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.     

COMPUTERIZED ASSESSMENT OF PREFERENCE FOR SEVERELY HANDICAPPED INDIVIDUALS

An investigation was conducted to demonstrate the application of a computerized assessment procedure for determining the preferences of persons with severe handicaps. A computer program was designed to interpret subjects' microswitch activations to produce three distinct types of events (visual, auditory, and tactile). A combination of a multiple baseline design across subjects with a multiple treatment design involving three separate conditions was used. The data obtained from the computerized assessment procedure revealed idiosyncratic preference patterns for the three subjects. Results of the investigation demonstrated that the preferences of severely handicapped individuals can be systematically assessed and analyzed.     

DISPLACEMENT OF LEISURE REINFORCERS BY FOOD DURING PREFERENCE ASSESSMENTS

Identification of reinforcers for individuals with developmental disabilities is often based on the outcome of preference assessments in which participants make selections from among a variety of items. We determined the extent to which individuals might show a general preference for food items over leisure items during such assessments and whether leisure items that are “displaced” by food items might nevertheless function as reinforcers. Arrays consisting of food items only and then nonfood items only were presented separately to 14 participants and then were ranked to determine preference. The top selections from these initial assessments were subsequently combined in a third assessment, and preferences were again established. All but 2 participants showed a general preference for food items, such that selection of nonfood items in the combined arrays was displaced downward relative to selection of nonfoods in the nonfood-only arrays. Two of the participants were exposed to a condition in which a nonfood item was delivered contingent on the occurrence of an adaptive response, and increased rates of responding by both individuals were observed. Results are discussed in terms of limitations posed by using only food items as reinforcers and the resulting need to take precautionary measures when attempting to identify nonfood reinforcers.     

EFFECTS OF MEMORY AIDS ON THE DYADIC CONVERSATIONS OF INDIVIDUALS WITH DEMENTIA

The effects of a prosthetic memory aid on the conversational content and social skills of dyads with dementia were evaluated. Six individuals with moderate to severe dementia served as either subject or partner in dyads during 5-min conversational probes conducted three times per week in daycare and nursing-home settings. During phases when a memory aid, consisting of personally relevant picture and sentence stimuli, was available, most subjects used their own aid to improve the quality of conversations by increasing the frequency of on-topic statements, diminishing nonproductive utterances, lengthening their conversational turn, and/or increasing the frequency of turns taken. Most partners demonstrated awareness of social discourse conventions by appropriately relinquishing conversational dominance, decreasing both content and nonproductive utterances, and increasing acknowledging or affirmative comments when subjects used memory aids. Naive judges' ratings of aided and unaided conversational samples on seven conversational dimensions reflected differences in perceptions of significant improvement as a function of the conversational discourse style of each dyad.     

BEHAVIORAL ASSESSMENT OF FEEDING PROBLEMS OF INDIVIDUALS WITH SEVERE DISABILITIES

As many as 80% of the individuals with severe or profound mental retardation exhibit feeding problems. Although behavioral interventions have been used to treat these problems, no assessment procedure for determining a functional relationship between a person's acceptance of food and the type and texture of that food has been reported. The purpose of this study was to test a behavioral assessment procedure for a feeding problem of limited intake. Five individuals with severe or profound mental retardation were fed 10 to 12 types of foods with one or more textures. Behavioral categories of acceptance, rejection, expulsion, and other negative behavior were recorded. Results indicated that each subject fit into one of four categories of feeding problems: (a) total refusal, (b) type selectivity, (c) texture selectivity, or (d) type and texture selectivity. Thus, although all 5 subjects exhibited limited intake, the food characteristics correlated with the problem were different for each individual. Results suggest that treatments for limited intake may be based on assessments that show the association of food type or texture to a person's rejection or expulsion of food.     

Preference for leisure items over edible items in individuals with dementia: A replication

We replicated previous research in which adults with dementia tended to show a preference for leisure items over edible items when presented in the same array. Additionally, we conducted engagement analyses with the highest, middle, and lowest preference leisure items to determine whether relative preference corresponded to engagement in the natural environment. The most highly preferred stimulus for 6 out of 7 participants was a leisure item, and for each of those six the top 3 preferred stimuli were leisure stimuli. For 4 participants, the most preferred stimulus also produced the longest duration of engagement. We discuss the issues we encountered when conducting preference assessments with adults with intact vocal verbal repertoires, and suggest potential explanations for the displacement of edibles by leisure stimuli in older adults with dementia.     

ASSESSMENT OF PREFERENCE FOR VARIED VERSUS CONSTANT REINFORCERS

One method that has been demonstrated to improve the effectiveness of reinforcement is stimulus (reinforcer) variation (Egel, 1980). Egel found that bar pressing increased and responding occurred more rapidly during varied reinforcement than during constant reinforcement when identical stimuli were used across phases for 10 individuals with autism. The purpose of the current investigation was to assess the preferences of 7 individuals for varied presentation of slightly lower quality stimuli relative to constant access to the highest quality stimulus. Varied presentation was preferred over constant reinforcer presentation with 4 participants, and the opposite was true for 2 participants. One participant did not demonstrate a preference. These results suggest that stimulus variation may allow less preferred reinforcers to compete effectively with a more highly preferred reinforcer for some individuals.     

THE INFLUENCE OF ANTECEDENTS AND CONSEQUENCES ON THE OCCURRENCE OF BIZARRE SPEECH IN INDIVIDUALS WITH DEMENTIA

We conducted a series of assessments to determine the differential effects of common antecedents and consequences that can influence the occurrence of bizarre speech in three women with moderate to severe dementia. First, a traditional functional analysis was conducted to assess the function of bizarre speech. After results revealed differentially higher levels of bizarre speech during control sessions, an antecedent analysis was conducted. During this second assessment, all consequences were held constant, and only the antecedents (i.e., open‐ended questions, yes/no questions, and comments) were altered. Bizarre speech was differentially higher when open‐ended questions were presented, replicating previous studies. The final assessment conducted was a modified functional analysis to further assess the effects of consequences on bizarre speech. More typical consequences were assessed, including two tests for a positive function (attention in the form of correction and attention in the form of following along) and two tests for a negative function (a break from one question and a break from all questions). Results consistently revealed that antecedents produced greater differentiation in responding than social consequences. These findings provide evidence that behavioral assessments may need to be modified to better capture the relevant environmental variables that influence problem behavior in individuals with dementia. Copyright © 2014 John Wiley & Sons, Ltd.     

ON THE CORRESPONDENCE BETWEEN PREFERENCE ASSESSMENT OUTCOMES AND PROGRESSIVE‐RATIO SCHEDULE ASSESSMENTS OF STIMULUS VALUE

The current study examined whether stimuli of different preference levels would be associated with different amounts of work maintained by the stimuli, as determined through progressive‐ratio schedule break points. Using a paired‐choice preference assessment, stimuli were classified as high, moderate, or low preference for 4 individuals with developmental disabilities. The stimuli were then tested three times each using a progressive‐ratio schedule (step size of 1; the break‐point criterion was 1 min). In 10 of 12 possible comparisons, higher preference stimuli produced larger break points than did lower preference stimuli.     

MULTICOMPONENT INTERVENTION FOR AGITATED BEHAVIOR IN A PERSON WITH ALZHEIMER'S DISEASE

We evaluated a multicomponent intervention for agitated behavior in a man with probable Alzheimer's disease. Hypotheses about variables controlling his agitated behavior guided intervention design. Based on staff interviews, direct observations, and brief experimental probes, intervention components were chosen to increase rate of reinforcement and decrease aversive aspects of his job. Intervention reduced agitated behavior without disrupting his work rate.     

EVALUATION OF THE MULTIPLE-STIMULUS WITHOUT REPLACEMENT PREFERENCE ASSESSMENT METHOD USING ACTIVITIES AS STIMULI

The current study examined the accuracy of the multiple-stimulus without replacement (MSWO) preference assessment for identifying preferred common classroom activities as reinforcers with children with behavioral disorders. The accuracy of predictions from the MSWO regarding high, medium, and low stimulus preference was tested by providing contingent access to activities for completing math problems within an independent seatwork format. Overall, there was an interaction effect between preference ranking (high, medium, or low) and number of problems completed. The results confirm and extend previous findings regarding the accuracy of predictions with the MSWO. The findings also reveal, however, some individual differences that may account for instances in which student behavior did not conform to predictions of stimulus preference assessments.     

EMERGENCE OF REINFORCER PREFERENCE AS A FUNCTION OF SCHEDULE REQUIREMENTS AND STIMULUS SIMILARITY

Tustin (1994) recently observed that an individual's preference for one of two concurrently available reinforcers under low schedule requirements (concurrent fixed-ratio [FR] 1) switched to the other reinforcer when the schedule requirements were high (concurrent FR 10). We extended this line of research by examining preference for similar and dissimilar reinforcers (i.e., those affecting the same sensory modality and those affecting different sensory modalities). Two individuals with developmental disabilities were exposed to an arrangement in which pressing two different panels produced two different reinforcers according to progressively increasing, concurrent-ratio schedules. When two dissimilar stimuli were concurrently available (food and a leisure item), no clear preference for one item over the other was observed, regardless of the FR schedules in effect (FR 1, 2, 5, 10, and 20). By contrast, when two similar stimuli were concurrently available (two food items), a clear preference for one item emerged as the schedule requirements were increased from FR 1 to FR 5 or FR 10. These results are discussed in terms of implications for conducting preference assessments and for selecting reinforcers to be used under training conditions in which response requirements are relatively high or effortful.     

THE USE OF BEHAVIORAL ASSESSMENT TO PRESCRIBE AND EVALUATE TREATMENTS FOR SEVERELY HANDICAPPED CHILDREN

Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.     

REINFORCER ASSESSMENT FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES AND VISUAL IMPAIRMENTS

We assessed the applicability of two previously developed reinforcer assessment procedures to children with developmental disabilities and visual impairments. Greater differentiation between stimuli was observed with a choice procedure than with a preference procedure. Measurement of compliance and rate of responding in adaptive skill training confirmed that the choice procedure accurately identified reinforcing stimuli. The preference procedure produced false positive predictions of reinforcer efficacy.     

AGENCY AND MORAL RELATIONSHIP IN DEMENTIA

Abstract: This essay examines the goals of care and the exercise of guardianship authority in the long-term care of persons with Alzheimer's disease and other forms of chronic, progressive dementia. It counters philosophical views that deny both agency and personhood to individuals with Alzheimer's on definitional or analytic conceptual grounds. It develops a specific conception of the quality of life and offers a critique of hedonic conceptions of quality of life and models of guardianship that are based on a hedonic legal standard of "best interests." As an alternative, it proposes a conception of quality of life based on the notions of "semantic agency" and "memorial personhood."     

EFFECTS OF PREFERENCE AND REINFORCER VARIATION ON WITHIN-SESSION PATTERNS OF RESPONDING

We examined correspondence between preference assessment outcome and within‐session patterns of responding in one subject with autism. Responding maintained by a single highly preferred item resulted in a greater total number of responses, a slower decline in within‐session response rates, and a greater proportion of short interresponse times compared to responding maintained by varied moderately preferred (MP) stimuli. Presenting varied MP stimuli within the same session produced greater levels and more sustained responding than presenting those same stimuli individually.     

A FURTHER ANALYSIS OF THE VALUE OF CHOICE: CONTROLLING FOR ILLUSORY DISCRIMINATIVE STIMULI AND EVALUATING THE EFFECTS OF LESS PREFERRED ITEMS

We sought to address limitations of prior research that has isolated choice as an independent variable. Children's preferences for the opportunity to choose were evaluated in a concurrent‐chains arrangement in which identical consequences were available in choice and no‐choice conditions. Results demonstrated that preference for choice, in and of itself, was (a) evident in children, (b) not controlled by illusory discriminative stimuli such as the amount from which to choose, and (c) generally unaffected by less preferred and potentially unimportant consequences.     

Excess disability and malignant social psychology: A case study of Alzheimer's disease

An in-depth case study was undertaken to assess the effects of what Kitwood has termed ‘malignant social psychology’ on the observed behaviour of an Alzheimer's disease sufferer. Interviews were conducted with the spouse and observations were made in an adult day-care centre, where staff members were also interviewed. Abilities that the spouse reported to be absent at home were readily observed at the day-care centre, lending support to Brody's idea of excess disability, i.e. disability not due to disease alone. Furthermore, forms of malignant social psychology existed in the home environment but did not exist in the day-care centre. Excess disability and its absence coincided with the presence and absence of aspects of malignant social psychology. The sufferer's behaviour was found to be affected not only by the extant neuropathology, but also by social relationships.     

CORRESPONDENCE BETWEEN SINGLE VERSUS DAILY PREFERENCE ASSESSMENT OUTCOMES AND REINFORCER EFFICACY UNDER PROGRESSIVE‐RATIO SCHEDULES

Research has suggested that a daily multiple‐stimulus‐without‐replacement (MSWO) preference assessment may be more sensitive to changes in preference than other assessment formats, thereby resulting in greater correspondence with reinforcer efficacy over time ( DeLeon et al., 2001 ). However, most prior studies have measured reinforcer efficacy using rate of responding under single‐operant arrangements and dense schedules or under concurrent‐operants arrangements. An alternative measure of reinforcer efficacy involves the evaluation of responding under progressive‐ratio (PR) schedules. In the present study, 7 participants were given a single paired‐stimulus (PS) preference assessment followed by daily MSWO preference assessments. After each daily MSWO, participants responded for each stimulus on a PR schedule. The correspondence between break points and preferences, as assessed by the 2 assessment formats, was examined. Results demonstrated that both preference assessments did equally well at predicting reinforcer efficacy, although the PS more consistently identified the most effective reinforcer.     

THE FUNCTIONS OF ASSESSMENT: IMPLICATIONS FOR SELECTION AND DEVELOPMENT OF DEVICES FOR ASSESSING REPERTOIRES IN CLINICAL,EDUCATIONAL, AND OTHER SETTINGS

An attempt is made to identify the many different functions that assessment of an individual's repertoire can serve. Implications of these functions for the character of and evidence about assessment devices are suggested. The functions fall into two general groups, those which influence decisions regarding an individual learner, and those which influence policy, program development, and scientific knowledge. The first group of functions is presented in a rough chronological sequence such that they form a “behavioral assessment funnel,” beginning with functions involving broad-band assessment to identify likely persons and skill areas, and narrowing to the precise pinpointing, monitoring, and follow-up functions. The contribution of behavior analysis and behavior therapy to assessment methodology in this sequence is identified as well as the areas where more traditionally conceived methods are still useful. The second group of functions and behavioral contributions to it are then discussed.