Insistence on Sameness in Autistic Children: a Stimulus Control Analysis with Implications for Assessment and Support

Objectives

A characteristic of some individuals with autism is described as an “insistence on sameness.” For these individuals, a violation of sameness may occasion problem behavior. Given this, a more precise understanding of the construct of sameness from a behavioral perspective is desirable for assessment and intervention purposes. In this paper, we first examined the role of an existing behavioral theory, stimulus overselectivity, in relation to this issue. A detailed stimulus control analysis led to the conclusion that this theory does not adequately account for problem behavior occasioned by violations of sameness. Based on this analysis, we developed a conceptual model for assessing and treating problem behavior associated with insistence on sameness.

Methods

Three representative cases from our past clinical experience with children with autism were employed to develop the conceptual model: (a) paying attention to too few stimuli, (b) paying to too many stimuli, and (c) paying attention to sequentially presented stimuli. Following a detailed stimulus control analysis of each case, we introduce a competing behavior pathways framework for organizing a functional assessment of child problem behavior occasioned by violations of sameness, and for developing a behavior support plan that emphasizes prevention, teaching, and positive reinforcement. We then apply the framework to the three cases, and illustrate its utility for developing an individualized, multicomponent positive behavior support plan for each of the children.

Conclusions

We conclude the paper with considerations for future research to empirically examine the proposed conceptual framework for understanding and treating problem behavior in individuals with autism associated with violations of sameness.