DEFINING,VALIDATING, AND INCREASING INDICES OF HAPPINESS AMONG PEOPLE WITH PROFOUND MULTIPLE DISABILITIES

In this study we attempted to operationalize, measure, and increase happiness among people with profound disabilities. Happiness indices were defined and observed among 5 individuals. Validation measures indicated that (a) increases in happiness indices were observed when individuals were presented with most preferred stimuli relative to least preferred stimuli, (b) increases in unhappiness indices were observed when they were presented with least preferred relative to most preferred stimuli, and (c) practitioner ratings of participant happiness coincided with observed indices. Subsequently, classroom staff increased happiness indices through presentation and contingent withdrawal of activities. Results suggested that a behavioral approach can enhance happiness as one aspect of quality of life among people with profound disabilities. Research directions are offered that focus on using a behavioral approach to investigate other private events that are important among people with disabilities.     

Reducing indices of unhappiness among individuals with profound multiple disabilities during therapeutic exercise routines.

A program was developed to reduce indices of unhappiness that accompanied therapeutic exercise routines among people with profound multiple disabilities. Indices of unhappiness were recorded, using an observation system that had been validated through previous research involving happiness-related variables, while support personnel conducted exercises with 3 participants. A multicomponent program was then implemented that involved presenting highly preferred stimuli before, during, and after each exercise session. Results indicated that the program was accompanied by reduced indices of unhappiness for each participant relative to the traditional method of conducting the exercises, although changes in the preferred stimuli used with 1 participant were required before consistent reductions occurred. Results are discussed regarding the importance of reducing unhappiness indices as a means of enhancing aspects of the daily quality of life for people with profound multiple disabilities. Areas for future research are also discussed, focusing on expanding the unhappiness-reduction procedures to other routine events that may occasion indices of unhappiness.     

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.     

A microswitch‐based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities

We assessed the use of a microswitch‐based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.     

An enriched teaching program for reducing resistance and indices of unhappiness among individuals with profound multiple disabilities

We evaluated an enriched teaching program for reducing resistance and indices of unhappiness displayed by 3 individuals with profound multiple disabilities during teaching sessions. The program involved presentation of preferred activities before, during, and after each teaching session, discontinuation of identified nonpreferred activities, and a brief break and preferred activity following occurrence of resistance. Implementation of the enriched teaching program was accompanied by reductions in resistance and indices of unhappiness for each participant. Results also indicated no negative impact of the program on participant performance of the teaching steps or staff teaching proficiency. Staff questionnaire responses provided a degree of social validation for the observed changes in that staff reported the participants liked the enriched teaching program more than the traditional teaching process. Directions for future research discussed include identifying critical aspects of the overall program and the potential relation between teaching proficiency and the program's enrichment effectiveness.     

Further evaluation of the use of preference categories to identify novel reinforcers: A systematic replication

Preference assessments are frequently used to identify reinforcers for individuals with autism spectrum disorder and intellectual and developmental disabilities. Although well‐established procedures have been shown to identify preferred stimuli for individual items that can be used in skill acquisition and behavior reduction programs, little research has been conducted on identifying categories of preferred items. In this study, paired‐stimulus preference assessments were conducted with 4 individuals with autism spectrum disorder. Researchers classified the edible stimuli as belonging to 1 of 4 categories: chocolate (e.g., chocolate chips and M&M's^®), salty/crunchy (e.g., chips and crackers), gummy (e.g., Swedish Fish^® and Starburst^®), or fruit/vegetable (e.g., grape and apple). Preference hierarchies were identified for individual stimuli and for categories of stimuli. For all participants, at least 3 of the 4 most preferred items came from the same category. Novel items (i.e., items not included in the preference assessments) identified by the researchers as belonging to the high‐preference category functioned as effective reinforcers during subsequent reinforcer assessments for all participants. This finding suggests that clinicians could identify likely effective edible reinforcers based on an individual's categorical preference without explicit testing.     

Reinforcing efficacy of interactions with preferred and nonpreferred staff under progressive-ratio schedules

Research has not systematically assessed and validated preferences for staff in adults with developmental disabilities. Three adults with developmental disabilities (aged 32 to 43 years) identified preferred and nonpreferred staff using verbal and pictorial preference assessments. During break-point analyses with progressive-ratio schedules, all 3 had higher break points when working for positive social interaction with their preferred staff mamber than with their nonpreferred staff member.     

Evaluation of absolute and relative reinforcer value using progressive-ratio schedules

We evaluated behavior exhibited by individuals with developmental disabilities using progressive-ratio (PR) schedules. High- and low-preference stimuli were determined based on the results of a paired-stimulus preference assessment and were evaluated in subsequent reinforcer and PR assessments using concurrent and single schedules of presentation. In Experiment 1, results showed that for 2 of 3 participants, stimuli determined to be low-preference functioned as reinforcers when evaluated independent of high-preference stimuli. Further, the results from Experiment 2 showed that low-preference stimuli also functioned as reinforcers under gradually increasing PR requirements. Results suggest that for cases in which a high-preference stimulus is unavailable or impractical, the contingent delivery of relatively less preferred stimuli may maintain appropriate behavior, even as schedule requirements increase.     

Increasing the happiness of individuals with profound multiple disabilities: replication and extension

A multielement design was used to compare the effects of three treatments on the happiness of 3 individuals with profound multiple disabilities. The conditions were typical programming using materials selected by staff, presentation of preferred materials plus social interaction, and social interaction alone with no materials present. Both the presentation of the preferred items with social interaction and social interaction alone resulted in higher happiness indicators than typical programming. The combination of preferred items and social interactions was somewhat superior to social interaction alone.     

EFFECTS OF REINFORCEMENT CHOICE ON TASK RESPONDING IN INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

The effects of reinforcement choice on task performance were examined with 6 individuals who had been diagnosed with severe to profound mental retardation. Five highly preferred items were identified for each participant via stimulus preference assessments. Participants then were exposed to choice and no-choice conditions that were alternated within reversal and multielement designs. During choice sessions, participants were permitted to select between two preferred stimuli contingent on responding. During no-choice sessions, the therapist delivered a single item contingent on responding. Preference for the stimuli was held constant across conditions by yoking the items delivered during no-choice sessions to those selected during the immediately preceding choice sessions. All participants exhibited similar rates of responding across choice and no-choice conditions. These findings indicate that for individuals with severe disabilities, access to choice may not improve task performance when highly preferred items are already incorporated into instructional programs.     

EVALUATION OF A BRIEF STIMULUS PREFERENCE ASSESSMENT

We evaluated the utility of a brief (5-min) stimulus preference assessment for individuals with developmental disabilities. Participants had noncontingent (free) access to an array of stimuli and could interact with any of the stimuli at any time. Stimuli were never withdrawn or withheld from the participants during a 5-min session. In Experiment 1, the brief preference assessment was conducted for 10 participants to identify differentially preferred stimuli, and reinforcer assessments were conducted to test the reinforcing efficacy of those stimuli identified as highly preferred. In Experiment 2, a comparison was conducted between the brief preference assessment and a commonly used paired-stimulus preference assessment. Collectively, results demonstrated that the brief preference assessment identified stimuli that functioned as reinforcers for a simple operant response, identified preferred stimuli that were differentially effective as reinforcers compared to nonpreferred stimuli, was associated with fewer problem behaviors, and required less time to complete than a commonly used paired-stimulus preference assessment.     

TEACHING CHOICE MAKING DURING SOCIAL INTERACTIONS TO STUDENTS WITH PROFOUND MULTIPLE DISABILITIES

We taught 4 students with profound multiple disabilities to use a microswitch communication system to request a change in recreational stimuli during social interactions with nondisabled peers. In Study 1, we conducted a preference assessment across a range of stimuli for each student. The most and least preferred stimuli were incorporated into microswitch communication system training in Study 2. During the second study, 3 of the 4 students (a) learned to use the microswitch communication system to control stimulus presentation, (b) more clearly differentiated their time among stimuli, and (c) increased their level of general alertness. Study 3 extended the use of the microswitch communication system to social interactions with nondisabled peers. Two students were more engaged in interactions when they chose when to change stimuli; 1 student was more alert when a peer chose when to change activities; a 4th student showed an undifferentiated pattern. The outcomes of the investigation are discussed in terms of the effects of controlling stimulus presentation on the behavior of students with profound multiple disabilities and the stability of preference hierarchies over time.     

Examination of the influence of contingency on changes in reinforcer value

This study examined how the amount of effort required to produce a reinforcer influenced subsequent preference for, and strength of, that reinforcer in 7 individuals with intellectual disabilities. Preference assessments identified four moderately preferred stimuli for each participant, and progressive-ratio (PR) analyses indexed reinforcer strength. Stimuli were then assigned to one of four conditions for 4 weeks: fixed-ratio (FR) 1 schedule, escalating FR schedule, yoked noncontingent (NCR) delivery, and restricted access. Preference assessments and PR schedules were then repeated to examine changes in selection percentages and PR break points. Selection percentages decreased for all NCR stimuli but increased for most of the restricted stimuli. There were no systematic changes in selection percentages for either of the contingent stimuli. Break points increased, on average, for all conditions, but the increase was highest for the restricted stimuli and lowest for the NCR stimuli. These results are discussed in relation to recent basic research addressing the influence of effort on stimulus value.     

VALIDATING PREDICTED ACTIVITY PREFERENCES OF INDIVIDUALS WITH SEVERE DISABILITIES

We examined the accuracy of 24 staff members' predictions of activities preferred by 14 individuals with severe disabilities. For each of 144 activities, staff members assigned a client preference rating of “likes a lot,” “likes,” or “dislikes.” Two activities from each category were randomly selected for each individual with disabilities. Pairs of selected activities were presented to the individuals, who were prompted to choose an activity. Staff members' activity preference ratings correctly predicted the choices made by the individuals with disabilities for 78% of the trials. The more divergent the preference ratings of the paired activities, the more likely staff members were to predict correctly the activity selected by a participant.     

A COMPREHENSIVE EVALUATION OF REINFORCER IDENTIFICATION PROCESSES FOR PERSONS WITH PROFOUND MULTIPLE HANDICAPS

We evaluated comprehensively a preference assessment for identifying reinforcers for persons with profound multiple handicaps. Four experiments were conducted involving 18 individuals. Results of Experiment 1 replicated previous findings in that the assessment identified student preferences for respective stimuli, and caregiver opinion of preferences did not coincide with the systematic assessment. Results of Experiment 2 indicated highly preferred stimuli were likely to function as reinforcers in training programs, whereas stimuli not highly preferred did not function as reinforcers. Results of Experiment 3 suggested the 12 stimuli used in the assessment represented a comprehensive stimulus set for identifying preferences, although the utility of the set sometimes could be enhanced by caregiver opinion. Results of Experiment 4 indicated the assessment identified preferences likely to be maintained over time. Overall, results are discussed in terms of identifying limits and alternatives to a behavioral teaching technology when applied to persons with profound multiple handicaps.     

Integrating instructional procedures into traditional congregate care situations for people with severe disabilities

Many institutional and community residential agencies experience difficulties in providing habilitative services when direct care staff are working with groups of people with severe disabilities. We evaluated a means of assisting direct care personnel in integrating instructional strategies into traditional congregate care situations. In Experiment 1, integrated teaching strategies were operationalized for two direct care staff persons. The strategies were based on individualized client habilitative goals and the use of brief response prompting and contingent reinforcement paradigms. The staff members integrated the teaching procedures into their group routines with clients upon implementation of an integrated-teaching staff training and management program. The program involved two staff training sessions and ongoing performance feedback. In Experiment 2, four staff members in another living unit integrated the strategies into their group routines upon implementation of a simplified version of the program. Additionally, while the program was in effect, adaptive behaviors increased in frequency for 19 of 20 clients with profound multiple disabilities. Results of the experiments demonstrate a means through which residential agencies may enhance provision of continuous active treatment in accordance with clinical and governmental guidelines. Suggestions for future rescarch are provided, focusing on overcoming obstacles residential personnel face in providing treatment services in congregate situations.     

The Relation Between Obtained Preference Value and Reinforcer Potency

Stimulus preference assessments often include items suspected to be highly preferred. If only high‐preference stimuli are assessed, preference hierarchies may not accurately predict the results of reinforcer assessments (RA). In this study, paired‐stimulus (PS) preference assessments using items suspected to be preferred (PS‐1) generated distinct preference hierarchies. Subsequent RAs (RA‐1) indicated that high‐preference and low‐preference stimuli were associated with similar response rates. Additional assessments (PS‐2) were then conducted, using the least‐preferred item from PS‐1 plus seven new stimuli. The least‐preferred items on PS‐1 ranked as most preferred on PS‐2, and on RA‐2, the top‐ranked items functioned as reinforcers, but low‐ranked items did not. Implications for incorporating low‐preference items into clinical/educational programming are discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Long‐term stability of edible preferences in individuals with developmental disabilities

Multiple stimulus without replacement (MSWO) preference assessments were used to examine the stability of preference hierarchies in eight individuals with developmental disabilities. In Study 1, preference assessments using edible items were conducted 6 months apart; in Study 2, assessments were conducted 12 months apart. As in previous studies analyzing preference stability, individual differences in stability were found in both studies. However, mean rank order coefficients across participants revealed interesting findings in both comparisons. Generally, preference for edible items, particularly the most and least preferred stimuli, was more stable across time than has been found in other research conducted with leisure items. Stability was greater when only 6 months lapsed between assessments. Moreover, for three of the eight participants, rank order coefficients were significant across both studies indicating the possibility that some individuals may tend toward more stable preferences. Copyright © 2007 John Wiley & Sons, Ltd.     

Stimulation and microswitch‐based programs for enhancing indices of happiness: a maintenance assessment

This study assessed whether stimulation and microswitch‐based programs maintained their positive impact on indices of happiness over time. Three people with multiple disabilities, who had participated in a study comparing these programs, continued to be exposed to them over a maintenance period of 5 or 6 months. Maintenance data showed that the frequencies of indices of happiness increased or remained unchanged for two participants and declined for the third. The frequencies of microswitch activations were higher for two of the participants and largely unchanged for the other. Procedural aspects of the study, implications of the findings, and relevant issues for new research are discussed. Copyright © 2003 John Wiley & Sons, Ltd.