Using Multiple Schedules to Decrease Vocal Stereotypy of Students with ASD in Classroom Settings

Background: Stereotyped behaviors such as repetitive vocalizations are a defining feature of autism spectrum disorder (ASD) and can disrupt classroom instruction. Behavioral interventions have been shown to reduce stereotypy but are seldom implemented in schools because they are often designed for one-to-one settings and involve specialized teaching techniques. Structured, collaborative coaching models for teachers may help bridge this research-to-practice gap. Students with Autism Accessing General Education (SAAGE) is a modular intervention approach to address core features of ASD in educational settings. Within SAAGE, teachers are presented with guidelines for selecting and individualizing interventions (via individual “modules”), and receive coaching to implement these interventions. One SAAGE module focuses on vocal stereotypy, with intervention options that include a “Now/ Not Now” intervention, which aims to bring stereotypy under stimulus control using multiple schedules of reinforcement (e.g., Rapp et al., 2009).

Objectives: (1) Evaluate the effectiveness of a teacher-implemented multiple schedule intervention package for reducing vocal stereotypy. (2) Evaluate teacher fidelity within naturally occurring, academic instructional periods.

Methods: Two teachers worked collaboratively with their SAAGE coach to create a “Now/Not Now” intervention package for two students with ASD. For student 1, intervention included the following components: (a) visual instructions of the intervention, (b) multiple schedule visual (red/green card), (c) differential token reinforcement of low-rate (DRL) behavior during the “not now” condition, and (d) response interruption during the “not now” condition. For student 2, intervention included: (a) a social story, (b) multiple schedule visual, and (c) response cost with a visual during the “not now” interval. Following intervention development, the coach provided in-vivo skills-training to teachers and collected teacher fidelity data. Teachers observed the frequency of vocal stereotypy during academic instruction and completed the 29-item Usage Rating Profile (URP), rated from 1 (strongly disagree) to 6 (strongly agree), which assessed teacher perception of the SAAGE intervention. We used a quasi-experimental interrupted time series design (with reversal for student 2) to evaluate the intervention.

Results: For student 1, vocal stereotypy decreased to 0 during the “not now” interval and the interval was successfully increased to 5 minutes. For student 2, vocal stereotypy decreased to near-zero rates and the “not now” interval was successfully increased to 30 minutes. Teacher intervention adherence and quality were 85.19 and 100 percent for student 1, respectively, and M(SD)=88.19(10.29) and M(SD)=93.06(12.19) percent for student 2. On the URP, mean ratings for teacher 1 and teacher 2, respectively, were 6.00 and 5.67 for Acceptability, 6.00 and 6.00 for Understanding, and 6.00 and 5.67 for Feasibility.

Conclusions: Both multiple schedule intervention packages brought vocal stereotypy under stimulus control and decreased stereotypy to zero or near-zero rates during the “not now” intervals. Teachers selected the intervention over other intervention options and implemented it with fidelity. They also rated the SAAGE process as acceptable and feasible. Results provide preliminary evidence that teachers can learn to use behavioral interventions for stereotypy and that, with teacher input, the interventions can be practical to implement throughout the classroom routine, making this a potentially effective and feasible intervention option.