Situation specificity in attention-seeking problem behavior. A case study.

Previous research on attention-seeking problem behavior has focused on individuals who misbehaved under general conditions of low adult attention. In general, no detailed analyses were conducted to determine whether different situations involving low levels of adult attention (such as familiar vs. unfamiliar adults, setting events, or the presence or absence of peers) exacerbated or attenuated problem behavior. The current case study demonstrates that, for one adolescent, all situations involving low levels of adult attention were not equally discriminative for problem behavior. Two functional analyses concerning different situations involving low levels of adult attention were conducted. The first analysis consisted of systematically manipulating antecedent and consequence conditions related to adult attention and task demands. This analysis indicated that low levels of adult attention evoked problem behavior. The second analysis involved two different conditions presenting low levels of adult attention. In one, the adult spoke to another child; in the second, the adult spoke to another adult. This second analysis revealed that, when the adult spoke to another adult, problem behavior resulted. However, when the adult spoke to another child, problem behavior did not occur. On the basis of these functional analyses, a positive intervention was designed to reduce problem behavior. Theoretical implications related to functional analysis are discussed, and applied issues concerning functionally based treatment selection are explored.

Behavioral interventions to reduce maladaptive responding in youth with dual sensory impairment. An analysis of direct and concurrent effects.

Many persons who have multiple sensory, physical, and developmental disabilities display behaviors that interfere significantly with adaptive functioning and social acceptance. In this investigation, the efficacy of multiple component behavioral interventions for reducing maladaptive responding exhibited by two individuals with dual sensory impairment and profound mental retardation was evaluated. Results indicated that differential reinforcement of other behavior (DRO) approaches were not effective in either case. However, when deceleration procedures (overcorrection or brief physical restraint) were added, target behaviors decreased quickly. Also, interventions were faded in such a way that gains were maintained for 6 months with only minimal effort by staff. Ongoing assessment of concurrent effects of behavior reduction strategies revealed increases in time on task or amount of work completed, even though these responses were not targeted specifically. Yet negative side effects (e.g., increases in self-stimulation) also were documented, highlighting the importance of evaluating multiple behaviors during intervention. Finally, despite the fact that objective assessments led to positive conclusions regarding treatment efficacy, ratings of baseline and treatment behavior samples by independent judges showed overall improvement in only one case. These findings suggest the need for multifaceted evaluation to determine the utility of interventions in applied settings.

Decreasing drooling with oral motor stimulation in children with multiple disabilities.

Many persons with severe and profound disabilities exhibit chronic and excessive drooling, which can have unfavorable effects on their socialization and health. Few treatments to reduce this behavior, however, have been evaluated systematically. In the present investigation, oral motor stimulation was used with 2 children who attended a residential educational facility for students who are blind and who have multiple disabilities. The treatment involved the brushing of the hard palate, the upper and lower gums, the tongue, and the inside of both cheeks at 1-hr intervals during the school day. The efficacy of this approach was demonstrated with a withdrawal experimental design. Because this treatment did not eliminate drooling, vibration was applied to the chin and neck, first in conjunction with the oral motor stimulation and then contingent on the subject's having a dry face. Vibration did not have additional therapeutic effects. The results of this study are discussed in relation to the existing literature on modification of drooling and the difficulty of effecting change in the behavior of persons with severe and profound mental and physical disabilities.

Evaluation of biofeedback for improving head and trunk position in children with multiple, severe disabilities.

: Many children with severe and profound disabilities exhibit poor head or trunk control. Because achievement of head and trunk righting is imperative for development across motor, cognitive, and social skills areas, physical therapists generally attempt to encourage appropriate posture via exercises and positioning. Biofeedback, in which information concerning head and trunk position is provided to children via alternative sensory channels, may represent an adjunctive treatment that can be carried out throughout the child's day, without the therapist's presence. In this study, a simple biofeedback strategy that provided music contingent on appropriate posture was evaluated with two young children with multiple, severe disabilities. The children responded to this intervention by increasing the time they spent in correct positions. Thus, the procedure showed promise for use during unstructured times to facilitate therapy goals. Future research should attempt to determine optimal treatment duration, types of feedback that are effective, and improvements in adaptive behavior over time.

A graduated guidance procedure for teaching self-dressing skills to multihandicapped children.

The effectiveness of a graduated guidance procedure for increasing independence in dressing was examined in a multiple baseline analysis across behaviors. Two multihandicapped children were trained to dress in socks, pants, and shirt. In training sessions, subjects completed the entire sequence of steps involved in putting on the training garment on each trial. Trainer assistance was provided as necessary, but was faded systematically according to a hierarchy of intrusiveness. Positive reinforcement was delivered contingent on dressing with increased independence. Assessment of independent responses followed each training session. Dependent measures were derived from a task analysis of each dressing behavior. Results showed that both children learned dressing skills, although rates of acquisition varied considerably. Generalization of treatment effects to similar garments was observed; maintenance of skills was evident at follow-up probes conducted at 36 weeks for one child and 18 weeks for the other.

Parent training to increase compliance in a young multihandicapped child.

A training program was implemented to modify a mother's behavior management skills to improve compliance in her 4-year-old child who suffered from severe developmental and physical disabilities. A multiple baseline analysis indicated that behavioral intervention was effective in training the mother to make definitive commands, provide appropriate positive attention, and persist with commands during social interactions with her child. In addition, substantial improvement in the child's compliance with mother's commands followed introduction of parent training. Further, positive collateral effects included the child's increased time on-task and decreased oppositional behavior. All gains were maintained at a 6-month follow-up probe.

Use of the alternating treatments design as a strategy for empirically determining language training approaches with mentally retarded children.

The present study was conducted as a practical demonstration of the potential utility of the alternating treatments design (ATD) in determining the most efficacious language training approach with mentally retarded children. Two subjects were chosen who used single words to communicate but who did not combine words to form sentences. Two sentence triads consisting of four words each and rated as equivalent in difficulty were trained. Each triad had one sentence trained using oral speech methods, a second trained using total communication methods, and a third sentence trained using a "modified" total communication approach. Each training procedure involved chaining sentence parts, reinforcement, and prompting. Oral methods involved presenting vocal stimuli and requiring vocal responses. Total communication methods involved presenting vocal and signed stimuli and requiring vocal and signed responses. The "modified" total communication approach also involved presenting vocal and signed stimuli, but required only vocal responses. For the initial sentence triad with each child, an alternating treatments design was used to determine the relative efficacy of the three language training methods. This approach was repeated with a second sentence triad for each child using a multiprobe technique within a multiple baseline design. Results were consistent within each subject but differed across subjects, with one child benefitting most from total communication methods and the other benefitting most from oral speech methods. Results were discussed in terms of the utility of the alternating treatments design as a potentially useful aid to traditional decision-making in the selection of language training strategies commonly employed with mentally retarded children.

A behavioral approach to the training and assessment of feeding skills in multihandicapped children.

In the present study, a behavioral program for training feeding skills was evaluated using a multiple-baseline experimental design. Six hospitalized mentally retarded-behaviorally disordered children served as subjects. Three groups of two subjects each were instructed in three feeding skills: chewing with mouth closed, appropriate utensil use, and appropriate napkin use. Training consisted of praise for appropriate display of target behaviors; on occurrence of inappropriate behavior, the following sequence was carried out: 10-second time-out; instruction in appropriate behavior including modeling and manual guidance; and behavioral rehearsal. Results indicated positive behavior change in training sessions and in immediately succeeding sessions during which training was withheld. Furthermore, behavioral gains were judged to be clinically significant by a group of independent observers. Modest generalization and maintenance of training effects were also evidenced.

An alternating treatments comparison of oral and total communication training with minimally verbal retarded children.

This study was a comparison of the effects of oral speech with total communication (speech plus sign language) training on the ability of mentally retarded children to repeat 4-word sentences. Three children were chosen who used single words to communicate but who did not combine words into complete sentences. Three sentence pairs were trained, with each pair having one sentence trained using oral methods and an equivalent one trained using the total communication approach. Both training procedures involved chaining sentence parts, reinforcement, and prompting. Oral methods involved presenting vocal stimuli and requiring vocal responses whereas total communication methods involved presenting vocal and signed stimuli and requiring vocal and signed responses. For the initial sentence pair with each child, an alternating treatments design was used to determine the relative efficacy of the two language training approaches. This was repeated with a second and third sentence pair using a multiprobe technique within a multiple baseline design. Results pointed to the superiority of the total communication approach in facilitating sentence repetition. Possible explanations of these results are offered and the utility of the alternating treatments experimental design is discussed.

Treatment of compulsive rituals with visual screening: a case study with long-term follow-up.

The present study reports on the use of visual screening, a mildly aversive response suppression procedure, as a treatment for reducing compulsive behaviors in a four and one-half year-old developmentally disabled boy. Two distinct patterns of compulsive responding were observed: repetitive (stereotyped) shoe-related behaviors and a ritualistic shoe-related act. The effect of visual screening on repetitive shoe-related responses was initially evaluated in a laboratory setting under A-B-A-B-B1 experimental conditions and systematically extended to the classroom setting in multiple baseline fashion. Visual screening was also contingently applied as treatment for the shoe-related ritual, with the effects analyzed using a similar multiple baseline format across hospital residential unit and natural home settings. Results of the study indicated that visual screening was an effective treatment for suppressing both forms of the subject's compulsive responding and that it was an easily learned and administered procedure from both staff and parent perspectives. Follow-up data across 12 months were obtained and indicated that the effect of treatment was exceptionally durable.