What are 4 key take home treatment strategies that SLPs and OTs can apply.

I believe that it is important to first ask some questions regarding the repetitive behaviors including: Does the obsession, routine or repetitive behavior restrict the person's opportunities, cause distress or discomfort or negatively impact the individual's learning, participation or interaction? I would question if the behavior needs to be addressed if the answers to the above questions are NO. From the literature that I have read from adults with autism, it is evident that there is a benefit to SOME of the repetitive behaviors utilized in order to reorganize, regroup and de-stress. AND… What function does the repetitive behavior, routine or obsession have for the individual? Completing an FBA to try to determine the purpose/reason/cause of the repetitive behavior will likely provide necessary information to guide intervention strategies based on the function. All of that being said, some take home treatment strategies may include…


Contingency Modification Procedures are based on the premise that repetitive behaviors are learned and maintained by operant contingencies; there are studies that indicate this is an effective approach to reducing repetitive behaviors including verbal perseverations (Rehfeldt & Chambers, 2003). There are 2 types of procedures that can be utilized under this approach to reduce repetitive behaviors; 1.) contingent – utilized in response to a target behavior and may include punishment, 2.) noncontingent – utilized when a behavior is not exhibited for a period of time, reward for not engaging in the behavior. This would include differential reinforcement of other behaviors (DRO) or differential reinforcement of incompatible behaviors (DRI). Care needs to be taken when utilizing these approaches as obviously, the contingent approach can be viewed as punishment and not well viewed in many settings. I am not recommending this type of intervention but felt compelled to review it as it is listed as an effective approach in the literature.

Teaching and Prompting Alternative Activities – this is in direct contrast to those techniques in which the main purpose is to reduce the behavioral repertoire of individuals with autism; this approach seeks to expand the individual’s behavioral options.

One such example would be to provide social skills training which has been shown to decrease repetitive motor behaviors. A study conducted by Loftin et al., (2008), found that social interaction is incompatible with repetitive motor behavior. They hypothesize that because social interaction does not come easily to the individual with autism, the individual likely has to provide his/her full attention to engage in the social interaction. By providing training in social skills as well as the communication skills required for increased social interaction, and utilizing the necessary strategies and supports for the individual’s needs, the individual will be more competent and better able to engage in social interactions. We have learned of the difficulties that an individual with autism has in regard to social interactions and communication abilities, so care needs to be taken to address the areas of need to enhance the ability to participate in appropriate social and communicative interactions.

To address the issue that many individuals participate in repetitive behaviors to modify or alter arousal levels - monitor the sensory/arousal levels of the individual and incorporate strategies to neutralize the arousal state (environmental modifications, use of visuals, provide intervention strategies that will teach the individual alternative methods or strategies to achieve self regulation). I believe this starts at a very young age. Beginning to identify how a child is “feeling” either verbally or pictorially – utilizing concepts of self regulation (engine speeds). Developing strategies and teaching how to ask for assistance or seek the strategy independently by again using words or pictures. And I believe a huge first step is validating what the individual is feeling and teaching others in the lives of the individual that what he or she is “feeling” or perceiving on a sensory level is very REAL to them. I have seen this change in approach to an individual, even a very young child, make a huge difference. The idea is that by neutralizing the arousal level of an individual, there will be a decrease in the repetitive behaviors utilized by the individual in an attempt to self-regulate or block further sensory input. A study conducted by Gabriels et al, found that decreasing visual distractions in the learning environment reduces restrictive, repetitive and stereotyped behaviors, interests and activities (RBs) and increased on task behaviors. This study further indicates that reinforcing the environmental modifications to minimize visual distractors and increase regular opportunities for tactile and deep pressure/heavy work input helps to decrease RBs. This certainly is an implication for those of us who support children with autism in typical classroom environments where there are numerous visual distractors especially in preschools.

Teaching skills in general has been shown to decrease repetitive behaviors (motor, play, speech), in that skill development provides options for further choices and interactions. This will reduce the likelihood that an individual with autism will have only one option to carry out the same behavior over and over again (Turner, 1999).

Some literature encourages individual’s working with or interacting with individuals with autism, to join in the repetitive behavior. There is supportive information of the positive interactions that are elicited when the repetitive behavior is mimicked and joined. A relationship of sorts is established from which the behaviors can begin to be reshaped or expanded. As a way to first establish a relationship, then slowly expand behaviors in order to teach new skills.

As posed in an earlier post: review of the literature indicates that the perseverative nature of ASD individuals, while most often viewed as a weakness, can be regarded as a possible strength. Byrna Siegel reminds us as interventionists, that the perseverative tendencies may be utilized to influence motivation in a child who may otherwise be non-motivated. She challenges us to be creative and utilize the goal directed motivation (which can be seen when a “stim” or “stimming toy” is present) to achieve new learning.

Obsessions may be positively channeled to increase skills and areas of interest, promote self-esteem, and expand an individual's social group. Looking creatively at a particular obsession or repetition and thinking of ways of developing it into something more functional for the individual can be a very effective way of managing the behavior.

In summary
 Intervene early by setting boundaries around repetitive behaviors and obsessions from a young age and as they emerge.
 Increase environmental structure by using visual cues (eg timetables, daily planners), social stories, and pre-planning strategies to prepare for stressful events or change.
 Provide skill development opportunities including social skills training, relaxation and emotions identification training and skills to assist the individual better cope with change.
 Increase social, recreational and vocational opportunities for the person.
 Set clear and consistent boundaries around the behavior by rationing the object, the time or the place - remember to start small and go slowly.
 Explore alternative, more appropriate activities that have the same function as the repetitive behavior.
 Use obsessions to motivate and reward, develop skills, increase social opportunities and improve self-esteem.

Hope these posts have been informative and helpful. I have enjoyed reading others' special topics as well.


"Angela loved to rummage in the dustbins. Rather than stop the behavior, she was given the regular job of sorting the rubbish for recycling (bottles/paper/plastic) and ensuring rubbish was placed in the appropriate bins. Regular time was scheduled every day for this activity. A condition of this job was that she wears disposable gloves whilst sorting the rubbish and always wash her hands afterwards." (Clements & Zarkowska, 2000, p. 162)

The National Autistic Society, Obsessions, repetitive behaviors and routines, 2008

Turner, Michelle. "Annotation: Repetitive Behaviour in Autism: A Review of
Psychological Research." Journal of Child Psychology and Psychiatry 40.6
(1999): 839-849.

Loftin, Rachel, Samuel Odom, and Johanna Lantz. "Social Interaction and
Repetitive Motor Behaviors." Journal of Autism and Developmental Disorders
38 (2008): 1124-1135.

Rehfeldt, Ruth Anne, and Mark R. Chambers. "Functional Analysis and Treatment of Verbal Perseverations Displayed by an Adult with Autism."
Journal of Applied Behavioral Analysis 36 (2003): 259-261.

http://www.bbbautism.com/pdf/article_57_restricted_repertoires_in_autism.pdf

http://www.autismtreatmentcenter.org/contents/reviews_and_articles/research-social_interraction.php