The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism.

We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants' shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel-to-toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.