asking the student a question (e.g., “What color is this?”), giving an instruction requiring a vocal response (e.g., “Tell the class what sound the dog makes.”) or pointing to a picture or object while asking, “What is this?” The RIR procedure provides an opportunity for the student to respond with appropriate vocalizations that can then be reinforced by the teacher. Using RIR to decrease the occurrence of stereotypic vocal behavior may have a positive side effect. This procedure often increases the student’s opportunity to receive reinforcement for an appropriate response that, in turn, may increase appropriate vocalizations. Responding to the student’s appropriate speech during the RIR intervention with praise and other natural reinforcement has been shown to increase a variety of appropriate and spontaneous speech.

For effective implementation during classroom instruction, a three-step procedure is employed. The first step consists of gaining the student’s attention at the onset of vocal stereotypy. As soon as the student begins to engage in vocal stereotypy, the teacher should obtain the student’s attention by saying his or her name or tapping the student on the shoulder. Once the teacher has the student’s attention, he or she moves to step 2.

Step 2 consists of asking the student a question or giving the student a demand that requires a verbal response. The teacher should use questions or demands that are related to the content or materials of the lesson and that have a high probability of an accurate, fluid response by the student. For example, if the students are engaged in a lesson on the postal service, the teacher might ask the student, “Who delivers the mail?” After the student responds with the related word or phrase, the teacher moves on to Step 3.

Step 3 includes reinforcing the student’s attempts at an appropriate verbal response or providing corrective verbal feedback (Wells, Collier, & Sheehey, 2016). See Table 1 (Ahearn et al., 2007) for an expanded description of these implementation steps.

Table 1.

Implementation Steps in Response Interruption and Redirection Procedure During Instruction.

Steps	Description
Step 1 Gain attention Example: Teacher, “Jon”	- As soon as vocal stereotypy begins, say student’s name - Tap him on the shoulder if he does not orient and repeat his name
Step 2 Ask a question or place a verbal demand Example: Teacher, “Who delivers the mail?”	- Questions or demands should pertain to the content or materials of the lesson - Use demands with a high probability of an accurate, fluid response from student (refer to list of prepared prompts)
Step 3 Reinforce appropriate vocalizations Example: Student, “Letter man”	- When student responds with related word or phrase, provide verbal praise - Reinforce all relevant attempts, even if incorrect - If student does not provide appropriate verbal response, use vocal imitation (Teacher, “Say, mail man” in an expectant tone) - Reinforce when he attempts to imitate vocal model - If he does not repeat the prompt, then provide corrective feedback by repeating the verbal model (“mail man”), pause and then provide another verbal prompt (“mail man”) until he responds correctly or makes a reasonable attempt

Implementing in a Group Setting

The RIR intervention has been used as a one-to-one intervention in home, clinic, and school settings. RIR can also be used effectively in a group instructional setting to reduce vocal stereotypy in children and youth with ASD (Wells et al., 2016). Using RIR in a group setting provides teachers with a strategy that supports inclusion of students with ASD who engage in vocal stereotypy without detracting from the learning of group members. But embedding RIR in group instruction requires some planning. Although any question or vocal demand that the student will respond to can be used, the RIR intervention can be made less obtrusive and more specific to lesson content with good planning. Demands related to lesson content have a high probability of resulting in an appropriate vocal response from the student with ASD that will reduce the disruptiveness of the intervention on other students.

It is important to examine the instructional content of impending lessons to determine the related questions or vocal demands that can be presented to the student for which he/she knows the appropriate response. This requires that the teacher has adequate knowledge of the student to select questions or demands for which there is a high probability of the student making a relevant response. To implement RIR effectively, a written list of the vocal demands that relate to the planned instructional content, that are appropriate for the student, should be prepared. This list can then be used as a reference during instruction for selection of prompts. This preparation helps to ensure a quick interruption of the student’s vocal stereotypy and a smooth instructional delivery of the RIR procedure.

Training Paraprofessionals

The RIR procedures are easy for classroom staff to learn and implement in one-to-one or group instruction settings. Teachers can train classroom staff to implement RIR effectively. Staff training can be accomplished by (a) providing the classroom staff with a written procedural checklist of the steps in the RIR intervention, (b) modeling the implementation of the RIR procedures with a student with ASD while staff mark each step as completed on the procedural checklist, and (c) providing staff with supervised practice sessions with feedback on their accuracy in following the steps on the procedural checklist. Training staff to implement RIR may increase the use of the procedure resulting in decreases in vocal stereotypy across the day.

Data-Based Decision Making

Prior to intervention, baseline data should be collected to determine the frequency and/or magnitude of the vocal stereotypy. Data could be collected using either frequency (number of occurrences during a specified time period) and/or duration (number of seconds the stereotypy occurs). Then, the effectiveness of the intervention can be monitored using the same data collection method that was used to collect the baseline data. The behavioral data should be recorded on a graph to guide decision making. Visual analysis of graphed data provides a means of quickly identifying the change or lack of change in the behavior (Alberto & Troutman, 2013).

As with all interventions with students with ASD, there is the possibility that the student’s behavior will not change as desired when RIR is implemented. Challenges to successful implementation are often related to the (a) vocal demands, (b) reinforcement, or (c) fidelity of implementation. Upon implementation, if data do not indicate a reduction in frequency or duration of vocal stereotypy then the RIR troubleshooting guide (see Table 2) can be reviewed and adjustments systematically made to implementation procedures. The troubleshooting guide uses questions to guide identification of appropriate changes to intervention procedures based on student characteristics and presenting behaviors.

Table 2.

Troubleshooting Questions and Answers.

Issue	Question and Troubleshooting Options
Student does not respond to some of the vocal demands	Question: Has he responded to the demand recently? - No, remove the demand from RIR. Provide other teaching opportunities for student to learn and practice the response until fluent. - Yes, ensure you gain attention first. Repeat demand, exaggerate expectant tone and/or use gestural prompt.
Student does not respond vocally to any demand	Question: Does the student have some functional vocal language? - No, any communication system that the student can use fluently will provide the opportunity for him to respond if he has the appropriate symbols on the low or high tech device to do so. Be sure he has the appropriate vocabulary available. - Yes, check that he will respond to the specific vocal demands you are presenting in a one to one communication exchange, outside of group instruction. Question: Is reinforcement available? - Not sure, first review what the student will work for. Remember, praise or social reinforcement may not be a strong enough motivator during group instruction. Try adding a visual (token, checkmark) or tangible reinforcement that has worked in other settings for all reasonable attempts at responding during group work. - Yes, be sure to provide the reinforcement for all reasonable attempts at responding, even if incorrect. Change reinforcement frequently to maintain high level of motivation. If using praise or social reinforcement, try increasing your enthusiasm to magnify the effect.
Student responds but behavior has not decreased	Question: Are you implementing procedure with fidelity? - Not sure, either video tape yourself and review to ensure that you followed steps accurately each time vocal stereotypy occurred or have another staff member use a procedural checklist of the steps to record how accurately you followed the steps. - Yes, increase the number of vocal demands presented when vocal stereotypy occurs from one to three on each occurrence. Provide minimal reinforcement until final demand.

When graphing the behavioral data, indicate where procedural changes were made on the graph for efficient tracking of instructional decisions and student progress with a quick visual review of the graphed data. An example of graphed data from a RIR intervention is provided (see Figure 1).

Figure 1.

Student’s Vocal Stereotypy as a Percentage of Instructional Time.

Summary

The RIR intervention is an evidence-based procedure to reduce vocal stereotypy in students with ASD (Wong et al., 2014). In addition, the procedures are quick and simple to implement and can be incorporated into ongoing instruction in a group setting with a little planning. Due to the simplicity of the intervention, training for paraprofessional staff can be completed with a brief training session and subsequent monitoring to ensure fidelity of implementation procedures.

Reducing vocal stereotypy provides the opportunity to develop the student’s social and communicative skills that are vital to the student’s inclusion in general education classrooms (Hume, Plavnick, & Odom, 2012) and other inclusive opportunities. Using RIR during group instruction to reduce vocal stereotypy of a student with ASD has tremendous implications for increasing their social acceptance as well as improving their learning outcomes and inclusive educational experiences.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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