Children with autism often need interventions to increase socially appropriate behaviors and decrease socially inappropriate ones. Lanzarini E, Pruccoli J, Grimandi I, Spadoni C, Angotti M, Pignataro V, Sacrato L, Franzoni E, Parmeggiani A. xW]o6}7Gi~JPpthA%g0Erm9@}.EMb:uE>|jOD2.5IfV~q3yE;j#OV|+E"zGX:X~'/7{`lZ Annu Int Conf IEEE Eng Med Biol Soc. If your child or student is presenting with stereotypy that interferes with learning, it is valuable to look at this study, as well as similar studies by Cassella, Sidener, Sidener, & Progar (2011) and Athens, Vollmer, Sloman, & Pipkin (2008). This means people who do a lot of stereotypy tend to make slower progress at school. BCOTB accepts the following major insurance plans: Anthem, Baycare, Beacon, BCBS, Cigna, Humana, MHNet, Meritain Health, UnitedHealthcare, and TRICARE. Would you like email updates of new search results? Behavior analysts use evidence-based practices like those described above to help individuals to decrease their behavior and increase appropriate skills. The speakers vocal stereotypy is similar to other types of stereotypic behavior in that it does not mediate socially, but it does appear to be maintained as a result of its sensory inputs. 2017 Nov;20(8):491-501. doi: 10.1080/17518423.2016.1265604. Stereotypy. Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/stereotypy. Athens et al. The most common forms are hand flapping, shaking objects and repeating vocal sounds. J Appl Behav Anal. putting gloves on a boy that bites his fingers for the tactile sensation of his fingers against his teeth, physically blocking a girl from hitting her head against a table for the auditory sensation the banging sound produces). In Cassella et al., 2011, vocal stereotypy was defined as a variety of vocalizations and repetition of words and phrases. 0000001176 00000 n saying banana when this was not appropriate) and repetitive loud, unintelligible vocalizations (e.g. 0000002300 00000 n Conclusions 0000013145 00000 n Changing the environment may result in a decrease in behavior, but appropriate alternatives must be provided. Epub 2016 Dec 23. Clipboard, Search History, and several other advanced features are temporarily unavailable. government site. Each morning, I know Greyson is awake because he has a distinctive crow: a cross between a babble and a siren that goes from high to low over and over. Using the examples from above, providing the boy that flaps his hands access to a fan and providing salty snacks to the girl during specific times of the day may decrease the stereotypy throughout the day. spectrum disorder and . Post was not sent - check your email addresses! Children with autism often display vocal stereotypies, which can include chanting, repeating words or phrases, or making noises such as grunting or humming . This effectively disables the scripting and redirectes it to the next task. The term vocal stereotypy was dened as "any repetitive sounds or words produced by an individual's vocal apparatus that are maintained by nonso-cial reinforcement" (p. 36). While vocal stereotypies can be frustrating for caregivers and loved ones, they can also serve as a means of self-regulation and communication for children with autism. These behaviors manifest in different ways, depending on the person. Abstract. Before 2021 Jun 29;11(7):862. doi: 10.3390/brainsci11070862. Echolalia from a transdiagnostic perspective. Generally speaking parents and clinicians should use only evidence-based practices when attempting to treat stereotypy and other maladaptive behaviors associated with autism. Contact our offices in Brandon, Tampa, or Wesley Chapel to set up a complimentary consultation to discuss how these and other techniques may benefit your family. The redirection involved prompts for vocal behavior such as saying Where do you live? or Say red. When a child made an appropriate vocalization, it was always followed by a teacher comment. 0000024542 00000 n Absolutely! Specifically, the authors review the research literature on behavioral interventions to reduce engagement in vocal stereotypy with an emphasis on the applicability of the procedures in the natural environment and discuss the clinical implications and limitations of research conducted to date. Ways to Better Understand Echolalia and Vocal Stereotypy, Functional Communication Goals for Autism. 0000026460 00000 n Furthermore, postintervention probes revealed significantly lower levels of vocal stereotypic behavior in the natural environment than preintervention probes. Little Miracles Preschool & Early Childhood Center, Special Education Itinerant Teacher (SEIT), Special Education Teacher Support Services, Still Connected: An Eden II Programs Update, Preschool & Early Childhood Reopening Plans, Eden II is a proud recipient of DYCD funding and support, Top Autism Websites Recommended by Parents. The VSQ can be used in a variety of settings, including clinics and homes. To save this word, you'll need to log in. Using Vocal Stereotypy as a Symptomatic Assessment and Treatment for Children with Autism J APPS BEHAVI ANAL. The VSQ is capable of being used in a variety of settings, including clinics and homes. 2019. HHS Vulnerability Disclosure, Help Remember stereotypy is usually happening because the person has no other way of entertaining himself or herself. Data analysis of response interruption and redirection as a treatment for vocal stereotypy. Issue 75 Helping Your Child with Autism Thrive. Brain Sci. bRMdDP @ Y29Cn zx.d0hqd`)H3 9Xt0Q@ HI endstream endobj 80 0 obj <> endobj 81 0 obj <>/Font<>>>/Fields[]>> endobj 82 0 obj <<>> endobj 83 0 obj <>/MediaBox[0 0 612 792]/Parent 75 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 84 0 obj <> endobj 85 0 obj <> endobj 86 0 obj <> endobj 87 0 obj [250 333 0 0 0 833 778 0 333 333 500 564 250 333 250 278 500 500 500 500 500 500 500 500 500 500 278 278 0 0 0 444 0 722 667 667 722 611 556 722 722 333 389 722 611 889 722 722 556 0 667 556 611 722 722 944 0 0 0 0 0 0 0 500 0 444 500 444 500 444 333 500 500 278 278 500 278 778 500 500 500 500 333 389 278 500 500 722 500 500 444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 444] endobj 88 0 obj <> endobj 89 0 obj [226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 507 507 507 507 507 507 507 507 507 507 0 0 0 0 0 0 0 579 0 533 0 488 0 0 0 0 0 0 420 0 0 662 517 0 543 459 487 0 567 0 0 487 0 0 0 0 0 0 0 0 0 0 0 498 0 0 0 230 0 0 0 0 525 527 0 0 0 391] endobj 90 0 obj <>stream . However there are many more forms of stereotypy and these include opening and closing the mouth, facial grimacing, head tilting, head shaking, shoulder shrugging, body tensing, stamping feet, twirling objects, spinning, ear covering, staring at objects, side looking and vocal scripting. The site is secure. The teacher praised the student for using appropriate language when they voiced, and he or she requested that the request be granted as soon as possible. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. 2012 Mar;36(2):146-64. doi: 10.1177/0145445511427192. This site needs JavaScript to work properly. operational definitions of commonly occurring behaviors note: these definitions may not be . scripting frequently results in high frequency, inconsistent onset and offset. We, as parents or caretakers, become accustomed to repetitive speech, or even what we think is babbling. government site. A very simple answer to that question is that people with autism do stereotypy just because they like doing it. 0000029192 00000 n Features Stats Integration Plugin developed by YD. This is called RIRD Response Interruption/Redirection. For example, a person with autism might say the same word or phrase over and over again, or they might make repetitive noises like grunting or screaming. effective in reducing vocal stereotypy during the red-card sessions. Vocal stereotypy autism is a condition in which an individual makes repetitive vocalizations, such as echolalia or palilalia. Assessing and Treating Vocal Stereotypy in children with autism, William H Ahearn,Kathy M Clark, andRebecca P.F MacDonald, New England Center for Children And Northeastern University, This article was featured in Issue 75 Helping Your Child with Autism Thrive. McDonald and Bo In Chung published a study in the Journal of Applied Behavior Analysis entitled Assessing and Treating Vocal Stereotypy in Children with Autism. The study defined vocal stereotypy as any instance of noncontextual or nonfunctional speech and included singing, babbling, repetitive grunts, squeals, and phrases unrelated to the present situation. It focused on four learners (two boys and two girls) who had autism and were referred for the study because their vocal stereotypy interfered with their ability to learn. Vocal stereotypy is a common problem behavior in individuals with autism spectrum disorders that may interfere considerably with learning and social inclusion. According to Webster's Dictionary, the definition of stereotypy is: frequent repetition of the same, typically purposeless movement, gesture, posture, or vocal sounds or utterances Stereotypy is directly linked to autism spectrum disorders and is included in the third criteria of the diagnostic and statistical manual (DSM-5) for autism diagnosis. One of the most significant challenges related to the autism spectrum disorder (ASD) condition is the presence of vocal stereotypy which can interfere with learning, auditory processing and desirable social behaviours. This may involve blocking the behavior from occurring. The vocal stereotypy of two boys ranging from 4- to 7-years-old was decreased by having them complete a one-step direction that did not require a vocal response contingent on the vocal stereotypy occurring. Stereotypy is one of the core diagnostic features of autism spectrum disorder and warrants behavioral intervention when it negatively impacts the person's life. The term stereotypy has a number of variations. One common method is to provide positive reinforcement for desired vocalizations. Children with visual stereotypies exhibit a characteristic form of motor aphasia, which can be extremely disruptive to their lives. Initially the interval is very short so the person can easily receive the reinforcer, but the duration of the interval is systematically expanded based on the persons progress. Artificial intelligence for the measurement of vocal stereotypy. kFZ;VI=6'#m]N "pr6c}aAaqi yA(Ra@d(= sc0L%&! As a result, it is possible to attribute behavior change to punishment. Additionally, stereotypy tends to interfere with learning. Definition Vocal and/or motor self-stimulatory behaviors sometimes interfere in learning or community inclusion. **BCOTB has been Tampas leading provider of pediatric ABA therapy since 2003. xZrF}WT>79v]IYR}@H (/}@ FOIA It is a hybrid of echolalia and vocal stereotypy, and it is either noncontextual or nonfunctional. Another big reason to target stereotypy is that people who engage in a lot of stereotypy are at a much greater risk of developing other, more severe behaviors like self-injury and aggression. Vocal stereotypy is a common problem behavior in individuals with autism spectrum disorders that may interfere considerably with learning and social inclusion. My experience is that the people with autism who do a lot of stereotypy tend to lack appropriate leisure skills. normal speaking voice lasting longer than 3 seconds with tears), throwing (moving objects not intended to be thrown through space farther than 3 ft), banging floor (using any part of the body or an object to make contact with the floor with sufficient force to make a sound), screaming (vocalizations louder than normal s peaking voice lasting To assist clinicians in treating the behavior and to guide researchers in identifying gaps in the research literature, the authors provide an overview of research on vocal stereotypy in individuals with autism spectrum disorders. In an effort to utilize an intervention for vocal stereotypy, a response interruption and redirection (RIRD) has been evaluated in two studies to determine its effectiveness. 2023 Jan 25;8:23969415231151846. doi: 10.1177/23969415231151846. National Library of Medicine Home Communication Skills Ways to Better Understand Echolalia and Vocal Stereotypy. During the Rhode Derby, children may initiate communicative attempts that persist in the absence of treatment and, in some cases, may result in more appropriate responses if the environment is enriched. Singing, babbling, repetitive grunts, squeals, and other phrases unrelated to the present are examples of this. Echolography is a practice of repeating the same song or line over and over in no specific order, usually for no reason. Because stereotypic behaviors frequently reinforce the sensory consequences that occur when they are elicited, treating them is difficult. In the case of repetitive movements or sounds, some consider any movement or sound to be a stereotypy, while others consider movements that are excessively repetitive or have a specific purpose, such as hand-flapping a baby. It does not store any personal data. Stereotypy is also associated with higher levels of parenting stress and parents often rate stereotypy among the most difficult aspects of autism to deal with. Vist stimulus quality (VsQ) is a 14-item survey that measures the parents memories of visual stereotypies (e.g., type of stimulus, gaze direction, head orientation, and stimulus action status) that their children displayed during their childhood. A sensory extinction is the process of altering the environment or interfering with behavior in order to achieve sensory extinction. These cookies ensure basic functionalities and security features of the website, anonymously. 0000020444 00000 n MeSH It appears that Max has developed a, Post the Definition of stereotypy to Facebook, Share the Definition of stereotypy on Twitter. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. The https:// ensures that you are connecting to the It is very important to make stereotypy go away, especially in younger people with autism. Operational definitions activity. 2017 Jul;2017:279-282. doi: 10.1109/EMBC.2017.8036816. Inter-observer agreement (IOA) datawere scored for 30% of all sessions. 0000026170 00000 n In RIRD, when the child made an inappropriate vocalization, the teacher blocked them by interrupting immediately, then redirecting them to another behavior. %PDF-1.6 % Delivered to your inbox! Nice job!). Phonic and Motor Stereotypies in Autism Spectrum Disorder: Video Analysis and Neurological Characterization. The study describes potential interventions from previous research before introducing its goal of interrupting the vocal response then redirecting. echolalia, according to Schreibman and Carr (1978), is the act of imitating another persons speech. defined vocal stereotypy as loud, repetitive, noncontextual verbalizations (such as saying banana when its not appropriate) and repetitive, meaningless vocalizations (such as saying aaaah). But in a store or restaurant, my strategy is usually to ignore the onlookers, hug Greyson, and hear my favorite repetitive phrase of his: Mommy, I love you. I have known some parents who simply smile to open the door for questions, or at the very least, to make the people aware that their staring is being noticed. Four children with autism spectrum disorders were studied in this study, which aimed to determine whether they could communicate normally. If echolalia is added to the RRB criteria B1, it may result in an undue focus on this symptom, ignoring the many other more common ways that speech is produced in individuals with ASD. BCOTB accepts most major insurances, including, but not limited to: Aetna, Anthem, Baycare, Beacon, BCBS, Cigna, CMS, Florida Blue, Humana, MHNet, Meritain Health, Magella Health, UnitedHealthcare, and TRICARE. In 2007, William H. Ahearn, Kathy M. Clark, Rebecca P.F. Send us feedback. Microphones and video camera were used to collect data and were used for analysis. Abstract. Unable to load your collection due to an error, Unable to load your delegates due to an error. The idea is to teach the person to do some appropriate behaviors instead of doing the stereotypy. A similar study used contingent demands on stereotypy and response cost to determine its effectiveness to decrease vocal stereotypy. 2021 Mar 28;11(4):431. doi: 10.3390/brainsci11040431. 0000002950 00000 n Autism Dev Lang Impair. The https:// ensures that you are connecting to the Training a Neural Network for Vocal Stereotypy Detection. 0000031094 00000 n Learn a new word every day. In Cassella et al., 2011, vocal stereotypy was defined as a variety of vocalizations and repetition of words and phrases. PMC J Exp Anal Behav. TrainingsCareersCalendarsNewsletter Signup. An 11-year-old boys vocal stereotypy was reduced by using a series of vocal demands (similar to Rhode Island Rating Disposition) in addition to a response fee. Environmental Enrichment: This is a procedure that involves providing the person with some other form of stimulation so that they no longer need the stimulation they receive from doing the stereotypy. This means that the individual who is working on reducing their vocal stereotypies would watch and listen to someone else produce the desired vocalizations. 120 0 obj<>stream Observing the subspace that the data lives in allows us to detect vocal stimming and sounds of frustration. The confused stares are inevitable when we are parents of children with ASD. The Ins and Outs of Automatically Reinforcing Behaviors and Increasing Speech Sounds and Vocal Requests! Maybe theyre curious, or maybe theyre judgmental. The idea behind RIRD is to decrease the probability of the vocal stereotypy and increase appropriate behaviors (i.e. Finding a competing replacement behavior or a less obvious behavior which serves the same function (s) will limit interference of such behaviors. 2013 Feb;34(2):739-44. doi: 10.1016/j.ridd.2012.10.007. 0000000636 00000 n Since stereotypy is frequently automatically reinforcing, (meaning that the behavior is maintained by the sensation produced by the behavior) it is especially difficult to address. VSQ is gender- and age-neutral in third. Although stereotypies are frequently benign and can provide a wide range of benefits, they can also be indicators of mental illnesses such as autism and obsessive-compulsive disorder. Annu Int Conf IEEE Eng Med Biol Soc. Please enable it to take advantage of the complete set of features! This type of response blocking or sensory extinction often is used to decrease the inappropriate behavior by withholding the sensory stimulation produced by the stereotypic behavior. As a result of the discussion, appropriate vocalizations, mands, tacts, comments, and greetings were exchanged between Mitchell, Peter, and Alice. Depending on how it is used, the VSQ can be used in a variety of settings, including clinics and homes. The cookies is used to store the user consent for the cookies in the category "Necessary". In one study it required a motor response which also decreased the vocal stereotypy. Stimulus Control Procedure for Reducing Vocal Stereotypies in an Autistic Child. These cookies will be stored in your browser only with your consent. 0000001815 00000 n Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. The .gov means its official. doi: 10.1016/j.pcl.2011.10.006. 0000001428 00000 n Many claims that the function is similar to nonfunctional echolalia for easing anxiety. The children ranged in age from 3-11. The goal of the assessment was to proceed as quickly as possible with treatment in order to minimize the amount of time required. Vocal responses were required until the child complied with 3 consecutive vocal responses with the absence of the vocal stereotypy. 0000008107 00000 n Epub 2020 Nov 3. 2022 Nov 25;7:23969415221140464. doi: 10.1177/23969415221140464. Sensors (Basel). removal of the toy) was implemented. ZuT hm(0uq$=BikL=sK|O'\9J6iQt 5P-P3~8uc{E2jP~nkW} T4/q pv&J. Enter your email address below to get a free issue of the magazine & top autism tips direct your inbox, Enter your email below to receive the free guide and get top autism tips to your inbox, __CONFIG_colors_palette__{"active_palette":0,"config":{"colors":{"3e1f8":{"name":"Main Accent","parent":-1}},"gradients":[]},"palettes":[{"name":"Default Palette","value":{"colors":{"3e1f8":{"val":"var(--tcb-skin-color-0)"}},"gradients":[]},"original":{"colors":{"3e1f8":{"val":"rgb(19, 114, 211)","hsl":{"h":210,"s":0.83,"l":0.45}}},"gradients":[]}}]}__CONFIG_colors_palette__, __CONFIG_colors_palette__{"active_palette":0,"config":{"colors":{"f3080":{"name":"Main Accent","parent":-1},"f2bba":{"name":"Main Light 10","parent":"f3080"},"trewq":{"name":"Main Light 30","parent":"f3080"},"poiuy":{"name":"Main Light 80","parent":"f3080"},"f83d7":{"name":"Main Light 80","parent":"f3080"},"frty6":{"name":"Main Light 45","parent":"f3080"},"flktr":{"name":"Main Light 80","parent":"f3080"}},"gradients":[]},"palettes":[{"name":"Default","value":{"colors":{"f3080":{"val":"rgb(23, 23, 22)","hsl":{"h":60,"s":0.02,"l":0.09}},"f2bba":{"val":"rgba(23, 23, 22, 0.5)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.5}},"trewq":{"val":"rgba(23, 23, 22, 0.7)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.7}},"poiuy":{"val":"rgba(23, 23, 22, 0.35)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.35}},"f83d7":{"val":"rgba(23, 23, 22, 0.4)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.4}},"frty6":{"val":"rgba(23, 23, 22, 0.2)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.2}},"flktr":{"val":"rgba(23, 23, 22, 0.8)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.8}}},"gradients":[]},"original":{"colors":{"f3080":{"val":"rgb(23, 23, 22)","hsl":{"h":60,"s":0.02,"l":0.09}},"f2bba":{"val":"rgba(23, 23, 22, 0.5)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.5}},"trewq":{"val":"rgba(23, 23, 22, 0.7)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.7}},"poiuy":{"val":"rgba(23, 23, 22, 0.35)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.35}},"f83d7":{"val":"rgba(23, 23, 22, 0.4)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.4}},"frty6":{"val":"rgba(23, 23, 22, 0.2)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.2}},"flktr":{"val":"rgba(23, 23, 22, 0.8)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.8}}},"gradients":[]}}]}__CONFIG_colors_palette__. eCollection 2022 Jan-Dec. Autism Dev Lang Impair. 0000024171 00000 n say ball, etc.) 0000005047 00000 n In other words they do stereotypy because they are not able to entertain themselves in any other way. Data collection procedures were implemented to ensure appropriate and inappropriate responses. The system incorporates audio, video and wearable accelerometer bas 0000024916 00000 n But opting out of some of these cookies may have an effect on your browsing experience. Brain Sci. Only a few studies have been published in recent years into the study of vocal stereotypic behavior. Nice job using your words!). These example sentences are selected automatically from various online news sources to reflect current usage of the word 'stereotypy.' 0000033332 00000 n Hitting o Hitting is defined as any occurrence of making contact with any part of another person's body with an open or closed hand from a distance of six inches or more. Don't be surprised if none of them want the spotl One goose, two geese. People with verbal abilities are more likely than those who arent to develop fundamental speech patterns. whats your name, where do you live?) or echoic (e.g. 'Hiemal,' 'brumation,' & other rare wintry words. A vocal stereotypy is a repetitive or persistent pattern of speech that is characterized by a restricted range of intonation and/or pitch, monotonous quality, and/or prolonged duration. Test your knowledge - and maybe learn something along the way. What Assistive Technology for Speech and Language Disorders Are Available and How do They Work? Can Autistic Children Have Cluttering Speech? While this type of behavior does occur in typically developing children (think of a young child singing the same song repeatedly for several weeks or a toddler repeating a newly learned sound) there is concern that this behavior persists in children with autism and other developmental disabilities in such a manner that it interferes with learning. The distinction between the two is clear (now). Speech that is not contextual or functional is classified as vocal stereotypy. It is possible to argue that the vibration generated by engaging in vocalizations is reinforcement. . Autism Dev Lang Impair. A vocal stereotypy is a repetitive or persistent pattern of speech that is characterized by a restricted range of intonation and/or pitch, monotonous quality, and/or prolonged duration. An ABCBC reversal design was used to compare the effects of xed time reinforcement and a DRO schedule of reinforcement on the occurrence of vocal stereotypy. Those who oppose typically do so due to social objection, out of concern that a setting could be disrupted by the behaviors. The fascinating story behind many people's favori Can you handle the (barometric) pressure? Stereotypy comes in many forms. Youve been there. First, all three studies note that implementation of demands contingent on vocal stereotypy have functioned as a punisher. However, the review suggests that more research is needed to assist clinicians in initially selecting interventions most likely to produce desirable changes in vocal stereotypy and collateral behavior in specific circumstances. 77 44 Summer 2007: 40(2): 264575. The system incorporates audio, video and wearable accelerometer based sensors. 0000002129 00000 n 0000002066 00000 n Another technique that can be used is to model desired vocalizations. For example, if vocal stereotypy occurred, the instructor gained the childs attention and then the child was required to complete a vocal task (e.g. Low levels of vocal stereotypy are sometimes observed when sensory stimulation is administered in a variety of ways (e.g., Ahearn, Clark, DeBar, Florentino, Vollmer, Marcus, et al., 1994). The treatment integrity was well above 95%, but low treatment integrity would have a negative impact on the outcome.