An examination of avoidance extinction procedures in treatment of maladaptive higher-order repetitive behavior in autism

Higher-order repetitive behaviors are key elements to the definition and expression of autism spectrum disorders. Variously labeled compulsion, ritual, or sameness, these complex behaviors cause stress to the individual, interfere with adaptive activities, and generally diminish quality of life. Procedures used to address similar behaviors characteristic of other disorders, such as obsessive-compulsive disorder, frequently share a common basis in avoidance extinction. From basic flooding to cognitive-behavioral therapies utilizing graduated exposure, these methods are well established in ameliorating avoidance maintained behaviors. The present study includes two aims: (1) assess the utility of basic avoidance extinction procedures in treating maladaptive higher-order repetitive behavior among persons with autism, and (2) provide an initial examination of physiological arousal as it pertains to the performance of such behaviors. Three male participants with frequent, nonsocially maintained higher-order repetitive behaviors were selected from a pool of 18 adults with autism and intellectual disability. Results indicated that intervention achieved extinction for 2 of the 3 participants, with the third showing a decrease in target behavior. Heart rate data were available for one participant. Significant differences between epochs related to the presence or absence of the controlling stimulus were detected. Implications and limitations of experimental results are discussed.