A multimodal behavior analytic model for evaluating the effects of medical problems on nonspecific behavioral symptoms in persons with developmental disabilities

A relationship between various medical illnesses and the frequency and severity of nonspecific behavioral symptoms such as aggression and self-injury has been described by a number of writers. None, however, provides a clinical case formulation model that articulates the specific nature of this relationship or the manner in which potential biomedical influences interact with psychological and socioenvironmental ones to determine the occurrence and strength of behavioral symptoms. A model is described in this paper that suggests possible contributions of medical illnesses or conditions to occurrence of nonspecific behavioral symptoms and provides a diagnostic basis for selecting and evaluation related interventions. © 1997 John Wiley & Sons, Ltd.     

Prevalence of severe behavior disorders in persons with mental retardation and treatment procedures used in community and institutional settings

A statewide survey of moderate and severe behavior disorders in persons with mental retardation in institutional and community settings was conducted. Information on the treatment procedures used and the adequacy of available resources in both settings was also gathered. Results indicated that community staff had considerably less experience than institutional staff in dealing with serious behavior disorders exhibited by persons with substantial cognitive and physical impairments. The types of aberrant behaviors with the highest prevalence rates showed differences in the institutions and the community. The largest differences in prevalence rates for severe behavior disorders in the two settings occurred for aggressive and self-injurious behaviors. Community staff thus had appreciably less experience than institutional staff in designing interventions for severe aggressive and self-injurious behaviors. About half of the identified individuals in both settings received psychotropic medications. Institutional staff were most likely to use restrictive behavioral procedures than community staff. Findings indicated that the most restrictive procedures were used primarily with only certain severe behavior disorders. Subjective ratings of the overall effectiveness of interventions were lower by community than institutional staff. The usefulness of the obtained data base for statewide planning in the area of behavioral supports is discussed.     

Home-based intervention for infants with developmental disorders

A hom-based therapeutic program for infants with developmental disorders is described. The program is used at the Institute for Psychophysiological and Speech Disorders, Belgrade, Yugoslavia. Significant changes in infant developmental competence provide support for the use of parents as direct intervention agents for their infants. Positive changes in marital and family relationships are important side effects of parent involvement in the therapeutic habilitation of their children.     

Expanding the utility of behavioral momentum for youth with developmental disabilities

Non‐compliance with requests in educational or therapeutic settings interferes with teaching and learning. Recent studies indicate that the probability of compliance can be increased when short sequences of requests with a high probability of compliance are followed by a request less likely to be followed by compliance. The high probability command sequence (HPCS) consists of requests that produce compliance rates of 80% or more. For some individuals with severe disabilities it is difficult to find sufficient number of requests that result in 80% compliance. This study assessed the effects of two levels of high probability request sequences on compliance with subsequent low probability requests. The three participants (ages 7, 11, and 20) met the diagnostic criteria for autism and/or severe to profound mental retardation. Results showed that both high (>80% compliance) and medium (50–70% compliance) request sequences produced increases in compliance to subsequent requests that had produced low compliance rates (<40%) during baseline. No systematic differences were observed between high and medium probability sequences. Copyright © 2000 John Wiley & Sons, Ltd.     

A survey of the use of facilitated communication in community agencies serving persons with developmental disabilities

Service providers to individuals with developmental disabilities at seven North Dakota agencies were surveyed on their current and past use of facilitated communication (FC). Perceived validity and effectiveness of FC were also assessed. Seventeen percent of the 177 direct care and supervisory staff surveyed reported that they had never heard of FC, 36% were aware of but had never used FC, 28% had previously used FC, and 18% currently used the technique despite overwhelming experimental evidence that FC is not a valid means of communication for people with disabilities. The results indicated that respondents who had previously used FC, but did not do so currently, gave it the lowest ratings of validity, usefulness, and likability, while current users gave FC the highest ratings. Current users had the fewest years of experience in the field of developmental disabilities. The majority of current users said guardian approval should not be required prior to the use of FC, whereas the majority of past users and non-users said that guardian approval should be required. © 1998 John Wiley & Sons, Ltd.     

Reducing the serious behavior problems of people with developmental disabilities living in the community

Trends and issues regarding the community-based support of people with developmental disabilities who exhibit severe behavior problems are discussed. Living in the community provides a unique framework within which behavior change programs are developed, implemented, and monitored. Support models for people with challenging behavior need to: (a) program for diversity across people, settings, and activities; (b) plan for high levels of integration in community settings among typical community members; and (c) meet guidelines regarding restrictions in intervention typologies. Increasingly, behavior analysts are conducting analog and in vivo assessments prior to intervening in order to develop an understanding of why behavior problems are occurring. Along with the increase in assessing the functions of behavior, is a greater attention to the contexts in which interventions are applied. The rearranging of contexts, communication training, choice-making, matching people's competence to their settings, the use of novelty, and proactive programing reflect these concerns.     

A brief account of statistical tests for single-case research with persons with developmental disabilities

Education and rehabilitation research with persons with developmental disabilities is often based on single-case designs (with small numbers of ordinal data points collected at irregular intervals) and relies upon graphic display and visual inspection of the data. This paper (a) provides a brief account of some statistical tests, which may serve to supplement the visual inspection process and (b) underlines some of their strengths and limitations to help education and rehabilitation personnel make a reasonable choice among them.     

Psychiatric and behavioral disorders in persons with Down syndrome

Similar to the state of the broader intellectual disabilities field, many gaps exist in the research and treatment of mental health concerns in people with Down syndrome. This review summarizes key findings on the type and prevalence of behavior and emotional problems in children, adolescents, and adults with Down syndrome. Such findings include relatively low rates of severe problems in children, and well-documented risks of depression and Alzheimer's disease in older adults. The review also considers emerging data on autism, and the paucity of studies on adolescents. Three next steps for research are highlighted, including a need to: (1) connect research on psychiatric status and diagnoses across developmental periods, including adolescence, and to examine such associated processes as sociability, anxiety and attention; (2) unravel complicated biopsycho-social risk and protective factors that serve to increase or diminish psychopathology; and (3) identify evidence-based treatments that both reduce distressful symptoms and enhance well-being in individuals with Down syndrome.     

Translational behavior analysis: from laboratory science in stimulus control to intervention with persons with neurodevelopmental disabilities

Throughout its history, laboratory research in the experimental analysis of behavior has been successful in elucidating and clarifying basic learning principles and processes in both humans and nonhumans. In parallel, applied behavior analysis has shown how fundamental behavior-analytic principles and procedures can be employed to promote desirable forms of behavior and to prevent or ameliorate undesirable forms in clinical, educational, and other settings. Less obviously, there has also emerged a small but identifiable bridging field that can potentially connect and inform both basic and applied behavior analysis. Although such translational behavior analysis uses laboratory methodologies, research targets are selected largely for their value in ultimate application to improve the human condition. I will discuss the distinction of translational behavior analysis from basic and applied behavior analysis and consider the potential contribution that translational research can make in the development of the science of behavior.     

Rational Rehabior Problem-Solving as a career development intervention for persons with disabilities

This article describes a cognitive-behavioral, psycho-educational program entitled Rational Behavior Problem-Solving. Also presented is a review of three research studies investigating its effectiveness in promoting the career development of persons with disabilities.Roy C. Farley, Ed.D. is an Associate Fellow of the Institute for Rational-Emotive Therapy, and an Associate Professor of Rehabilitation Education and Research with the Arkansas Research and Training Center in Vocational Rehabilitation at the University of Arkansas.     

Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.     

Microcomputer-based programmed instruction in identity matching to sample for persons with severe disabilities

Three individuals with mental retardation, who had failed to learn identity matching to sample with standard fading and prompting procedures, were given microcomputer-based programmed instruction. The methods were based on an analysis of two features of typical identity matching procedures: (a) within each trial, the current sample stimulus must control comparison selection, and (b) across trials, specific comparison stimuli must function both as S+ and as S–, depending upon the sample presented (conditional discrimination). During the first phase of training, one-trial acquisition of discriminative stimulus control was established in a nonconditional discrimination context where the S+ or S– functions of specific stimuli did not change from trial to trial. After one-trial learning was established, conditional discrimination was programmed by gradually introducing reversals of S+/S– stimulus functions. All three participants learned to perform conditional identity matching. Avenues for further analysis of the prerequisites for conditional discrimination and continued development of programmed methods are discussed.     

Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities

Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint‐reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior‐specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

The relationship between predictability and problem behavior for students with severe disabilities

Two single-case studies were conducted to examine the extent to which signaled (predictable) and unsignaled (unpredictable) events were associated with changes in the level of problem behavior during instruction. Two students with moderate-to-severe intellectual disabilities and autism participated in the study. Each student was nominated for the study based on a teacher's report that problem behaviors were much more likely when novel or unsignaled events occurred. Functional assessments were conducted with each student and the specific predictability features (signals) associated with low and high levels of problem behavior were identified. Multi-element and reversal designs were employed to examine the extent to which increased predictability was associated with reduced problem behavior. Results supported the use of functional assessment procedures to determine whether signals that provide information about the content, duration, timing, and/or consequences of future events could reduce problem behaviors.     

Validation of technical criteria for setting IPP goals for persons with developmental disabilities in residential settings

Data were collected from documentation from an annual IPP system on the technical adequacy of goals set and subsequently achieved. Goal characteristics coded included functionality of goal set (natural environment, natural materials, and age-appropriateness), ideological characteristics (community presence, choices and decisions, maintaining and developing competence, positive social role, and community participation), behavioral technical adequacy (named person responsible, achievement date, and stated in measurable terms), and curriculum domain. Multiple regression analysis revealed that goals that were written in a technically correct fashion and that involved functional skills were more likely to be achieved. A greater variety of life goals predicted fewer goals being achieved.     

Effects of deprivation on engagement in preferred activities by persons with developmental disabilities

This study examined the effects of deprivation on engagement in activities for 3 adult men with developmental disabilities. First, an assessment was conducted to identify a high- and a low-preference activity for each participant. Second, the high-preference activity was made available following three amounts of deprivation of the activity (15 min, 2 hr, and 1 to 4 days); the low-preference activity was made available following the schedule of deprivation that produced the highest level of engagement by each participant in the high-preference activity. The results were that 1 to 4 days of deprivation produced the highest average amounts of engagement in the high-preference activity for each participant; this amount of deprivation did not produce high engagement in the low-preference activities. Third, the deprivation procedures and results were replicated when high-preference activities were presented by teachers during the participants' daily activities when their engagement had been quite low.     

Predicting the relative efficacy of three presentation methods for assessing preferences of persons with developmental disabilities

Choices were presented to 9 individuals with developmental disabilities using a two-choice format. Each pair of items, selected based on prior preference assessment, was presented to each participant in three conditions (actual items, pictures of the items, and spoken-name presentation) using a reversal design. The evaluation was conducted using food items, and was then repeated using nonfood items. The participants were also given a test to measure their skills on discrimination tasks ranging in difficulty from simple to conditional discriminations. The participants' abilities to make consistent choices with food and nonfood items were predicted, with 94% accuracy, by their discrimination skills. The findings suggest that presentation methods can affect the accuracy of a choice assessment, and that the systematic assessment of basic discrimination skills can be used to predict the effectiveness of different presentation methods in this population.