Mastering Scholarly Writing Remove or Replace: Header Is Not Doc TitleOutline Worksheet Introduction In paper An opening statement that frames your focus Autism self-management treatment without child's vocalization. Inappropriate language replacement with verbal labeling will be more functional than the normal verballing. Who The psychologists are working towards developing a stimuli language that will help autistic students improve their learning and responding skills. Echolalia's language has always responded inappropriately to questions that should replace verbal representation for more effectiveness. What Children with autism are normally rejected and treated differently from others. Standardizing their learning skills or rather simplifying their response through verbal stimulation will, in turn, raise self-management. When The program generalization and maintenance will take place in phases. They are evolving from the initial settings to the new vocalization. Where The research will be conducted in a wide range to ensure more participants are reached out. Why? The intended project will ease communication between autism-affected children and others as well as between themselves. Body Paragraph 1 In paper Topic sentence Coming up with the visual language entails the incorporation of knowledge from the physician to the verbal developer. Observation 1 In an experiment to test the language, the sequence wording in a sentence or a question must be repeated for emphasis regardless of verbalization. Support 1 Though verbalization may have considered most accurate concerning autism, errors may occur, which may amount to the incorrect response. Therefore, the tutor must proofread the question to ensure correctness. A combination of correct and incorrect verbiage will add up to an incorrect and inappropriate presentation. Conclusion The tutor should go through the verbalized questions to ensure no errors may lead to incorrect responses. This will improve the efficiency and effectiveness of audiotaped or videos as intended. Body Paragraph 2 In paper Topic sentence Young children diagnosed with autism made it necessary to come up with some ways for self-development. Observation 1 From the research, communication improvement will improve their learning skills and how the affected interact with other children. Autism children are frequently discriminated against due to a lack of mutual understanding. Support 1 On the conducted research, according to Karl, his module went through upon the third trial. This is a positive indication that verbalization can be depended upon when questioning. Conclusion Though the stimuli differed from one participant to the other, at least there is a mutual language used by both the tutor and the respondent. This indicates a positive step towards verbalization. Body Paragraph 3 In paper Topic sentence It's essential to note that it can lead to communication breakdown on echolalia treatmen ...

1. Mastering Scholarly Writing
Remove or Replace: Header Is Not Doc TitleOutline Worksheet
Introduction
In paper
An opening statement that frames your focus
Autism self-management treatment without child's vocalization.
Inappropriate language replacement with verbal labeling will be
more functional than the normal verballing.
Who
The psychologists are working towards developing a stimuli
language that will help autistic students improve their learning
and responding skills. Echolalia's language has always
responded inappropriately to questions that should replace
verbal representation for more effectiveness.
What
Children with
autism are normally rejected and treated differently from
others. Standardizing their learning skills or rather simplifying
their response through verbal stimulation will, in turn, raise
self-management.
When
The program generalization and maintenance will take place in
phases. They are evolving from the initial settings to the new
vocalization.
Where

2. The research will be conducted in a wide range to ensure more
participants are reached out.
Why?
The intended project will ease communication between autism-
affected children and others as well as between themselves.
Body Paragraph 1
In paper
Topic sentence
Coming up with the visual language entails the incorporation of
knowledge from the physician to the verbal developer.
Observation 1
In an experiment to test the language, the sequence wording in a
sentence or a question must be repeated for emphasis regardless
of verbalization.
Support 1
Though verbalization may have considered most accurate
concerning autism, errors may occur, which may amount to the
incorrect response. Therefore, the tutor must proofread the
question to ensure correctness. A combination of correct and
incorrect verbiage will add up to an incorrect and inappropriate
presentation.
Conclusion
The tutor should go through the verbalized questions to ensure
no errors may lead to incorrect responses. This will improve the
efficiency and effectiveness of audiotaped or videos as
intended.
Body Paragraph 2

3. In paper
Topic sentence
Young children diagnosed with autism made it necessary to
come up with some ways for self-development.
Observation 1
From the research, communication improvement will improve
their learning skills and how the affected interact with other
children. Autism children are frequently discriminated against
due to a lack of mutual understanding.
Support 1
On the conducted research, according to Karl, his module went
through upon the third trial. This is a positive indication that
verbalization can be depended upon when questioning.
Conclusion
Though the stimuli differed from one participant to the other, at
least there is a mutual language used by both the tutor and the
respondent. This indicates a positive step towards verbalization.
Body Paragraph 3
In paper
Topic sentence
It's essential to note that it can lead to communication
breakdown on echolalia treatment, thus causing stigmatization
in autism-affected children.
Observation 1

4. Autism Spectrum Disorder(ASD) can be reduced by treatment
intervention, especially when examined at an earlier stage.
Therefore, to enhance the treatment, participant features,
echolalia type, research, and design indicators must be
considered before prescribing any treatment.
Support 1
Although there is no single treatment that can be fully
described, physicians often combine several methods to achieve
the set goal. After behavior analysis, the treatment endorsed is
evaluated according to the despondence, mainly in visual cues
and verbal modeling.
Conclusion
Due to the lack of a specific treatment, medics should examine
the autism and describe the type of treatment to the patient. A
follow-up on the method used is also necessary.
Conclusion
In paper
Restatement of thesis statement
The main aim is to attain a common verbalized method that can
be recognized internationally and used during the examination.
The method should also ensure communication between autism
and other people.
Summary of introduction (who, what, when, where, why, and
how) 1 or two sentences
For the research's success, the intended purpose, participant,
research methods, and time must be observed.
Summary of body paragraph 1

5. Dealing with autism disorder entails a collaboration from
medics, parents, and the affected kids. This will help in
verbalization or echolalia destruction and self-development and
building self-esteem in the young affected children.
Summary of body paragraph 2
Eradicating stigmatization among young children diagnosed
with autism is the main goal. However, attaining a common
language is complicated due to different responses from various
participants. Thus verbalization stimuli must be tested regularly
before approval as the official examination language.
Summary of body paragraph 3
Through teamwork, the intended verbalization will work. This
entails awareness through mass education and special training
programs to the affected.
Overall ending thought/sentence for the reader
Society should learn to embrace and appreciate children with
autism; this will reduce stigmatization. Engaging them in daily
activism and motivation will boost their self-esteem as they are
no less human beings. Learning verbalization to enhance
communication is also necessary.
�
1
4

6. REVIEW PAPER
Treatment of Echolalia in Individuals with Autism Spectrum
Disorder: a Systematic Review
Leslie Neely1 & Stephanie Gerow2 & Mandy Rispoli3 &
Russell Lang4 & Nathan Pullen4
Received: 15 October 2015 /Accepted: 25 November 2015
/Published online: 4 December 2015
# Springer Science+Business Media New York 2015
Abstract Echolalia can lead to communication breakdowns
that increase the likelihood of social failure and stigmatization
in children with autism spectrum disorder (ASD). In an effort
to facilitate evidenced-based intervention and inform future
research, this systematic review analyzes peer-reviewed stud-
ies involving the treatment of echolalia in individuals with
ASD. Using predetermined inclusion criteria, a total of 11
studies were identified, reviewed, and summarized in terms
of the following: (a) participant characteristics (e.g., verbal
and cognitive functioning), (b) type of echolalia (e.g., delayed
or immediate), (c) intervention procedures, (d) intervention
outcomes, (e) maintenance and generalization of outcomes,
and (f) research design and other indicators of rigor (i.e., cer -
tainty of evidence). Nine studies successfully reduced echola-
lia in a total of 17 participants. However, only six of those nine
studies met criteria to be classified as providing the highest
level of certainty (i.e., conclusive). The findings of this review
suggest that a number of treatment options can be considered
promising practices for the treatment of echolalia in children
with ASD. Although no single treatment package can be de-
scribed as well-established evidence-based practice, all 11
studies involved behavior analytic intervention components,
suggesting strong support for operant-based treatments. In

7. particular, behavior analytic interventions demonstrating
conclusive levels of evidence included cues-pause-point, dif-
ferential reinforcement of lower rates of behavior, script train-
ing plus visual cues, and verbal modeling plus positive rein-
forcement for appropriate responses. Implications for practi-
tioners and directions for future research are offered.
Keywords Autism spectrum disorder . Echolalia .
Treatment . Systematic review
Autism spectrum disorder (ASD) is a developmental disorder
characterized by deficits in social communication skills and
excesses in repetitive and restrictive patterns of behaviors
(Diagnostic and Statistical Manual of Mental Disorders [5th
ed.; DSM-5]; American Psychiatric Association [APA] 2013).
The combination of behavioral excesses and deficits can man-
ifest as a repetitive, restricted pattern of vocal behavior called
echolalia (Stribling et al. 2007). Echolalia is typically defined
as the socially awkward or inappropriate verbatim repetition
of part or all of a previously spoken utterance (Karmali et al.
2005; Stribling et al. 2007; Valentino et al. 2012). The initial
utterance, that is then repeated, may come from another per-
son in the environment or from a recording (television or
audio source) and maybe immediate or delayed. Immediate
echolalia occurs when the latency between initial utterance
and repetition is within a few seconds, whereas delayed
echolalia occurs when the time between the initial utterance
and the repetition involves longer durations, inclusive of
repetitions occurring days after the initial utterance being
echoed (Foxx et al. 2004; Hetzroni and Tannous 2004).
Another form of echolalia is palilalia. Palilalia involves the
repeating of one’s own words in a quiet whispered voice
immediately following the initial typical volume utterance
(Karmali et al. 2005).

8. * Leslie Neely
[email protected]
1 Department of Educational Psychology, The University of
Texas at
San Antonio, 501 W. Cesar E. Chavez Blvd., San
Antonio, TX 78207-4415, USA
2 Texas A&M University, College Station, TX, USA
3 Purdue University, West Lafayette, IN, USA
4 Texas State University, San Marcos, TX, USA
Rev J Autism Dev Disord (2016) 3:82–91
DOI 10.1007/s40489-015-0067-4
http://crossmark.crossref.org/dialog/?doi=10.1007/s40489-015-
0067-4&domain=pdf
Although language repetition is part of typical child
development (Howlin 1982). some children with ASD en-
gage in echolalia that persists past the early childhood
developmental period (Barrera and Sulzer-Azaroff 1983;
Neely 2014; Fay 1969). In addition, children with ASD
often engage in echolalia that lacks social context Lovaas
et al. 1973) and occurs at a higher rate than in typically
developing children (Fay 1973).
Echolalia may (a) complicate educational programs de-
signed to improve speech, (b) contribute to communication
breakdowns, (c) increase the likelihood of social failure or
stigmatization, and (d) increase the risk of challenging behav-
ior (Light et al. 1998; Valentino et al. 2012). For example,
Valentino et al. (2012) identified a 3-year-old male with
ASD who repeated the instruction Bsay^ during echoic train-
ing. The immediate echolalia was interfering with instruction

9. and complicating the educational program aimed at teaching
the child to tact. Previous research aimed at identifying the
operant function of echolalia suggests that the complete range
of functions found to maintain other behaviors (e.g., automatic
reinforcement, socially mediated positive reinforcement, and
socially mediated negative reinforcement) may also reinforce
and maintain echolalia (Goren et al. 1977; Healy and Leader
2011).
A descriptive review by Kavon and McLaughlin (1995)
identified two interventions with preliminary support for the
treatment of echolalia (i.e., cues-pause-point and more general
verbal prompting interventions). Cues-pause-point is a behav-
ioral intervention that has been evaluated for the treatment of
immediate echolalia. Cues-pause-point was introduced by
McMorrow and Foxx (1986) in their treatment of a 21-year-
old male with ASD. The cues-pause-point intervention con-
sists of a trainer providing a visual cue to the learner to remain
silent (cue). The trainer then maintains the visual cue while
providing instructions about the upcoming teaching session.
The trainer poses a question and provides a short pause fol-
lowing the question (pause). Finally, the trainer points to a
card to prompt the learner to verbalize the answer to the ques -
tion (point). For example, to teach the individual with ASD to
respond appropriately to the question, BWhat is your name?,^
the trainer held up an index finger to cue silence (cue), stated,
BI’m going to ask you some questions, do your best to answer
them correctly^ (pause), asked the question, pointed to a card
with the person’s name prompting the correct response
(point), and then provided reinforcement contingent on the
correct response. Following the initial study by McMorrow
and Foxx, follow-up studies extended the procedure to indi-
viduals with less developed language skills (McMorrow et al.
1987) and individuals with intellectual disabilities (Foxx,
Faw, McMorrow, Kyle, & Bittle 1988) and then demonstrated
that reductions of echolalia following cues-pause-point could

10. be maintained up to 57 months following the cessation of the
intervention (Foxx and Faw 1990).
Kavon and McLaughlin’s (1995) review categorized the
remaining interventions as verbal prompting interventions.
Studies in that category used a combination of reinforcement,
prompting, and error correction to reduce echolalia but did not
utilize the more specific sequence of cues-pause-point (e.g.,
Freeman et al. 1975; Lovaas 1977). For example, Freeman
et al. (1975) used positive reinforcement for correct
responding to questions and an error prevention procedure
(consisting of interrupting the echolalia) to treat the echolalia
of a 5-year-old male with autism. The intervention produced
decreases in echolalia that maintained following the with-
drawal of intervention. Although the review by Kavon and
McLaughlin provides evidence in support of these interven-
tions, additional studies have emerged over the last 20 years
and an updated systematic review appears warranted.
Therefore, the purpose of this review is to update and ex-
tend the previous review by Kavon and McLaughlin by (a)
utilizing broader inclusion criteria not limited to behavioral
(operant) approaches, (b) conducting a systematic review of
the literature, (c) rating each included study’s certainty of ev-
idence (quality of research design and controls) so results can
be considered in light of each study’s methodological rigor,
and (d) identifying advances in treatment that may have de-
veloped since the previous review. A review of this nature is
intended to offer directions for future research and to provide
guidance to practitioners interested in the use of evidence-
based treatments for echolalia in children with ASD.
Method
Search Procedures

11. Four electronic databases were searched to identify potential
studies for this review: ERIC (EBSCO), Medline, Psychology
and Behavioral Sciences Collection, and PsycINFO. There
were no limitations on publication year, but results were lim-
ited to English language, peer-reviewed research. Terms to
describe individuals with an ASD were combined with terms
to describe echolalia. The terms for individuals with an ASD
included BAsperger,^ Bautis*,^ Bdevelopmental disab*,^
BASD,^ and BPDD-NOS.^ The terms searched to describe
echolalia included Becholal*,^ Brepetitive speech,^ Brepetitive
verbal*,^ Brepetitive talking,^ Brepetitive communication*,^
and Bpalilalia.^ Following the initial search, the last name of
the first author of each included study was also entered into
PsychINFO to identify any other potentially relevant studies
that had been published by that author. Finally, the reference
list of Kavon and McLaughlin (1995) was examined for ad-
ditional studies meeting inclusion criteria.
These search procedures were conducted in May 2014,
updated in April 2015, and yielded a total of 568 articles
(534 from the original search and 34 from the updated search).
Rev J Autism Dev Disord (2016) 3:82–91 83
The title and abstracts of the 568 articles were screened using
the predetermined inclusion criteria (see BInclusion Criteria^
section) to identify articles for potential inclusion in this re -
view. Following this screening of title and abstracts, a total of
46 articles were identified for further review.
Inclusion Criteria
The 46 articles were then downloaded and evaluated based on
the pre-set inclusion criteria. Studies were included if they (a)

12. included a participant diagnosed with ASD or was described
as an individual with Bautistic-like behaviors^ (included due
to the age of the literature base), (b) implemented an interven-
tion and reported outcomes for echolalia (inclusive of palilalia
and defined as repetition of a previously spoken word or
phrase) as a dependent variable, (c) employed an experimental
design (inclusive of single-case and group experimental de-
signs), and (d) echolalia outcomes for the individual with
ASD could be disaggregated from participants without ASD
and target behaviors other than echolalia. Studies which im-
plemented interventions for individuals with ASD who uti -
lized echolalic speech but did not present outcomes related
to the echolalia were excluded (e.g., Barrera and Sulzer -
Azaroff 1983; Charlop-Christy and Kelso 2003; Charlop
1983). Studies which evaluated echolalia under different con-
ditions but did not implement an intervention to address echo-
lalia were also excluded (e.g., Rydell and Mirenda 1994;
Violette and Swisher 1992). In addition, studies which imple-
mented interventions to treat other repetitive speech (i.e.,
noncontextual vocal stereotypy, such as a sound rather than a
word or phrase) were excluded (e.g., Mancia et al. 2000; Ahearn
et al. 2000; Taylor et al. 2005). Studies excluded because data
on echolalia were not disaggregated from other outcomes in-
volving other topographies of behavior were Arntzen et al.
(2006) and Mancia et al. (2000). For example, Arntzen et al.
(2006) taught a 44-year-old woman functional verbal responses
and tracked subsequent decreases in aberrant verbal behavior.
Although aberrant verbal behavior included repetitive echolalic
responses, the aberrant verbal behavior also included
Bpsychotic^ verbalizations and results for the two were
collapsed into one dependent variable. Finally, Cohen (1981)
was excluded because the figure referenced in the article was
not included in the article and was not accessible to the authors
after multiple attempts to locate the figure through university-
based library services. Ultimately, a total of 11 studies met
inclusion criteria and were included in this review.

13. Descriptive Synthesis
Included studies were reviewed and summarized based on the
following categories: (a) participant characteristics (e.g., ver-
bal and cognitive functioning), (b) type of echolalia (e.g., de-
layed or immediate), (c) intervention procedures, (d)
intervention outcomes, (e) maintenance and generalization
of outcomes, and (f) research design and other indicators of
rigor (i.e., certainty of evidence). Participant description in-
cluded the number of participants with ASD, their ages, and
gender. Participant verbal and cognitive functioning was cod-
ed using reported standardized assessments or was gleaned
from detailed descriptions of participant functioning.
Echolalia was coded as either immediate, delayed, or palilalia,
and when noted in the reviewed study, the operant function of
echolalia was noted. Various procedural aspects were coded to
identify intervention protocols or components (e.g., cues-
pause-point protocol, script training, or reinforcement
procedures)
Intervention outcomes were summarized and coded as nega-
tive, mixed, or positive. As all 11 studies employed single-case
research designs, study outcomes were determined based on vi-
sual analysis criteria for single-case research outlined by
Kennedy (2005). A study was rated as having negative results
if there was no reduction observed in echolalia as indicated by a
flat or increasing trend in the intervention phase as compared to
the baseline phase. Studies were coded as having mixed results
if
some, but not all, of the participants demonstrated a reduction
in
echolalia during the intervention phase relative to the baseline
phase. Positive results indicated that echolalia decreased in all
participants during intervention phase as relative baseline.

14. The study’s capacity to provide a certainty of evidence was
rated as suggestive, preponderant, or conclusive, with conclu-
sive being the highest rating (Schlosser 2009; Simeonsson and
Bailey 1991; Smith 1981). Studies rated as conclusive had the
following: (a) an experimental design capable of establishing
experimental control (e.g., ABAB, multiple-baseline design,
alternating treatments design), (b) sufficient interobserver
agreement (IOA) collected on the observed educator behav-
iors (i.e., agreement coefficients above 80 % and IOA collect-
ed for a minimum of 20 % of the sessions), (c) intervention
procedures detailed enough to promote replication of the pro-
cedures, (d) operationalized descriptions of the dependent var -
iable, and (e) demonstrated convincing effects of the interven-
tion for every participant (i.e., received a rating of positive
results). A study rated as preponderant met most of the criteria
for a Bconclusive^ study, but results may have demonstrated
Bmixed^ effects of the intervention for some or all of the
participants with ASD. Any study that (a) lacked an experi-
mental design capable of establishing experimental control,
(b) did not meet the minimum IOA criterion, (c) did not
operationally define the intervention procedures, (d) or did
not operationally define the dependent variable were auto-
matically rated as offering suggestive evidence.
Interrater Reliability
Inclusion Criteria To ensure accurate application of the in-
clusion criteria, two raters reviewed each of the 46 articles,
84 Rev J Autism Dev Disord (2016) 3:82–91
resulting from the systematic search and initial title/abstract
review, for potential inclusion. Agreement was reached on

15. whether to include or exclude a study on 100 % of the articles.
Descriptive Synthesis To establish interrater reliability (IRR)
for the data summaries, two independent raters coded five of
the 11 included articles (46 %). A third rater reviewed the
independent data summaries and made a decision as to wheth-
er the summaries agreed. IRR was calculated based on wheth-
er the two raters agreed on the extracted data. There were a
total of 30 items in which there could be agreement or dis-
agreement (i.e., five studies with six data categories each).
IRR was calculated using percent agreement by dividing the
total number of agreements by the sum of the agreements and
disagreements and multiplying by 100 % to convert to a per-
centage. Initial agreement for the coding of studies was 90 %.
In instances of disagreement, the raters discussed until 100 %
agreement was reached.
Results
Table 1 created from the coded study summarizes and displays
each study according to the following: (a) participant charac-
teristics (e.g., verbal and cognitive functioning), (b) type of
echolalia (e.g., delayed or immediate), (c) intervention proce-
dures, (d) intervention outcomes, (e) maintenance and gener -
alization of outcomes, and (f) research design and other indi -
cators of rigor (i.e., certainty of evidence).
Participant Characteristics
The 11 studies included a total of 25 participants with ASD.
Ten of the 11 studies reported the gender of their participants
with 17 male and 5 female participants. One study did not
report participants’ gender (Laski et al. 1988). All of the stud-
ies reported the participants’ ages, with a mean reported age of
8 years (range 3–21 years) across studies.

16. Ten studies (90 %) reported information regarding partici -
pants’ verbal or cognitive functioning. Four studies (36 %)
reported results from standardized cognitive assessments
(i.e., Stanford-Binet, Merrill-Palmer, and Peabody Picture
Vocabulary Test (PPVT)) with three studies including four
participants with extremely low cognitive functioning (16 %;
Handen et al. 1984; McMorrow and Foxx 1986; Nientimp and
Cole 1992) and one study including one participant with
below-average to average cognitive functioning (4 %;
Freeman et al. 1975). Three studies (27 %) reported results
from standardized language assessments (i.e., Alpern-Boll
and PPVT-III) indicating extremely low verbal abilities and
below-average cognitive functioning for eight of the 25 par-
ticipants (32 %; Foxx et al. 2004; Karmali et al. 2005; Palyo
et al. 1979). Five of the studies reported descriptive
information regarding the language functioning of partici-
pants, all of which suggested below-average verbal abilities
for 16 of the 25 participants (64 %; Ganz et al. 2008; Hetzroni
and Tannous 2004; Karmali et al. 2005; Laski et al. 1988;
Valentino et al. 2012).
Type of Echolalia
Across the 11 studies, five targeted immediate echolalia only
(45 %; Foxx et al. 2004; McMorrow and Foxx 1986;
Nientimp and Cole 1992; Palyo et al. 1979; Valentino et al.
2012), two targeted delayed echolalia only (18 %; Ganz et al.
2008; Handen et al. 1984), and three studies (27 %) targeted
both immediate and delayed echolalia (Freeman et al. 1975;
Hetzroni and Tannous 2004; Laski et al. 1988). Finally, one
study targeted palilalia (Karmali et al. 2005). No study report-
ed operant functions of target behaviors.
Intervention Procedures

17. All of the 11 studies employed an intervention with behavioral
analytic components (e.g., differential reinforcement, model -
ing, prompting). Five of the 11 studies (45 %) evaluated the
effects of specific treatment package on echolalia (i.e., cues -
pause-point; Natural Language Paradigm, and computer-
based intervention). Cues-pause-point was the most frequent
treatment package evaluated (n=3; 27 %; Foxx et al. 2004;
McMorrow and Foxx 1986; Valentino et al. 2012). For exam-
ple, Valentino and colleagues (2012) evaluated the use of
cues-pause-point to treat a 3-year-old male child who echoed
the instruction say during echoic training. Decreased echolalia
and increase appropriate responding (e.g., repeating the target
word without echoing say) were noted.
Laski et al. (1988) trained parents to implement the Natural
Language Paradigm within a clinical setting and then assessed
the effects of the parent implemented program on child com-
munication outcomes. Parents were taught to use direct rein-
forcement of verbal attempts, to promote turn-taking with play
items, to vary stimuli and exemplars, and to utilize shared
control (i.e., rotating between child-led and parent-led activi-
ties). Although appropriate vocalizations were the primary
dependent variable, child engagement in echolalia was mea-
sured as an ancillary variable with mixed results noted for the
effects of the Natural Language Paradigm on echolalia.
The final treatment package was a computer program enti-
tled BI Can Word It Too^ that was available in both Arabic and
Hebrew (Hetzroni and Tannous 2004). The program presented
participants with a simulated situation in which a parent asked
the participant a question. The participant would then choose
the appropriate sentence or question option, and an animation
of their choice would be played. For example, if the question
was Bwhat would you like to play with^ and the participant
selected the option BI want to play ball with you,^ an

18. Rev J Autism Dev Disord (2016) 3:82–91 85
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an
as
k
ed
q
u
es
ti
o
n
;
im
m
ed
ia
te
ec
h
o
la
li
a
C
ue
s-
p

28. au
se
-p
o
in
t
P
os
it
iv
e
P
o
si
ti
v
e
u
si
n
g
a
g
ra
d
u
al
in
te
rv
en
ti
o

29. n
fa
d
in
g
p
ro
ce
d
ur
e)
/
p
o
si
ti
v
e
ac
ro
ss
n
o
v
el
se
tt
in
g
,
an
d
n
o

30. ve
l
tr
ai
ne
r
C
o
n
cl
u
si
v
e
F
re
em
an
et
al
.
(1
9
75
)
n
=
1
;
m

31. al
e;
5
y
ea
rs
N
o
st
an
d
ar
d
iz
ed
la
n
g
u
ag
e
as
se
ss
m
en
t;
IQ
as
se
ss
m

32. en
ts
ra
n
g
ed
fr
o
m
8
1
(S
ta
nf
o
rd
-B
in
et
)
to
1
2
0
(M
er
ri
ll
-P
al
m
er

33. ).
Im
m
ed
ia
te
an
d
d
el
ay
ed
ec
h
o
la
li
a
P
o
si
ti
v
e
re
in
fo
rc
em
en
t

34. fo
r
co
rr
ec
t
an
sw
er
s
an
d
er
ro
r
co
rr
ec
ti
o
n
p
ro
ce
d
u
re
to
b
lo
ck

35. ec
h
o
la
li
a
P
os
it
iv
e
N
o
t
re
p
o
rt
ed
/n
o
t
re
p
o
rt
ed
S
u
g
ge
st
iv

36. e;
A
B
A
d
es
ig
n
;
IO
A
w
as
n
o
t
as
se
ss
ed
G
an
z
et
al
.
(2
0
08
)

37. n
=
2
m
al
es
;
7
an
d
1
2
y
ea
rs
b
N
o
st
an
d
ar
d
la
n
g
u
ag
e
as
se
ss
m
en
ts

38. .
N
o
co
g
n
it
iv
e
as
se
ss
m
en
ts
.
P
1
:
d
if
fi
cu
lt
y
w
it
h
W
h
-
q
u
es

39. ti
o
n
s;
ag
e-
ap
p
ro
p
ri
at
e
p
h
o
n
o
lo
g
ic
al
an
d
se
m
an
ti
c
sp
ee
ch
P

40. 2
:
A
g
e-
ap
p
ro
p
ri
at
e
p
ho
n
o
lo
g
ic
an
d
se
m
an
ti
c
sk
il
ls
;
ra
re
ly
in

41. it
ia
te
d
co
n
v
er
sa
ti
o
n
.
P
1
:
R
ep
ea
te
d
p
h
ra
se
s
fr
o
m
te
le
v
is
io

42. n
an
d
v
id
eo
g
am
es
;
d
el
ay
ed
ec
h
ol
al
ia
P
2
:
R
ep
ea
te
d
p
h
ra
se
s

43. fr
o
m
so
n
g
s
an
d
b
o
o
k
s;
de
la
y
ed
ec
h
o
la
li
a
S
cr
ip
t
tr
ai
n
in
g

44. an
d
v
is
u
al
cu
es
P
os
it
iv
e
N
o
t
re
p
o
rt
ed
/n
o
t
re
p
o
rt
ed
C
o
n

45. cl
u
si
v
e
H
an
d
en
et
al
.
(1
9
84
)
n
=
1
;
m
al
e;
1
6
y
ea
rs
N
o
st

46. an
d
ar
d
iz
ed
la
n
g
u
ag
e
as
se
ss
m
en
t;
m
en
ta
l
ag
e
o
f
5
y
ea
rs
11
m

47. o
n
th
s
(S
ta
n
fo
rd
-B
in
et
).
R
ep
ea
te
d
st
at
em
en
ts
an
d
/o
r
as
k
in
g
sa

48. m
e
q
u
es
ti
o
n
m
u
lt
ip
le
ti
m
es
a
d
ay
;
d
el
ay
ed
ec
h
o
la
li
a
D

49. if
fe
re
n
ti
al
re
in
fo
rc
em
en
t
o
f
lo
w
er
ra
te
s
P
os
it
iv
e
P
o
si
ti
v

50. e
at
9
an
d
1
4
m
o
n
th
s
fo
ll
o
w
-u
p
/n
o
t
re
po
rt
ed
C
o
n
cl
u
si
v
e

51. H
et
zr
o
n
i
an
d
T
an
n
o
u
s
(2
0
0
4
)
n
=
5
;
3
m
al
es
an
d
2
fe
m
al

52. es
;
7
.8
,
8
,
8
.5
,
11
.5
,
an
d
1
2
.5
y
ea
rs
N
o
st
an
d
ar
d
iz
ed
la
n

53. g
u
ag
e
as
se
ss
m
en
ts
.
N
o
co
g
n
it
iv
e
as
se
ss
m
en
ts
.
Im
m
ed
ia
te
an
d

54. d
el
ay
ed
ec
h
o
la
li
a
S
o
ft
w
ar
e
p
ro
g
ra
m
(I
C
an
W
o
rd
it
T
o
o

55. )
M
ix
ed
N
o
t
re
p
o
rt
ed
/r
es
u
lt
s
g
en
er
al
iz
ed
to
au
th
en
ti
c
se
tt
in

56. g
s
fo
r
so
m
e
p
ar
ti
ci
p
an
ts
S
u
g
ge
st
iv
e;
o
n
e
le
g
o
f
ev
er
y
p
ar

57. ti
ci
p
an
t’
s
M
B
D
d
id
n
o
t
d
em
o
n
st
ra
te
ef
fe
ct
s;
ad
d
it
io
n
al

58. in
fo
rm
at
io
n
n
ec
es
sa
ry
fo
r
re
p
li
ca
ti
o
n
of
in
te
rv
en
ti
on
K
ar
m
al

59. i
et
al
.(
2
0
0
5
)
N
=
5
;
4
m
al
e
an
d
1
fe
m
al
e;
3
to
4
y
ea
rs
N
o

60. rm
-r
ef
er
en
ce
d
as
se
ss
m
en
ts
in
d
ic
at
ed
sp
ee
ch
d
el
ay
s
fo
r
al
l
p
ar

61. ti
ci
p
an
ts
;
n
o
co
gn
it
iv
e
as
se
ss
m
en
ts
re
p
o
rt
ed
P
al
il
al
ia
w
as
al
l

62. re
la
te
d
to
ch
il
d
re
n
’s
m
o
v
ie
s
o
r
so
n
g
s;
d
el
ay
ed
p
al
il
al
ia
T

63. ac
t
m
od
el
in
g
p
lu
s
p
o
si
ti
ve
re
in
fo
rc
em
en
t
o
f
ap
p
ro
p
ri
at
e
re

64. sp
o
ns
es
P
os
it
iv
e
N
o
t
re
p
o
rt
ed
/p
o
si
ti
v
e
ac
ro
ss
se
tt
in
g
s

65. C
o
n
cl
u
si
v
e
L
as
k
i
et
al
.
(1
9
8
8
)
n
=
3
;
g
en
de
r
n
o
t
sp
ec
if

66. ie
d
;
5
.8
,
6
.2
,
an
d
8
.1
1
y
ea
rs
a
Im
m
ed
ia
te
an
d
d
el
ay
ed
ec
h
o
la

67. li
a
N
at
u
ra
l
L
an
g
u
ag
e
P
ar
ad
ig
m
M
ix
ed
N
o
t
re
p
o
rt
ed
/n
o
t

68. re
p
o
rt
ed
S
u
g
ge
st
iv
e
(e
ch
o
la
li
a
w
as
an
an
ci
ll
ar
y
d
ep
en
d
en
t
v

69. ar
ia
b
le
)
86 Rev J Autism Dev Disord (2016) 3:82–91
T
ab
le
1
(c
o
n
ti
n
u
ed
)
A
rt
ic
le
P
ar
ti
ci
p
an

70. t
ch
ar
ac
te
ri
st
ic
s
T
y
p
e
o
f
ec
h
o
la
li
a
In
te
rv
en
ti
o
n
p
ro
ce
d
u
re

71. s
In
te
rv
en
ti
o
n
o
u
tc
o
m
es
M
ai
n
te
n
an
ce
an
d
g
en
er
al
iz
at
io
n

72. o
f
o
ut
co
m
es
C
er
ta
in
ty
o
f
ev
id
en
ce
N
o
st
an
d
ar
d
iz
ed
la
n
g
u
ag

73. e
as
se
ss
m
en
ts
;
P
1:
co
u
ld
im
it
at
e
so
un
d
s
an
d
a
fe
w
w
o
rd
s
o
n

74. re
q
u
es
t,
ra
re
ly
in
it
ia
te
d
,
an
d
re
ce
p
ti
v
e
v
o
ca
b
u
la
ry
le
ss

75. th
an
1
5
w
o
rd
s.
P
6
an
d
P
8
:
Bl
ar
g
er
v
o
ca
b
u
la
ri
es
^
an
d
us
ed
sh

76. o
rt
p
h
ra
se
s;
ra
re
ly
sp
o
k
e
sp
on
ta
n
eo
u
sl
y.
M
cM
o
rr
o
w
an
d

77. F
ox
x
(1
9
8
6
)
&
F
o
x
x
an
d
F
aw
(1
9
9
0
)
n
=
1
;
m
al
e;
2
1
y
ea

78. rs
N
o
st
an
d
ar
d
iz
ed
la
n
g
u
ag
e
as
se
ss
m
en
t.
N
o
v
er
b
al
in
it
ia
ti

79. on
s;
d
id
n
o
t
re
sp
o
n
d
to
q
u
es
ti
o
n
s;
n
ea
rl
y
al
l
v
er
b
al
iz
at
io

80. n
s
w
er
e
ec
h
o
la
li
c.
IQ
o
f
4
0
u
si
n
g
th
e
P
P
V
T
.
R
ep
ea
te
d
st
at

81. em
en
ts
;
im
m
ed
ia
te
ec
h
o
la
li
a
E
x
p
er
im
en
t
1
:
cu
es
-p
au
se
-
po

82. in
t
an
d
th
en
p
au
se
o
n
ly
E
x
p
er
im
en
t2
an
d
3
:m
o
d
el
in
g
P

83. o
si
ti
v
e
P
o
si
ti
v
e
at
5
7
m
o
n
th
s
fo
ll
o
w
-u
p
(F
o
x
x
an
d
F
aw

84. 1
9
9
0
)/
re
su
lt
s
d
id
n
o
t
g
en
er
al
iz
e
to
n
ew
q
u
es
ti
o
n
(c
u
es

85. -p
au
se
-p
o
in
t
n
o
t
u
se
d
in
g
en
er
al
iz
at
io
n
p
ro
b
es
)
C
o
nc
lu
si

86. v
e
N
ie
n
ti
m
p
an
d
C
o
le
1
9
9
2
n
=
3
;
2
m
al
es
an
d
1
fe
m
al

87. e;
1
2
,
1
2
.8
,
1
3
.4
y
ea
rs
N
o
st
an
d
ar
d
iz
ed
la
n
g
u
ag
e
as
se

88. ss
m
en
t.
A
ll
d
es
cr
ib
ed
as
v
er
b
al
b
u
t
p
ro
m
p
t
d
ep
en
d
en
t.
P
1
:
IQ

89. 3
8
an
d
P
2
:
IQ
3
2
(S
ta
n
fo
rd
-B
in
et
).
N
o
IQ
o
n
fe
m
al
e
p
ar
ti

90. ci
p
an
t
R
ep
ea
te
d
al
l
o
r
p
ar
t
o
f
a
g
re
et
in
g
;
im
m
ed
ia
te
ec
h

91. o
la
li
a
C
o
n
st
an
t
ti
m
e
d
el
ay
an
d
co
n
ti
n
g
en
t
v
er
b
al
pr
ai
se

92. P
o
si
ti
v
e
P
o
si
ti
v
e
fo
r
tw
o
o
f
th
e
p
ar
ti
ci
p
an
ts
d
u
ri
n
g
im

93. m
ed
ia
te
w
it
h
d
ra
w
al
o
f
in
te
rv
en
ti
o
n
/m
ix
ed
w
it
h
g
en
er
al
iz
at

94. io
n
to
n
o
v
el
p
ee
rs
fo
r
tw
o
o
f
th
re
e
p
ar
ti
ci
p
an
ts
S
u
g
g
es
ti
v

95. e;
p
re
-
ex
p
er
im
en
ta
l
d
es
ig
n
(A
B
d
es
ig
n
;
o
n
e
p
ar
ti
ci
p
an
t)

96. an
d
A
B
A
d
es
ig
n
a
(t
w
o
p
ar
ti
ci
p
an
ts
)
P
al
y
o
et
al
.
(1
97
9
)
n

97. =
1
;
fe
m
al
e;
5
.7
y
ea
rs
b
V
in
el
an
d
S
o
ci
al
Q
u
o
ti
en
t
63
;
A
lp
er

98. n
-B
o
ll
IQ
61
;
A
lp
er
n
-
B
o
ll
co
m
m
u
n
ic
at
io
n
ag
e
eq
u
iv
al
en
t
2

99. ye
ar
s
Im
m
ed
ia
te
ec
h
o
la
li
a
P
u
n
is
h
m
en
t
fo
r
ec
h
o
la
li
a,
po
si
ti

100. v
e
re
in
fo
rc
em
en
t
fo
r
ap
p
ro
p
ri
at
e
re
sp
o
n
se
s,
pr
o
m
p
ti
n
g
u
si

101. n
g
ta
p
e
re
co
rd
in
g
of
ap
p
ro
p
ri
at
e
re
sp
o
n
se
P
o
si
ti
v
e
P
o

102. si
ti
v
e
at
1
2
m
o
n
th
s
fo
ll
o
w
-
u
p
/p
o
si
ti
v
e
g
en
er
al
iz
at
io
n
ac

103. ro
ss
se
tt
in
g
s
an
d
st
im
u
li
(u
n
tr
ai
n
ed
qu
es
ti
o
n
s)
S
u
g
g
es
ti

104. v
e;
p
re
-
ex
p
er
im
en
ta
l
d
es
ig
n
(A
B
d
es
ig
n
)
V
al
en
ti
no
et
al
.

105. (2
0
1
2
)
n
=
1
;
m
al
e;
3
y
ea
rs
T
ac
t
re
p
er
to
ir
e
in
cl
u
d
ed
7
5

106. co
m
m
o
n
w
o
rd
s;
in
tr
av
er
b
al
s
in
cl
u
d
ed
fi
ll
-i
n
s
to
so
n
g
s,

107. an
im
al
so
u
n
d
s,
an
d
th
e
fu
n
ct
io
n
o
f
so
m
e
it
em
s.
R
ep
ea
te
d
Bs
ay

108. ^
d
ur
in
g
ec
h
o
ic
s
tr
ai
n
in
g
;
im
m
ed
ia
te
ec
h
o
la
li
a
C
u
es
-p
au
se

109. -p
o
in
t
P
o
si
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Rev J Autism Dev Disord (2016) 3:82–91 87
animation of a father and child playing ball would appear.
The participant was then observed in their classroom, and
data were collected on appropriate and inappropriate verbal
behavior. Results were mixed with some participants
demonstrating improvement in echolalia and some demon-
strating no improvement.
The remaining six studies employed a variety of behavior
analytic interventions to treat echolalia. Behavioral compo-
nents included error correction and differential reinforcement
(n=2; Freeman et al. 1975; Palyo et al. 1979). differential
reinforcement of lower rates (n=1; Handen et al. 1984).
modeling and positive reinforcement (n=2; Karmali et al.
2005; Palyo et al. 1979). modeling (n=1; McMorrow and
Foxx 1986). time delay and differential reinforcement (n=1;
Nientimp and Cole 1992). and visual cues with differential
reinforcement (n=1; Ganz et al. 2008). For example,
Handen and colleagues (1984) implemented differential rein-
forcement of lower rates (DRL) of behavior to decrease the
echolalia of a 16-year-old male with ASD. The intervention
occurred over an 18-month time frame and involved pro-
viding the participant with tokens for engaging in lower
rates of echolalia than a predetermined criterion. When
the participant engaged in echolalia below the target
rate, he exchanged the tokens for a tangible item from
his reinforcement menu. The intervention was effective

118. in reducing the participant’s engagement in echolalia;
however, after intervention was removed, the partici-
pant’s echolalia returned to baseline levels.
In another study, Ganz et al. (2008) taught two children
with ASD who engaged in echolalia to engage in reciprocal
social-communicative responses (e.g., compliments, ques-
tions, and statements corresponding to the current activity).
Responses were taught by providing visual scripts of the target
response and systematically fading scripts over three phases.
To reduce echolalia, a visual cue was presented which sig-
naled to the participant that they should cease talking (i.e., a
3″×3″ line drawing of a face with a finger in front of the
mouth indicating Bquiet^). This visual cue was introduced
only if the participant engaged in echolalia. Results indicated
clear decreases in echolalia.
Intervention Outcomes
The data from nine of the studies indicated that the results
were positive for all participants (Foxx et al. 2004; Freeman
et al. 1975; Ganz et al. 2008; Handen et al. 1984; Karmali et al.
2005; McMorrow and Foxx 1986; Nientimp and Cole 1992;
Palyo et al. 1979; Valentino et al. 2012). Data from two of the
studies suggested mixed results with some participants dem-
onstrating improved behavior and some demonstrating no im-
provement (Hetzroni and Tannous 2004; Laski et al. 1988).
The first study( Laski et al. 1988) measured echolalia as an
ancillary dependent variable and provided pre- and post-
treatment means for echolalia, with no differences noted in
one setting (i.e., the break room). The second study
(Hetzroni and Tannous 2004) utilized a multiple baseline de-
sign across settings to evaluate the effects of their technology-
based intervention on participant echolalia. However, de-
creases in echolalia were not demonstrated for all three set-

119. tings for any of the participants undercutting the experimental
control of the multiple baseline design. The two studies with
mixed results represented 8 of the 25 participants.
Maintenance and Generalization
Five of studies assessed maintenance of behavior change
(Foxx et al. 2004; Handen et al. 1984; Nientimp and Cole
1992; Palyo et al. 1979; Valentino et al. 2012). and one study
was published as a long-term follow-up to the McMorrow and
Foxx study (1986; Foxx and Faw 1990). The timing of the
collection of maintenance data ranged from immediately fol-
lowing the conclusion of the intervention (Foxx et al. 2004;
McMorrow and Foxx 1986; Nientimp and Cole 1992) to
57 months after the intervention (Foxx and Faw 1990). All
studies reported that echolalia levels at maintenance were be-
low baseline levels. Seven studies assessed stimulus general -
ization (Foxx et al. 2004; Hetzroni and Tannous 2004;
Karmali et al. 2005; McMorrow and Foxx 1986; Nientimp
and Cole 1992; Palyo et al. 1979; Valentino et al. 2012) in-
cluding generalization across settings, people, materials, and
different preceding utterances (questions). Four studies report-
ed positive results for generalization (Foxx et al. 2004;
Karmali et al. 2005; Palyo et al. 1979; Valentino et al.
2012). Two studies reported that generalization occurred for
some participants but not for all (Hetzroni and Tannous 2004;
Nientimp and Cole 1992). One study found that results did not
generalize for the participants (McMorrow and Foxx 1986).
Certainty of Evidence
Six of the studies were categorized as offering a conclusive
level of evidence with positive results, sufficient research de -
sign and IOA data, and detailed procedural descriptions (Foxx
et al. 2004; Ganz et al. 2008; Handen et al. 1984; Karmali et al.
2005; McMorrow and Foxx 1986; Valentino et al. 2012). Five

120. studies were categorized as suggestive (Freeman et al. 1975;
Hetzroni and Tannous 2004; Laski et al. 1988; Nientimp and
Cole 1992; Palyo et al. 1979). Of the five studies, three did not
demonstrate experimental control (Freeman et al. 1975;
Nientimp and Cole 1992; Palyo et al. 1979). two studies had
mixed results (Hetzroni and Tannous 2004; Laski et al. 1988).
and one study did not assess IOA (Freeman et al. 1975). None
of the studies was classified at the preponderant level of
evidence.
88 Rev J Autism Dev Disord (2016) 3:82–91
Discussion
The purpose of this review was to identify promising practices
for decreasing echolalia in individuals with ASD. This sys-
tematic literature review synthesized 11 studies which
employed a variety of behavioral interventions. Of the 11
studies, nine reported positive results for 17 participants, and
two of the studies reported mixed results for two participants.
When examining the quality of the literature base, six of the 11
studies were classified as providing conclusive evidence.
Ultimately, the findings of this review indicate that the litera-
ture base cannot conclusively support any one approach for
the treatment of echolalia in individuals with ASD.
Implications for Research
The first purpose of this review was to update the previous
review by Kavon and McLaughlin (1995) to identify effective
interventions for the treatment of echolalia in individuals with
ASD. Although no single intervention procedure or package
met any of the commonly used criteria for classification as a
well-established or evidence-based practice (e.g., Chambless

121. and Holland 1998; Odom and Wolery 2003). a number of
themes emerged. First, of the six studies classified as conclu-
sive, all contained behavioral analytic intervention compo-
nents (e.g., programmed reinforcement contingencies) sug-
gesting support for operant-based treatments in the reduction
of echolalia for individuals with ASD. When considering im-
mediate echolalia, the cues-pause-point intervention was iden-
tified as effective in three studies (Foxx et al. 2004;
McMorrow and Foxx 1986; Valentino et al. 2012). This con-
clusion supports the previous descriptive review identifying
cues-pause-point as a potentially effective intervention for im-
mediate echolalia. Of note, only two studies have evaluated
the effects of cues-pause-point since the previous review
(Kavon and McLaughlin 1995) highlighting the need for more
research in this area.
Conclusive studies evaluating interventions for delayed
echolalia also utilized behavioral analytic components. Three
interventions, DRL of behavior (Handen et al. 1984). script
training plus visual cues (Ganz et al. 2008). and tact modeling
plus positive reinforcement for appropriate responses
(Karmali et al. 2005). were all identified as effective for de -
layed echolalia. Of particular interest is the study by Ganz
et al. (2008) which utilized visual cues to signal to the partic -
ipant that they should cease talking. In addition, visual scripts
were provided to prompt the target response. Although not
inclusive of all the elements of cues-pause-point, Ganz et al.
did implement a cue to remain silent and a point to prompt the
correct answer. In addition, the DRL of behavior intervention
by Handen et al. (1984) utilized differential reinforcement
which was a contingency in effect in the cues-pause-point
interventions. Overall, the research combined provides
preliminary support for operant-based behavioral interven-
tions in general and cues-pause-point in particular.

122. As the interventions evaluated in these studies align with
the operant conditioning paradigm, it is alarming that none of
the studies assessed the operant function of echolalia. In other
forms of challenging behavior (e.g., aggression, property de-
struction, and self-injury), identifying the function of the be-
havior via a functional analysis procedure (Iwata et al.
1982/1994; Lydon et al. 2012) is associated with better re-
sponse to treatment (e.g., Didden et al. 2006). Of particular
concern is that echolalia may serve various social as well as
non-social communicative functions for individuals with ASD
(Goren et al. 1977; Healy and Leader 2011). If echolalia is
reduced during treatment but a functionally equivalent re-
placement behavior is not taught, this could limit the mainte-
nance and generalization of the behavioral change
(Schreibman and Carr 1978). In addition, as there is diver -
gence within the field regarding whether echolalia is nonfunc-
tional (e.g., Lovaas, Schreibman, and Koegel 1974). a neces-
sary part of developing functional communication (e.g.,
Roberts 2014). or serves a social function (e.g., Prizant and
Duncan 1981). identifying the function of echolalia would
help guide future research and practice.
One potential strength of this literature base is the assess-
ment of maintenance of behavioral change following cessa-
tion of the intervention phase. Of the six articles that assessed
the maintenance of behavioral change, all reported positive
results indicating levels of echolalia maintained below base-
line levels during follow-up sessions. However, although sev-
en of the studies did evaluate the generalization of the results
across stimuli, people, and settings, results were mixed with
only four reporting successful generalization. Future re-
searchers might consider evaluating interventions to promote
sustained behavioral change (e.g., fading, multiple exemplar
training; Valentino et al. 2012).
Implications for Practice

123. A second purpose of this review was to offer guidance to
practitioners interested in the use of evidence-based treatments
for individuals with ASD. Given the limited number of con-
clusive studies, recommendations as to an evidence-based in-
tervention for decreasing echolalia cannot be drawn.
However, the results of this review did suggest that cues-
pause-point, which was investigated by three different studies
with positive results and conclusive levels of evidence, is po-
tentially effective for immediate echolalia (Foxx et al. 2004;
McMorrow and Foxx 1986; Valentino et al. 2012). Although
these results support the conclusions from previous research
that cues-pause-point is potentially effective (Kavon and
McLaughlin 1995). practitioners should use caution when
implementing this intervention due to the limited number of
studies. In particular, practitioners should closely monitor the
Rev J Autism Dev Disord (2016) 3:82–91 89
intervention effects through ongoing progress monitoring and
rely on objective data to evaluate the effectiveness of the
intervention.
Limitations of this Review
There are a couple of limitations of this review to consider.
First, the definition of echolalia used by the authors was
intended to distinguish echolalia from vocal stereotypy.
However, it was difficult to identify a definition of echolalia
that was accepted throughout the literature base. In addition,
as none of the studies reported the function of the target echo-
lalia behavior, it is uncertain whether echolalia was isolated
from other forms of vocal stereotypy. A second limitation is
the age of the literature base. Of the 11 studies reviewed, six of

124. the studies were published over 20 years ago. As research
quality indicators have evolved dramatically in the past
20 years, the age of this literature base may have been a factor
in the conclusiveness of the evidence. In addition, since the
review by Kavon and McLaughlin (1995). only five additional
studies have been published on this topic. Therefore, there is a
need to update and expand this literature base to promote the
use of evidence-based practices in the treatment of echolalia
for individuals with ASD. A third limitation is the procedures
used to code intervention outcomes as applied to this literature
base. Study results were rated as Bpositive,^ mixed, or
Bnegative^ with mixed indicating that some but not all partic-
ipants demonstrated improvements in behavior. Five of the 11
included studies contained only one subject with ASD, there-
fore restricting the rating of the outcomes to either negative or
positive. Although restricted codes could have negatively im-
pacted intervention outcome ratings, all of the studies with one
subject received positive ratings. However, the limited num-
ber of subject limits the external validity of the conclusions. A
fourth limitation is the absence of large-scale randomized con-
trol trials in the resulting literature base. Although this might
be a reflection of the exceptionality of the population, the
exclusive use of single-subject designs limits the external va-
lidity of this literature base. A fifth limitation of this review is
the focus on individuals with ASD. Future researchers might
consider expanding to include other developmental disabil -
ities to ensure a more comprehensive review. Such an analysis
might allow for distinctions relevant to the presentation and/or
treatment of echolalia in children with ASD relative to indi -
viduals with other forms of disability.
Compliance with Ethical Standards
Funding The authors report no funding for this manuscript.
Conflict of Interest The authors report no conflicts of interest.

125. Ethical Approval This article does not contain any studies with
human
participants performed by any of the authors.
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Reproduced with permission of the copyright owner. Further
reproduction prohibited without
permission.
Treatment of Echolalia in Individuals with Autism Spectrum
�Disorder: a Systematic ReviewAbstractMethodSearch
ProceduresInclusion CriteriaDescriptive SynthesisInterrater
ReliabilityResultsParticipant CharacteristicsType of
EcholaliaIntervention ProceduresIntervention
OutcomesMaintenance and GeneralizationCertainty of
EvidenceDiscussionImplications for ResearchImplications for
PracticeLimitations of this ReviewReferences*Indicates studies
which were included in this review
ment program to reduce stereotypic (repetitive) behav-
iors. Four children diagnosed with autism were referred
because of high frequency of stereotypic behaviors (e.g.,
arm flapping, finger flexing, humming, nonsense vocal-
izations). After self-management procedures were taught,
stereotypic behaviors decreased to zero levels for all chil -
dren, however, the two children with vocal stereotypies
required a longer period of self-management before de-
creases were noted. Similarly, Stahmer and Schreibman
(1992) investigated the effects of self-management pro-
cedures for a variety of target behaviors including in-

137. creasing appropriate play skills, and reducing stereotypic
behaviors of three children with autism. Participants were
7 to 13 years old and were referred for treatment by their
parents due to destructive and obsessive behavior with
toys in unsupervised settings. Appropriate play increased
for all three children during treatment, fading, posttreat-
ment, and follow-up observations and self-stimulatory
behavior decreased to zero levels. Results from these
studies indicated the successful use of self-management
to reduce inappropriate behaviors (R. L. Koegel &
Koegel, 1990), to increase schedule following (Newman,
Buffington, O’Grady, Poulson, & Hemmes, 1995), and
INTRODUCTION
Self-management procedures, as reported in the
literature, have incorporated components of self-
assessment, self-recording, and self-reinforcement (R. L.
Koegel & Frea, 1993). Applications of self-management
to children with autism have evolved from procedures to
(a) improve on task behaviors of children with retarda-
tion, learning disabilities, and behavior disorders; and
(b) to decrease disruptive, inappropriate, or stereotypic
behaviors (Gardner, Clees, & Cole, 1983; L. K. Koegel,
Koegel, Hurley, & Frea, 1992; Reese, Sherman, & Shel-
don, 1984; Shapiro, McGonigle, & Ollendick, 1980; Stah-
mer & Schreibman, 1992). In an exemplary study, R. L.
Koegel and Koegel (1990) assessed whether children with
autism could be taught to use a self-management treat-
Brief Reports
Brief Report: Reduction of Inappropriate Vocalizations for
a Child with Autism Using a Self-Management Treatment
Program

138. Catherine Mancina,1 Melody Tankersley,2 Debra Kamps,1,4
Tammy Kravits, 1
and Jean Parrett3
Self-management procedures that incorporate elements of self-
assessment, self-recording, and
self-reinforcement have reduced stereotypic (i.e., repetitive)
behaviors in children with autism
in clinical settings. This study examined the effects of a self-
management program used to re-
duce high rates of inappropriate vocalizations (e.g., humming,
tongue clucking, perseverative
and echolalic words/phrases) in a 12-year-old girl having autism
served in a public school
classroom. When self-management was applied to inappropriate
vocalizations in a multiple-
baseline design during leisure, prevocational, and reading tasks,
the occurrence of vocaliza-
tions decreased. Implications for teaching these procedures in
classroom settings are discussed.
KEY WORDS: Self-management procedures; autism;
inappropriate vocalization.
Journal of Autism and Developmental Disorders, Vol. 30, No. 6,
2000
599
0162-3257/00/1200-0599$18.00/0 © 2000 Plenum Publishing
Corporation
1 University of Kansas, Kansas City.
2 Kent State University, Kent, Ohio.
3 Kansas City, Kansas Public Schools, Kansas City.
4 Address all correspondence to Debra M. Kamps, Juniper

139. Gardens
Children’s Project, 650 Minnesota Avenue, 2nd floor, Kansas
City,
Kansas 66101.
to increase social behaviors (R. L. Koegel & Frea, 1993;
Stahmer & Schreibman, 1992).
The purpose of the present study was to extend
the literature on classroom-based self-management
procedures. The investigation examined the effects of
self-management procedures for a 12-year-old girl di-
agnosed with autism and moderate mental retardation.
Three inappropriate behaviors were identified for the
participant (i.e., vocalizations, facial movements,
body movements); however, self-management proce-
dures were applied to only one behavior (i.e., vocal-
izations) and collateral effects were observed for the
others. Because studies indicated that the reduction of
vocalizations requires longer durations of treatment
in children with autism (R. L. Koegel & Koegel,
1990), the amount of time required to teach the self-
management procedures and the levels to which tar-
get behaviors decreased were investigated.The present
study, therefore, focused on the reduction of vocaliza-
tions with effects noted for (a) change in the target be-
havior, (b) change in collateral behaviors, (c) the
treatment effects across tasks, (d) the accuracy of the
student’s self-recording, and (e) time required to teach
the procedures.
METHOD, STUDY 1

140. Participant and Settings
Target student.The participant, Keri, a 12-year-
old African American girl, was diagnosed with autism
and moderate mental retardation. Keri attended sum-
mer school in a self-contained, special education
classroom located in an urban, elementary school set-
ting. On the Wecshler Intelligence Scale for Children
(Wecshler, 1974), Keri scored a 46 on the perfor-
mance subtest. No information concerning her verbal
subtest was provided. Her estimated full IQ range was
between 42 and 55. She read sight words and simple
sentences, had good verbal comprehension, and re-
sponded correctly to yes/no questions. She indepen-
dently participated in prevocational and leisure
activities. Of primary concern to her teacher was her
verbal behavior. Keri’s verbal communication (two-
to-three-word phrases) was continuously interrupted by
noises (humming, whistling, tongue clucking); and per-
severative vocalizations. She also exhibited stereotypic
body and facial movements. Assessments and inter-
views indicated that these behaviors were primarily
maintained by sensory stimulation. Keri’s teachers re-
ported that her vocalizations were very disruptive, and
interfered with her academic and social learning. Keri
600 Mancina, Tankersley, Kamps, Kravits, and Parrett
was most attentive in quiet environments with one-to-one
teaching situations.
Treatment Providers/Observers.All three indi-
viduals who participated in this study including the first
author, a research associate, and a doctoral student had
at least 5 years experience using behavioral techniques
to teach children with autism, behavior disorders,

141. and/or other developmental disabilities. Treatment
providers also served as observers for the study.
Setting. The experimental sessions were con-
ducted in a special education classroom (20 × 40 m),
located in a public school, 4 to 5 days a week. Sessions
lasted 5 minutes each. Four to six sessions were con-
ducted every morning within a 3-hour period. Keri fol-
lowed her regular morning schedule of activities with
self-management sessions conducted during typical
tasks (i.e., leisure, prevocational, and reading). Keri
was seated at her own desk located in the back of the
classroom. One treatment provider and one observer
sat in chairs placed on each side of her, and five stu-
dents were also working at individual desks.
Dependent Variables and Measurement
Dependent Variable/Target Behavior.The ob-
server recorded occurrence or nonoccurrence of three
categories of behavior: (a) vocalizations, (b) facial
movements, (c) and body movements during 10-second
intervals for 5 minutes. Occurrence of self-injurious be-
havior within 10-second intervals was also recorded.
The occurrence of vocalizations was identified as the tar -
get behavior, however, all three behaviors were mea-
sured to examine collateral effects of the self-management
procedures. Vocalizations were defined as (a) noises such
as humming, whistling, tongue clucking, and (b) perse-
verative (repeated) and echolalic words or phrases. Fa-
cial movements were recorded as any nonfunctional
movements of the face including exaggerated eye
blinks, rolling eyes, noncontextual smiling, tongue pro-
trusions, and raising and lowering of eyebrows. Body
movements were defined as any nonfunctional body
movements including hand and finger manipulations,

142. stomping feet, head butts, elbow jabs, and head jerks.
Any occurrence of self-injury, such as hand biting or
hitting her head, was recorded.
Observations.Data were collected by the treat-
ment providers. They randomly rotated between teach-
ing and supervising the self-management procedures
and recording the data. Data were collected using a 10-
second whole interval recording procedure to record
the occurrence or nonoccurrence of (a) target vocal -
izations, (b) facial movements, (c) and body move-
ments. When a self-injurious behavior was observed,
the observer placed a circle around the interval to in-
dicate the occurrence of a self-injurious behavior. Data
were recorded during leisure, prevocational, and read-
ing tasks. Data were not taken during self-reinforcement
(see Procedures).
Reliability. Interobserver reliability was collected
for each behavior during baseline and treatment
phases, for 38% (n = 36) of all sessions, using video-
tapes of sessions. The primary observer and the treat-
ment provider viewed the tapes simultaneously, while
scoring independently. An agreement was scored if
both observers recorded a “+” or when both recorded
a “−” for each behavior in an interval. Reliability was
measured by calculating the number of agreements be-
tween the two observers divided by the number of
agreements and disagreements, multiplied by 100. The
mean percentage of reliability for vocalizations was
95% (R = 63–100%), 87% (R = 63–100%) for facial
movements, and 89% (R = 75–100%) for body move-
ments.

143. Experimental Design and Procedures, Study 1
A multiple-baseline design (Kazdin, 1984) across
tasks was used to teach Keri to use self-management
procedures. Occurrences of the inappropriate vocal-
izations and collateral behaviors were recorded during
experimental conditions: baseline (A) and treatment
phases (B). Treatment (self-management) was only ap-
plied to inappropriate vocalizations, as the teacher de-
termined this to be the most problematic behavior.
Baseline (A).Data were collected during Keri’s
participation in leisure, prevocational, and reading tasks,
as included in her IEP and presented to her by the class-
room teacher. Baseline data were collected over 11 days
for the leisure task, 20 days for the prevocational task,
and 32 days for the reading task, Leisure task materials
included coloring and sticker books, drawing boards,
memory match games, photograph albums, and puzzles.
Prevocational materials/activities included sorting,
stamping, and collating items. Materials used during the
reading tasks included flash cards, worksheets, and the
student’s Edmark® reading book.
Treatment Phases (B).Self-management proce-
dures, adapted from a training manual by R. L. Koegel,
Koegel, and Parks (1990), were implemented first dur-
ing leisure tasks followed by, prevocational, and read-
ing tasks. The treatment procedures incorporated the use
of (a) the same classroom materials as used in baseline
tasks, (b) self-management materials, and (c) the teach-
ing of self-management including: identification of be-
Reduction of Inappropriate Vocalizations 601

144. haviors, self-recording, self-reinforcement, independent
use of the program, and assessing student accuracy.
Teaching the self-management programtook place
in Keri’s summer school classroom. Self-management
materials served as stimuli for Keri to perform the
self–management procedures and included a Timex dig-
ital watch with a repeat alarm to signal 10-second in-
tervals, self-recording sheets (i.e., a sheet of paper with
12 empty boxes with the words “quiet” and “noisy”
written beside them), visual prompts (i.e., 4 inch × 6
inch quiet card), and reinforcers. Keri was taught to
correctly identify her target behavior (i.e., vocaliza-
tions) through modeling. The treatment provider mod-
eled quiet and noisy behavior, asked Keri “Was I quiet
or noisy?” (with gestures toward cards with the words
quiet and noisy), reinforced correct responses and cor -
rected errors. When Keri responded correctly during 8
of 10 trials for five consecutive sessions, Keri was then
required to model quiet and noisy behavior in 8 of 10
trials (emphasis on quiet behavior), for three consecu-
tive sessions (emphasis on quiet).
Keri was then taught to assess target behavior
using the self-recording sheet. Training and continued
practice followed the instruction (i.e., “Get ready, show
me quiet.”) and an instruction to record in the quiet
box (or noisy box). Once Keri consistently marked the
box that described the behavior she was modeling, she
was taught self-recording using the watch, with initial
intervals of 5 seconds, as the longest observed dura-
tion that Keri could work, play, or sit without dis-
playing the target behavior (vocalizations). The watch
was started when the treatment provider gave the in-
struction to work quietly (“Get ready. Show me quiet
when you color.”). When the watch beeped, the treat-

145. ment provider stopped the watch, and Keri was asked
“Were you quiet or noisy?”. When Keri responded
(“quiet” or “noisy”) she was instructed to check that
particular box (e.g., “That’s right. You were quiet.
Check the quiet box.”). If Keri was incorrect in her re-
sponse, she was verbally corrected and instructed to
mark the appropriate box. Keri often said the word
“quiet” during the interval. This was considered an ap-
propriate verbalization. During intervals when Keri
was noisy, the treatment provider prompted her to be
quiet (e.g., “That’s noisy. Show me quiet. That’s bet-
ter. That’s quiet.”).
After Keri could successfully self-record her be-
haviors when signaled by the watch, she was taught
self-reinforcement.Before presentation of each new
self-recording sheet, a variety of rewards (e.g., pop-
corn, cereal, stickers, raisins,) were shown to Keri.
Keri was instructed to (a) select six small rewards (six
602 Mancina, Tankersley, Kamps, Kravits, and Parrett
in the interval beeps from 5 seconds to 10 seconds. The
prompt-fading sequence was faded to, “Were you quiet
or noisy?,” to “Check it,” and finally to a gestural
prompt (a point to the paper). Also, verbal prompts to
be quiet during the interval were only given during the
intervals after Keri was noisy, and prompts were tied
to the self-management procedure and materials. Cri-
teria for implementation to the second (third) task was
completion of the self-management steps, successful in-
crease to 10-second intervals, and decreases in vo-
calizations to 50% or less of the intervals for five
sessions.

146. pieces of cereal, popcorn, raisins), (b) write the name
of the reward at the top of the self-recording sheet,
and (c) put the rewards on her desk above her self-
recording sheet. Edibles were earned for quiet boxes.
She was instructed to do the same for the one “spe-
cial” reward (tape player, sticker, soda, or several
pieces of the smaller rewards), which she selected to
earn for reaching performance criteria (3 of 6 quiet
intervals, then 4 of 6).
Teaching independence in self-recordingfollow-
ing successful self-management, consisted of
(a) gradual fading of verbal prompts, and (b) an increase
Fig. 1. Percentage occurrence of vocalizations during leisure,
prevocational, and reading tasks for Study 1.
Results and Discussion
Overall the target behavior, vocalizations, decreased
while collateral behaviors, facial and body movements,
showed variable changes with minimal generalization of
effects (Fig. 1 and Table I). During all tasks, the occur -
rence of vocalizations, facial movements, and body
movements ranged from 80–100% during baseline. Dur-
ing the treatment phase for leisure tasks (28 sessions),
self-management decreased vocalizations to 50% of the
intervals or less after 18 sessions. When self-management
was applied during prevocational tasks, the vocalizations
decreased to less than 50% occurrence after four sessions,
and continued to decrease to 20% occurrence or less. Dur-
ing reading tasks, the occurrence of vocalizations once
more decreased below 50% occurrence within the first

147. three sessions of self-management.
Though vocalizations remained below 50% oc-
currence, facial and body movements continued to
occur at higher rates than the target behavior. As de-
picted in Table I (means by condition, and last five ses-
sions of treatment), no change in facial movements
occurred following treatment for vocalizations during
leisure tasks, with some generalization of effects to
final sessions during prevocational and reading tasks.
Limited generalization was noted in the occurrence of
body movementsfollowing treatment for vocalizations.
Keri’s self-injurious behavior was recorded during
baseline and intervention. A total of 49 instances of
self-injury were noted during sessions. The frequency
was similar during baseline and treatment.
Results from Self-Management Procedures
Keri’s accuracy in self-recording her quiet and
noisy behavior was recorded during treatment phases
(5 sessions for leisure tasks, 3 sessions for prevocational
Reduction of Inappropriate Vocalizations 603
tasks, and 4 sessions for reading tasks). She averaged
85% accuracy per session with a range of 78–92%. The
initial teaching of the self-management steps required
6 days of intensive instruction for an average of 3 hours
a day, with training continuing during the leisure tasks
until Keri’s vocalizations decreased to 50% occurrence
or less. Keri required 2 days of teaching before vocal -
izations decreased to 50% occurrence during the prevo-
cational tasks, and required only 1 day of teaching during
reading. While vocalizations decreased, she did not reach
independence, still needing verbal and gestural prompts

148. to use the program.
STUDY 2: SELF-MANAGEMENT WITH THE
TEACHER AS TREATMENT PROVIDER
A continuation of self-management was conducted
with Keri in Study 2, beginning in the fall term with in-
corporation of the following procedures: (a) training the
classroom teacher as treatment provider in the self-man-
agement procedures, (b) lengthening the duration of the
interval for quiet behavior, (c) increasing the number of
intervals on the self-recording sheet, (d) gradually fad-
ing verbal prompts to increase independence, (e) fading
tangibles to natural reinforcers, and (f) fading the prox-
imity and presence of the treatment provider.
Participant, Setting, Design, and Procedures
The teacher, a paraprofessional, and five students
with autism, were present in the classroom. The class-
room teacher had 11 years of teaching experience in
special education classroom settings. Self-management
procedures were implemented during scheduled class-
room tasks involving leisure, prevocational, and read-
ing activities, as in Study 1. Self-management procedures
were conducted approximately 20–30 minutes a day,
four to five times a week.
Dependent Measures and Design.Dependent mea-
sures were identical to those in Study 1 with the same
definitions for the target and collateral behaviors. Oc-
currence of inappropriate vocalizations, facial and body
movements were recorded during continuous 10-second
observations for 5-minute sessions. Observers for Study
2 included the first author and a research assistant with
9 years of teaching experience with children with

149. autism. Reliability was computed for 9% of the data
files (14 of 137 sessions). Mean agreement was 91% (R
= 83–100%) for vocalizations, 83% (R = 52–100%) for
facial movements, and 80% (R = 67–100%) for body
movements. A multiple-baseline design was used to
evaluate treatment effects across tasks.
Table I. Means for Facial and Body Movement, Self-Injurious
Behavior Across Conditions During Study 1
Task Baseline Treatment for vocalizations
Mean percentage occurrence—Facial Movements
Leisure 89 83 (87, final 5 sessions)
Pre-Voc 92 74 (68, final 5 sessions)
Reading 94 84 (73, final 5 sessions)
Mean percentage occurrence—Body Movements
Leisure 83 84 (79, final 5 sessions)
Pre-Voc 87 79 (82, final 5 sessions)
Reading 95 89 (81, final 5 sessions)
Frequency of self-injurious behavior
Leisure 0.250 0.285 (0.00, final 5 sessions)
Pre-Voc 0.060 0.625 (0.00, final 5 sessions)
Reading 0.176 0.100 (0.20, final 5 sessions)
Baseline. Baseline observations occurred during
Keri’s regular leisure, prevocational and reading tasks
with the same materials used in Study 1 and no self-
management procedures.
Self-Management Procedures.In Study 2, the role
of the treatment provider was transferred to the class-

150. room teacher. Teacher training included (a) task analy-
sis of each component of self-management procedures,
(b) videotaped examples of the student using self-man-
agement procedures, (c) modeling of prompting and self-
management procedures by the first author, and (d)
604 Mancina, Tankersley, Kamps, Kravits, and Parrett
monitoring and feedback concerning her performance as
treatment provider for 5 days of training. Once the
teacher training was completed, self-management pro-
cedures identical to those used in Study 1 were imple-
mented: (a) identification of target behavior, (b)
recording of the target behavior, (c) self-recording using
the watch, and (d) self-reinforcement.
During the treatment phase, the number of self-
recording boxes per page was increased from 6 to 10.
The duration of intervals ranged from 10–40 seconds,
and was variable throughout all treatment phases. If Keri
Fig. 2. Percentage occurrence of vocalizations during leisure,
prevocational, and reading tasks for Study 2.
Reduction of Inappropriate Vocalizations 605
exhibited vocalizations and was not successful (i.e., did
not earn a reward using the self-management procedures)
on three consecutive self-recording sheets, the duration
of the interval was lowered. Also, the number of suc-
cessful (i.e., quiet) intervals required to receive a reward
was increased to 8 of 10 quiet intervals.
In Study 2, limited independence with self-man-

151. agement procedures was obtained. Verbal prompts and
gestural prompts were faded; however, Keri frequently
required gestural prompts toward the end of the ses-
sions. Because Keri continued to require prompts to re-
main on-task, proximity by the treatment provider was
limited to the area within the classroom.
Results and Discussion
In Study 2, vocalizations decreased, facial move-
ments remained unchanged, and body movements de-
creased. As depicted in Figure 2, baseline levels of
vocalizations were high (76–97%), with a decrease to
41% occurrence in the first treatment session, and con-
tinued decreases to near zero levels. Self-management
during prevocational tasks decreased vocalizations to
below 20% after the first treatment session, with zero
levels during several sessions of the treatment phase.
During reading, vocalizations decreased to lower lev-
els; however, the decrease was variable, ranging from
0–60% occurrence. An increase in final sessions ap-
peared to be related to task difficulty. Facial movements
showed some variability but continued to occur at
higher rates than vocalizations. Body movements de-
creased to lower levels during treatment for vocaliza-
tions, indicating some generalization of treatment
effects. Self-injurious behavior was somewhat lower
during the Study 2 period, except during frustrating
tasks (see Table II).
GENERAL DISCUSSION
Similar to positive findings in prior research (e.g.,
R. L. Koegel & Koegel, 1990; Reese, Sherman, & Shel-
don, 1984), self-management was highly effective in

152. decreasing inappropriate vocalizations. In general,
treatment effects were slower during the initial program
(Study 1, Task 1) with quicker results for the second
and third tasks and during Study 2. In addition, both
teachers reported that Keri was much quieter with more
appropriate behavior when using the self-management
program. Generalization of treatment effects were noted
for one of two collateral behaviors. Though the findings
were encouraging, a limitation was that Keri did not learn
complete independence, nor were procedures able to be
faded within the period of study. Larger changes in tar-
get and collateral behaviors may have been obtained with
(a) the use of behavioral programming to address behav-
iors such as noncompliance, (b) an augmentative com-
munication system, and (c) programs to increase social
competencies. Longer treatment may also be necessary
for students with (a) lower cognitive ability, (b) high
rates of challenging behaviors, rates, and (c) a long his-
tory of behaviors with insufficient interventions (R. L.
Koegel, Koegel, Van Voy, & Ingham, 1988).
ACKNOWLEDGMENT
This research was supported by the Office of Spe-
cial Education and Rehabilitation Services, U.S. De-
partment of Education, Grant H023C00024 to the
University of Kansas.
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Table II. Means for Facial and Body Movements, Self-Injurious
Behavior Across Conditions During Study 2
Task Baseline Treatment for vocalizations
Mean percentage occurrence—Facial Movements
Leisure 71 72 (62, final 5 sessions)
Pre-Voc 84 82 (89, final 5 sessions)
Reading 83 80 (78, final 5 sessions)
Mean percentage occurrence—Body Movements
Leisure 71 52 (35, final 5 sessions)
Pre-Voc 82 66 (58, final 5 sessions)
Reading 85 74 (59, final 5 sessions)
Frequency of self-injurious behavior
Leisure 0.000 0.090 (0.00, final 5 sessions)

154. Pre-Voc 0.000 0.000 (0.00, final 5 sessions)
Reading 0.420 1.500 (2.80, final 5 sessions)
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3

156. Academic Journal Observations
Cassandre Moise
Capella University
Description of the Writing in Journals
1. Scope; Main Ideas
The combined objectives of ABA field journals reviewed is to
predict and control behaviours regarded crucial socially. Each
of the journal articles contend to sufficiently cover the various
subfields of ABA field of study .They are all aligned to the
basic goal of enhancing performance through alteration of
environmental factors influencing socially important
behaviours. In addition, the articles covers components of ABA
field for instance, shaping, prompting, chaining and prompt
fading. Lastly, the articles covers the dimensions of ABA and
their relevance.

157. 2. Structure
APA format is effectively applied in the Journal articles to
clearly provide significant understanding of the field’s diverse
and complex topics. The ideas concerning ABA field are
presented with optimal clarity for a wide range of readers to
conceptualize the basics. Paragraphs are written long to detailed
but a brief to the point description of the individual subject. An
average the articles have 4 to 6 sentences paragraphs (APA
style).In addition, the article bodies are well structured with
suitable introduction and conclusions of their topic coverage.
3. Comparison of Ideas and Styles in the Journals
Application of other styles apart from APA facilitates
broad presentation of the main ideas covered in the journal
articles. In contrast, the content of particular theme of ABA
may slightly vary from one journal to another. Furthermore
authors have highlighted their ideas through cautious, well
researched and convincing discussions that genuinely captures
the reader’s attention. It is evident that the nature of content
presentation quietly affects the reader’s morale and captivation
to continue reading about a certain article topic.
References
Averina, M., Nilssen, O., Brenn, T., Brox, J., Arkhipovsky, V.
L., & Kalinin, A. G. (2005). Social and lifestyle determinants of
depression, anxiety, sleeping disorders and self-evaluated
quality of life in Russia. Social Psychiatry and Psychiatric
Epidemiology, 40(7), 511-518.
Kodak, T., & Piazza, C. C. (2008). Assessment and behavioral
treatment of feeding and sleeping disorders in children with
autism spectrum disorders. Child and adolescent psychiatric
clinics of North America, 17(4), 887-905.
Van Tongerloo, M. A., Bor, H. H., & Lagro-Janssen, A. L.
(2012). Detecting autism spectrum disorders in the general
practitioner’s practice. Journal of autism and developmental

158. disorders, 42(8), 1531-1538.
Drafting Your Text Scoring Guide
Due Date: Unit 5
Percentage of Course Grade: 10%.
CRITERIA NON-PERFORMANCE BASIC PROFICIENT
DISTINGUISHED
Introduce thesis
within context for
appropriate
audience.
25%
Does not introduce
thesis within context
for appropriate
audience.
Introduces thesis,
but the context is not
clearly connected to

159. the appropriate
audience.
Introduces thesis
within context for
appropriate
audience.
Introduces thesis within
context for appropriate
audience, providing a clear
connection to the topic,
purpose, and aspects.
Incorporate
evidence with
coherent placement
that supports
structure of
arguments.
25%
Does not incorporate
evidence with
coherent placement
that supports
structure of
arguments.
Incorporates
evidence in only a
basic fashion,
lacking evidence-
based reasoning.

160. Incorporates
evidence with
coherent
placement that
supports structure
of arguments.
Incorporates evidence with
coherent placement that
supports the structure of
arguments, using clear and
direct reasoning.
Present a clear and
complete argument.
25%
Does not present a
clear and complete
argument.
Presents only a
basic argument.
Presents a clear
and complete
argument.
Presents a well-developed,
clear and complete
argument.
Utilize proper
mechanics including
spelling, grammar,

161. and APA formatting
25%
Does not utilize
proper mechanics
including spelling,
grammar, and APA
formatting.
Utilizes most, but not
all, proper
mechanics including
spelling, grammar,
and APA formatting.
Utilizes proper
mechanics
including spelling,
grammar, and APA
formatting.
Utilize proper mechanics
including spelling, grammar,
and APA formatting in a
comprehensive and
informed fashion.