1. Treating Social Communication Behavior in Asperger’s Disorder Celeste Domsch, Ph.D. Baylor University Stephen Camarata, Ph.D. Vanderbilt University ASHA Annual Convention 2003 Chicago, Illinois

2. Purpose To examine the effects of treatment on social communication behaviors in one child with Asperger’s Disorder

3. 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

4. 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

5. 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.”

6. 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

7. 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

8. 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

9. 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

10. Results: Treated Behaviors - Rocking

11. Results: Treated Behaviors – Hand Flapping

12. Results: Untreated Behaviors

13. Results: Subjective Judgments of Appropriateness

14. 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

15. 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)

16. 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.