1. Elaborate on the coca-cocaine commodity value chain and the ill.docx

1. Elaborate on the coca-cocaine commodity value chain and the
illegal drug industry in Latin America. In doing so, discuss the
parallels with the dynamics of legal international trade under
the influence of increasing globalization and economic
integration.
2. Please discuss in your own words (no quotes) the Mexican
Cartels and how they have defied U.S. Drug Policies. In doing
so, discuss Operation Intercept, and Operation Condor.
3. Please discuss in detail the fight against violence and terror
on the Southwest Border of the United States. In doing so, also
list and discuss the three points keyed in on by Kingpins and
corruption (2017).
4. Please define, describe, and discuss what is meant by “A Line
in the sand.” Then, summarize the Majority Report by the
United States House Committee on Homeland Security
Subcommittee on Oversight, Investigations, and Management.”
Your conclusion should provide some solution to the problem of
southwest border security.

EDUCATION AND TREATMENT OF CHILDREN Vol. 37, No.
3, 2014
Pages 407–430
An Evaluation of a Treatment Package
Consisting of Discrimination Training and
Differential Reinforcement with Response Cost
and a Social Story on Vocal Stereotypy for a
Preschooler with Autism in a
Preschool Classroom
Amanda P. Laprime and Gretchen A. Dittrich
Simmons College
Abstract
The purpose of the study was to evaluate the use of a treatment
package com-
prised of a social story, discrimination training, and differential
reinforcement
with response cost on the vocal stereotypy of one preschooler
diagnosed with
an autism spectrum disorder. The study took place in a
preschool classroom
of a public school and was implemented by the classroom
teacher and staff.
A changing criterion design was employed to evaluate
experimental control.
The results of this study demonstrated a clear decrease in vocal
stereotypy as
compared to baseline.
Keywords: Vocal Stereotypy, Response Cost, Differential

Reinforcement,
Changing-Criterion Design
A defining characteristic of autism spectrum disorders (ASDs)
involves repetitive vocalizations or body movements, otherwise
de-
fined as stereotyped behavior (American Psychiatric
Association,
2000). Rapp and Vollmer (2005) conducted a review of the
literature
and concluded that the majority of stereotypic behaviors are
main-
tained by automatic reinforcement. Skinner defined verbal
behav-
iors as “behavior reinforced through the mediation of other
persons”
(1957, p.2). Though repetitive vocal responses may
topographically
appear to be verbal, if the consequences maintaining such
responses
are not mediated by a listener, they then could instead be
defined as
vocal stereotypy maintained by automatic reinforcement.
Vaughn and
Michael (1982) defined automatic reinforcement as a
contingency not
mediated by a listener. Therefore, vocal stereotypy may be
maintained
This study was conducted by the first author in partial
fulfillment of the requirements
for the Ph.D. degree in behavior analysis at Simmons College.
We thank the staff at the
LABBB Collaborative for their dedication and hard work with
their students and this
study.

Address correspondence to Amanda Laprime, Department of
Behavior Analysis, Sim-
mons College, 300 Fenway, Boston, MA 02115; e-mail:
[email protected]
408 LAPRIME and DITTRICH
by the sensory byproduct it produces (Ahearn, Clark,
MacDonald, &
Chung, 2007). Because the reinforcing consequence cannot
always be
separated from the response, stereotypic behaviors may be
difficult to
extinguish. Vocal stereotypy is especially problematic in that
the audi-
tory product of the response is often challenging to block or
place on
sensory extinction. In addition, stereotypy may often persist
when the
individual is alone or void of social contingencies (Falcomata,
Roane,
Hovanetz, Kettering, & Keeney, 2004; Iwata, Dorsey, Silfer,
Bauman,
& Richman, 1982,1994; Rincover, 1978).
Based on the difficulty of separating the auditory byproduct of
vocal stereotypy and the response itself (i.e., the movement of
the vo-
cal musculature), behavior change of vocal stereotypy achieved
by
sensory extinction may be attributed to punishment
contingencies and
not extinction (Ahearn et al., 2007). Ahearn and colleagues

evaluated
the efficacy of a punishment contingency on reducing vocal
stereoty-
py with response interruption and redirection. The participants
were
given vocal demands contingent on any instance of vocal
stereotypy,
which effectively reduced responding for all four participants
(Ahern
et al., 2007). Rapp and colleagues (Rapp, Patel, Ghezzi,
O’Flaherty, &
Titterington, 2009) extended the literature on mild punishment
proce-
dures by assessing whether vocal stereotypy could be brought
under
stimulus control of arbitrary stimuli. Their results demonstrated
that
vocal stereotypy was suppressed in the presence of a red card
after
the implementation of the response cost contingency when the
card
was present. The authors concluded that the negative
punishment
procedure was effective at establishing the red card as a
discrimina-
tive stimulus related to punishment (SDP) by being paired with
both
positive and negative punishment (Rapp et al., 2009).
Researchers have also examined the effects of negative punish-
ment on vocal stereotypy; specifically, response cost was found
to be
effective at reducing vocal stereotypy in individuals with ASDs.
Fal-
comata and colleagues (2004) compared noncontingent
reinforcement

(NCR) and NCR with response cost to decrease vocalizations
main-
tained by automatic reinforcement. Initially, levels of
vocalizations
decreased moderately during the NCR conditions, but with the
addi-
tion of a response cost in which a Walkman© was removed
contingent
on vocal stereotypy, responding decreased to near zero levels
for the
participant (Falcomata et al., 2004).
Previous studies have also employed response cost procedures
with token boards (Kostinas, Scandley, & Luiselli, 2001;
Truchlicka,
McLaughlin, & Swain, 1998). During this procedure, tokens,
which
function as conditioned reinforcers, are removed contingent
upon
the occurrence of a target response. At the end of a
predetermined
409VOCAL STEREOTYPY
amount of time, remaining tokens can be exchanged for a
backup re-
inforcer (Cooper, Heron, & Heward, 2007). For example,
Kostinas and
colleagues (2001) employed a response cost procedure with a
token
system in which the participant was given 15 tokens at the start
of
each day. Contingent upon the occurrence of a perseverative
verbal-

ization, a token was removed. By the end of the day, if at least
one
token remained on the board, a preferred snack was delivered.
Re-
sults demonstrated a decrease in perseverative vocalizations for
the
one participant (Kostinaset al., 2001). In a similar study,
Truchlicka
and colleagues (1998) decreased errors during spelling exams
and
increased accuracy in spelling performance in three participants
fol-
lowing implementation of a token-based response cost system.
Fur-
thermore, the authors concluded that the token economy with
the
response cost component was en effective intervention for use
in edu-
cational settings, such as a middle school.
Social stories have also been used in conjunction with response
cost and token board systems (Kuttler, Myles, & Carlson, 1998).
So-
cial stories describe a situation and the contingencies related to
de-
sired responses for that situation. The contingencies are
described
in a manner by which they are easily understood by the person
for
whom the social story was written (Grate & Garand, 1993).
Social sto-
ries were demonstrated to increase the effects of contingencies
related
to token economies (Kuttler et al., 1998). Additionally, social
stories
are often recommended not as a behavior change agent, but

instead
to help facilitate a better social understanding of the
contingencies
related to improvements in behavior and functioning in social
situ-
ations (Kokina & Kern, 2010). The American Psychiatric
Association
(2000) has suggested that social stories may address the need
for
predictability for children with autism in social situations and
that
visually cued instruction that may be more discernable than
verbal
instructions (Quill, 1997). This may be additionally important
in situ-
ations such as public school settings, where students may not
have
constant support and are required to share their teachers. In a
meta-
analysis conducted by Kokina and Kern (2010) on the use of
social
stories, the authors found that 21% of the participants in studies
that
employed social stories included preschoolers, while 60% of the
par-
ticipants were elementary aged. The majority of the studies
surveyed
utilized social stories which focused on a reduction of
inappropriate
behaviors and an increase in social skills (Kokina & Kern,
2010). The
research on social stories have described their effects as
potentially ef-
fective, at best (e.g., Ali & Frederickson, 2006; Rust & Smith,
2006), yet
they are often viewed positively by teachers and parents as a

feasible
and effective intervention (Smith, 2001). However, meta-
analytic data
suggest that they social stories are often utilized in conjunction
with
behavior change procedures leading to difficult with
determining the
isolated effects of social stories on behavior alone (Kokina &
Kern,
2010). While response cost systems with token boards and
social sto-
ries have been demonstrated to be effective at decreasing
behaviors,
such as precursors to tantrum behavior, perseverative
vocalizations,
and calling out in the classroom (Kostinas et al., 2001; Kuttler
et al.,
1998), to date, the efficacy of a treatment package utilizing
these meth-
ods has not been evaluated with vocal stereotypy in a public
school
classroom.
When evaluating methods to decrease behavior, reinforcement-
based procedures, either alone or in conjunction with
punishment
procedures, may be considered. For example, differential
reinforce-
ment interventions have been empirically demonstrated to
mitigate
the negative side effects of punishment or extinction procedures

(Catania, 1997). However, the combination of punishment
procedures
with differential reinforcement has been demonstrated to be
more ef-
fective at reducing problematic behavior than differential
reinforce-
ment alone (Buckley & Newchok, 2005; Kostinas et al., 2001).
Differ-
ential reinforcement of low rates of behavior (DRL), first
described by
Fester and Skinner (1957), effectively reduced disruptive
behaviors in
individuals with disabilities, including but not limited to
requests for
teacher attention (Austin & Bevan, 2011), stereotypy (Singh,
Dawson,
& Manning, 1982), and physical and verbal aggression
(Alderman
& Knight, 1997). A DRL procedure involves the delivery of
positive
reinforcement contingent uponthe frequency of a target behavior
oc-
curring less than or equal to a predetermined limit during a
specified
period of time (Deitz, 1977). A DRL procedure is often used
when be-
haviors occur too often to be susceptible to other reinforcement
con-
tingencies (e.g., differential reinforcement of other behavior;
Martin
& Pear, 2010).
Kostinas and colleagues (2001) compared the effects of a DRL
procedure to a DRL with a response cost procedure on
perseverative
verbal behavior in an adult diagnosed with obsessive-

compulsive dis-
order. Results demonstrated that the DRL with response cost
proce-
dure produced greater reductions in perseverative speech than
the
DRL procedure alone (Kostinas et al., 2001). The authors
concluded
that DRL alone did not effectively reduce perseverative
verbaliza-
tions, and that the absence of inappropriate responses may be
the re-
sult of the participant avoiding negative consequences (i.e., the
loss
of a token), rather than accessing positive reinforcement
(Kostinas
et al., 2001). Though the authors did not discuss the function of
the
problem behavior, in the case of behaviors maintained by
automatic
411VOCAL STEREOTYPY
reinforcement, it may be difficult to either substitute a
functionally
equivalent reinforcer or find a reinforcer that will compete with
the
byproduct of stereotypy when using differential reinforcement
alone
(Falcomata et al., 2004).
The purpose of the current study was to extend the literature on
establishing SDP control of vocal stereotypy using arbitrary
stimuli and
a DRL with a token-based response cost procedure. A social

story was
used to describe the contingencies in place during the
experimental
sessions. All experimental sessions were conducted within a
public
school environment, with public school staff implementing the
pro-
cedures.
Method
Participant and Setting
David was a 4-year-old male who had been diagnosed with
an autism spectrum disorder. He had been diagnosed at the age
of
2-years-old. One year prior to the study, the Early Intervention
De-
velopmental Profile (Rogers et al., 1981) had been
administrated to
David. His social emotional skills were scored at the age
equivalent
of 33 months, self-care 25 months, cognition was scored at 30
months,
perceptual fine motor was 24 months, gross motor was 32
months,
receptive language was 24–31 months, and expressive language
was
scored at 26 months. The most recent speech and language
testing was
conducted during the study. Results from the Clinical
Evaluation of
Language Fundamentals® preschool second edition (Semel,
Wiig, &
Secord, 2008) suggested that David had a receptive language
index of

61 (which was 2 standard deviations below the mean), and the
results
of the Peabody Picture Vocabulary Test fourth edition (Lloyd &
Dunn,
2007) yielded a score of 74 (which was also 2 standard
deviations from
the mean).
He had been nominated for the study by his classroom teacher
and mother due to the high rate of vocal stereotypy at both
school and
home. David attended an integrated preschool classroom in a
pub-
lic elementary school. Four to six other students with
developmental
disabilities attended his classroom five days per week. During
two
of the five days the classroom was integrated with neurotypical
pre-
schoolers. The classroom included one special education teacher
and
three classroom assistants. The special education teacher had
taught
in a preschool classroom for children with autism for 11 years
and
had a master’s of science in intensive special needs at the time
of the
study. She had taken post-masters classes in Applied Behavior
Anal-
ysis (ABA) after completing her degree. The other three
classroom

assistants had a range of education from a high school diploma
to
an associates and bachelor’s degree. They had been working for
6 to
14 years with children with developmental disabilities. None of
the
classroom assistants had any classes or specific training in ABA
other
than workshops intermittently provided by their employer.
All sessions were conducted in the preschool classroom
through-
out the school day. The classroom included three individual
student
work areas divided by partitions, a circle area comprised of a
rug and
individual seats, and three tables, each identified by their shape
and
color. Sessions were conducted by the classroom assistant or
teacher
who was working with David for that period of time, and the
class-
room assistant or teacher also worked with one or two other
students
while running the experimental sessions. The study was
conducted
from September through February of the academic school year,
ex-
cluding programmed school breaks and weekends.
Response Measurement and Data Collection
Vocal stereotypy was defined as any instance in which David
engaged in non-contextual vocal word or sound output for three
con-
secutive seconds. An example included, David verbally

repeating the
plot of a television show during lunch while looking at his food.
A
non-example included if David responded to a question,
attempted
to ask a question, or engaged in contextual or non-contextual
vocal
output when making eye contact with an adult.
Partial interval recording (Johnston & Pennypacker, 1980) data
were collected during two to four experimental sessions per
day. Per-
centage of intervals in which vocal stereotypy occurred was
calcu-
lated by dividing the number of intervals in which vocal
stereotypy
occurred by the total number of intervals and multiplying by
100 per-
cent. Intervals were between 1 to 2 min in length for a total of 5
to
10 min depending on the experimental condition. The length of
the
intervals was determined at the onset of the experiment after the
re-
sults of the descriptive assessment demonstrated a high
frequency of
vocal stereotypy with little to no breaks in between episodes.
While
average frequency was not formally recorded, a 1 min session
was
determined to be the initial interval to evaluate if such a
measure
was representative of the overall occurrence of vocal stereotypy
and
was determined to be feasible for the staff in terms of data
collection.

The total session time was determined based on two criteria,
first,
sessions would start at small enough intervals so David would
access
reinforcement frequently, second, the total session duration was
long
enough to be effective while being manageable for
implementation by
classroom staff.
413VOCAL STEREOTYPY
Experimental Design
A changing conditions design (Kazdin, 1982) with an embed-
ded changing criterion design (Weis & Hall, 1971) was
employed to
evaluate the effects of discrimination training and differential
rein-
forcement of low rates (DRL) of behavior with response cost on
vocal
stereotypy. Criterion was initially set at 80% based on baseline
lev-
els of responding. The criterion was increased by 20%
systematically
when David engaged at or below criterion specific levels of
respond-
ing for two consecutive sessions. In order to demonstrate a
functional
relationship the criterion was increased to a previously attained
level
and then systematically decreased again.
Descriptive Assessment

Antecedent, behavior, consequence (Bijou & Baer, 1963) data
were recorded by the classroom behavioral consultant prior to
the
beginning of the study during targeted weekly observations.
Each ob-
servation occurred for approximately 30 min. The classroom
staff col-
lected daily data on (a) percent of intervals in which vocal
stereotypy
occurred for up to five 5 min sessions, (b) the activity (Figure
1), and
(c) the day of the week (Figure 2). An analysis of these
variables was
Figure 1. Average percentage of 1 min intervals during a 5 min
session where
vocal stereotypy occurred across classroom activities during
descriptive as-
sessment.
0
10
20
30
40
50
60
70

80
90
100
Group PT Snack Choice Story Music Circle Lunch Cooking 1:1
Work
OT
Group
Art
Activity
Pe
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in
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O
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conducted in order to develop a hypothesis regarding
environmental

events that potentially maintained vocal stereotypy. The results
of the
assessment suggested that vocal stereotypy was maintained by
posi-
tive automatic reinforcement. This conclusion was made for the
fol-
lowing reasons: (a) teachers reported that no consequence
appeared
to result in an increase or decrease in the occurrence of the
behavior,
and that when left alone, David was likely to engage in
continuous
vocal stereotypy; (b) responding was variable with no clear
trend
throughout the assessment (see Figure 3), and no clear patterns
in re-
sponding among days, activities, or time; and (c) responding
occurred
at lower levels during activities in which there were other
auditory
stimuli present (see Figure 1).
At the onset of the study, the behavioral consultant met with
the guardian and the teacher to determine goals for the
intervention.
Goals identified were as follows: 1) the intervention would
begin
with the criterion set so that David could contact reinforcement
(i.e., 5
min sessions comprised of 1 min intervals), and 2) the session
length
would be systematically increased to 10 min total
duration(comprised
of five 2-min intervals). The terminal duration was set to
approximate
the duration of work sessions in kindergarten, to which David

was
transitioning the following year.
Figure 2. Average percentage of 1 min intervals across 5 min
sessions where
vocal stereotypy occurred across days of the week.
0
10
20
30
40
50
60
70
80
90
100
Monday Tuesday Wednesday Thursday Friday
Pe
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Day of the Week
415VOCAL STEREOTYPY
Staff Training
The classroom teacher and assistants were trained to implement
all experimental conditions by the classroom behavioral
consultant
who was also the primary experimenter of the study. During the
first
phase of training, the consultant reviewed the written behavior
plan
of implementation procedures with the teacher and assistants. In
the
second phase, the behavioral consultant modeled the
implementation
of the experimental conditions for the staff in vivo. In the third
phase,
each staff was individually observed implementing the
experimental
conditions and then given immediate feedback. The classroom
teach-
er and staff were required to go through the training sequence
prior to
running the experimental procedures.

Figure 3. Percentage of intervals in which vocal stereotypy
occurred during
baseline (BL) and treatment (DRL/RC) across 1 min intervals
during 5 min ses-
sions, 1.5 min intervals during 7 min sessions, and 2 min
intervals during 10
minute sessions. Arrows indicate criterion (C=criterion) levels
on the graph.
C1 represents 80% of intervals, C2 represents 60% of intervals,
C3 represents
40% of intervals, C4 represents 20% of intervals, C5 represents
40% of inter-
vals, C6 represents 20% of intervals, C7 represents 0% of
intervals, and C8
represents 20% of intervals.
0
10
20
30
40
50
60
70
80
90

100
Baseline
C 6
DRL/RC
C 3
C 4
C 5
C 7
5 min 7.5 min 10
min
C 8
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Sessions
C1
C2
1 11 21 31 41 51 61 71 91 101 111 121 131 141 151 161 17181
Procedures
General Procedures. Across all experimental conditions, class-
room teachers and staff were instructed to implement the
treatment
procedures two to four times per day. The frequency was
determined
based on teacher reports of how often they could implement the
pro-
cedures, based on staffing and the number of students in the
class-
room (which changed at times).
David’s school day was broken up into activities in which there
were no specified programmed consequences for vocal
stereotypy
and activities in which programmed consequences were imple-
mented following the occurrence of vocal stereotypy. The

teacher
and classroom assistants met with the behavioral consultant to
de-
termine these activities. Playground, choice time, and free play
were
isolated as times when David was allowed to engage in vocal
stereo-
typy without the occurrence of a programmed consequence.
Circle,
small group activities, lunch, snack, and individual work time
were
determined to be times when vocal stereotypy competed with
other
desired responses, and it was therefore targeted for decrease
utilizing
the treatment package.
It was determined that changes in criteria would be communi-
cated to the classroom staff by the behavioral consultant after
an anal-
ysis of the current data. The behavioral consultant was
scheduled to
be in the classroom one to two times per week. For this reason,
David
may have met criteria and then remained in that phase of the
study
until the next time the behavioral consultant was in the
classroom for
consultation. Therefore, the number of days in a particular
phase of
the study was variable.
Baseline. The baseline condition occurred throughout the entire
school day. During baseline, staff redirected David to have a
quiet
voice (via verbal instruction paired with a finger put to the lip)

con-
tingent on any instance of vocal stereotypy. The social story,
token
board, and bracelets were not utilized during baseline.
Discrimination training. The no programmed consequence
condi-
tion was labeled the green condition, and a green circle was
placed
on the classroom schedule for those activities in which there
would
be no programmed consequence for vocal stereotypy. The
DRL/RC
condition was identified as the red condition, and the activities
that
resulted in the programmed consequence for vocal stereotypy
were
labeled with a red circle on the classroom schedule. The red and
green
colors were to serve as conditional stimuli associated with
differen-
tial consequences. In addition, the labels on the schedules
served as
prompts for the classroom staff regarding which experimental
con-
dition to run. It was determined that during some designated red
417VOCAL STEREOTYPY
activities it was not feasible for the red condition to be
implemented
due to insufficient staffing; therefore, during these times the
green
condition was implemented. It is important to note that the red

and
green designations were a guide for classroom staff, but the red
con-
dition did not occur for every occurrence of a red activity, due
to
staffing issues.
At the start of any scheduled activity in the classroom, the staff
instructed David on the condition specific contingency and
provided
him with the corresponding social story (Appendix B). At any
time
during the day in which the classroom staff did not run the red
condi-
tion, they implemented the green condition.
The DRL/RC condition was comprised of three phases. The pur-
pose of the phases was to systematically increase the amount of
time
in which the treatment package was implemented while
systematical-
ly decreasing the amount of intervals in which David could
engage in
vocal stereotypy. The first phase was implemented to establish
stimu-
lus control of vocal stereotypy across 5 min sessions. The
purpose of
the second and third phases was to systematically increase the
dura-
tion of time in which he was not engaging in vocal stereotypy.
Within
the first and second phase, the number of intervals in which
David
could engage in vocal stereotypy and receive contingent
reinforce-
ment was systematically decreased (i.e., the DRL). The purpose

of the
third phase was to evaluate if low levels of vocal stereotypy
could be
maintained across a longer session duration.
DRL and response cost (DRL/RC). At the start of the condition,
the
social story (Appendix B) was given to David and he was
instructed
to read it aloud. Simultaneously, a red wristband or watch was
put on
David’s wrist to signal the onset of the red condition. Staff
presented
a token board filled with five tokens and a prize box filled with
pre-
viously identified preferred items. The timer was set for the
phase
specific interval and started. If at any point during the interval
David
engaged in vocal stereotypy, the staff showed him the token
board
and removed a token. They then prompted a quiet voice by
holding a
finger up in front of their lips and counting to three, and
repeated this
procedure until David remained quiet for three consecutive
seconds.
Instructions were reintroduced regarding the contingency in
place. If
David engaged in vocal stereotypy at any other time during the
same
interval, the staff redirected him one time by holding a finger
up in
front of their lips.
At the end of the condition specific time, if David had kept the

criterion specific number of tokens, the green condition was
imple-
mented and he was given access to the prize box and all
tangibles
in the box for a predetermined reinforcement time. If David did
not
have the specified number of tokens remaining on the token
board,
the contingency for reinforcement was described. If the program
was
going to be run immediately again, the red condition continued;
if
the program could not be run again, the green condition was
imple-
mented.
Phase 1. During phase 1 of the DRL/RC, all sessions were com-
prised of five 1 min intervals for a total of a 5 min session.
Contingent
on meeting the criteria, reinforcement time was 1 min. The
phase began
with a predetermined criterion of 80% or less of intervals with
vocal
stereotypy (C1). Once this criterion was met, the criterion
decreased to
60% or less of intervals with vocal stereotypy (C2). Upon
meeting this
criterion, the criterion decreased to 40% or less of intervals
with vocal
stereotypy (C3). The next two criteria changes involved a
decrease to

20% or less of intervals with vocal stereotypy (C4) and a
reversal back
to 40% or less of intervals with vocal stereotypy (C5).
prised of five 1.5 min intervals for a total of a 7.5 min session.
Con-
tingent on meeting the criteria, reinforcement time was 1–2 min.
The
phase began with a predetermined criterion of 20% or less of
intervals
with vocal stereotypy, and once this was met, the criterion was
de-
creased to 0% or less of intervals with vocal stereotypy.
Figure 4. Average percentage of intervals where vocal
stereotypy occurred
across experimental conditions.
0
10
20
30
40
50
60
70
80

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100
Baseline
Criterion 1
Phase 1:
Criterion 2
Phase 1:
Criterion 3
Phase 1:
Criterion 4
Phase 2:
Criterion 5
Phase 2:
Criterion 6
Phase 2:
Criterion 7
Phase 3:
Criterion 8
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Experimental Condition
Phase 1:
419VOCAL STEREOTYPY
prised of five 2 min intervals for a total of a 10 min session.
Contingent
on meeting the criteria, reinforcement time was 2–3 min. The
criterion
for this phase was 20% or less of intervals with vocal
stereotypy.
No programmed consequence. At the start of the no programmed
consequence condition, the social story (Appendix B) was given
to
David and he was instructed to read it aloud. Simultaneously, a
green
wristband or watch was put on David’s wrist to signal the onset
of
the green condition, and David was instructed of the condition
spe-
cific contingency. There was no programmed consequence for
any in-
stance of vocal stereotypy.
Interobserver Agreement

Interobserver agreement (IOA) was collected for 25% of
sessions.
The behavioral consultant simultaneously recorded occurrences
of
vocal stereotypy independent of the classroom staff. Data were
com-
pared to identify the number of agreements and disagreements
IOA
was calculated by dividing the number of agreements by the
sum of
agreements and disagreements and multiplying by 100 to
determine a
percentage. Agreement was 97% (range of 60% to 100%). The
low data
point at 60% occurred during session 16 of baseline, when the
behav-
ioral consultant recorded repeated occurrences of vocal
stereotypy
during only one interval, but the classroom staff recorded the
repeat-
ed occurrences of stereotypy as occurring across consecutive
intervals
(i.e., although the repeated stereotypy occurred during the same
in-
terval, the staff recorded each instance in a new interval).
Feedback
on data collection was given to the staff following the recording
error.
Recording errors were not observed during any subsequent
observa-
tions, nor with any other classroom staff; therefore, additional
train-
ing was not conducted.
Social Validity

Social validity was assessed with a 7-point Likert scale consist-
ing of 10 questions and a brief open-ended comments section
(Ap-
pendix A). The form was adapted from the Treatment
Acceptability
Rating Form-Revised (TARF-R; Reimers & Wacker, 1988).
David’s
guardian, teacher, classroom staff, and home-based behavioral
con-
sultant recorded data on social validity at the end of the study.
Results
Experimental conditions. The results of the baseline condition
and
DRL/RC are shown in Figures 3 and 4. During baseline, David’s
vo-
cal stereotypy occurred at moderate levels during recorded
sessions,
averaging 60% of five 1 min partial intervals. When
discrimination
training and DRL/RC was implemented, vocal stereotypy
stabilized
with little variability at 56% of five 1min partial intervals on
average
in criterion 1 of phase 1. Criterion increases resulted in
decreases in
vocal stereotypy to 37% of five 1 min partial intervals on
average in
criterion 2 of phase 1, 26% of five 1 min partial intervals on

average in
criterion 3 of phase 1, and 15% of five 1 min partial intervals
on aver-
age in criterion 4 of phase 1. When the criterion was decreased
vocal
stereotypy increased to 28% of five 1 min partial intervals on
aver-
age in criterion 5 of phase 1.A return to the previous criterion
and an
increase in the duration of the session resulted in a decrease in
vocal
stereotypy to 12% of five 1.5 min partial intervals on average in
crite-
rion 6 of phase 2. The last criterion increase resulted in an
additional
decrease in vocal stereotypy to 10% of five 1.5 min partial
intervals on
average in criterion 7 of phase 2. A return to the previous
criterion and
an increase in the duration of the session resulted in a slight
decrease
in vocal stereotypy to 8% of five 2 min partial intervals in
criteria 8 of
phase 3 (see Figure 3 and Figure 4).
Social validity. Results from the social validity assessment (Ap-
pendix A) indicated that staff rated the procedures as a socially
ac-
ceptable way to decrease vocal stereotypy (mean of 5 out of 5
possible
points), while being easy to implement (mean of 4.5 out of 5
possible
points), and minimally intrusive to the participant (mean of 4.75
out
of 5 possible points). The raters also indicated that the
procedures

resulted in an improved rate of appropriate vocalizations both
dur-
ing (mean of 5 out of 5 possible points) and outside of session
(mean
of 4.75 out of 5 possible points respectively), and did not result
in
adverse side effects for the participant (mean of 5 out of 5
possible
points).
Discussion
In the current study, discrimination training paired with a
DRL/RC contingency effectively reduced the occurrence of
automat-
ically reinforced vocal stereotypy in a public school preschool
class-
room. The results of the intervention were achieved across a
time pe-
riod of 5 months, demonstrating the efficacy of the intervention.
The
results of the current study were similar to those of previous
studies
(e.g., Falcomata et al., 2004; Rapp et al., 2009) and suggested
that re-
sponse cost and discrimination training effectively reduced
vocal
stereotypy. In addition, these procedures could be implemented
in
a setting that was not experimental, with less experimental con-
trol, and still result in substantial reductions in interfering
problem
behaviors.

421VOCAL STEREOTYPY
Although there was some variability in the data, overall, the
contingent removal of a token paired with the opportunity to
earn a
prize box for low rates of vocal stereotypy was effective at
reducing
vocal stereotypy, even when the intervention was not
implemented
the same number of times daily. It appeared that the presence of
the
red bracelet enhanced the discrimination of the contingency
when the
DRL/RC was in effect; therefore, the red bracelet came to exert
SDP
control over vocal stereotypy. Rapp and colleagues (2009)
suggested
that establishing SDP control might be useful in educational
settings
because it may result in a teacher or trainer needing to provide
fewer
consequences to maintain low levels of problem behavior.
While the
current study did not record data on vocal stereotypy in the
presence
of the red bracelet without the DRL/RC contingency, low levels
of re-
sponding were maintained across 10 min sessions (Figure 3).
These
data support that establishing stimulus control of automatically
main-
tained problem behavior in the presence of arbitrary stimuli and
not
teachers, may reduce the need for intensive teacher supports to
main-
tain low levels of responding in educational settings.

Additionally, the red bracelet may have come to exert SD
control
over other responses that resulted in social positive
reinforcement;
therefore, in the presence of the red bracelet, positive tangible
rein-
forcement (i.e., prize box) for behaviors other than vocal
stereotypy
may have competed with the hypothesized automatic
reinforcement
derived from the vocal stereotypy. Teacher reports indicated
that to-
ward the end of the study, David occasionally refused the prize
box
and asked to engage in the current activity and continue to wear
the
red bracelet (i.e., restart the response cost). One hypothesis is
that by
reducing the interference of vocal stereotypy, other activities in
the
classroom became conditioned reinforcers. Alternatively, the
tokens
themselves may have become conditioned reinforcers and
keeping
them may have been as reinforcing as earning the prize box,
thus sup-
porting the role of tokens as mediating reinforcement to the
ultimate
reinforcer.
Teacher reports also indicated that there were days when David
engaged in vocal stereotypy and then asked the teachers for the
red
bracelet. The response product of vocal stereotypy may have
become

aversive due to being paired with the response cost contingency
dur-
ing the DRL/RC condition. Previous researchers (i.e., Rappet
al., 2009;
Lerman & Vorndran, 2002) demonstrated that verbal reprimands
be-
came effective punishers after being paired with a response
cost. A
similar effect may have occurred in the current study, except
that the
response product of the vocal stereotypy may have become an
effec-
tive punisher after the systematic pairing with the response cost.
The results of the current study contributed to the literature re-
garding effective treatment of vocal stereotypy in several ways.
First,
outcomes replicated and extended the results of previous
research
(i.e., Falcomata et al., 2004; Rapp et al., 2009) which
demonstrated
the effectiveness of establishing SDP control via a negative
punish-
ment procedure. Second, the current data demonstrated the
utility of
employing differential reinforcement of low rates of behavior
(DRL)
paired with mild punishment procedures to decrease
automatically
maintained problem behavior that was not susceptible to other
dif-
ferential procedures due to initial high rates of response. Lastly,

the
current procedures were implemented throughout the day in a
public
school preschool classroom. The classroom was integrated two
days
per week and staffed by individuals with minimal experience
with be-
havior analysis, and no experience conducting research. The
obtained
data suggested that the current procedures were not only
effective
but could be implemented in a natural environment without
exten-
sive training in behavior analysis or research methods.
Anecdotal reports suggested that David’s vocal verbal behav-
ior increased in the classroom. Though no formal data were
collected,
during observations David consistently used full sentences to
tact the
occurrence of classroom events, intraverbals to answer
questions, and
mands for attention. The DRL/RC contingency was also
implemented
by David’s guardians in the home and community, and they
reported
similar effects as the current study.
Several limitations to the current study should be noted. First,
a formal functional analysis was not conducted; therefore, other
vari-
ables may have maintained David’s vocal stereotypy. Future
studies
should ensure a function-based treatment prior to employing
punish-
ment procedures. Second, criterion changes did not occur

immedi-
ately after David met criterion for the phase. The experimenter
was
only available to visit the classroom one to two times per week.
Based
on this schedule, the phase was changed when the experimenter
was
able to go into the classroom, score the data, and then inform
the class-
room staff of the next phase. This resulted in some phases
where Da-
vid met criterion and remained in the phase for many
consecutive
sessions (e.g., criterions 5 and 8), or met criterion but then
remained in
the phase and variable responding occurred (e.g., criterions 1, 2,
3, 4,
6, and 7). While it is unclear if the delayed criterion change
influenced
response variability, substantial changes were evident,
demonstrating
that the procedures were efficacious in a less controlled
environment.
An additional limitation to the current study was that two
students with developmental disabilities joined the classroom
dur-
ing the second phase of the study. Variability in those data may
be
423VOCAL STEREOTYPY
attributed to less sessions daily as well as increases in staff to
stu-

dent ratios. Regardless, responding continued to remain at low
lev-
els, suggesting that the intervention was one that would not
require
constant staff attention to be successful. Another limitation was
that
the green condition was implemented when David earned the
prize
box and items that were hypothesized to evoke vocal stereotypy
such
as Thomas the Tank Engine© were put into the prize box and
not
available throughout the day. Previous studies (i.e., Charlop,
Kurtz,
& Casey, 1990) have evaluated the effects of using
automatically rein-
forced problem behavior as a reinforcer in differential
reinforcement
programs. The hypothesis that vocal stereotypy may also have
been a
reinforcer for low rates during the red condition was not
evaluated in
this study but may warrant further investigation as an
independent
variable. Additionally, the number of red and green sessions
were not
held constant daily. While red sessions did occur two to four
times
daily, there was no specific schedule; rather, session
implementation
was based on the classroom staff having the opportunity to run
the
program. Therefore it is unclear as to how many sessions were
neces-
sary to establish and maintain SDP control of vocal stereotypy.
Lastly,

vocal stereotypy was not measured in the green condition;
therefore,
it is unclear if vocal stereotypy remained the same when not
under
SDP control of the red bracelet or decreased across all
conditions. If
data were recorded during the green condition and there was a
de-
crease in responding compared to baseline, it would suggest that
the
classroom itself came to exert some SDP control of vocal
stereotypy.
If vocal stereotypy remained at the same levels in the green
condi-
tion as in baseline, reductions during the red condition may also
be
attributed to an abolishing operation in effect (Laraway,
Syncerski,
Michael, & Poling, 2003). David was able to engage in
behaviors that
produced automatic reinforcement at other times before and
after the
onset of the red condition (i.e., during any time he wore the
green
bracelet); therefore, he may have temporarily satiated on the
response
product of vocal stereotypy, resulting in a momentary decrease
in
the value of such reinforcement and reducing the occurrence of
vocal
stereotypy.
An additional limitation was that David’s guardians were im-
plementing the system in the home and community. Reports
from
the guardian and home-based behavioral consultant suggested

that,
within the home and community settings, the intervention
remained
at the beginning phases (i.e., 5 min sessions with 1 min
intervals)
and that the procedures may have been altered slightly due to
the
parents’ needs in the home and community. This may have pro-
duced a confound in two ways: 1) changing contingencies may
have
mitigated some of the effects in the classroom, increasing
variability
in vocal stereotypy and requiring that David contact the
contingen-
cies in the classroom before coming under control of the
classroom-
specific contingencies in place, and 2) the effects of the
intervention
may have been artificially increased, and generalization across
dif-
ferent staff and settings in the school may have been due to
expo-
sure to the contingencies in locations and with persons outside
of the
school, suggesting that some programming for generalization
was in
fact occurring.
The results of the current study provided many areas that war-
rant further investigation. First, future research should evaluate
if

changes in responding would remain suppressed without the
token
system and only the presence of the red bracelet. Second, the
occur-
rence of appropriate vocalizations should be measured. Previous
re-
search (i.e., Ahearn et al., 2007; Rapp et al., 2009) found that
there were
increases in appropriate vocalizations along with decreases in
vocal
stereotypy when implementing punishment procedures for vocal
ste-
reotypy. Future researchers should also compare the effects of
estab-
lishing stimulus control with arbitrary stimuli (i.e., the red
bracelet) or
stimuli in the environment that may naturally come to exert
stimulus
control (i.e., the classroom activity or location). For example,
when
one walks into the library, there is SDP control over the volume
of one’s
voice due to a history of punishment from the librarian in the
library.
One research question would be to evaluate generalization and
sup-
pression of vocal stereotypy over time with naturally occurring
stim-
uli being paired with the DRL/RC contingency as compared to
the red
bracelet or some other arbitrary stimulus. Lastly, it should be
evalu-
ated if the green condition is necessary for the development of
strong
SDP control. The results of the current study have many
implications

for practitioners, in terms of assessing and treating vocal
stereotypy in
an applied setting, with classroom staff implementing the
procedures.
The treatment package was developed based on the literature
but also
addressed desired outcomes reported by the guardian and
teacher
and the available resources of the behavioral consultant, the
teacher,
and the classroom staff.
In the current study, David’s vocal stereotypy was brought
under control of the colored bracelets, with the addition of a
cor-
responding response cost system and social story. While
effective,
the intervention was implemented at various times per day with
different staff, and across multiple settings within the school.
Re-
sults demonstrated that the effects of the intervention were
general-
ized without direct training and that the effects were maintained
throughout vacations, during days with fewer sessions, and
without
425VOCAL STEREOTYPY
constant oversight by a graduate-level behavioral clinician.
Further-
more, results suggested that a DRL with response cost
procedure
may be an effective way to reduce behaviors maintained by
auto-

matic reinforcement, without the use of extinction-based
procedures
or the side effects typically associated with punishment
procedures.
It remains imperative that behavioral consultants work with
guard-
ians, teachers, and classroom staff to develop efficacious
interven-
tions that can be successfully implemented with intermittent
over-
sight from the consultant.
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429VOCAL STEREOTYPY
Appendix A
Social Validity Scale
Token System + Red Bracelet
After implementing the procedures or watching the implemen-
tation of the procedures in the classroom, please answer all
questions
honestly and to the best of your ability. His will help to
interpret the

overall social validity of the study for future reference.
1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree,
5 = strongly agree
1. I like the token system + red bracelet procedure. 1 2 3
4 5
2. I think this procedure was easy to implement. 1 2 3
4 5
3. I am satisfied with my students/child’s response
to the procedure.
1 2 3 4 5
4. The token system + red bracelet reduced my stu-
dent/child’s vocal stereotypy during the session.
1 2 3 4 5
5. I thought the token system + red bracelet proce-
dure was intrusive.
1 2 3 4 5
6. The token system + red bracelet program was a
socially appropriate intervention for my student/
child.
1 2 3 4 5
7. I think token system + red bracelet training re-
sulted in an improved rate of appropriate vocal-
izations during the session.

1 2 3 4 5
8. I think token system + red bracelet resulted in
an improved rate of appropriate vocalizations out-
side of the sessions.
1 2 3 4 5
9. My child/student will benefit in the long run
from the procedures implemented in this study.
1 2 3 4 5
10. I think token system + red bracelet training
produced negative emotional reactions in my stu-
dent/child.
1 2 3 4 5
Please feel free to write in any additional comments regarding
the
study here:
Appendix B
Red Condition Social Story:
Green Condition Social Story:
Reproduced with permission of the copyright owner. Further

reproduction prohibited without
permission.

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