Volume 8, Issue 2 (March & April 2017 -- 2017)                   BCN 2017, 8(2): 95-104 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Zarafshan H, Salmanian M, Aghamohammadi S, Mohammadi M R, Mostafavi S. Effectiveness of Non-pharmacological Interventions on Stereotyped and Repetitive Behaviors in Preschool Children With Autism: A Systematic Review. BCN. 2017; 8 (2) :95-104
URL: http://bcn.iums.ac.ir/article-1-609-en.html
1- Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran.
3- PhD Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Full-Text [PDF 749 kb]       |   Abstract (HTML) 

1. Introduction

Autism Spectrum Disorders (ASDs) are neurodevelopmental disorders with poorer cognitive performance that affect about 1% of population and characterized by impairments in three domains of function; social interaction, communication, and Repetitive or Stereotyped Behaviors (RSBs) (American Psychiatric Association, 2013; Lai, Lombardo, & Baron-Cohen, 2014; Mohammadi, Salmanian, & Akhondzadeh, 2011; TehraniDoost, Salmanian, Ghanbari-Motlagh, & Shahrivar, 2012; Salmanian, Tehrani-Doost, & Shahrivar, 2012). Repetitive or Stereotyped Behaviors (RSBs) refer to vocal or motor behaviors (Matson, Kiely, & Bamburg, 1997; Smith, & Van Houten, 1996) and manipulation of objects (Falcomata, Roan Feeney, & Stephenson, 2010) without any apparent function (Singer, 2009). These behaviors have negative effects on learning and social capacity of the people with ASDs (Pierce & Courchesne, 2001; Nadig, Lee, Singh, Bosshart, & Ozonoff, 2010) and also negatively affect function, well-being, stress level, and parenting of their families (Bishop, Richler, Cain, & Lord, 2007; Lounds, Seltzer, Greenberg, & Shattuck, 2007; Shattuck et al., 2006; Greenberg, Seltzer, Hong, & Orsmond, 2006). Repetitive and stereotyped behaviors (RSBs) are common in people with autism (around 90%) and begin around 3-4 years of age (Hollander et al., 2004; Watt, Wetherby, Barber, & Morgan, 2008) and continue through the life. Given the significant negative effects of RSBs on people with autism and its early emergence, finding relevant interventional methods to treat and reduce RSBs are crucial. Generally, interventions in the field of autism are divided into two broad categories; comprehensive models and focused practices (Odom, Boyd, Hall, & Hume, 2009). Comprehensive models address different developmental and behavioral skills in children with autism, while, focused practices address specific skills or symptoms (Boyd, McDonough, & Bodfish, 2011). Many different therapeutic strategies are used to manage RSBs. Pharmacotherapy is the most studied method that is shown to be effective on the reduction of symptoms among children with autism in clinical trial studies (Pearson et al., 2013; Mohammadi et al., 2013; Klaiman, Huffman, Masaki, & Elliott, 2013). However, evidence shows a high risk of negative effects, including weight gain, sedation, and extrapyramidal effects (Weitlauf et al., 2001). Side-effects of pharmacotherapy are the main reason which calls for developing non-pharmacological interventions such as self-management (Mancina, Tankersley, Kamps, Kravits, & Parrett, 2000), cognitivebehavioral therapy (Gajdzik, & Brynska, 2012), behavioral therapy (Conroy, Asmus, Sellers, & Ladwig, 2005; Britton, Carr, Landaburu, & Romick, 2002), and parent training (Scahill et al., 2012; Pajareya & Nopmaneejumruslers, 2011). In the meantime, there is no census over the relevant and usage of these methods. The present study explores the literature on nonmedical interventions that are used to treat RSBs by systematic method to better understand this field.

2. Methods

2.1. Databases and search strategy

Two authors independently performed a search strategy on Medline/PubMed, Scopus, and PsycINFO for English-language studies published up to 23 April, 2014 with following search terms; (“Autistic Disorder” OR “Autism spectrum disorder” OR “Pervasive developmental disorder” OR “Asperger Syndrome”) AND (“Stereotyped Behavior” OR “Motor Stereotypies” OR “Repetitive Behavior” OR “Repetitive use of object” OR “Repetitive speech”) AND (Treatment OR Intervention OR Therapy). We customized our search term for every database and used specific terms for “stereotyped and repetitive behaviors” based on DSM-5 description of ASDs. We also reviewed the bibliographies of retrieved articles and conference proceedings to obtain additional citations and references.

2.2. Study selection criteria

English-language case studies and clinical trials were considered eligible for this analysis if they dealt with ASD in preschool age period (under 7 years). We used those articles that addressed any non-pharmacological interventions on reducing stereotyped and repetitive behaviors in preschool children with autism. Furthermore, the qualified studies had to report sufficient statistics for data syntheses. Exclusion criteria comprised all articles that dealt with pharmacological, traditional, dietary, and herbal interventions.

2.3. Study selection and data extraction methods

Four independent reviewers screened relevant articles for inclusion criteria and assessed the quality of eligible articles with CONSORT checklist. High quality studies were included in data syntheses. Authors extracted data of each article onto extraction forms prepared in Microsoft Excel 2007. Variables which were extracted from case studies included study design, intervention, 

outcome, cases age (month)/sex, intervention sessions, mean baseline, and outcome values. Variables which were abstracted from clinical studies included study design, number of participants in each intervention and control groups, mean age of participants in each group, intervention duration, outcome, and results.
2.4. Data analyses
The included studies were homogeneous with respect to design and participant characteristics. The data, results, and conclusions of case studies were synthesized separately from data and results of clinical trials. In the case of articles in which multiple interventions had been performed (e.g. ERIN N. AHRENS et al. 2011) experiments were extracted separately. Because of lack of clinical trials on this field and insufficient data, we were not able to perform further statistical and meta-analyses. 
3. Results
Six hundred and sixty-four articles were found and inserted into End Note software ver. X6. After removing duplicate articles retrieved by two search engine databases, 490 articles were remained in the study (Figure 1). Then, authors reviewed the remained articles by titles and then by abstracts to check for potentially relevant studies. Afterward, 4 authors independently, assessed the quality of 78 eligible full texts with CONSORT checklist. Finally, 15 high-quality studies were included in data analyses.
The included articles were published from 1987 to 2013. The data and results and conclusions of 12 case studies were presented in Table 1 (ERIN N. AHRENS et al. 2011 has allocated 2 lines in tables due to multiple experiments and outcomes). Three studies designed as AB, two as ABA, and reminders as ABAB. In these case studies, baseline and final points each included several sections, in which investigators observed and counted the number of stereotyped behavior. In Table 1, mean baseline refers to mean number of stereotyped behavior for all sections at baseline. Similarly, the mean outcome refers to mean number of stereotyped behavior for all sections at final point. The data and results of 3 clinical trials were presented separately in Table 2. Two of them were randomized clinical trial and another one was designed as cross-over clinical trial.


Figure 1. Flowchart for selection procedure of articles.



3.1. Participants
Thirty-nine participants were included in 12 case studies (stereotypy in 4 of them were measured in two times one after vocal and then after motor response interruption and redirection (RIRD) ERIN N. AHRENS et al. 2011). Four participants were female and others (most of them) were male. 
3.2. Interventions and outcomes
Interventions were completely heterogeneous in case studies, including non-contingent auditory stimulation, response interruption and redirection, teaching the children to request assistance on difficult tasks, family-implemented treatment for behavioral inflexibility (FITBI) with treatment approach, vocal or motor response interruption and redirection (RIR), brushing, water mist treatment, exposure response prevention (ERP), tangible reinforcement/social reinforcement, and music. Interventions in clinical trials included touch therapy, kata techniques training program, and aerobic exercise. However, the outcomes were vocal (6 studies) or motor stereotypy.


4. Discussion
Apparently, many different techniques were used in treating behavioral stereotypies in children with autism. These techniques are based on different approaches; mostly behavioral (Schumacher & Rapp, 2011; Ahearn, Clark, MacDonald, & In Chung, 2007; Ahrens, Lerman, Kodak, Worsdell, & Keegan, 2011; Boyd, McDonough, Rupp, Khan, & Bodfish, 2010; Cassella, Sidener, Sidener, & Progar, 2011; Kang et al., 2013; Boyd, Woodard, & Bodfish, 2013) and sensory (Saylor, Sidener, Reeve, Fetherston, & Progar, 2012; Davis, Durand, & Chan, 2011; Bailey, Pokrzywinski, & Bryant, 1983; Field et al., 1997) approaches. The results show that almost all techniques have positive effects on reduction of behavioral stereotypies, but surprisingly two of them had both positive and negative effects Boyd, Woodard, & Bodfish, 2013; Ahearn et al., 2007).
Behavioral approaches are based on the idea that positive response reinforces a behavior, but negative response suppresses the original behavior (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Iwata et al., 1994). In regards to stereotyped behaviors, investigators think that stereotyped behaviors are self-motivated and maintained because of their positive result on children with autism (Asmus, Ringdahl, Sellers, Call, Andelman, & Wacker, 2004). Finding and changing the consequences of stereotyped behaviors can decrease these behaviors (Rapp, 2006; 2007). Included studies in our review have reported similar findings. In these studies, researchers that manipulated the consequences of behaviors could change undesirable behaviors (Schumacher, & Rapp, 2011; Ahrens et al., 2011).
Another theory in explaining stereotyped behavior claimed that impairment in functional communication would lead to repetitive and stereotyped behaviors (Mandy & Skuse, 2008); children with autism who cannot communicate with environment have several unmet needs that cause inappropriate behaviors (Sigafoos & Meikle, 1996). Based on our review, Durand found that teaching children with autism to request help, reduced motor stereotypy (Durand & Carr, 1987).
Sensory dysfunctions are common in children with autism and can be categorized as hyper-responsiveness, hypo-responsiveness, and sensory seeking (Boyd et al., 2010). The association between sensory dysfunction and repetitive behaviors has been explored in several studies (Gabriels et al., 2008; Boyd, McBee, Holtzclaw, Baranek, & Bodfish, 2009). These studies have shown a significant association between sensory dysfunction and stereotypy that can be considered in interventions (Boyd et al., 2010). Some studies that we found were in line with this idea. They revealed that interventions that have been considered sensory issues would decrease repetitive behaviors (Schumacher, & Rapp, 2011; Bailey, Pokrzywinski, & Bryant, 1983; Field et al., 1997; Lanovaz, Sladeczek, & Rapp, 2011).
As seen above, interventions that have focused on positive reinforcement (tangible reinforcement, social reinforcement), improvement of communication skills (teaching kids to request help) and sensory problems (brushing protocol, water mist treatment, and touch therapy) are most effective. These methods are supported by previous literature in the field of autism. Numerous studies have shown that using principles of applied behavior analysis (ABA) is effective in reduction of autism symptoms. Core principle of ABA is positive reinforcement. Our review shows that using positive reinforcements decreases stereotypic behaviors. Sensory processing problems and communication difficulties are considered as underpinning of stereotypic behaviors in people with autism. Our review also shows that intervention that focused on these area have successfully decreased stereotypic behaviors.
An important issue that should be considered in interpretation of the results of these studies is related to their case study designs which their results do not reveal reliable evidence. Only three of them were RCT and used intervention except behavioral interventions. Intensity of disease, duration of intervention, number of sections and therapist experiments can predict response to non-pharmacological treatment.
Non-pharmacological interventions on stereotyped and repetitive behaviors in preschool children with autism was based on sensory and behavioral techniques. The results show that almost all these techniques have positive effects on reduction of behavioral stereotypies, but surprisingly two of them (tangible and social reinforcement, and brushing protocol) had both positive and negative effects. 
4.1. Suggestions
Most current studies have used single subject design that leads to inability to control many confounders. Thus, we can’t precisely infer that which method can decrease 

stereotypic behaviors in autistic children better than other methods. Also, there is no comparison between methods in current studies. Well-designed study protocol and comparison between different methods is necessary to direct clinicians and parents to choose the best method. In addition, specific characteristics of children with autism should be considered. Some of them show stereotypic behaviors due to sensory processing problems, some due to communication problems, and some for behavioral problems. Future studies should carefully evaluate participants and clarify which methods better decrease stereotypic behavior in any subtype. Furthermore, research using more precise methods (RCT) can clarify what methods and techniques are effective in reducing repetitive behavior of children with autism. Also previous studies have revealed that autism phenotypes may predict psychological adjustments in parents and developing siblings (Mohammadi, Zarafshan, & Ghasempour, 2012; Mohammadi & Zarafshan, 2014), so we suggest that future trials on stereotypy behaviors also consider psychological effects on families of children with ASDs.
4.2. Limitations
Poor accessibility to full text of articles and insufficient data for performing meta-analysis are the main limitations for this study.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We acknowledge the Psychiatry & Psychology Research Center,  Roozbeh Hospital, and Tehran University of Medical Sciences for providing facilities to perform this research. 
Conflict of Interest
The authors declared no conflict of interests. 

Ahrens, E. N., Lerman, D. C., Kodak, T., Worsdell, A. S., & Keegan, C. (2011). Further evaluation of response interruption and redirection as treatment for stereotypy. Journal of Applied Behavior Analysis, 44(1), 95–108. doi: 10.1901/jaba.2011.44-95

American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of mental disorders: DSM 5. Oxon: Bookpoint.

Asmus, J. M., Ringdahl, J. E., Sellers, J. A., Call, N. A., Andelman, M. S., & Wacker, D. P. (2004). Use of a short-term inpatient model to evaluate aberrant behavior: Outcome data summaries from 1996 to 2001. Journal of Applied Behavior Analysis, 37(3), 283–304. doi: 10.1901/jaba.2004.37-283

Bahrami, F., Movahedi, A., Marandi, S. M., & Abedi, A. (2012). Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder. Research in Developmental Disabilities, 33(4), 1183–1193. doi:10.1016/j.ridd.2012.01.018

Bailey, S. L., Pokrzywinski, J., & Bryant, L. E. (1983). Using water mist to reduce self-injurious and stereotypic behavior. Applied Research in Mental Retardation, 4(3), 229–241. doi: 10.1016/s0270-3092(83)80004-6

Bishop, S.L., Richler, J., Cain, A. C., & Lord, C. (2007). Predictors of perceived negative impact in mothers of children with autism spectrum disorder. (2007). American Journal of Mental Retardation,  112(6), 450-61. doi: 10.1352/0895-8017(2007)112[450:POPNII]2.0.CO;2

Boyd, B. A., Baranek, G. T., Sideris, J., Poe, M. D., Watson, L. R., Patten, E., & Miller, H. (2010). Sensory features and repetitive behaviors in children with autism and developmental delays. Autism Research, 3(2), 78-87. doi: 10.1002/aur.124

Boyd, B. A., McBee, M., Holtzclaw, T., Baranek, G. T., & Bodfish, J. W. (2009). Relationships among repetitive behaviors, sensory features, and executive functions in high functioning autism. Research in Autism Spectrum Disorders, 3(4), 959–966. doi: 10.1016/j.rasd.2009.05.003

Boyd, B. A., McDonough, S. G., & Bodfish, J. W. (2011). Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism. Journal of Autism and Developmental Disorders, 42(6), 1236–1248. doi: 10.1007/s10803-011-1284-z

Boyd, B. A., McDonough, S. G., Rupp, B., Khan, F., & Bodfish, J. W. (2010). Effects of a Family-Implemented Treatment on the Repetitive Behaviors of Children with Autism. Journal of Autism and Developmental Disorders, 41(10), 1330–1341. doi: 10.1007/s10803-010-1156-y

Boyd, B. A., Woodard, C. R., & Bodfish, J. W. (2013). Feasibility of exposure response prevention to treat repetitive behaviors of children with autism and an intellectual disability: A brief report. Autism, 17(2), 196–204. doi: 10.1177/1362361311414066

Britton, L. N., Carr, J. E., Landaburu, H. J., & Romick, K. S. (2002). The efficacy of noncontingent reinforcement as treatment for automatically reinforced stereotypy. Behavioral Interventions, 17(2), 93–103. doi: 10.1002/bin.110

Cassella, M. D., Sidener, T. M., Sidener, D. W., & Progar, P. R. (2011). Response interruption and redirection for vocal stereotypy in children with autism: a systematic replication. Journal of Applied Behavior Analysis, 44(1), 169–173. doi: 10.1901/jaba.2011.44-169.

Conroy, M. A., Asmus, J. M., Sellers, J. A., & Ladwig, C. N. (2005). The use of an antecedent-based intervention to decrease stereotypic behavior in a general education classroom: A case study. Focus on Autism and Other Developmental Disabilities, 20(4), 223–230. doi: 10.1177/10883576050200040401.

Davis, T. N., Durand, S., & Chan, J. M. (2011). The effects of a brushing procedure on stereotypical behavior. Research in Autism Spectrum Disorders, 5(3), 1053–1058. doi: 10.1016/j.rasd.2010.11.011.

Durand, V. M., & Carr, E. G. (1987). Social influences on “self-stimulatory” behavior: analysis and treatment application. Journal of Applied Behavior Analysis, 20(2), 119–132. doi: 10.1901/jaba.1987.20-119.

Falcomata, T. S., Roan H. S., Feeney, B. J., & Stephenson, K. M. (2010). Assessment and treatment of elopement maintained by access to stereotypy. Journal of Applied Behavior Analysis, 43(3), 513-7. doi:  10.1901/jaba.2010.43-513

Field, T., Lasko, D., Mundy, P., Henteleff, T., Kabat, S., Talpins, S., et al. (1997). Brief report: Autistic children’s attentiveness and responsivity improve after touch therapy. Journal of Autism and Developmental Disorders, 27(3), 333-8. PMID: 9229263

Gabriels, R. L., Agnew, J. A., Miller, L. J., Gralla, J., Pan, Z., Goldson, E., et al. (2008). Is there a relationship between restricted, repetitive, stereotyped behaviors and interests and abnormal sensory response in children with autism spectrum disorders? Research in Autism Spectrum Disorders, 2(4), 660–670. doi: 10.1016/j.rasd.2008.02.002.

Gajdzik, M., & Brynska, A. (2012). Differences in cognitive-behavioral therapy in treating people with Asperger's Syndrome. Psychiatria i Psychologia Kliniczna, 12(1), 52-56.

Greenberg, J. S., Seltzer, M. M., Hong, J., & Orsmond, G. I. (2006). Bidirectional effects of expressed emotion and behavior problems and symptoms in adolescents and adults with autism. American Journal of Mental Retardation, 111(4), 229-49. doi: 10.1352/0895-8017(2006)111[229:BEOEEA]2.0.CO;2

Hollander, E., Phillips, A., Chaplin, W., Zagursky, K., Novotny, S., Wasserman, S., et al. (2004). A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology, 30(3), 582–589. doi: 10.1038/sj.npp.1300627.

Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2(1), 3–20. doi: 10.1016/0270-4684(82)90003-9.

Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., et al. (1994). The functions of self-injurious behavior: An experimental-epidemiological analysis. Journal of Applied Behavior Analysis, 27(2), 215–240. doi: 10.1901/jaba.1994.27-215.

Kang, S., O’Reilly, M., Rojeski, L., Blenden, K., Xu, Z., Davis, T., et al. (2013). Effects of tangible and social reinforcers on skill acquisition, stereotyped behavior, and task engagement in three children with autism spectrum disorders. Research in Developmental Disabilities, 34(2), 739–744. doi: 10.1016/j.ridd.2012.10.007.

Klaiman, C., Huffman, L., Masaki, L., & Elliott, G. R. (2013). Tetrahydrobiopterin as a treatment for autism spectrum disorders: a double-blind, placebo-controlled trial. Journal of Child and Adolescent Psychopharmacology, 23(5), 320–328. doi: 10.1089/cap.2012.0127

Lai, M. C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383(9920), 896–910. doi: 10.1016/s0140-6736(13)61539-1.

Lanovaz, M. J., Sladeczek, I. E., & Rapp, J. T. (2011). Effects of music on vocal stereotypy in children with autism. Journal of Applied Behavior Analysis, 44(3), 647–651. doi: 10.1901/jaba.2011.44-647.

Lounds, J., Seltzer, M. M., Greenberg, J. S., & Shattuck, P. T. (2007). Transition and change in adolescents and young adults with autism: longitudinal effects on maternal well-being. American Journal of Mental Retardation, 112(6), 401-17. doi: 10.1352/0895-8017(2007)112[401:TACIAA]2.0.CO;2

Mancina, C., Tankersley, M., Kamps, D., Kravits, T., & Parrett, J. (2000). Journal of Autism and Developmental Disorders, 30(6), 599–606. doi: 10.1023/a:1005695512163.

Mandy, W. P. L., & Skuse, D. H. (2008). Research review: What is the association between the social-communication element of autism and repetitive interests, behaviours and activities? Journal of Child Psychology and Psychiatry, 49(8), 795–808. doi: 10.1111/j.1469-7610.2008.01911.x.

Matson, J. L., Kiely, S. L., & Bamburg, J. W. (1997). The effect of stereotypies on adaptive skills as assessed with the DASH-II and Vineland Adaptive Behavior Scales. Research in Developmental Disabilities, 18(6), 471–476. doi: 10.1016/s0891-4222(97)00023-1.

Mohammadi, M. R., Salmanian, M., & Akhondzadeh, S. (2011). Autism spectrum disorders in Iran. Iranian Journal of Child Neurology, 5(4), 1-9.

Mohammadi, M. R., Yadegari, N., Hassanzadeh, E., Farokhnia, M., Yekehtaz, H., Mirshafiee, O., et al. (2013). Double-blind, placebo-controlled trial of risperidone plus amantadine in children with autism. Clinical Neuropharmacology, 36(6), 179–184. doi: 10.1097/wnf.0b013e3182a9339d

Mohammadi, M., & Zarafshan, H. (2014). Family function, parenting style and broader autism phenotype as predicting factors of psychological adjustment in typically developing siblings of children with autism spectrum disorders. Iranian Journal of Psychiatry, 9(2), 55-63.

Mohammadi, M. R., Zarafshan, H., & Ghasempour, S. (2012). Broader autism phenotype in Iranian parents of children with autism spectrum disorders vs. normal children. Iranian Journal of Psychiatry, 7(4), 157-63.

Nadig, A., Lee, I., Singh, L., Bosshart, K., & Ozonoff, S. (2010). How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism. Neuropsychologia, 48(9), 2730–2739. doi: 10.1016/j.neuropsychologia.2010.05.020.

Odom, S. L., Boyd, B. A., Hall, L. J., & Hume, K. (2009). Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(4), 425–436. doi: 10.1007/s10803-009-0825-1.

Oriel, K. N., George, C. L., Peckus, R., & Semon, A. (2011). The effects of aerobic exercise on academic engagement in young children with autism spectrum disorder. Pediatric Physical Therapy, 23(2), 187-193. doi: 10.1097/PEP.0b013e318218f149

Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism, 15(5), 563–577. doi: 10.1177/1362361310386502.

Pearson, D. A., Santos, C. W., Aman, M. G., Arnold, L. E., Casat, C. D., Mansour, R., et al. (2013). Effects ofextended release methylphenidate treatment on ratings of Attention-Deficit/Hyperactivity Disorder (ADHD) and Associated Behavior in Children with Autism Spectrum Disorders and ADHD 

Symptoms. Journal of Child and Adolescent Psychopharmacology, 23(5), 337–351. doi: 10.1089/cap.2012.0096.

Pierce, K., & Courchesne, E. (2001). Evidence for a cerebellar role in reduced exploration and stereotyped behavior in autism. Biological Psychiatry, 49(8), 655–664. doi: 10.1016/s0006-3223(00)01008-8.

Rapp, J. T. (2006). Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: A preliminary investigation. Journal of Applied Behavior Analysis, 39(1), 137–140. doi: 10.1901/jaba.2006.37-05.

Rapp, J. T. (2007). Further evaluation of methods to identify matched stimulation. Journal of Applied Behavior Analysis, 40(1), 73–88. doi: 10.1901/jaba.2007.142-05.

Salmanian, M., Tehrani-Doost, M., & Shahrivar, Z. (2012). Visual memory of meaningless shapes in children and adolescents with autism spectrum disorders. Iranian Journal of Psychiatry, 7(3), 104-8. PMCID: PMC3488864

Saylor, S., Sidener, T. M., Reeve, S. A., Fetherston, A., & Progar, P. R. (2012). Effects of three types of noncontingent auditory stimulation on vocal stereotypy in children with autism. Journal of Applied Behavior Analysis, 45(1), 185–190. doi: 10.1901/jaba.2012.45-185.

Scahill, L., McDougle, C. J., Aman, M. G., Johnson, C., Handen, B., Bearss, K., et al. (2012). Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems. Journal of American Academy of Child and Adolescent Psychiatry, 51(2), 136-46.

Schumacher, B. I., & Rapp, J. T. (2011). Evaluation of the immediate and subsequent effects of response interruption and redirection on vocal stereotypy. Journal of Applied Behavior Analysis, 44(3), 681–685. doi: 10.1901/jaba.2011.44-681.

Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., et al. (2006). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1735–1747. doi: 10.1007/s10803-006-0307-7.

Sigafoos, J., & Meikle, B. (1996). Functional communication training for the treatment of multiply determined challenging behavior in two boys with autism. Behavior Modification, 20(1), 60–84. doi: 10.1177/01454455960201003.

Singer, H. S. (2009). Motor stereotypies. Seminars in Pediatric Neurology, 16(2), 77–81. doi: 10.1016/j.spen.2009.03.008.

Smith, E. A., & Van Houten, R. (1996). A comparison of the characteristics of self-stimulatory behaviors in “normal” children and children with developmental delays. Research in Developmental Disabilities, 17(4), 253–268. doi: 10.1016/0891-4222(96)00007-8.

Tehrani-Doost, M., Salmanian, M., Ghanbari-Motlagh, M., & Shahrivar, Z. (2012). Delayed face recognition in children and adolescents with autism spectrum disorders. Iranian Journal of Psychiatry, 7(2), 52-6. PMCID: PMC3428637

Watt, N., Wetherby, A. M., Barber, A., & Morgan, L. (2008). Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 38(8), 1518–1533. doi: 10.1007/s10803-007-0532-8.

Weitlauf, A. S., McPheeters, M. L., Peters, B., Sathe, N., Travis, R., Aiello, R., et al. (2001). Therapies for children with autism spectrum disorder: behavioral interventions update [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25210724

Type of Study: Review | Subject: Cognitive Neuroscience
Received: 2016/07/4 | Accepted: 2016/11/30 | Published: 2017/03/1

Add your comments about this article : Your username or Email:

Send email to the article author

© 2018 All Rights Reserved | Basic and Clinical Neuroscience

Designed & Developed by : Yektaweb