An Innovative Behavioral Treatment for Restrictive, Rigid Behaviors Displayed in Persons with ASD

Background:  Efficacious psychopharmacological interventions for repetitive behaviors and rigid routines have not been identified for persons with ASD. Temporary reductions in repetitive motor actions may be achieved with applied behavior analytic (ABA) interventions, but generalization beyond the intervention setting and maintenance over time have not been demonstrated. Moreover, ABA interventions for more complex routines do not yet exist.

Objectives: To conduct an initial efficacy trial of a behavioral intervention to reduce restrictive, rigid behaviors.  

Methods: This study recruited 2 male participants aged 9 and 10 who attended a private, non-profit educational agency. A reversal design across multiple behaviors was used for these participants. All behaviors were initially observed in a baseline condition, and an assessment to determine degree of rigidity was conducted. The intervention for each behavior was then introduced.  Next, a reversal of the intervention back to baseline was conducted, and then the intervention was re-introduced.  Finally, an assessment of maintenance was conducted to determine whether the treatment gains continue over time.  The baseline assessment consisted of a modified functional analysis in which data were collected on a participant’s rigid, routine behavior. After baseline, the experimenter conducted 3-4 30-minute sessions per week. Sessions included (1) a lag-reinforcement schedule to encourage any variation from the rigid routine, (2) interruption of the routine if it occurred, and (3) an individualized social script to address the problem behavior. The script described the behavior, listed how the child might feel if he could not engage in the behavior, presented coping strategies and what others would think if the child accomplished the changes, specified what he would earn for accomplishing the change, and reaffirmed that the child would be okay.  

Results: Both participants displayed high rates of protests (3 or more protests per session) and low rates of compliance (0-10% of session time) when they were asked to change their rigid behaviors.  After the intervention, the number of protests dropped to 0-1 per session and the rate of compliance rose dramatically (i.e. 85-100% of session time).  Follow-up data collected for Participant 2 has continued to show this change 4 and 8 weeks after the intervention was concluded. 

Conclusions: Although further testing through larger efficacy trials is necessary, this 3-part intervention shows promise for addressing restrictive, rigid behaviors by both reducing the problem behavior and promoting varied adaptive behaviors.