Weight management for individuals with intellectual and developmental disabilities: rationale and design for an 18 month randomized trial.

Weight management for individuals with intellectual and developmental disabilities (IDD) has received limited attention. Studies on weight management in this population have been conducted over short time frames, in small samples with inadequate statistical power, infrequently used a randomized design, and have not evaluated the use of emerging effective dietary strategies such as pre-packaged meals (PMs). Low energy/fat PMs may be useful in individuals with IDD as they simplify meal planning, limit undesirable food choices, teach appropriate portion sizes, are convenient and easy to prepare, and when combined with fruits and vegetables provide a high volume, low energy dense meal. A randomized effectiveness trial will be conducted in 150 overweight/obese adults with mild to moderate IDD, and their study partners to compare weight loss (6 months) and weight maintenance (12 months) between 2 weight management approaches: 1. A Stop Light Diet enhanced with reduced energy/fat PMs (eSLD); and 2. A recommended care reduced energy/fat meal plan diet (RC). The primary aim is to compare weight loss (0-6 months) and weight maintenance (7-18 months) between the eSLD and RC diets. Secondarily, changes in chronic disease risk factors between the eSLD and RC diets including blood pressure, glucose, insulin, LDL-cholesterol, and HDL-cholesterol will be compared during both weight loss and weight maintenance. Finally, potential mediators of weight loss including energy intake, physical activity, data recording, adherence to the diet, study partner self-efficacy and daily stress related to dietary change will be explored.

A discrimination analysis of training-structure effects on stimulus equivalence outcomes.

Experiments designed to establish stimulus equivalence classes frequently produce differential outcomes that may be attributable to training structure, defined as the order and arrangement of baseline conditional discrimination training trials. Several possible explanations for these differences have been suggested. Here we develop a hypothesis based on an analysis of the simple simultaneous and successive discriminations embedded in conditional discrimination training and testing within each of the training structures that are typically used in stimulus equivalence experiments. Our analysis shows that only the comparison-as-node (many-to-one) structure presents all the simple discriminations in training that are subsequently required for consistently positive outcomes on all tests for the properties of equivalence. The sample-as-node (one-to-many) training structure does not present all the simple discriminations required for positive outcomes on either the symmetry or combined transitivity and symmetry (equivalence) tests. The linear-series training structure presents all the simple discriminations required for consistently positive outcomes on tests for symmetry, but not for symmetry and transitivity combined (equivalence) or transitivity alone. Further, the difference in the number of simple discriminations presented in comparison-as-node training versus the other training structures is larger when the intended class size is greater than three or the number of classes is larger than two. We discuss the relevance of this analysis to interpretations of stimulus equivalence research, as well as some methodological and theoretical implications.

Equivalence class establishment, expansion, and modification in preschool children.

Preschool children were taught four two-choice match-to-sample conditional discriminations with 10 arbitrary visual stimuli. For 6 participants, 2 of the 10 stimuli served as the sample, or conditional, stimuli in all discriminations. For 5 additional participants, the same pair of stimuli served as the discriminative, or comparison, stimuli in all discriminations. Equivalence classes were established with more participants in the latter group, replicating prior research with participants with retardation. Four participants, in whom equivalence classes were established and who were available for further participation, were exposed to new conditional discriminations without trial-by-trial feedback and involving some novel and some familiar stimuli. Consistent conditional responding was observed, and tests for inclusion of the novel stimuli in the original classes showed class expansion. Training to reverse the unreinforced conditional performances produced a reversal of class membership in 3 of 4 participants, an outcome not consistent with other studies. The results are discussed with respect to the interaction of class structure and size.

Comparison of reinforcement schedules in the reduction of stereotypy with supported routines.

The rates and durations of stereotypic behaviors in four adolescents with severe mental retardation were measured during two daily vocational training sessions and during contiguous periods of leisure in their special education classrooms. Vocational training was conducted in two different tasks, alternating across days. The task requirements for each participant were matched to each participant's learning and performance characteristics. The participants were exposed to a fixed ratio schedule of tokens exchangeable for food items on one task and to a variable interval schedule for the same consequences on the second task. The schedules were chosen as an initial test of a matching-law based prediction by Myerson and Hale (1984): Variable interval reinforcement for adaptive behavior will produce less allocation of responding to maladaptive behavior than will a ratio-based intervention. When work performances stabilized, the schedules of token delivery were reversed across the tasks and performances again stabilized. Results are reported for periods when work performances met stability criteria. Stereotypy occurred more during leisure than during vocational training under either schedule. The major differences in stereotypy between leisure and vocational training were differences in episode length rather than rate of onset. Onset of stereotypy in vocational training, however, occurred at higher rates under the interval schedule than under the ratio schedule in both tasks. The results are discussed in terms of Myerson and Hale's prediction and implications for further research and application.

A response-restriction analysis of stereotypy in adolescents with mental retardation: implications for applied behavior analysis.

The behavior of 4 adolescents with severe or profound mental retardation was evaluated in the presence of four sets of materials during periods of unstructured leisure activity. Functional engagement with the materials, stereotypic engagement with the materials, stereotypy without interaction with the materials, and other aberrant behaviors were recorded. Across a series of experimental conditions, the number of sets of materials was reduced from four to one by eliminating the set most frequently manipulated in each preceeding condition. In the final condition, four sets of materials were again made available for manipulation. The procedures replicated Green and Striefel's (1988) response-restriction analysis of the activity preferences and play behaviors of children with autism. In general, the results of the present experiment replicate those of Green and Striefel in that reallocation of responding was idiosyncratic and unpredictable as sets of materials were removed. Nevertheless, the results provided insight into how responding might be reallocated if it were restricted through behavioral interventions rather than by restriction of access. Thus, the results are discussed with respect to how response-restriction analyses may be useful in identifying topographies of behavior that could be included in differential reinforcement contigencies that are designed to affect stereotypic behavior and in the selection and arrangement of environmental stimuli to minimize the presence of evokers of stereotypy.

W. Edwards Deming, quality analysis, and total behavior management.

During the past 10 years, the inclusion of the word "quality" in descriptions of production methods, management approaches, educational systems, service system changes, and so forth, has grown exponentially. It appears that no new approach to any problem is likely to be given much consideration today without overt acknowledgment that some improvement in quality must be the outcome. The origins of the importance of quality are primarily rooted in the awakening recognition of the influence of W. Edwards Deming in the post-World War II restoration of Japanese industry. We provide a brief overview of Deming's approach to modernizing management methods and discuss recent criticisms from the field of organizational behavior management that his approach lacks emphasis on the role of reinforcement. We offer a different analysis of Deming's approach and relate its evolution to the contingencies of reinforcement for the behavior of consulting. We also provide an example of problem solving with Deming's approach in a social service setting familiar to many behavior analysts.

Investigating the generality of the delayed-prompt effect.

Two experiments were conducted in an attempt to replicate the findings of Touchette's classic 1971 experiment. The results obtained were more variable than those obtained by Touchette. Four of 34 subjects learned the Horizontal E discrimination without errors. Ten subjects preempted the red prompt stimulus erroneously. Twelve subjects failed to preempt. Among those who failed to preempt, at least six had not learned the target discrimination. There were also five subjects who failed to preempt who, on subsequent tests, demonstrated that they had learned the target discrimination. For these subjects, the onset of the prompt appeared to grant "permission to respond." An attempt is made to account for the differences in the current results and those of Touchette (1971). We also compare our results to the usually successful application of the delayed prompt to education and training problems. We note that the procedures used in these successful applications are often quite different from those in the original Touchette experiment and our own.

A program evaluation of classroom data collection with bar codes.

A technology incorporating bar code symbols and hand-held optical scanners was evaluated for its utility for routine data collection in a special education classroom. A different bar code symbol was created for each Individualized Educational Plan objective, each type of response occurrence, and each student in the first author's classroom. These symbols were organized by activity and printed as data sheets. The teacher and paraprofessionals scanned relevant codes with scanners when the students emitted targeted behaviors. The codes, dates, and approximate times of the scans were retained in the scanner's electronic memory until they could be transferred by communication software to a computer file. The data from the computer file were organized weekly into a printed report of student performance using a program written with commercially available database software. Advantages, disadvantages, and costs of using the system are discussed.

The nonequivalence of behavioral and mathematical equivalence.

Sidman and his colleagues derived behavioral tests for stimulus equivalence from the axiom in logic and mathematics that defines a relation of equivalence. The analogy has generated abundant research in which match-to-sample methods have been used almost exclusively to study interesting and complex stimulus control phenomena. It has also stimulated considerable discussion regarding interpretation of the analogy and speculation as to its validity and generality. This article reexamines the Sidman stimulus equivalence analogy in the context of a broader consideration of the mathematical axiom than was included in the original presentation of the analogy and some of the data that have accumulated in the interim. We propose that (a) mathematical and behavioral examples of equivalence relations differ substantially, (b) terminology is being used in ways that can lead to erroneous conclusions about the nature of the stimulus control that develops in stimulus equivalence experiments, and (c) complete analyses of equivalence and other types of stimulus-stimulus relations require more than a simple invocation of the analogy. Implications of our analysis for resolving current issues and prompting new research are discussed.

The role of instructions in the transfer of ordinal functions through equivalence classes.

In two experiments, adult subjects completed match-to-sample training and testing to establish four equivalence classes of four figures each. Then the subjects were taught one three-position sequence consisting of one stimulus from Class 1, one from Class 2, and one from Class 3. Inclusion of Class 4 stimuli in sequences was never reinforced, but two different stimuli from Class 4 appeared as distractors on each sequence trial. Tests assessed whether subjects would produce novel three-position sequences composed of members of Classes 1 through 3 that had not been used in sequence training. Three subjects in Experiment 1 received instructions about the match-to-sample and sequencing tasks, in addition to training contingencies. All 3 demonstrated equivalence class formation after match-to-sample training. After they were taught one sequence with one member of Classes 1 through 3, none of these subjects produced untrained sequences with other equivalence class members reliably. One additional sequence was trained directly; thereafter 1 subject showed some evidence of transfer of the trained ordinal functions across the remaining members of the equivalence classes, but the other 2 did not. Following a review of equivalence class training and testing and a review of the original sequence training, all 3 subjects produced most of the predicted, untrained sequences on tests. Experiment 2 replicated Experiment 1 with 2 adults but omitted all instructions except the minimal ones necessary to initiate responding. Unlike the subjects in Experiment 1, both of these subjects demonstrated virtually complete transfer of ordinal functions through the equivalence classes after direct training on just one sequence composed of one member of Classes 1 through 3.

Long-term stability of equivalence relations in the absence of training or practice.

An adult male with mild mental retardation, whose laboratory history included training in a match-to-sample task on 16 arbitrary relations among 16 visual stimuli and 2 auditory stimuli, had performances that showed the development of 112 additional arbitrary relations that had never been reinforced. In the presented study on 2-year and 3-year follow-up tests for these derived relations, his performances remained stable despite the absence of opportunities to practice these relations between the tests and the absence of explicit feedback during the tests. The similarity to the long-term stability of language was discussed.

Equivalence classes generated by sequence training.

In Experiment 1, 3, adult females were taught with verbal instructions and contingencies to select, in sequence, three arbitrary visual stimuli from an array of five stimuli. After four different sequences were taught, match-to-sample tests assessed emergent conditional relations among all stimuli that had been selected in the same order in the sequences. Subjects' performances indicated development of four stimulus classes, three based on ordinal position and one based on nonselection. Next, match-to-sample training established conditional relations between each of four novel figures and one member of each of the ordinal stimulus classes. Tests confirmed that the classes were equivalence classes, each expanded by one new member. In subsequent sequence tests, the new stimuli were selected in a sequence that was consistent with ordinal class membership. Experiment 2 replicated Experiment 1 with 2 different adult females, but the verbal instructions were omitted. Results were similar to Experiment 1, except that extensive review and retesting were required before expansion of the ordinal classes with the novel figures was observed.

The merger and development of equivalence classes by unreinforced conditional selection of comparison stimuli.

Three experiments assessed the likelihood that subjects with histories of equivalence class development would respond conditionally on new discriminations in the absence of differential consequences for responses. In the first two experiments, two groups of subjects with different experimental histories, but whose performances showed four equivalence classes, responded on trials without explicit reinforcement involving samples from two of the classes and comparisons from the other two classes, in a two-choice matching-to-sample format. Subjects consistently selected a particular comparison in the presence of a particular sample. Subsequent tests showed the emergence of equivalence relations between stimuli from classes linked by the unreinforced conditional selections. Subsequently, in Experiment II, the subjects' responses in the conditional selection trials were reinforced if the selection was reversed from that made previously. Although reversed selection was maintained, 2 of the 3 subjects continued to perform on equivalence relation trials according to their original unreinforced selections. In the third experiment, these 2 subjects responded on a series of conditional discriminations involving three new pairs of sample stimuli and one new pair of comparison stimuli. No explicit reinforcement followed responses on any trial in this experiment. Subsequent tests for equivalence between sample stimuli revealed the development of two equivalence classes.

Establishing auditory stimulus control over an eight-member equivalence class via conditional discrimination procedures.

Two eight-member equivalence classes of visual stimuli were established during three phases of a training program. In Phase 1, two training arrangements were compared. In one, 3 subjects were taught on different trials to select from a single pair of comparison stimuli (A1, A2) in response to eight sample stimuli that were trained in pairs (B1, B2; C1, C2; D1, D2; E1, E2). In the second arrangement, subjects were taught to select from four pairs of comparisons (B1, B2; C1, C2; D3, D2; E2, E2) in response to two samples (A1, A2). Training with the single pair of comparison stimuli resulted in the development of equivalence relations (B1C1, B2C2, D1B1, D2B2, B1E1, B2E2, C1D1, C2D2, C1E1, C2E2, D1E1, D2E2, and their reciprocals) between the sample stimuli without direct training of these relations. In the other training arrangement, these relations among the comparison stimuli developed in the performance of 1 subject only. In Phase 2, three new pairs of stimuli (F1, F2; G1, G2; H1, H2) were substituted for three of the original pairs (B1, B2; C1, C2; D1, D2) and the training arrangements for the groups were reversed. Following training, the performances that showed equivalence relations on the probes in the first phase also showed equivalence relations in the second phase. If such relations did not develop in the first phase, they did not do so in the second phase. In Phase 3, relations between stimuli across the two previous phases (e.g., B1F1, B2F2, B1G1, B2H2, C1F1, etc.) were investigated. The 4 subjects whose performances showed the development of these relations were taught to select one stimulus from each class (E1 and E2) in response to a verbal label (I1 and I2) and then were tested to see if the verbal label controlled responding to the remaining members of the class (e.g., I1A1, I2A2, I1B1, I2B2, etc.). For 3 subjects, this generalized control occurred; for the 4th, generalization occurred only after verbal training with a second pair of visual stimuli (F1 and F2). In retests several months later, these auditory-visual relations were found to be intact or, if not, were recovered without direct training.

Behaving appropriately in new situations: a stimulus class analysis.

Ways in which initially unrelated stimuli can be established as members of the same stimulus class were reviewed and the suggestion made that such classes may explain individual's abilities to behave in appropriate ways in novel situations. Possible process limitations of retarded persons in developing such classes were discussed.