Teaching Children with Autism to

Prefer Books or Toys Over

Stereotypy or Passivity

Robin Nuzzolo-Gomez Abstract: Two experiments were conducted with 4 students with autism to test the relationship
between either toys or books as conditioned reinforcers for observing or playing and their effect
Mandy A. Leonard
on stereotypy and passivity. Experiment 1 consisted of a single preschool student who emitted
Eyleen Ortiz
and frequent intervals of passive behavior and infrequent intervals of looking at books in a free play
Celestina M. Rivera setting. After systematic training sessions involving pairings of reinforcers with looking at
The David Gregory School books, he engaged in looking at books significantly more than in his baseline in free play and
decreased intervals of passivity. Experiment 2 involved a multiple baseline across 3 students.
R. Douglas Greer Baseline data were followed by toy-play conditioning sessions run concurrently with free-play
Columbia University observations. The 2 students who emitted frequent rates of stereotypy in baseline had signifi-
cantly fewer intervals of stereotypy after toys were conditioned as reinforcers and toy play
increased for all 3 students.

Stereotypy is a prevalent behavior of children with autism.
Greer, Becker, Saxe, and Mirabella (1985) defined stereo-
typy as cycles of repetitive movements that have no appar-
ent consequences for the individual who is emitting the
responses beyond the movement itself. Some children with
autism engage in abnormally frequent rates of stereotypy
(Baumeister & Forehand, 1972). Research has been con-
ducted on stereotypical behavior and its interference with
more adaptive behaviors such as toy play
(Koegel, Fire-
stone, Kramme, & Dunlap, 1974) and academic instruc-
tion (Koegel & Covert, 1972). Numerous treatments have
been utilized to decrease stereotypical behaviors and most
of these have been punishment procedures, including
physical restraint (Marholin & Townsend, 1978), overcor-
rection (Foxx & Azrin, 1973), and even the use of electric
shock (Baumeister & Forehand; Lovaas, Schaeffer, & Sim-
mons, 1965). Punishment procedures have been effective
in decreasing stereotypy but often have limited mainte-
nance of initial treatment effects.
Positive approaches, although less prevalent in the
corpus of literature, have also been successfully imple-
mented to decrease stereotypical behavior in children with
autism. These positive treatment approaches have included
differential reinforcement of other behavior (Harris & Wol-
chik, 1979), spaced responding differential reinforcement
of low rates (Singh, Dawson, & Manning, 1981), and teach-
ing children functionally equivalent communication (Du-
rand & Carr, 1987). Two experiments utilizing positive
treatment approaches showed that high rates of stereotyp-
ical or passive behaviors in children or young adults with
autism or pervasive developmental disorder could be re-
duced when the participants were taught to play (Eason,
White, & Newsom, 1982; Greer et al., 1985). Eason et al.
taught children to play with toys, and the instruction re-
sulted in increases in toy play and decreases in stereotypy.
Their data showed that learning to play with the toy re-
sulted in decreases in stereotypy when the children had the
toys and were reinforced with extrinsic reinforcers for toy
play. Greer et al. (1985) sought to determine whether the
toys or play objects could reinforce play that replaced
stereotypy when teachers were not present. In one experi-
ment they found that students whohad never engaged in
stereotypy would do when their preferred toy was re-
so
moved, suggesting that the function of stereotypy was play.
In a second study, they found that conditioning the rein-
forcement effects of playing with a ball resulted in the re-
duction of stereotypy and physical assaults by young adults
who had been institutionalized for many years. Moreover,

80
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after 6 months of not having access to the ball, reintroduc-
tion of the ball immediately reduced stereotypy for several
sessions. Together, these studies suggested that stereotypy
was a form of play and that instruction that conditioned
play objects as reinforcement was a valid and nonpunitive
approach to the treatment of stereotypy or passivity in
free-play settings.
In other laboratory studies of both children and
adults, researchers found that durable preference could be
developed for previously nonpreferred stimuli by pairing
conditioned reinforcers (praise or tokens) with nonpre-
ferred stimuli until the nonpreferred stimuli become the
preferred stimuli, as measured by moment-to-moment re-
inforcement control (Greer, 1981; Greer, Dorow, & Randall,
1975). These data showed that new choices could be condi-
tioned. Greer et al. (1985) showed that newly conditioned
reinforcers could replace stereotypy and, consequently, ob-
serving or playing behavior could displace the formerly
preferred stereotypical behavior.
The following two experiments were designed to de-
termine whether the findings of Greer et al. could be ex-
tended to preschool children with autism. In the following
experiments, toys and books were conditioned as rein-
forcers through training sessions in which prosthetic rein-
forcement was paired with the toys or books until the
students chose to use the conditioned items. We then ob-
served whether the conditioning procedure affected the
free-play choices of stereotypy, passivity, or play. Can stu-
dents’ choices be conditioned so that newly conditioned
reinforcers lead to more appropriate independent play that
replaces aberrant behavior? Experiment 1 investigated the
effect of conditioning looking at books and the choice of
passivity or looking at books in a free-play setting. Experi-
ment 2 sought to determine whether students who showed
little or no toy play in a free-play setting would replace
stereotypy with toys when the toys were conditioned as re-
inforcers for play in training sessions. Would the stimulus
control of playing with toys or looking at books replace the
stimulus control of the effects of stereotypy or passivity in
free-play settings as a function of training sessions devoted
to conditioning the new stimuli as reinforcers?
EXPERIMENT 1
Method
PARTICIPANT
One student (Student A) participated in the experiment.
Student A was a 3-year-old boy diagnosed with autism. He
was diagnosed by a medical doctor using the Childhood
Autism Rating Scale (Schopler, Reichler, & Renner, 1988),
on which he achieved an overall score that placed him in
the moderate to severe range for an autism spectrum
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81
disorder. He was toilet trained, ambulatory, and able to
perform activities of daily living with partial physical assis-
tance. He followed one-step vocal commands and could
vocally mand and tact single words. He was chosen from a
group of seven students because systematic observations
showed that he emitted frequent intervals of passivity and
few intervals of looking at books in a free-play setting. The
participant also imitated movements modeled by the ex-
perimenter, which was a characteristic he needed to have
in order to teach him to look at books.
SETTING
The observation and training took place in a self-
contained special education classroom in a publicly
funded, private day school for preschool children with
autism. The classroom had a one-to-one student to staff
member ratio. There were six students and six staff mem-
bers present in the classroom when the participant was ob-
served and conditioned to look at books. The books that
were available were constant in type and number through-
out the entire experiment. The conditioning of books was
done at a large table in the back of the classroom. All other
data were taken in a play area referred to as the free-play
setting. The free-play setting was a 10 by 5 foot area in the
back of the student’s classroom in which there was a single
toy box containing toys and a bookshelf containing ap-
proximately 100 books written on a kindergarten level.
DEPENDENT VARIABLES
Two categories were observed: (a) looking at books and
(b) passivity. Looking at books was defined as exhibiting be-
haviors such as touching and making eye contact with a
book. Passivity was defined as not looking at, touching, or
searching for a book, or sitting and not responding to toys
or books. If both of the two response categories occurred
during the interval, both were recorded for the interval.
DATA COLLECTION
Data were collected during 5-minute observation sessions
in the free-play setting. A total of 60 intervals were con-
ducted in each 5-minute session. Observers who directly
collected the data were cued in 5-second intervals with a
staff member’s vocal command, &dquo;Record.&dquo; A staff member
would set a digital timer for 5 minutes and at the end of
each 5-second interval would give the vocal command,
&dquo;Record.&dquo; This vocal command served as the prompt for
the observers to record the data by hand on grid sheets
with columns for the two dependent variables-looking at
books and passivity. There were 60 consecutive 5-second
intervals. Partial interval recording was used, and intervals
could contain more than one response class. For example,
82
if theparticipant looked at a book for 2 seconds and en-
gaged in passive behavior for the following 3 seconds, both
response classes were recorded for that interval. The con-
ditioning of books was then started and data were taken in
the same manner. The experimenter ran one session of
book conditioning, waited at least 30 minutes, and then
placed the child in the free-play setting. Data were taken in
this format for each session of treatment.
INTEROBSERVER AGREEMENT
The percentage of interobserver agreement was calculated
for both of the dependent variables by dividing the num-
ber of interval agreements by the total number of interval
agreements and disagreements and multiplying this num-
ber by 100. A second observer conducted independent
agreement observations for 38% of the total sessions. The
mean agreement was 97% with a range of 90% to 100%.
BOOK CONDITIONING PROCEDURES
The student was conditioned to look at books using a set
of scripted procedures that were part of a program de-
signed to teach toy conditioning (Greer et al., 1985). Each
session consisted of 20 learn units (Greer & McDonough,
1999), which were scored in terms of whether the student
self-initiated, independently looked at the book following
the experimenter antecedent, &dquo;You do it,&dquo; or required phys-
ical prompting to look at the book. To begin each learn
unit, if necessary, the experimenter prompted the student
to look toward the book. A book was then placed in front
of the child, and he was given 5 seconds to initiate looking
at the book. If he did, vocal praise and edible reinforce-
ment in the form of pretzels and crackers were delivered
and a plus was recorded on the data sheet for self-
initiation. If he did not respond, the experimenter mod-
eled turning the pages and looking at the book. The book
was then placed back in front of the student and he was
told, &dquo;You do it.&dquo; If he then looked at the book, vocal praise
and edible reinforcement were delivered and a plus was
recorded on the data sheet for independently looking at
books. If he did not look at the book, a physical prompt
was used, a vocal correction of, &dquo;This is looking at the
book&dquo; was delivered, and a minus was recorded on the data
sheet for independently looking at books. Training ses-
sions were continued throughout the entire conditioning
phase. Separate free-play sessions were run concurrently
but were separated from the training sessions by at least
30 minutes. Concurrent free-play sessions were conducted
following the exact procedures applied in baseline sessions.
No vocal praise and edible reinforcement were delivered to
the student in the free-play setting for all conditions. Data
from the book conditioning procedure are not present for
brevity’s sake, but criterion for the student was at least 90%
self-initiated looking at books for two consecutive sessions.
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EXPERIMENTAL DESIGN
An ABCA design and two follow-up probes were used to
compare the effects of books versus no books on the stu-
dent’s passivity. Phase A represents observation of the
free-play setting with books available. Phase B represents
post-book conditioning with books present. Phase C rep-
resents post-book conditioning without books present.
The final phase represents a reversal to baseline conditions
with books present. The dependent variables were looking
at books and passivity. The independent variable was a
book conditioning procedure.
Results
During baseline conditions, the student looked at books
for a range of 0 to 25 intervals with a mean of 14.5 and was
passive for a range of 21 to 57 intervals with a mean of
38.8. In Phase B, post-book conditioning, the student
showed an immediate increase in looking at books and a
significant decrease in passivity. The student looked at
books for a range of 39 to 57 intervals with a mean of 55.9
and was passive for a range of 2 to 21 intervals with a mean
of 10.1. To test for a functional relationship, in Phase C,
books were removed from the free-play setting and only
passivity was measured. The overall trend was ascending
with a range of 10 to 54 and a mean of 38 intervals of pas-
sivity. A reversal to baseline condition was then conducted.
In the reversal phase the looking at books data ranged
from 33 to 59 intervals present with a mean of 50.8. Two
follow-up probes were conducted 30 days and 90 days after
the experiment, and resulting data showed that the books
maintained stimulus control as a function of the book
conditioning with the student looking at books in 58 and
60 intervals (see Figure 1).
Discussion
The data showed a functional relationship be-
resulting
tween the book conditioning procedure and the student’s
increase in looking at books and decrease in passivity. Data
showed that books acquired stimulus control as a function
of the book conditioning procedures. When books were
removed from the environment, the student remained
passive for the majority of the sessions. It can also be
stated that the absence of books resulted in the student’s
passivity.
EXPERIMENT 2
Method
PARTICIPANTS
Three students (Students A, B, and C) participated in the
experiment. All three were diagnosed by a medical doctor

Figure 1. intervals of looking at books and passivity in the free-play setting.
using the Childhood Autism Rating Scale, on which they
achieved an overall score that placed them in the moderate
to severe range for an autism spectrum disorder. Student A
was a 4-year-old boy. He was toilet trained, ambulatory,
and able to perform activities of daily living with minimal
assistance. He followed multistep vocal commands and
could vocally mand and tact using multiple autoclitics.
Student B was a 7-year-old girl. She was toilet trained and
ambulatory but unable to perform activities of daily living
without partial physical assistance. She followed one-step
commands and could vocally mand and tact using multi-
ple autoclitics. Student C was a 7-year-old boy. He was toi-
let trained, ambulatory, and able to perform activities of
daily living with minimal assistance. He followed multistep
vocal commands and could vocally mand and tact using
multiple autoclitics. They were chosen from a group of
eight students because systematic observations showed
that they emitted the highest rates of stereotypy and the
lowest rates of toy play in a free-play setting. All partici-
pants were able to imitate 10 movements modeled by the
experimenter, which was a characteristic they needed to
have in order to teach them to play with toys. The toys were
used to be conditioned for stimulus control.
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83
SETTING
The observation and training took place in a self-
contained special education classroom in a publicly
funded, private day school. The classroom had a one-to-
one student to staff member ratio. There were five students
and seven staff members present in the classroom when
the participants were observed and conditioned to play
with toys. The toys available were blocks, balls, puzzles,
musical instruments, cars, trucks, a toy garage, dolls, doll-
houses, and stuffed animals. The conditioning of toys was
done at a large table in the back of the classroom. All other
data were taken in a toy area referred to as the free-play
setting.
RESPONSE CLASSES
Two categories of responses were observed: (a) toy play
and (b) stereotypy. Toy play was defined as exhibiting be-
haviors such as touching the toy or using it in the manner
for which it was designed with no end other than the ma-
nipulation of the toy itself. Stereotypy was defined as hand
flapping or clapping, finger-flicking, making nonsensical
84
vocal noises, object mouthing, and rocking. A toy-play re-
sponse could not involve the student concurrently emit-
ting any stereotypical behavior. If the student utilized the
toy in a stereotypical manner, this was recorded as an oc-
currence of stereotypy for that interval. If both of the two
response categories occurred separately during that inter-
val, both behaviors were recorded for the interval.
DATA COLLECTION
Data were collected during 5-minute observation sessions.
A total of 60 intervals were conducted in each 5-minute
session. Observers who directly recorded the data were
cued in 5-second intervals with a staff member’s vocal
command, &dquo;Record.&dquo; A staff member set a digital timer for
5 minutes and at the end of each 5-second interval gave the
vocal command, &dquo;Record.&dquo; This vocal command served as
a prompt for the observers to record the data
by hand on
grid sheets of the two response classes-toy play and
stereotypy. There were 60 consecutive 5-second intervals.
Partial interval recording was used, and intervals could
contain more than one response class. For example, if the
participant played with a toy for 2 seconds and engaged in
stereotypy for the following 3 seconds, both responses
were recorded for that interval. The conditioning of toys
was then started and data were taken in the same manner.
The experimenter ran one session of toy conditioning,
waited at least 30 minutes, and then placed the child in the
free-play setting. Data were taken in this format for each
session of treatment.
INTEROBSERVER AGREEMENT
The percentage of interobserver agreement was calculated
for both of the dependent variables by dividing the num-
ber of interval agreements by the total number of interval
agreements and disagreements and multiplying this num-
ber by 100. A behavior analyst supervisor conducted
agreement observations for all three participants. The per-
centage of agreement was calculated for 46% of Student A’s
sessions, with the mean agreement being 100%; 39% of
Student B’s sessions, with the mean agreement being
100%; and 37% of Student C’s sessions, with the mean
agreement being 100%.
TOY PLAY CONDITIONING PROCEDURES
The students were conditioned to play with toys using a set
of scripted procedures that were part of a program de-
signed to teach toy play (Greer et al., 1985). Each session
consisted of 20 learn units (Greer & McDonough, 1999),
which were scored in terms of whether the student self-
initiated, independently played with the toy following the
experimenter antecedent, &dquo;You do it,&dquo; or required physical
prompting to play with the toy. To begin each learn unit, if
Downloaded from pbi.sagepub.com at NORTH CAROLINA STATE UNIV on May 15, 2015
necessary, the experimenter prompted the student to look
at the toy. The toy was then placed in front of the child and
he or she was given 5 seconds to initiate toy play. If he or
she did so, vocal praise and edible reinforcement in the
form of candy, pretzels, or popcorn were delivered and a
plus was recorded for self-initiation on the data sheet. If
the child did not respond, the experimenter then modeled
playing with the toy. The toy was then placed back in front
of the student and he or she was told, &dquo;You do it.&dquo; If the
child then played with the toy, vocal praise and edible re-
inforcement were delivered and a plus was recorded on the
data sheet for independently playing with the toy. If he or
she did not play with the toy, a physical prompt was used,
a vocal correction of, &dquo;This is playing with the toy&dquo; was de-
livered, and a minus was recorded on the data sheet for in-
dependently playing with the toy. Training sessions were
continued throughout the entire conditioning phase. Sep-
arate free-play sessions were run concurrently but were
separated from the training sessions by at least 30 minutes.
Concurrent free-play sessions were conducted following
the exact procedures applied in baseline sessions. No pros-
thetic consequences were delivered to the student in the
free-play setting for all conditions. Data from the toy con-
ditioning procedure are not present for brevity’s sake, but
criterion for the student was at least 90% self-initiated toy
play for two consecutive sessions.
EXPERIMENTAL DESIGN
’
The experimental design used was a multiple baseline across
participants (Cooper, Heron, & Heward, 1987). Phase A
represents observation of the free-play setting. Phase B
represents the onset of conditioning toy play and the free-
play observations continued. The dependent variables were
toy play and stereotypy. The independent variable was a
toy-play conditioning procedure.
Results
Baseline data showed that Student A had a range of 0 to 50
intervals with toy play present, with a mean of 20. His
stereotypy ranged from 0 to 60 intervals present, with a
mean of 32.6. During the toy-conditioning phase there was
an ascending trend, and
toy play continued at high rates
with only one session of overlap at Session 14. The range
of toy play in the conditioning phase was 10 to 60 intervals
present with a mean of 36.6. The range of stereotypy in the
conditioning phase was 0 to 21 with a mean of 6.7.
Student B had a range of 0 to 42 baseline intervals with
toy play present and a mean of 15.8. Her stereotypy
ranged from 1 to 43, with a mean of 13.4. During the toy-
conditioning phase there was an immediate increase in toy
play with the data remaining at high steady rates through-
out the remainder of the experiment. The range of toy play
in the conditioning phase was 29 to 58 intervals present,

with a mean of 41.5. The range of stereotypy in the condi-
tioning phase was 0 to 13, with a mean of 6.8.
Student C had a range of 0 to 41 baseline intervals
with toy play present, only one session over 12 intervals,
with a mean of 7.3. His stereotypy ranged from 34 to 59,
with a mean of 41.1. During the toy-conditioning phase
there was a sharp increase in toy play, with the data re-
maining at high steady rates throughout the remainder of
the experiment. The range of toy play in the conditioning
phase was 0 to 56 intervals present, only one session under
35 intervals, with a mean of 37. The range of stereotypy in
the conditioning phase was 0 to 30, with only one session
higher than 11 intervals present, with a mean of 12.7 (see
Figure 2).
All three participants’ data showed an increase in toy
play and a decrease in stereotypy after the conditioning
procedure.
Discussion
The data from this experiment showed that the toys ac-
quired stimulus control for play behavior as a function of
the conditioning procedure. The toys functioned as rein-
forcers for the children, and over time they sought out the
toys in the free-play setting, rather than engaging in stereo-
typical behavior. The data demonstrated that stereotypical
behaviors have a play function and can be replaced with
play behavior. Student A played with toys in only three of
the five baseline sessions. After the toy-play conditioning
sessions began, toy play increased significantly, with all but
one session having higher intervals of toy play than stereo-
typy. Stereotypy remained at low, stable intervals through-
out the conditioning phase.
Student B had three out of nine baseline sessions that
showed high rates of toy play, but all other sessions had less
than 11 intervals of toy play present. After the toy-play
conditioning sessions began, toy play remained at high and
stable rates throughout the remainder of the experiment.
Stereotypy also remained at low, stable rates throughout
the remainder of the experiment.
Student C showed the least amount of toy play for all
participants, with only 1 of 10 baseline sessions with more
than 11 intervals of toy play present. After Session 1 of the
toy-play conditioning phase, Student C showed steady,
high rates of toy play throughout the remainder of the ex-
periment.
The resulting data showed that the conditioning of toy
play resulted in a decrease in stereotypy for all three stu-
dents. This suggests that the consequences of toy play had
stronger stimulus control than those of stereotypy and that
stereotypy has a play function and therefore can be re-
placed with play behavior. For these participants, it was not
necessary to use an aversive procedure or treat stereotypy
directly. These results indicate that behavior analysts can
use a student’s known reinforcers to replace nonpreferred
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485
behaviors with more appropriate activities, such as playing
with toys and looking at books. However, further research
on reinforcement conditioning should be conducted.
GENERAL DISCUSSION
One of the trends in behavior analysis and special educa-
tion over the last few years has been giving students choices
in daily activities. Certainly this is important, but we as
educators are concerned with the expansion of choices. For
example, it is not enough to teach children to read; we
want to teach so that children choose to read in their free
time. In effect, we argue that this goal can be achieved by
expanding the student’s community of reinforcers because
the availability of conditioned reinforcers strongly affects
the student’s choice. Thus, research that expands choice
is critical.
For students like those studied in these experiments
and those of Greer et al. (1985), it is not necessary to use
punitive procedures or treat stereotypy directly. Punitive
procedures temporarily suppress stereotypy; we need pro-
cedures that replace the function of stereotypy for individ-
uals. Parents and teachers of children with autism need
positive tools to deal with how children with autism spend
their free time. Many individuals with autism engage in
stereotypy or passivity in their free time. One of the prob-
lems of designing treatments for stereotypy is that the
function of the behavior in free time has not been sub-
jected to analysis (Greer et al., 1987). However, when chil-
dren engage in stereotypy during free time, the behavioral
effects themselves are controlling the behavior. Most if not
all individuals engage in brief episodes of stereotypy, par-
ticularly when we are waiting and have nothing interesting
in which to engage ourselves. These episodes are usually
brief because we can entertain ourselves by engaging in
various activities such as reading, playing solitaire, doing
crossword puzzles, or working on our laptops. Perhaps we
engage in stereotypy when our community of reinforcers is
not readily available to break up our continual behavior.
We speculate that stereotypy occurs as a function of a
paucity of preferred activities that is a result of a lack of re-
inforcement conditioning.
The data in these experiments and in those of Greer
et al. (1985) and Eason et al. (1982) suggest that this is a
tenable theory. If this were proven to be the case, it would
be of critical importance to the educational curricula of
children with autism. That is, one of the goals for educa-
tors of individuals with stereotypy should be to provide
systematic and direct instruction that involves the use of
reinforcement conditioning procedures. Thus, rather than
merely being taught to read or play with toys, children
would be taught under pairing conditions until the toys or
books control choice in free time. Indeed, one of the most
important goals of education for all students is to expand
students’ preferences for activities of all types.
 86

Figure 2. Intervals of toy play and stereotypy prior to, concurrent with, and after toy-play conditioning
sessions.

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ABOUT THE AUTHORS
Robin Nuzzolo-Gomez, MPhil, is the behavior analyst di-
rector of the David Gregory School, a CABASO model school
for students with autism and other developmental disabili-
ties. Her current research interest includes the role of the
supervision learn unit on teachers’ scientific tacts and con-
tingency shaped repertoires. Mandy A. Leonard, MA,
Eyleen Ortiz, MA, and Celestina M. Rivera, MA, are cur-
rently PhD candidates at Columbia University, Teachers Col-
lege. Their current research interest is in decreasing echolalia
and palilalia in preschool students with autism. R. Douglas
Greer, PhD, is a professor of education and psychology and
is the coordinator of the Behavior Analysis Program at
Teachers College, Columbia University. His current interests
include CABAS model of education and the learn unit. Ad-
dress : R. Douglas Greer, Columbia University, Teachers Col-
lege, PO Box 76, New York, NY 10027.
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Action Editor: Robert L. Koegel