Treating Social Communication Behavior in Asperger’s Disorder by byt34827


									Treating Social Communication
    in Asperger’s Disorder

      Celeste Domsch, Ph.D.
        Baylor University
     Stephen Camarata, Ph.D.
      Vanderbilt University

  ASHA Annual Convention 2003
       Chicago, Illinois

 To examine the effects of treatment
 on 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
             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-
            Method: Participant
• One participant, an 8-year-old male
• IQ = 143 on the Stanford-Binet
• Adaptive behavior composite = 98 on the
• Receptive vocabulary quotient = 114 on PPVT-R
• Expressive vocabulary quotient = 136 on
• “… 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
• Two SLPs unfamiliar with study served as
• 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-
• Presented in randomized order
Results: Treated Behaviors - Rocking
Results: Treated Behaviors – Hand Flapping
Results: Untreated Behaviors
Results: Subjective Judgments
     of Appropriateness

• 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
• 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

• 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)

• 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

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