“…Fourth, definitions of VS often include repetitiveness as a central characteristic, and there is wide variation in terms of how many repetitions qualify an utterance as VS (e.g., Cassella, Sidener, Sidener, & Progar, 2011;O'Connor, Prieto, Hoffman, DeQuinzio, & Taylor, 2011;Rapp, Patel, Ghezzi, O'Flaherty, & Titterington, 2009). Fifth, it is a concern that operational definitions of VS differ appreciably from study to study and even across multiple reports involving the same researcher (e.g., Enloe & Rapp, 2014;Rapp et al, 2009Rapp et al, , 2012. Last, a consideration somewhat outside the scope of the current topic but still worth mentioning, is that definitions of VS appear to be based on the assumption that all unconventional vocalizations are voluntary rather than associated with comorbid neurologic tic disorders or medication side effects.…”