An Exploration of Perseverative Behaviors in Young Children with Autism

By Madison M. Ralph and K. Alisa Lowrey
2016, Vol. 8 No. 02 | pg. 2/3 |

Data Analysis

Observations

To analyze the data, the researcher highlighted hard copies of the observations by hand. The researcher began the highlighting by deciding which behaviors were most prominent in the clinic and assigning each group of behaviors a highlighter color. Once notes were color-coded, the researcher then analyzed themes for commonalities and outliers.

First coding

During the first coding, the researcher determined emergent themes based on the most prevalent behaviors. The most apparent theme was Mary’s speech perseverations. The researcher created two specific categories out of Mary’s speech perseverations: those that were a direct result of a probe (highlighted pink) and those that existed outside of the probes (highlighted orange). An example of a perseveration resulting from the probe (pink) would be if the interventionist asked Mary “What do you like to do for fun?” which is the probe for skill two, and she replied “playing outside.”

The researcher identified a third theme: the implementation of any behavioral intervention (highlighted green). This theme included any instance in which an interventionist redirected, prompted, positively reinforced, negatively reinforced, or blocked a behavior. An example of this would be an interventionist saying “good asking” to a participant after they appropriately expressed a want or need. Typically, the interventionists’ behavioral directions were seen after Caleb exhibited a challenging behavior. For this reason, Caleb’s challenging behavior pattern of screaming, throwing/hitting, jumping up, and trying to run out of the room was (highlighted yellow) included within this theme of “behavioral intervention.” An example of this would be Caleb yelling at a fellow participant while playing Don’t Break the Ice, throwing an ice cube game piece, standing up, running to the door and trying to run out of the clinic.

The three themes noted were those identified upon the first round of coding the observation notes; they are listed in Table 1. During this first analysis, the researcher began keeping a list of examples of each of the themes, particularly Mary’s verbal perseverations. This process revealed that Mary had far fewer perseverations resulting directly from a probe and many perseverations existing outside of a probe. Based on this finding, the researcher performed a second coding.

Second coding

Mary’s perseverations existing outside of a probe were broken down into two sub-themes: perseverations that were formed at the clinic and perseverations that were formed before the clinic. The researcher defined perseverations that developed at the clinic as any perseveration that began after the first three weeks of the clinic. This time frame was decided because Mary was only present for three of the six sessions from week one to week three, and the first perseveration noted that directly related to the clinic (“can I tap you on the shoulder”) was first seen on June 23 in week four. These perseverations were previously highlighted orange, so they were underlined grey during the second coding. The researcher defined perseverations that developed before the clinic as any perseveration noted before week four or any perseveration focused on a subject not at the clinic. Table 2 lists all of the specific perseverative phrases that were included within the two sub-themes of Mary’s perseverations outside of the probes.

Interviews

After both of the interviews were conducted, the researcher printed two hard copies of each interview for coding. On the first coding, the researcher highlighted the similarities between Dr. Raoul’s responses and Erik’s responses in yellow. The researcher highlighted contrasts in the responses in green. On the second coding of the interviews, the researcher went through both the responses and the questions to the interviews and highlighted based on the three themes identified for the observation notes. Any reference to Mary’s perseverations directly resulting from probes was highlighted pink, any reference to Mary’s perseverations existing outside of the probe was highlighted orange, and any reference to behavioral interventions was highlighted green.

Trustworthiness

This case included data that allows for triangulation (Stake, 1995) in the following ways: a literature review based on the historical treatment and EBP intervention with stereotypy in young children; a document review of interventionists’ qualifications; a document review of participants’ case files; direct observation to answer specific questions; and a conclusive interview with the clinic director. All data sources were triangulated to determine areas of intersection and difference. To increase trustworthiness, 30% of the researcher’s notes were also coded for themes by a secondary coder. Agreement was at 80%. Peer debriefing was the method implemented to evaluate progress, edit the study, and submit. The peer helped the researcher analyze the observations through the development of the data analysis procedures.

Results

The results are presented in terms of theme. In order to compile the themes, the researcher copy and pasted exemplars of each theme into three separate Word documents: one for Mary’s probe perseverations, one for Mary’s perseverations outside of the probes, and one for Caleb’s behavioral interventions. This allowed the researcher to view each instance noted in the observations pertaining to each theme and count the frequency of each behavior within the themes.

Mary’s Probe Perseverations

The first perseveration that Mary developed was in response to the probe “what do you like to do for fun?” From week three, which is the second session for which Mary was present at the clinic, Mary responded with “playing outside.” The interventionist found that Mary responded with this phrase 34 times out of the recorded 44 times she was given the probe. The ten times that Mary responds with something other than “playing outside” is when the skill is being targeted with the use of visual cue cards.

The second perseveration that Mary developed was in response to the probe “tell me about your day” There are three variations of Mary’s response to this probe: “have fun playing outside,” “did you have fun?, or a combination of both. Mary responded with one of these 21 out of the 35 recorded times she was probed on this skill. Three of the 37 times, Mary did not provide a relevant response or any response at all. 11 of the 34 times, Mary responded with the trained responses as a result of the visual cue cards.

The third and last perseveration that Mary developed was in response to “go ask _____ for a toy.” To this probe, Mary responded, “can you have a toy?” seven of the 34 times that she was probed for this skill. The difference in this skill is that Mary developed the perseveration within the first week, but no longer used the perseveration after the skill was targeted in week three. The three responses trained for this skill was saying the person’s name, tapping them on the shoulder, or saying “excuse me” before asking for a toy. Mary immediately started using the person’s name when she would request a toy. She did this 28 of the 37 times that she was probed for this skill. The main pattern that was noted with this theme is Mary forming an initial perseveration to the probes and then varying her response when trained with the cue cards.

Mary’s Perseverations Outside of the Probes

Perseverations developed before the clinic

The first perseveration that Mary exhibited in the clinic was repeating people’s names and naming people to address them, which was observed 81 times. The only pattern observed with this behavior is that she usually began each session by repeating names. Mary also came to the clinic saying “I’m sharing” or asking if she could share; this perseveration was observed 24 times. The perseveration of sharing was often said out of context, so it may have occurred as a result of prior intervention or training. Finally, Mary perseverated on people’s hair and eyes 52 times. This perseveration occurred during free play typically.

Perseverations developed at the clinic

The first of these is Mary asking if she can go home; Mary began the clinic not saying this phrase, but began saying it multiple times per session by week five. On week six Meg answered the question by showing Mary her watch and telling her that she could go home “when the big hand gets to the 12.” Within the next three weeks, Mary perseverated on “when the big hand gets to the 12?” 12 times when asking if she could go home. The combination of these two perseverations shows how quickly Mary was able to pick up on a phrase and perseverate on it. The other pattern associated with this perseveration is that it usually occurred towards the end of each session.

The second perseveration that was formed at the clinic and is considered prevalent is Mary saying “rawr!” or asking to play scare, which occurred 37 times. The pattern with this theme is how quickly it developed. The first time the behavior was observed was on July 2 during week six when Mary opened the door in the middle of the session and said “rawr!” Within the next three weeks, the phrase was noted 36 more times. A pattern associated with this perseveration is the reinforcement that the interventionists provided it. This is exemplified on July 9, when Mary runs up to Erik and says “rawr!” Erik immediately says “boo” and starts playing with Mary, commenting that they are playing “scare.” This perseveration potentially shows how much Mary increases a phrase when it is positively reinforced.

Caleb’s Behavioral Interventions

Redirection, “good asking,” blocking a behavior, and positive reinforcement were the prevalent intervention behaviors. The interventionists redirected an undesirable behavior 14 times within the clinic, told a participant “good asking” 12 times, blocked an undesirable behavior (always with Caleb) ten times, and provided positive reinforcement 11 times. A few interventionist behaviors were not considered significant due to their low frequency. One of these is prompting, which was only noted three times in the observations. It is important to note that even though prompting behavior by means of the interventionists was only noted in three instances, the clinic itself implemented prompting through the visual cue cards in each of the four skills. Caleb’s behavioral pattern was documented 12 times. This pattern must have included him yelling, trying to run out of the room, and hitting/throwing in order for it to be counted under this subtheme.

Interviews

The results of the interviews did not address specific SRBs. Rather the interview results provided a more overall look at the success of the clinic. Though Dr. Raoul’s answers reflected that he was able to see both the behavioral pattern Caleb exhibited and the verbal perseverations Mary exhibited, his focus was directed towards the data of the overall clinic. In terms of the success of the clinic, Dr. Raoul’s answers reflect that the clinic was successful. By focusing on the data, he told the researcher that the data reflect success in the acquisition of the skills taught and the teaching of three responses for each skill.

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