Distinguishing Obsessive-Compulsive Behavior From Stereotypy

Abstract

The current project was an initial attempt to develop assessment procedures for distinguishing between obsessive-compulsive (OC) and stereotypic behavior and evaluate the impact of different treatments for these behaviors. Two individuals with autism, one with repetitive behavior characteristic of OC behavior and one with repetitive behavior not characteristic of OC behavior, participated in the study. In Experiment 1, given that individuals with Obsessive-Compulsive Disorder (OCD) report experiencing unpleasant urges that are relieved when they perform compulsive actions, an attempt was made to identify these experiences by measuring heart rate and affect when access to repetitive behavior was restricted and allowed. In Experiment 2, a multiple schedules treatment was conducted with each participant, and in Experiment 3, the participant with autism and OC behavior completed exposure and response prevention (ERP) treatment. The overall results across studies suggest that one potential way to discriminate between OC behavior and stereotypy in nonvocal children with autism is to consider the topography of repetitive behavior along with changes in physiology and affect. In addition, it may be worth considering the use of ERP, a traditional treatment for OCD, to treat repetitive behavior maintained by automatic reinforcement if treatments that provide access to repetitive behavior are not effective.

Treating obsessive compulsive behavior and enhancing peer engagement in a preschooler with intellectual disability

“…Reductions in both behaviors were maintained at a 3‐week follow‐up. These results extend the applicability of combined ERP and function‐based protocols (Vause et al, ; Vause et al, ) to a child with ID and implementation in an inclusive preschool setting and contribute to a growing body of literature about treatments for OCBs using function‐based intervention (Chok & Harper, ; Rodriguez et al, ) or ERP (Boyd et al, ; Chok & Koesler, ).…”

“…Replication of the results with greater control of extraneous variables will be necessary in order to evaluate the treatment with greater internal validity. In order to determine the function of each OCB, an experimental functional analysis could be conducted in future studies with technology aimed at determining the role of physiological distress as a motivating operation for OCBs (Chok & Koesler, ). Further development of informant assessments addressing the role of automatic negative reinforcement in maintaining OCBs will further assist clinicians conducting functional behavioral assessments.…”

“…ERP is the process by which an individual is exposed to stimuli that trigger anxiety or distress and refrains from engaging in the compulsive behavior (March & Mulle, ). Using an ERP procedure, Chok and Koesler () treated a 14‐year‐old adolescent with ASD and ID who engaged in repetitive cleaning behaviors. By prompting attention to the items on the table to extinguish the respondent behavior (i.e., increased heart rate) and blocking attempts to clean to extinguish the operant behavior (i.e., repetitive cleaning), rates of cleaning decreased to near‐zero levels.…”

Decreased environmental complexity during development impairs habituation of reinforcer effectiveness of sensory stimuli

“…These repetitive behaviors are often associated with increased sensitivity to sensory stimuli [25–28]. Other types of repetitive behaviors are commonly observed in patients with obsessive-compulsive disorder and tic disorders [2], which are topographically different from the simpler forms of repetitive behaviors observed in ASD and SMD [69, 70].…”

Introduction to the Special Issue

“…Chok and Koesler (2014) introduced procedures for distinguishing repetitive behaviors that are categorized as stereotypy from repetitive behaviors that are categorized as obsessive compulsive. That is, the authors examined internal (i.e., change in heart rate) and external (i.e., indices of happiness) behavioral events that may be indicative of automatic positive reinforcement and automatic negative reinforcement functions, respectively.…”