Behavior disorder teams: An efficient institutional strategy

Recent trends toward deinstitutionalization have lead to an increased prevalence of behavioral and physical handicaps within institutional populations. At the same time, funding allocations have remained constant or have reduced creating an ever increasing need for the most efficient and cost-effective delivery of services. The present article traces the evolution of a program designed to create in-house panels of experts in an intermediate care facility for nonambulatory, severely and profoundly retarded children. The model is proposed as a means of improving quality of care and staff expertise and reducing the need for outside consultation.     

Pupillary responses in recognizing awareness in persons with profound mental retardation

Pupil-size changes have been shown to indicate positive or negative reactions to several sensory and psychologic stimuli in normal persons. Whether this could be extended to mentally retarded patients who lack ability for verbal or motor behavior was tested by pupillary responses to several visual, tactile, and auditory stimuli. 24 institutionalized severely and profoundly retarded patients were examined by video camera in their usual environments rather than in a controlled laboratory setting. The videotapes were later projected onto a screen for pupil-size measurements. Pupils dilated with pleasant stimuli, including visualizing a familiar person, soft touch to the arm, music, and soft compliments. There was constriction with presenting an unfamiliar person, rough grasp of the arm, and abrasive noise and harsh commands. The findings demonstrate the existence of pupil reactivity in profoundly retarded persons and suggest such testing as a means of determining which elements of their environment are pleasing or aversive to them.     

The collateral decrease of self-injurious behavior with teaching communicative gestures to individuals who are mentally retarded

The present study assessed the effect of teaching communicative gestures on the occurrence of self-injurious behavior and other behavior disorders with 14 individuals who are severely/ profoundly mentally retarded. Results show a statistically significant decrease of about 40% in self-injurious behavior as a collateral effect of an increased use of communicative gestures. Apart from a decrease in the occurrence of destructive behaviors, no other effects on other behavior disorders were found. Results are discussed in terms of the possible use of communicative gestures as a therapeutic supplement to standard procedures for decreasing self-injurious behavior with individuals who are nonverbal and mentally retarded.     

Behavioral expectations of retarded and nonretarded children

Two experiments were conducted to examine the effect of the mental retardation (MR) label on impression formation among retarded and nonretarded children and adolescents. The first experiment, conducted with nonretarded children in a mainstreamed school, indicated that they have pessimistic expectations of retarded children with regard to cognitive and ability-related behaviorsand, to a lesser extent, social behaviors (i.e., getting married). However, their reactions were not as pessimistic nor as “patronizing” as were those demonstrated by college students in previous research. In the second experiment, mentally retarded adolescents indicated that they also have negative behavioral expectations of retarded children, however, their self expectations were negative only for social behaviors. The results suggest that, among retarded persons, the expectations associated with the MR label are negative for social behavior, but apparently less pessimistic for cognitive and ability related tasks.     

Automatic and conscious processing in retarded and nonretarded adolescents

Educable mentally retarded and nonretarded adolescents participated in incidental learning tasks that emphasized the utilization of processes that were consciously controlled but not deliberately aimed at memory (Experiment 1). Retarded individuals' performance on a standard recognition test was equivalent to that of nonretarded subjects following phonetic encoding and nonstrategic encoding, but was deficient following semantic encoding. Retarded subjects also demonstrated a lower level of performance on a rhyme recognition task. In Experiment 2, retarded subjects provided a pattern of responding identical to that of nonretarded subjects on a picture-word interference task designed to assess automatic processing. The two groups produced equivalent levels of semantic activation. It was argued that the results of the two experiments indicate deficient semantic processing on the part of retarded individuals relative to that of nonretarded individuals that cannot be accommodated by a structural-deficiency model, a developmental-lag model, or a hypothesis that predicts intelligence-related differences only when the task involves the use of deliberate mnemonic strategies.     

Reduction of feces smearing in a profoundly retarded resident through contingent behavior-specific restraint and reduced attention

A 20-year-old profoundly retarded male resident of a state institution with a 12-year history of faces smearing (FS) was treated using an A-B design employing response contingent elbow restraint and reduced-attention. The rate of FS dropped sharply after the first week of treatment and then declined steadily until stabilizing at a relatively low rate. Incidental behaviors indicated that aversive effects of the treatment procedure were both mild and behavior specific. Procedures and results are compared with other behavioral approaches to treatment of self-injurious behavior.     

Group instruction with profoundly retarded persons: acquisition, generalization, and maintenance of a remunerative work skill.

We evaluated a group instruction program for teaching a vocational skill to profoundly retarded adults. The program involved designated trainer roles and both individual student-directed and total group-directed procedures. Results indicated that, following the program, participants acquired the skill of stamping addresses on envelopes, the skill generalized across an untrained type of envelope, and the skill maintained over time. The group activity was incorporated into the regular classroom without increased disruption and the participants earned a wage for their productivity. Implications for the development of a group instruction technology for severely handicapped persons are discussed.     

Why does working memory span predict complex cognition? Testing the strategy affordance hypothesis

We introduce and empirically evaluate the strategy affordance hypothesis, which holds that individual differences in strategy use will mediate the relationship between performances on a working memory (WM) span task and another cognitive task only when the same strategies are afforded by both tasks. One hundred forty-eight participants completed basic memory tasks and verbal span tasks that afford the same strategies, such as imagery and sentence generation, and completed reading comprehension tasks that afford different ones, such as self-questioning and summarization. Effective strategy use on WM span tasks accounted for variance in the span-memory relationship, but not for the span-comprehension relationship, supporting the strategy affordance hypothesis. Strategy use mediated the span-cognition relationship only when both tasks afforded the same strategies.     

Autonomic and behavioral evidence of "implicit" memory in amnesia

A profoundly amnesic patient with a left retrosplenial-fornix lesion was tested on a recognition task that evaluated both verbal and electrodermal aspects of new learning. In addition, "implicit memory" tasks (mirror reading and perceptual identification) were given. The patient displayed strong evidence of learning on all tasks although the results of this learning were not represented in explicit recall or recognition. These findings suggest that autonomic as well as behavioral evidence can index spared memory functions in amnesia. The specific meaning of electrodermal recognition and its possible place in the distinction between implicit and explicit memory is discussed.     

AN INSTITUTIONAL STAFF TRAINING AND SELF-MANAGEMENT PROGRAM FOR DEVELOPING MULTIPLE SELF-CARE SKILLS IN SEVERELY/PROFOUNDLY RETARDED INDIVIDUALS

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implication for future research and continued development of effective staff training and management programs.     

Effects of serial versus concurrent task sequencing an acquisition, maintenance, and generalization

Effects of serial and concurrent task presentation on skill acquisition, generalization, and maintenance were compared. Two severely retarded females participated. During serial training, items of one response class, tracing, were trained to mastery before those of a second task, vocal imitation. In the concurrent method, training on two different tasks, tracing and vocal imitation, alternated within sessions for fixed periods of time. There were no major differences between the serial and concurrent methods of instruction in the number of steps attained per behavior or in the number of trials required to reach criterion levels of performance. It was found however, that concurrent training resulted in more generalization. Retention results were not consistently related to training method.     

Instructional and behavior management practices implemented by elementary general education teachers

This investigation examined 317 general education kindergarten through fifth-grade teachers' use of instructional and behavioral management strategies as measured by the Classroom Strategy Scale (CSS)-Observer Form, a multidimensional tool for assessing classroom practices. The CSS generates frequency of strategy use and discrepancy scores reflecting the difference between recommended and actual frequencies of strategy use. Hierarchical linear models (HLMs) suggested that teachers' grade-level assignment was related to their frequency of using instructional and behavioral management strategies: Lower grade teachers utilized more clear 1 to 2 step commands, praise statements, and behavioral corrective feedback strategies than upper grade teachers, whereas upper grade teachers utilized more academic monitoring and feedback strategies, content/concept summaries, student focused learning and engagement, and student thinking strategies than lower grade teachers. Except for the use of praise statements, teachers' usage of instructional and behavioral management strategies was not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. HLMs suggested that teachers' grade level was related to their discrepancy scores of some instructional and behavioral management strategies: Upper grade teachers had higher discrepancy scores in academic performance feedback, behavioral feedback, and praise than lower grade teachers. Teachers' discrepancy scores of instructional and behavioral management strategies were not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. Implications of results for school psychology practice are outlined.     

TEACHING JOB INDEPENDENCE AND FLEXIBILITY TO MENTALLY RETARDED STUDENTS THROUGH THE USE OF A SELF-CONTROL PACKAGE

We examined mentally retarded individuals' use of picture cues and self-monitoring to initiate a series of tasks of varying type and order. Four severely to moderately retarded high school students participating in a vocational training program were trained to use a picture-cue system. The system consisted of photographs of vocational tasks that were inserted in the assigned order in a photoalbum sheet; self-management was accomplished by marking off each photo after its corresponding task was completed. Students were assigned seven tasks from a pool of 13 each day. Results indicated that the students quickly learned to use the picture-cue system to change tasks throughout their workday without trainer prompts and that performance was maintained as trainer feedback and presence were decreased. At the end of the study, two students who were exposed to novel photographs were able to initiate independently after only minimal training, suggesting that the use of the picture-cue system had become a generalized skill.     

ASSESSMENT OF STIMULUS PREFERENCE AND REINFORCER VALUE WITH PROFOUNDLY RETARDED INDIVIDUALS

We evaluated a procedure for identifying potential reinforcers with profoundly retarded individuals. In Experiment 1, six persons were repeatedly exposed to 16 stimuli, and approach behaviors to each stimulus were used to identify preferred and nonpreferred stimuli. In Experiment 2, we examined the reinforcing properties of preferred and nonpreferred stimuli by delivering them contingently on the occurrence of arbitrarily selected responses. Results revealed that the preferred stimulus conditions typically produced higher rates of responding than did either the baseline or the nonpreferred stimulus conditions, suggesting that the procedure can be used to assess reinforcer value for individuals with limited behavioral repertoires.     

Do the mentally retarded have poor memory?

The hypothesis that mentally retarded persons have a short-term memory deficit whixh is due to inadequate rehearsal strategies is reexamined. A reevaluation of results of a number of experiments suggests that normal and retarded persons differ on short-term memory tasks, and the superiority of normals is present from the time of initial stimulus exposure. While some evidence for slope differences in retention curves is found in a few tasks, it is not strong support for memory differences. The hypothesis that “memory” differences are due to differential encoding as a result of more adequate rehearsal by the normal subjects is unacceptable. If this were the case, some differences in slope of retention curves could be expected unless rehearsal beyond the encoding stage was totally precluded. The review points to a need for an empirical reevaluation of the issue with a full recognition that deficits in particular processes may characterize some retarded persons and not others.     

Vibration as a reinforcer with a profoundly retarded child

Data are presented which indicate that lever-pressing behavior of a profoundly retarded child could be reinforced by the contingent application of vibratory stimulation for each response. With vibration available 24 hr per day, no decrement in daily rate of responding for vibration was seen over a three-week period. Suggestions are made for further use of this finding in working with the profoundly retarded.     

LEISURE-DANCE INSTRUCTION FOR SEVERELY AND PROFOUNDLY RETARDED PERSONS: TEACHING AN INTERMEDIATE COMMUNITY-LIVING SKILL

We evaluated an approach for teaching an intermediate community living skill via a leisure-dance activity to institutionalized severely and profoundly retarded persons. The targeted skill was considered as intermediate in contrast to a community living skill per se because it was based on successful performances of higher functioning, noninstitutionalized retarded persons as opposed to nonhandicapped individuals. Definitions for appropriate dancing were established and then validated through observations of the performance of retarded persons living in the local community. The dance skills were then taught to four participants through serial training in leg movements, arm movements, and coordinated leg and arm movements, plus follow-up trainer supervision. Generalization was also programmed by way of multiple trainers and training settings. Results during structured assessments showed that all four residents acquired the dance skills and that both serial training and follow-up supervision were necessary for skill acquisition. Generalized increases in appropriate dancing at dances attended by the participants and retarded persons from the community were also demonstrated. However, in most cases some active supervision by caregivers was needed to enhance the generalized improvements. Results are discussed in terms of the applicability of this approach for validating goals when training other community-related skills to low-functioning populations.     

Suppression of Chronic High Frequency Spitting in a Multiply Handicapped and Mentally Retarded Adolescent

Excessive drooling and spitting are maladaptive behaviors often encountered among severely developmentally delayed children. In the present study a blind, deaf and retarded adolescent exhibited an extremely high rate of spitting which had resisted numerous classroom intervention efforts by teachers using punishment techniques. His recalcitrant spitting was eliminated with a behavioral intervention consisting of positive reinforcement for not spitting and facial screening for spitting. Experimental control was demonstrated using a multiple baseline across situations and within subject reversal design. The treatment package successfully eliminated the child's chronic spitting. Teacher reports one year later indicated the results maintained across time and spitting was no longer a problem. Social and academic implications of modifying such behaviors are discussed.