Promoting Self-Initiated Toileting in Children with Severe Developmental Disabilities

Abstract

This study assessed the possibility of teaching self-initiated toileting through a programme that (a) allowed the subjects (children with severe developmental disabilities) to remain in their normal contexts and(b) supplied these contexts with toileting cues. Frequent toileting occasions, reinforcement and reprimands were other features of the programme. The results showed that all three children involved in the study acquired self-initiated toileting. Two of them became virtually free from accidents, one continued to have a few accidents. The implications of the results are discussed.     

Single-Case Evaluation of a Negative Reinforcement Toilet Training Intervention

ABSTRACT

A negative reinforcement intervention was used to toilet train a child with multiple disabilities. The child appeared to actively withhold urinating in the toilet and was unresponsive to two positive reinforcement training programs. Negative reinforcement required that the child remain in the bathroom during toileting opportunities until he urinated properly. In-toilet urinating was achieved on the first day of intervention and the duration of training sessions decreased steadily. Appropriate toileting and an absence of urinary incontinence were documented post-intervention.     

A review of error correction procedures during instruction for children with developmental disabilities

Error correction procedures are remedial strategies presented following an incorrect response that increases the probability that a correct response will occur in the future. Error correction is commonly used during skill acquisition programs for children with developmental disabilities; however, the specific strategy used may differ considerably. Recent comparative studies have examined the effect of numerous error correction procedures on the efficiency of acquisition for children with developmental disabilities. Despite considerable merit, minor procedural differences and unique terms for similar procedures likely affect comparisons across studies. Here, we clarify the procedures and findings of these studies and suggest areas of future research.     

Recent research on emergent verbal behavior: clinical applications and future directions

This paper describes recent studies that have evaluated the functional independence of verbal operants. Procedures that facilitate the emergence of untrained verbal operants and important areas of future research to increase efficiency of language programs for children diagnosed with developmental disabilities are discussed.     

Quality care in residential placement for children and youth with developmental disabilities

There is a growing concern for quality care in residential placements outside of the natural family for children and youth with developmental disabilities. Ideally, children with developmental disabilities should remain with their natural parent or parents of parents with appropriate supports until the age when children typically leave home. In reality, parents of children and youth with development disabilities are not always able or willing to care for their children at home, and alternate residential placements must be found. This paper will discuss some of the issues surrounding the provision of quality care in out-of-home residential placements for children and youth with developmental disabilities.     

Personal and Environmental Factors Predict Participation of Children With and Without Mild Developmental Disabilities

Enhancing participation in age-related activities is a key goal in the education and rehabilitation of children with diverse disabilities. The aim of this study was to explore a multidimensional and ecological model of participation for young children. Seventy eight children with mild developmental disabilities (MDD, such as motor and visual-motor difficulties), and 110 children without disabilities, between the ages 4 and 6 years old, participated in the study together with their parents. Data were collected using standardized assessments for child capacities and newly developed questionnaires for child participation and for human and physical environmental factors. Associations were found between personal and environmental factors and the participation dimensions amongst young children, thus supporting the validity of the proposed model of participation. Moreover, the study results outline different pathways for the participation of children with and without MDD. Child factors (e.g. process skills) were found to be crucial predictors of participation particularly for children with MDD, whereas human environmental factor (e.g. maternal self-efficacy beliefs) was associated with higher participation scores especially for children without disabilities. These findings may facilitate the development of effective intervention programs which focus on environmental factors as well as on child factors.     

Training parent implementation of discrete-trial teaching: effects on generalization of parent teaching and child correct responding

Behavioral skills training was used to teach 3 parents to implement discrete-trial teaching with their children with developmental disabilities. Parents learned to implement discrete-trial training, their skills generalized to novel programs, and the children's correct responding increased, suggesting that behavioral skills training is an effective and efficient method of teaching discrete-trial teaching to parents.     

A methodology for assessing the functions of emerging speech in children with developmental disabilities

An approach based on Skinner's (1957) theory of verbal behavior has been developed to understand and teach elementary communication skills to children with autism and developmental disabilities (Sundberg & Partington, 1998). However, few studies have directly examined the characteristics of emerging language in children with developmental disabilities. The purpose of this study was to develop and evaluate an assessment for identifying the elementary functions of vocal speech in children. Participants were 4 children with developmental disabilities, aged 6 years to 12 years, who exhibited at least one distinguishable vocal response (word or phrase) frequently in the natural environment. The assessment focused on three verbal operants delineated by Skinner (mand, tact, and intraverbal). One or more functions were identified for at least one vocal response of each child. Results suggested that this assessment would be useful for (a) evaluating Skinner's theory, (b) guiding decisions about language training for individual children, and (c) studying the nature of expressive language development in children with developmental disabilities.     

发展性障碍儿童的脑发育特点及干预

随着发展认知神经科学的兴起, 研究者借助脑成像等技术探讨了发展性障碍儿童的脑结构发育特点, 发展缺陷与脑功能损伤的关系以及障碍干预和脑功能改善的机制等, 这为揭示发展性障碍儿童异常神经机制的共性和特异性, 进而为早期诊断和干预提供了重要的生物学标记。针对儿童期常见的发展性障碍, 从脑结构损伤、脑激活异常、脑网络连接和脑功能康复等方面对相关研究进行了总结, 指出未来研究应拓展角度, 注重揭示各发展性障碍之间异常脑发育特点的共性和特异性的具体表现、病理机制及基因基础等; 临床工作者应注重将脑发育的异常和功能改善用于辅助各类障碍的早期识别和干预效果评估。     

The developmental course of processing speed in children with and without learning disabilities

This study contrasted the development of processing speed in children with and without learning disabilities. We examined whether the same global mechanism presumed to be responsible for the normal developmental improvement in processing speed might also be associated with the processing speed deficiencies observed in children with learning impairments. One hundred and twenty-two children with learning disabilities in reading and/or math and 206 non-disabled community controls participated. There were no differences in relation of age to the development of processing speed for children with and without learning disabilities. We interpreted these results as suggesting that the underlying etiologies for the normal developmental change in processing speed and for the relative deficiencies in processing speed seen among children with learning disabilities were different.     

A Preliminary Study of Activation,Stress, and Self-Management of Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.     

Depression, learning disability, and school behavior problems

It is possible that recurrent depression (primary affective illness) is the most significant variable related to school problems of a behavioral nature in children manifesting developmental specific learning disabilities. The association of school problems and depression was investigated at a private school for children with developmental specific learning disabilities. These children were of normal intelligence and were free of primary conduct or thought disturbances. Prior to entering school, 95% of the students fulfilled criteria for developmental specific learning disabilities and 64% for depression with or without hyperactivity. Students manifesting no diagnosable behavioral condition prior to entrance continued to be relatively free of behavioral problems during their stay at school. Students with both depression and hyperactivity showed the most problematic behavior followed by students with depression without hyperactivity.     

The epidemiology of developmental disabilities in low-income countries

Although most of the world's children live in developing countries and may be at high risk for disability, very little is known about the prevalence and causes of developmental disabilities in these countries. This paper discusses methodological difficulties contributing to this lack of knowledge, and provides an overview of what is known about the epidemiology of developmental disabilities in low-income countries. At least some forms of developmental disability appear to be more common in low-income countries than in wealthier countries, despite the probability of higher mortality among children with disabilities in low-income countries. For example, most studies of severe mental retardation in low-income countries report prevalences greater than 5 per 1,000 children, while prevalence estimates from industrialized countries are consistently below this. Major risk factors for developmental disabilities in some low-income countries include specific genetic diseases, a higher frequency of births to older mothers, consanguinity, and specific micronutrient deficiencies and infections. Trauma and toxic exposures are also important risk factors, but their contributions to the etiology of developmental disabilities in low-income countries are not well documented. Though many of the causes of developmental disabilities are understood and preventable, proven methods of prevention are not being fully implemented in developing countries. Epidemiologic studies are needed to raise awareness of the public health impacts of developmental disabilities in low-income countries and to provide a basis for setting priorities and designing efficient interventions.     

Cerebellar tasks do not distinguish between children with developmental dyslexia and children with intellectual disability.

This paper explored the claim that only children with developmental dyslexia, whose reading ability is discrepant from their average general reasoning ability show specific deficits in motor tasks assessing cerebellar functioning (Fawcett et al., 2001, Cerebellar tests differentiate between groups of poor readers with and without IQ discrepancy. J. Learning Disabilities, 34, 119) and rapid serial naming (RAN, Wolf & Bowers, 1999, The double deficit hypothesis for the developmental dyslexias. J. Educ. Psychol., 91, 1). All available children between the ages of 11 and 14 were recruited from two special schools for children with either (a) formally-diagnosed intellectual disabilities (N = 18); or (b) formal diagnoses of developmental dyslexia (N = 25). These two groups of children did not differ on gender, age, pseudoword decoding abilities, or on 7 of 8 literacy measures, but did differ significantly, as expected on verbal and non-verbal reasoning tasks. Importantly, there were no deficits in bead threading ability or postural stability in the children with developmental dyslexia compared to the children with intellectual disabilities. There were also no between-group differences in rapid naming measures. The present results therefore provide no support for the claim that cerebellar deficits or RAN distinguish between children with dyslexia and children with intellectual disabilities that include reading.     

Medicaid: A potential source of revenue for special education

Currently, over 4.3 million children are receiving special services within the nation's schools because of physical, developmental, and educational disabilities. It is estimated that twice this number would benefit from special education services. Public Law 94–142, the Education for the Handicapped Act, offered the first real opportunity for many children with disabilities to receive special health and educational services. Public schools have become a primary setting for provision of services to these children, however, many states have encountered difficulty in procuring funding. One federally mandated source of revenue is the Medicaid program. In the fall of 1991, all state Medicaid and special education programs were asked to provide information concerning current or planned use of Medicaid funds for special education services. Responses were received from 36 states. Only 19 states reported using Medicaid funding in any capacity, and of these, only four required schools to bill Medicaid for services rendered. The majority of these programs are in the pilot stages of development. Special education services covered by Medicaid vary widely, as do reimbursement mechanisms. All 19 states allow Medicaid coverage for speech, physical, and occupational therapy. Only about half of those states provide allowances for diagnostic evaluation and assessment, while coverage for psychological services is provided by three-fourths of those states, and EPSDT screens by half of the states. Only two programs had been evaluated formally at the state and/or federal level. Medicaid remains a largely untapped source of revenue that could be used to help fund services for disabled children.     

A DISCRIMINATION TRAINING PROCEDURE TO ESTABLISH CONDITIONED REINFORCERS FOR CHILDREN WITH AUTISM

Although conditioned reinforcers are used in many behavioral intervention programs for individuals with developmental disabilities, little research has been conducted to determine optimal methods for establishing conditioned reinforcers. An early method that has received relatively little research attention is to condition a neutral stimulus as a discriminative stimulus and then use the stimulus as a programed consequence during skill acquisition. The current study evaluated the effects of a discrimination training procedure on establishing conditioned reinforcers for three children with autism. For all participants, previously neutral stimuli reinforced behaviors after acquiring discriminative properties during discrimination training. Copyright © 2014 John Wiley & Sons, Ltd.     

Trauma-Informed Care for Infant and Early Childhood Abuse

ABSTRACT

Trauma-informed care for those who experienced early childhood maltreatment is being developed to meet the needs of infant, toddler, and preschool victims of child abuse and neglect. This age group experiences a disproportionate amount of abuse, and the resultant toxic stress during this rapid developmental stage is more damaging than it is in later years. The concept of trauma-informed care in general is presented, followed by a focus on trauma care for early childhood abuse. Trauma-informed care for younger children is united by common principles and is seen as developmental, relational, sensory oriented, and evidence based in nature. Dissemination of knowledge about this unique population to every system that encounters survivors of any age has begun, although it must be broadened and increased. Evidence-based treatment programs for young children are available and effective but limited, especially for age 0–2. Home visiting programs for mothers and babies are effective and cost efficient. Major funding by U.S. Department of Health and Human Services to each state has significant potential for success because it targets mother-child attachment and care, as well as the disproportionate amount of damage resulting from early childhood abuse. Infants and preschoolers are in some ways comparable to children with disabilities due to their developmental limitations. The nature of this population requires a more rigorous and proactive awareness and identification process because these children are physically dependent on surrounding adults. Addressing child abuse in the first years of life offers an excellent opportunity to assist the most vulnerable victims and effectively reduce the impact to families and communities in the ensuing years.     

Psychometric properties of the Sutter-Eyberg Student Behavior Inventory with rural middle school and high school children

This study examined the psychometric properties of the Sutter-Eyberg Student Behavior Inventory (SESBI) in a rural sample of children and adolescents. Thirty-eight 5th- through 12th-grade teachers completed the SESBI on 726 children in their classrooms. High Cronbach's alphas supported the reliability of the SESBI scales in this population. Higher SESBI scores were obtained by boys than girls and by African American students than Caucasian students, more so at lower grades. Teacher's race did not affect SESBI scores. In contrast to children with developmental delay, children with learning disabilities obtained higher scores than others on the SESBI Intensity scale but not on the Problem scale. This suggests that teachers of children with learning disabilities recognize the higher frequency of problem behaviors in their students but do not consider these behaviors to be problems for themselves. On both SESBI scales, children with developmental delay were not distinguishable from peers without developmental delays.     

In vivo functional assessment and multi-element interventions for problem behaviors of students with disabilities in classroom settings

Persons with developmental disabilities often do not follow instructions or complete tasks in educational settings, thus further disadvantaging themselves as they try to lead more normalized lives. The purpose of this paper was to address the problems of three persons referred for not following instructions and for engaging in associated behavior problems (e.g., crying, hitting, throwing materials) when given instructions. A functional assessment was conducted in the natural school setting without any prescribed conditions as in analogue functional assessments. Results of the assessments showed that problem behaviors for two subjects occurred much more in demand conditions requiring active responses than in demand conditions requiring passive responses. The results for a third subject showed problem behaviors were associated with toileting demands, less so with other demand conditions, but not with conditions in which there were an absence of demands. Individualized multi-element interventions were based on the negative reinforcement hypothesis and were intended to make tasks less aversive and to make instructions easier to understand. Results of the interventions showed increases in task engagement and decreases in problem behaviors during the active tasks and toileting tasks for which interventions were programmed, as well as for the passive tasks and other demand conditions for which no interventions were programmed. Results were discussed in terms of the value of functional assessments in directing therapists to base interventions on hypotheses of the function of the presenting problem.     

两类数学学习困难小学儿童抑制控制水平的实验研究

为考察单纯型数学困难与混合型数学困难小学儿童的抑制控制水平及特点,使用Stroop色词命名测验和颜色匹配反转作业,对各30名的单纯型困难、混合型困难和对照组小学儿童的优势反应抑制能力进行测试、分析。结果发现:单纯型数学困难儿童抑制优势反应的能力显著低于对照组,但其对事物初次学习的能力与对照组相当;混合型数学困难儿童在对事物初次学习能力及对优势反应的抑制能力方面均显著低于对照组儿童,其中对事物的初次学习能力也显著低于单纯型数学困难儿童。