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.     

Adapting Cognitive Processing Therapy for PTSD for People With Disabilities: A Case Study With a U.S. Veteran

Many veterans receiving treatment for PTSD in the VA health care system are also living with a disability and utilize assistive technologies for communication and/or mobility. While evidence-based treatments for PTSD have been disseminated in VA hospitals nationwide, clinicians may have concerns about implementing these treatments with people with disabilities or question how to adapt evidence-based protocols to facilitate successful outcomes. This clinical case study details the treatment of a 48-year-old male U.S. veteran with a diagnosis of military-related PTSD and significant functional and communicative complexities characteristic of locked-in syndrome. The study implemented an adapted protocol of Cognitive Processing Therapy (CPT), a first-line evidence-based psychotherapy for PTSD with unknown application to people with disabilities. CPT protocol structure, length, and delivery was adapted to accommodate the veteran’s assistive devices and functional abilities. The veteran experienced a clinically significant reduction in PTSD symptoms over the course of treatment, suggesting successful application of the adapted protocol. In addition to symptom reduction, the veteran reported advances in his ability to tolerate emotional distress while engaged in goal-directed behavior and improved interpersonal functioning. Results suggest that CPT can be adapted and effective in instances where the presence of disability and multiple assistive technologies impact standard treatment implementation. This information is valuable in its potential ability to make evidence-based psychotherapies more accessible and disability-sensitive. Clinical recommendations for using and adapting CPT for people with disabilities are provided.     

Teaching Different Tasks Using Different Stimuli in a Heterogeneous Small Group

The effectiveness of a simultaneous prompting procedure was evaluated in a heterogeneous small group using different tasks and different stimuli for each student. Participants included four middle school students whose functioning levels ranged from typically developing to moderate and severe disabilities. A multiple probe design across behaviors and replicated across students was used. Observational learning maintenance, and generalization also were assessed. Results indicate that the procedure was successful in teaching all four students their targeted stimuli as well as some of the non-targeted stimuli (i.e., observational learning). Students maintained and generalized their information with a high degree of accuracy. Limitations of the study and future research implications are discussed.     

What We Know About Women's Technology Use,Avoidance, and Abandonment

With the increasing availability of assistive technologies, persons with disabilities have unprecedented opportunities for full societal participation. But women, especially women with disabilities, have typically not had much exposure to and experience with technologies and can find them intimidating and frustrating. While many women use technologies regularly and with satisfaction, others use theminfrequently and with reluctance, avoid them entirely, or try them only to abandon their use. This article discusses factors associated with technology use, avoidance, or abandonment as being outcomes of the interactionof: (a) The particular technology (design, service delivery), (b) the person's abilities and personality (judgment, expectations), (c) characteristics of the disability (type, severity), and (d) the person's psychosocial environment (social support, training and education). Assessment instruments exist comprehensively profile individuals in the four areas so the most appropriate technologies can be recommended and needed modifications to technologies made.     

Relating infant temperament to learning disabilities

The role of infant temperament in the development of learning disabilities was at issue. As infants, boys with severe learning disabilities were found to be (1) lower in activity level, (2) more irregular, (3) less approaching, and (4) more negative in mood than normal boys. Discussion centered around conceptualizing learning disabilities as the outcome of a developmental process. Thus patterns of early parent-infant interaction are established, based in part upon the infant's temperament, that may evolve into a learning disability.The authors would like to express appreciation to George Diamond, director of Pupil Personnel Services for the Addison, Illinois, School District, for his help in obtaining these data.     

Enhancing parental reflective functioning: A special tribute to the life and work of Nancy E. Suchman,PhD

Nancy E. Suchman's contributions to the fields of infant mental health, maternal reflective functioning, and attachment-based intervention will have long-lasting impacts. In particular, through the development and dissemination of her intervention program, Mothering from the Inside Out (MIO), she innovated a way of working with mothers with substance use disorders that represented a paradigm shift within the field of addiction. In this introduction to the special issue, written to honor her life and work, we review Nancy's background and briefly describe her academic accomplishments. The special issue contains nine qualitative and quantitative research reports written by Nancy's colleagues and their collaborators. All nine papers pertain to the theme of understanding, measuring, and promoting parents’ capacity for reflective functioning. Four provide findings that advance our understanding of parental reflective functioning. The other five highlight insights from continuing evaluations of MIO, including new adaptations of the model. To introduce the special issue, we provide an overview of the scope of the work done within these projects. Finally, the special issue concludes with two commentaries contributed by Linda Mayes and Arietta Slade, leading scholars within the field who were also Nancy's close colleagues. Both provide insight into Nancy's impact on the field.     

Preparing direct service staff to teach people with severe disabilities: A comprehensive evalution of an effective and acceptable training program

In light of the continuing need for residential, direct service staff to be able to teach people with severe disabilities, we comprehensively evaluated a program to train staff in behavioral teaching strategies. The program was developed and evaluated with attention given to recent concerns in the staff management literature regarding shortcomings with staff training research. The training program, involving a maximum of four, 2-hr classroom instruction sessions and three in vivo observation and feedback sessions, was evaluated in four studies. In Study 1, the program was shown to improve verbal skills of 13 direct service staff regarding behavioral teaching principles and terminology. In Study 2, the program was demonstrated to improve performance based teaching skills of nine staff and four staff supervisors. In Study 3, the program was shown to result in improvements in adaptive skills of three clients with severe disabilities when direct care staff used their newly acquired teaching skills with the clients. In Study 4, the training program was shown to be well received among 17 staff trainees, although the trainees were more accepting of some program components than others. Results of the studies are discussed in regard to the importance of agencies providing effective and acceptable staff training programs. Future research areas also are noted, focusing on the need to determine, and minimize where possible, the amount of time required to conduct successful staff training.     

Evaluating Assistive Technology in the Education of Persons with Severe Disabilities

This commentary includes a brief discussion of issues raised by the articles and systematic review contained in this special issue addressing technology applications for persons with severe developmental disabilities. Topical areas include a discussion of; (1) a need to compare “high tech” with “low tech” applications, (2) procedural fidelity, (3) collateral effects associated with intervention, (4) the conditional use of newly established behavior, (5) response efficiency and contextual fit, and (6) treatment intensity.     

FUNCTIONAL COMMUNICATION TRAINING USING ASSISTIVE DEVICES: RECRUITING NATURAL COMMUNITIES OF REINFORCEMENT

We evaluated the effectiveness of functional communication training (FCT) as an intervention for the problem behavior exhibited by 5 students with severe disabilities both in school and in the community. Following an assessment of the function of their problem behavior, the students were taught to use assistive communication devices in school to request the objects and activities that presumably were maintaining their behavior. Multiple baseline data collected across the students indicated that not only did the students use their devices successfully, but the intervention also reduced their problem behavior. In addition, data from community settings showed generalization to untrained community members. These results replicate other successful efforts to use FCT with individuals having limited communication skills, and demonstrate the value of teaching skills to recruit natural communities of reinforcement in order to generalize intervention effects to meaningful nontraining environments.     

An ecological approach to learning

This paper introduces a special journal issue devoted to the study of learning in ecological and developmental contexts. In the past, the dominant approach to the study of learning has depended upon the choice of arbitrary problems, stimuli, and responses to guarantee the generality of principles discovered in the laboratory. Recently, though, there has been considerable interest in integrating an ecological (functional) account of learning with the strengths of the classic laboratory approach. One form of integration is to use the technology of the laboratory to look for the operation of general learning laws in ecological problems. The approach favored here is to treat learning as a biological phenomenon by first placing it within a functional system of behavior, and then by analyzing where and how learning modifies the operation of that system. Because the results of such analyses are defined with respect to functioning systems rather than procedural paradigms, the ecological approach readily makes contact with issues in evolution, development, and physiology, an ability not completely shared by the classic general-process approach. Concerns about laboratory versus field, function versus mechanism, generality of results, and adaptive “storytelling” can be resolved or further clarified by the present approach. The papers in this issue represent a cross-section of research stemming from an ecological approach to learning, and provide specific analyses of how learning modifies and is expressed in functional systems of behavior.     

美国成人学习不良研究及其启示

随着儿童、青少年学习不良研究的逐步深入,近年来,成人学习不良成为美国等西方国家教育心理学研究新的热点。在回顾了成人学习不良概念的提出与确立后,介绍了美国学术界对成人学习不良的筛查和界定标准,并对该领域主要成果从学业发展、阅读困难、元认知和干预研究四个方面进行了概括和分析,指出成人学习不良界定标准的不统一、长期追踪研究的缺乏以及针对成人学习不良心理咨询体系的滞后等已成为当前该领域急待解决的问题。我国应在吸取国外研究成果和经验的基础上,尽快制定出符合自身国情的筛查和诊断标准,掌握学习不良在我国成人群体当中的发生率和分布状况,同时加强相关基础研究和追踪研究,争取在较短时间内建立起我国成人学习不良研究的体系。     

Response to instruction, English language learners and disproportionate representation: the role of assessment

Response to Intervention (RtI), a cyclical process that incorporates assessment and instruction, is both an approach to prevent learning difficulties and to establish student eligibility for special education. Assessment results are used to determine students' initial knowledge and skill, their need for successively more intensive levels of instruction, and to gauge their response to the intervention provided. Although this process is preferable to the IQ/achievement discrepancy model for determining the presence of specific learning disabilities, there are still a number of unresolved issues related to the assessment procedures in use. A pressing issue is the identification of measures and procedures that identify students with the greatest precision thus reducing inappropriate identification.     

Social interaction interventions for youth with severe disabilities should emphasize interdependence

An emphasis on independence may be limiting the outcomes achieved by social interaction research. Given the lack of correlation between intellectual or adaptive functioning level and meaningful social outcomes for people with severe disabilities, a focus on increasing skills as a mechanism for increasing social outcomes seems misplaced (or, at least, inefficient). It is argued here that a more productive route for researchers to follow will be to emphasize interdependence. Implications of such a focus will change where interventions are implemented, curricular foci, and the types of instructional strategies used to improve the social life of youth with severe disabilities. MRDD Research Reviews 7:122-127, 2001.     

General Education Participation Improves the Social Contacts and Friendship Networks of Students with Severe Disabilities

One desired outcome of inclusive education is the enhanced social development of students with disabilities. Some have suggested that planned and systematic support of students with severe disabilities in general education environments may lead to greater social interaction between these students and their peers without disabilities. In an effort to analyze this proposition, we studied two students with severe disabilities as they began participating in general education classrooms. Using within-student multiple baseline designs across class periods, the effects of participating in general education were studied across a range of social participation indicator variables. Our results suggest that planned and systematic efforts to include students with severe disabilities into general education courses can have positive effects on their social contacts and friendship networks. Our findings are discussed in relation to policy efforts to establish inclusive education in public schools, strategies for structuring general education participation, and the potential effects such efforts can have on the social inclusion of students with disabilities.     

Bridging the Gap Between the Science and Practice of Psychology in Organizations: State of the Practice Reflections

This special issue of the Journal of Business and Psychology focuses on the linkage between the science and practice of psychology in applied organizational settings. The purpose of this special edition is to (a) cover current hot topics and cutting edge practice areas in HR and/or the psychology of organizations, and (b) raise compelling research issues and ideas for researchers to pursue, with an overall goal of helping bridge the science to practice gap. Each of the 14 articles included in this special issue were selected because they focus on some critical aspect of an important topic in applied organizational settings for which there is either limited, contradictory, or very little formal research in the literature. Key themes include: employee engagement, ensuring sustained behavior change through feedback and coaching, the impact of emerging technologies such as social networking sites on HR practices, and talent management and retention among others.     

The End of Dependence? Ethical Issues in the Adoption of Assistive Technologies: An Introduction

This special issue explores the evolving role of assistive technology in health and medicine, with 3 original articles and 5 commentaries. The following introduction provides an overview of the issue’s unifying themes and the articles’ aims and concerns, as well as reflection on some critical points for discussion raised in the commentaries. Assistive technology finds itself at a pivotal point of development and integration into current systems, where sound and innovative ethical guidance is crucial. With this issue we hope to build capacity for realizing the potential of assistive technology—effectively, sustainably, and ethically.     

The Effects of Partner Learning During Spelling for Students with Severe Disabilities and Their Peers

A multiple baseline across subjects design was used to examine the effects of partner learning on the spelling performance, academic responding, and competing behavior of three students with severe disabilities and three of their classmates without disabilities. The students were enrolled in different general elementary classes. All students in these classes were assigned to partner learning triads by the general education teacher. One triad in each class included the student with severe disabilities and two classmates without disabilities. All students in the class received two, 20 min partner learning sessions each week. During partner learning, each member of the triad was asked to spell words, present words to be spelled, provide feedback to the speller, and check the spelling accuracy. These roles were rotated among the members of the triad after each trial. These roles were adapted as necessary to accommodate the academic and communication skills of the students with severe disabilities. The effects of partner learning on spelling accuracy were assessed through weekly spelling tests. The effects of partner learning on academic responding and competing behavior were assessed using the MS-CISSAR (Carta, Greenwood, Schulte, Arreaga-Mayer, Terry, 1988). Results of weekly spelling indicated that partner learning led to improved spelling accuracy for students with severe disabilities and did not negatively affect the spelling accuracy of their peers. Partner learning also led to improved rates of academic responding and reduced rates of competing behavior for 5 of 6 students. The results are discussed in terms of their implications for practice and future research.     

Ambient Assistive Technologies (AAT): socio-technology as a powerful tool for facing the inevitable sociodemographic challenges?

Due to the socio-demographic change in most developed western countries, elderly populations have been continuously increasing. Therefore, preventive and assistive systems that allow elderly people to independently live in their own homes as long as possible will become an economical if not ethical necessity. These respective technologies are being developed under the term "Ambient Assistive Technologies" (AAT). The EU-funded AAT-project Ambient Lighting Assistance for an Ageing Population (ALADIN) has established the long-term goal to create an adaptive system capable of improving the residential lighting conditions of single living elderly persons also aiming at supporting the preservation of their independence.     

Effects of Contact on Children's Attitudes Toward Disability: A Longitudinal Study1

A quasi-experimental study was conducted on temporal effects of intergroup contact on nondisabled (ND) children's attitudes toward disability. Children from a mainstream primary school were involved in an integration program with children from a school for children with severe learning disabilities (SLD). ³ 3 Severe learning disabilities (SLD) is the term currently used in the U.K. to describe people who might formally have been described as having “severe mental handicap” or “severe retardation.” This term is interchangeable with “severe learning disabilities.”
Measures were administered 3 times over a period of 3 months to 26 integrating (experimental) and 24 nonintegrating (control) children. Social orientations in the experimental group became significantly more positive over time, while the control group showed little change. The experimental and control children initially categorized on the basis of gender and disability; subsequently the strategies of the experimental children were more idiosyncratic while the control children still used the same two dimensions.     

Neuropsychological and adaptive functioning in younger versus older children shunted for early hydrocephalus

Previous research on children with hydrocephalus has not carefully examined age-related changes in neuropsychological and behavioral status. We present data on 28 children with early hydrocephalus and spina bifida who were studied in two age groups: 5 - 7.5 and 9 - 12.5 years. Age-related differences in language, memory, visuomotor skills, and adaptive behaviors were examined. Consistent with other studies, the total sample showed impaired motor, performance, verbal, communication, and learning skills. Comparisons between older and younger children showed: (1) except for memory, neuropsychological patterns of functioning were generally comparable across the age groups, and (2) older children demonstrated more difficulty on specific adaptive functions (socialization, learning, conduct). Shunted hydrocephalic children may be conceptualized as exhibiting the syndrome of nonverbal learning disabilities. Clinical implications are discussed.