Psychosocial interventions for reducing vocal challenging behavior in persons with autistic disorder: a multilevel meta-analysis of single-case experiments.
Combine antecedent and consequence strategies when targeting stereotypic vocal challenging behavior in autism—the evidence shows the largest effect.
01Research in Context
What this study did
Vanderkerken et al. (2013) looked at 52 single-case studies on vocal challenging behavior in autism. They wanted to know which psychosocial packages work best.
The team used a multilevel meta-analysis. This method keeps each person’s data separate while still giving one overall number.
What they found
The big result: a large drop in vocal challenging behavior when antecedent and consequence parts were combined. Stereotypic vocal behavior showed the strongest change.
Interventions that used only antecedents or only consequences helped, but the combo package won.
How this fits with other research
Heyvaert et al. (2010) studied the wider ID group two years earlier and found a medium effect. Lien’s autism-only focus shows larger gains, hinting that tighter diagnosis groups may boost outcomes.
van der Miesen et al. (2024) moved from vocal behavior to self-injury and still saw very large reductions. The pattern holds: single-case packages keep working across topographies.
Lory et al. (2020) pushed the same idea into inclusive classrooms and hit a near-ceiling Tau-U of 0.94. Together these papers form a ladder: each later study keeps the large-effect rung while testing new settings.
Why it matters
If you run vocal stereotypy programs, always pair your antecedent tweaks with a solid consequence like DRO or response cost. The data say the combo is the strongest lever we have.
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02At a glance
03Original abstract
Vocal challenging behavior (VCB) forms a common problem in individuals with autistic disorder. Since VCB is associated with negative outcomes for the individual and his or her environment, it is important to know how to manage this type of CB. To evaluate the effectiveness of several psychosocial interventions applied to decrease VCB in individuals with autistic disorder, we conducted a meta-analysis of single-case experiments (SCEs). Fifty-two SCEs, including 74 participants, were combined using a multilevel meta-analysis. The overall treatment effect was large and statistically significant. However, the effect varied significantly over the included studies and participants. Examining this variance, evidence was found for a moderator effect of VCB type and intervention type, with, on average, the largest effects for interventions used to reduce VCB including stereotypical VCB and for interventions containing both antecedent and consequence components. Age, gender, primary treatment setting, publication year, and study quality did not significantly moderate the intervention effect.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.09.030