treating social communication behavior in asperger’s disorder

Treating Social Communication Behavior

in Asperger’s Disorder

Celeste Domsch, Ph.D.Baylor University

Stephen Camarata, Ph.D.Vanderbilt University

ASHA Annual Convention 2003Chicago, Illinois

Purpose

To examine the effects of treatmenton social communication behaviors

in one child with Asperger’s Disorder

DSM-IV Diagnostic Criteria for Asperger’s Disorder

• Qualitative impairment in social interaction• Restricted, repetitive and stereotyped patterns of behavior,

interests, and activities• Disturbance causes clinically significant impairments in

social, occupational, or other areas of functioning• No clinically significant general delay in language• No clinically significant delay in cognition, self-help,

adaptive behavior or curiosity about the environment in childhood

Hypotheses tested:

1. That treatment for two inappropriate social communication behaviors would decrease their rate of occurrence in the participant

2. That the rate of occurrence for three untreated behaviors would not change

3. That subjective ratings of the participant’s overall appropriateness would improve post-treatment

Method: Participant

• One participant, an 8-year-old male• IQ = 143 on the Stanford-Binet• Adaptive behavior composite = 98 on the

Vineland• Receptive vocabulary quotient = 114 on PPVT-R• Expressive vocabulary quotient = 136 on

EOWPVT-R• “… his difficulties in peer relations, low frequency

of eye contact, inflexibility with routines, motor stereotypes, and weak adaptive behavior meet the criteria for a diagnosis of Asperger’s Disorder.”

Method: Design

• Multiple-baseline-across-behaviors design• Five impaired social communication behaviors

noted at outset of study:– 1. Rocking– 2. Hand flapping– 3. Facial contortions– 4. Inappropriate eye contact– 5. Inappropriate voice volume

• Rocking and hand flapping selected for treatment• Occurred more frequently than other behaviors

during baseline• Were more obviously stigmatizing

Method: Baseline

• Seven 10-minute samples collected• Participant asked to behave as he normally would

and discuss topics of interest to him• All videotaped• Reward was access to computer games on a laptop

Method: Treatment

• Employed the self-management strategy in Koegel and Frea (1993)– Participant identifies, labels, and receives rewards for

successful control of treated behaviors• 13 treatment sessions over 6-week period• Sessions were 30 to 45 min. long; 2-3 times/week• Sessions 1-4 treated only rocking• Sessions 5-13 treated rocking and hand flapping• If participant successfully controlled rocking and

hand flapping for intervals ranging from 1-2 minutes, he was immediately rewarded with brief access to computer games

Method: Subjective Judgment of Appropriateness

• Two SLPs unfamiliar with study served as observers

• Observers watched 10 one-minute videotaped samples of participant

• Rated each minute on a scale from 1-9 (“very inappropriate” to “very normal”)

• Five one-minute samples from pre-treatment and five from one sample taken at 4 weeks post-treatment

• Presented in randomized order

Results: Treated Behaviors - Rocking

Results: Treated Behaviors – Hand Flapping

Results: Untreated Behaviors

Results: Subjective Judgmentsof Appropriateness

Discussion

• Treatment appears to have been effective in reducing frequency of rocking, but had no apparent effect on hand flapping

• Treatment had no apparent effect on the three untreated behaviors (facial contortions, voice volume, eye gaze)

• Subjective judgments of overall appropriateness indicated improvement after treatment

Conclusions

• Self-management may be an effective strategy for improving some social communication behaviors in children with Asperger’s Disorder

• Most frequent behaviors may require intensive and isolated treatment (e.g., one behavior treated at a time)

• May want to consider substituting more appropriate behaviors, rather than attempting to eliminate inappropriate ones (e.g., hand wringing in lap for hand flapping near face)

Reference

• Koegel, R.L., & Frea, R.D. (1993). Treatment of Social Behavior in Autism Through the Modification of Pivotal Social Skills. Journal of Applied Behavior Analysis, 26, 369-377.

• Slides of this talk are also available at www.domsch.com.