Rapid assessment of severe cognitive impairment in individuals with developmental disabilities.

BACKGROUND: Most standardized intelligence tests require more than 1 hour for administration, which is problematic when evaluating individuals with intellectual disabilities and developmental disabilities (IDDD), because a significant proportion of these individuals can not tolerate lengthy evaluations. Furthermore, most standardized intelligence tests are of limited usefulness for individuals with severe cognitive deficits because of floor effects. METHODS: A number of low-difficulty items were selected from standardized tests. A total of 271 participants with profound, severe, moderate and mild levels of cognitive impairment took part in this study. In the formative phase, 68 participants were evaluated with the selected items, and those items that differentiated between levels of cognitive impairment were retained in the battery. The instrument was then modified and standardized with an additional 203 participants. RESULTS: The instrument, referred to as the Rapid Assessment for Developmental Disabilities (RADD), required 10-25 min for administration. Internal reliability estimates from the RADD total score and from individual subtests satisfied conventional and rigorous statistical criteria (median alpha r = 0.93). The RADD total score was strongly correlated with the level of cognitive impairment (rho = 0.86). The RADD total score and individual subtests differentiated between all levels of cognitive impairment ( Wilks Lambda = 0.135, F(42,525.832) = 12.075, P < 0.001). Receiver operating characteristic curves indicated the instrument was particularly sensitive to the cognitive abilities of the most seriously impaired participants. CONCLUSIONS: The RADD, composed of low-difficulty items from published tests, is rapidly administered, assesses a wide range of cognitive skills and differentiates among all levels of cognitive impairment. The battery has clinical utility with populations exhibiting short attention spans because of its ability to quickly assess a wide range of cognitive abilities. The RADD also has research potential for the documentation of cognitive function in studies of individuals with IDDD.

Planned Activities Training for mothers of children with developmental disabilities. Community generalization and follow-up.

Planned Activities Training (PAT) teaches mothers to plan and structure activities to prevent challenging child behaviors. PAT was evaluated with four mothers of children with developmental disabilities, including autism, Down Syndrome, and ADHD. PAT was used independent of any other behavior management techniques to examine its impact on mother and child behaviors, which were examined in addition to "fidelity" data on the mothers' implementation of PAT techniques. A multiple probe experimental design across two families with a replication across two more families demonstrated that PAT produced marked improvements in mother and child behavior in three generalization settings. In most cases, mothers' use of PAT procedures more than doubled. Three mothers' appropriate behavior increased from 25% to 40%. Improvements in child behavior ranged from 20% to more than 50%. Intervention gains were maintained at 1, 3, and 6 months. These results suggest that PAT is a useful technique for promoting durable generalization of mother child skills.

Improving parent-child interactions for families of children with developmental disabilities.

Child Management Training (CMT) involves compliance training with a focus on consistent use of antecedents and consequences. Planned Activities Training (PAT) focuses on teaching parents to plan for and engage in activities with their children. A multiple probe design counterbalancing PAT and CMT showed that PAT and CMT were about equally effective in improving mother-child interactions in four families with children with developmental disabilities. Responses to a social validation questionnaire indicated that parents were satisfied with the services received, and that PAT was the slightly preferred treatment. Prior research demonstrated that PAT enhanced the results of CMT. The practical advantages of PAT over CMT are discussed.

How much oral rehydration solution is actually administered during home-based therapy?

In some parts of the world up to one-half of all deaths in young children are attributable to dehydration associated with diarrhoea. As a countermeasure, mothers in underdeveloped countries are being successfully taught to give oral rehydration solution at home. There are, however, serious doubts as to whether mothers give their children enough. The focus of our investigation was a methodology capable of establishing the exact quantity of fluid administered by unsupervised mothers at home. Accurate quantitative data are essential for programme planning and evaluation. In our sample of 44 cases, only two children received more than 90 ml kg-1 day-1. The mean observed value was 44 ml kg-1 day-1 (SD 28.4); well below the recommended dosage. Preliminary data were also gathered on natural consequences which may discourage use of ORS such as vomiting, increased frequency of watery stools, and distaste for the solution.

A scatter plot for identifying stimulus control of problem behavior.

Line graphs that average response frequency over long periods obscure the major rate changes that indicate sources of behavioral control. A scatter plot can make patterns of responding identifiable and, in turn, suggest environmental features that occasion undesirable behavior. Use of scatter diagrams is illustrated in three cases.

Errorless learning: reinforcement contingencies and stimulus control transfer in delayed prompting.

Delayed prompting can produce errorless discrimination learning. There is inherent in the procedure a disparity in reinforcement density which favors unprompted over prompted responses. We used three schedules of reinforcement to investigate the impact of reinforcement probability on transfer of stimulus control. One schedule of reinforcement was equal prior to and following a prompt (CRF/CRF), the second favored unprompted responses (CRF/FR3), and the third favored responses following the prompt (FR3/CRF). Experimental questions concerned the probability of errors, the probability of transfer, and the rate of transfer in the context of delayed prompting. Transfer was accelerated when reinforcement probability favored anticipatory responding. The schedule that favored prompted responses did not prevent a shift to unprompted responding. Errors were infrequent across procedures. Reinforcement probability contributes to but does not entirely determine transfer of stimulus control from a delayed prompt.

Visual attention in retarded adults: combining stimuli which control incompatible behavior.

Eight severely retarded young men learned color and line-tilt discrimination. After 95% accuracy was achieved for both dimensions, they were combined to form "conflict-compound" stimuli in which prior reinforcement history was reversed for one element of the compound and unchanged for the other. When responding to the compound was 95% accurate, control exerted by each element was measured. The unchanged element consistently exercised control in agreement with the reinforcement contingencies associated with the compound, regardless of whether it was color or line orientation. The reversed element, which had a conflicting prior history or reinforcement, most often exerted control associated wtih original training, or no control, suggesting that it had been "ignored" during the compound. Conflict compounds produced selective attention. When elements were combined to form "compatible-compound" stimuli, both exercised control in agreement with the compound in post-tests. Selective attention was not produced by compatible compounds.

Withdrawal of chronic chlorpromazine medication: an experimental analysis.

Approximately 50% of all institutionalized, mentally retarded adults receive psychotropic medication to control inappropriate behavior. In this study, behaviors exhibited by five retarded adults were formally observed while they were on and off medication. Each subject had been receiving chlorpromazine for six or more years prior to the start of the study. The drug was withdrawn and readministered using a double-blind B-A-B (drug placebo-drug) design. Effects were highly individualized. Some desirable behavior emerged when chlorpromazine was discontinued.

Effects of diet and behavior therapy on social and motor behavior of retarded phenylketonuric adults: an experimental analysis.

The effects of a low phenylalanine diet on six retarded phenylketonuric adults were assessed. An ABA individual-subject design was used in experiment I to assess the effects of a low phenylalanine diet on social and motor behavior. Following a baseline during which the subjects ingested a normal phenylalanine diet (phase A), a low phenylalanine diet (phase B) was administered in a double blind fashion. Finally, the baseline condition (phase A) was reinstated (normal diet). The low phenylalanine diet resulted in few significant behavioral changes for those subjects with which proper methodologic controls were employed. However, for two of six subjects motor behavior, including stereotypy and tremor, seem to have ameliorated. In experiment II, applied behavior analysis techniques, including differential reinforcement of other behavior and time out, were combined to radically reduce the frequency of stereotypy and self-abuse exhibited by one of the six subjects of experiment I.

Transfer of stimulus control: measuring the moment of transfer.

Three severely retarded boys acquired simple form discriminations errorlessly. Each was first taught to press a red key versus a simultaneously present white key. After this discrimination had been established, black figures were superimposed on the red and white keys. Each correct response affected the next trial by delaying the onset of the red stimulus an additional 0.5 sec. Transfer of stimulus control to the figures was indicated when the subjects responded correctly before the onset of the red stimulus. A series of errorless discrimination reversals was accomplished with this technique, during which the number of trials to transfer systematically decreased with successive reversals.

Tilted lines as complex stimuli.

Severely retarded boys were taught to respond differentially to lines tilted at 45 degrees and 135 degrees . While all subjects could perform the discrimination, the aspect of the stimulus that controlled responding was shown to differ among subjects.

The effects of graduated stimulus change on the acquisition of a simple discrimination in severely retarded boys.

Methods were compared for teaching severely retarded boys to discriminate the position of a 0.75-in. black square and to press the response key closest to it. Seven boys were given trial-and-error training; one learned the task. The six boys who did not learn were presented with a program of graduated stimulus changes. All but one acquired the performance, and he was under appropriate control during the program. When he reached the criterion stimuli, he reverted to a position-based response learned during trial-and-error training. Six similar subjects were presented with graduated stimulus training alone. All six learned the criterion discrimination with few or no errors. Both groups were tested for retention of the criterion performance 35 days after training was completed. Two boys who had near-perfect criterion discrimination performances showed no signs of retention after 35 days. These boys had a history of trial-and-error training.