Respect for the developmentally disabled and forgoing life-sustaining treatment

A developmentally disabled person should be treated at all times as a unique individual and not as some anonymous "disabled person." The developmentally disabled should not be subjected to invasive medical treatment that is unduly burdensome or nonbeneficial, or be forced to endure a quality of life not meaningful to them as individuals. They have a right to refuse or accept treatment that a surrogate must exercise on behalf of each individual in a responsible and careful manner. Three cases and a preliminary approach to the ethical analysis of decisions to allow developmentally disabled persons to die by forgoing medical treatment are offered. The "best interests" of a developmentally disabled individual, properly understood, can serve as a useful and ethically defensible standard for determining the ethical propriety of surrogate decision making about forgoing life-sustaining medical treatment of the disabled.     

Sensory Extinction: A procedure for eliminating self-stimulatory behavior in developmentally disabled children

This study was designed to investigate the role of sensory reinforcement in the motivation of self-stimulation. If self-stimulatory behavior is maintained by its sensory consequences, such as the proprioceptive, auditory, or visual stimulation it produces, then such behavior should extinguish when those sensory consequences are not permitted. The present study introduces a new procedure, Sensory Extinction, in which certain sensory consequences are masked or removed, to examine whether self-stimulation is operant behavior maintained by sensory reinforcement. The effectiveness of Sensory Extinction was assessed by a reversal design for each of three autistic children, and the results showed the following. First, self-stimulation reliably extinguished when a certain sensory consequence was removed, then increased when that consequence was permitted. This was replicable within and across children. Second, different Sensory Extinction procedures were required for different self-stimulatory behaviors, since the sensory reinforcers supporting them were idiosyncratic across children. Finally, regarding clinical gains, the data suggest that Sensory Extinction may be a relatively convenient and rapid alternative for the treatment of self-stimulation. The present findings extend the efficacy of extinction as a behavior-modification technique to instances in which the reinforcer is purely sensory. The implications of these results for the treatment of other forms of deviant behavior are discussed.     

Relationship between intellectual status and reading skills for developmentally disabled children

The relationship between WISC-R Full Scale IQ and scores on the Woodcock Reading Mastery Tests were explored for 80 developmentally disabled children. While the children's reading skills correlated moderately and significantly with intellectual status, abstract reading skills, e.g., word comprehension, correlated more highly with Full Scale IQ than did concrete ones, e.g., word identification. The development of concrete learning patterns by such children was discussed, with an emphasis on the emotional importance of these learning styles to the children and their families.     

Medical problems,maladaptive behaviors,and the developmentally disabled

Research has shown that aberrant behaviors of people with developmental disabilities have multiple determinants; of these, medical problems and their potential relations to aberrant behaviors, have been, for the most part, not studied. This retrospective study examined the relations of 26 acute medical treatements to the aberrant behaviors of 10 elderly people with developmental disabilities. Results showed that 73.1% of the aberrant behaviors decreased in frequency after medical treatments. The study suggests the importance of acute medical problems and treatments as possible factors in the occurrence of aberrant behaviors in this population.     

Using a token economy in a community-based residential program for disabled adults: An empirical evaluation leads to program modification

The effects of an existing token reinforcement program upon the acquisition and maintenance of independent living skills of 12 disabled adults in two halfway houses were investigated. Tokens (points) were used to purchase advancement up a step/level system, pay daily “rent,” and purchase curfew extensions. Tokens were effective in maintaining independent living skill behaviors. However, hearing clients showed a decrease in independent living skill behaviors over the course of the program, while hearing impaired clients showed no change. This paradoxical finding appeared to be the result of inadvertant program contingencies that allowed a decrease in desired behaviors as subjects advanced to higher steps. The authors discuss how the program would be modified to increase behaviors associated with independent living skills.     

Coping behavior: Implications for disabled infants and toddlers

This article discusses the coping process and examines issues concerning the influence of a handicapping condition on the development of coping competence in young children. A preliminary study is reported that investigated the differences between the coping behavior of 25 developmentally disabled and 25 nondisabled children who were 4 to 34 months of age. The Early Coping Inventory was used to assess three categories of behavior related to adaptive coping efforts (sensorimotor organization, reactive behavior, and self-initiated behavior). Results indicated that the nondisabled children, as a group, demonstrated more effective coping-related behavior than did their disabled peers. The disabled children were situationally effective, in that behavior used effectively in one type of situation was not generalized to other types of situations. Their coping behavior tended to be erratic, inflexible, or limited in the range of available management strategies. The greatest discrepancy between the two groups was in their self-initiated behavior. The findings suggest the need for intervention services to address the enhancement of coping behavior of infants and toddlers with disabilities.     

Recommendations of the task force on privacy,human sexuality,and sex education for developmentally disabled persons

This article consists of a report submitted to the Massachusetts Commissioner of Mental Health in 1981 from the members of a citizens task force convened for the purpose of recommending policy to the Department in matters concerning privacy and human sexuality. The Chairman of the Committee was given responsibility for producing the information and resources necessary for the members to debate the issue with some intelligence, of facilitating the process and the deliberations, and of writing the final recommendations and report contained in this article. The need for policy in the areas of privacy and human sexuality for persons living in our state institutions serving the handicapped is a continuing and critical one. Resolution of the issues requires informed, courageous decision making by those who are responsible for the welfare of persons with mental or developmental deficiencies. The policy suggested in this article may serve as a step forward for those decision makers.     

Moral behavior and the development of verbal regulation

The present paper examines the relationship between the development of moral behavior and the development of verbal regulatory processes. Relational frame theory and the distinctions among pliance, tracking, and augmenting forms of rule governance are applied to the domain of moral behavior and its development, in order to identify the specific social and verbal contingencies that are responsible for an evolving moral repertoire. It is argued that moral behavior is controlled by relational and rule-following repertoires, and that these can be arranged into a rough progression: pliance, tracking, augmenting, social concern for pliance, social concern for tracking, and social concern for augmenting. Congruence with data derived from other research traditions is examined, and applied implications are explored.     

Analyses of changes in verbal behavior following a cognitive-behavioral treatment for impulsivity

Analyses were conducted to examine further the results of a cognitive-behavioral treatment for impulsivity in emotionally disturbed children (Kendall & Finch, 1978). The verbal behaviors of treated impulsive children, impulsive controls, and reflective children, recorded during MFF performance at pretreatment, posttreatment, and follow-up, were examined. The results indicated nonsignificant effects for several specific codes; however, the impulsive children that had received treatment evidenced a significant increase in total on-task verbal behavior at posttreatment. Discussion includes a consideration of these findings in regard to the efficacy of the cognitive-behavioral treatment and the need for research on the assessment of cognitive variables in children.This research was supported by grants from the National Institute of Mental Health (l F31 MH 05270-01) to the first author and from Virginia Mental Health Fund to the second author. Preparation of this report was also supported by a research grant from the Graduate School of the University of Minnesota (440-0160-4909-02). Thanks are extended to Donald MacEachern for his consultation on data analysis, to Steven D. Hollon and Terry F. Pechacek for consultation on computer analyses, and to Mary D. and Priscilla H. for coding the verbal data.     

Classroom behavior and the academic progress of learning disabled students

A total of 43 learning disabled (LD) students who were identified in grades 1–3 were followed up in their second year of special education services. Teachers completed the Classroom Behavior Inventory (CBI) for each LD student and for randomly selected classmates, and both groups of students were observed with the SCAN system in regular classroom settings. Group differences in teacher perceived task orientation, independence, and verbal expressiveness replicated previous findings with the CBI for this LD sample. SCAN observations partially replicated previous results in that LD children interacted with teachers more often than classmates. Multiple regression analyses indicated that both measures of behavior were predictive of reading achievement during year 1 when the LD children were identified, and that the CBI predicted academic progress from one year to the next. Both teacher ratings and observational evidence converged on the importance of task-oriented behavior, independent functioning, and socially appropriate behavior in understanding the poor achievement of LD students.