An enriched teaching program for reducing resistance and indices of unhappiness among individuals with profound multiple disabilities

We evaluated an enriched teaching program for reducing resistance and indices of unhappiness displayed by 3 individuals with profound multiple disabilities during teaching sessions. The program involved presentation of preferred activities before, during, and after each teaching session, discontinuation of identified nonpreferred activities, and a brief break and preferred activity following occurrence of resistance. Implementation of the enriched teaching program was accompanied by reductions in resistance and indices of unhappiness for each participant. Results also indicated no negative impact of the program on participant performance of the teaching steps or staff teaching proficiency. Staff questionnaire responses provided a degree of social validation for the observed changes in that staff reported the participants liked the enriched teaching program more than the traditional teaching process. Directions for future research discussed include identifying critical aspects of the overall program and the potential relation between teaching proficiency and the program's enrichment effectiveness.     

INCREASING INDICES OF HAPPINESS AMONG PEOPLE WITH PROFOUND MULTIPLE DISABILITIES: A PROGRAM REPLICATION AND COMPONENT ANALYSIS

We replicated a program to increase indices of happiness among people with profound multiple disabilities and conducted a component analysis of the program. The program involved presentation and contingent withdrawal of stimuli that had been identified as preferred based on preference assessments and staff opinion. The program was implemented with 3 adult students and was accompanied by increased happiness indices for each student. Subsequent implementation of the two types of stimuli indicated that preferred stimuli based on preference assessments were more consistently accompanied by increased happiness indices than were preferred stimuli based on staff opinion. Social validity measures supported the definition of happiness, in that raters' subjective opinions of the students' happiness coincided with the observed happiness indices. Results are discussed regarding the importance and practical implications of using preference assessments for determining stimuli for increasing happiness indices. Future research areas are suggested, focusing on increasing happiness and other quality-of-life indicators during the daily routines of people with profound disabilities.     

DEFINING,VALIDATING, AND INCREASING INDICES OF HAPPINESS AMONG PEOPLE WITH PROFOUND MULTIPLE DISABILITIES

In this study we attempted to operationalize, measure, and increase happiness among people with profound disabilities. Happiness indices were defined and observed among 5 individuals. Validation measures indicated that (a) increases in happiness indices were observed when individuals were presented with most preferred stimuli relative to least preferred stimuli, (b) increases in unhappiness indices were observed when they were presented with least preferred relative to most preferred stimuli, and (c) practitioner ratings of participant happiness coincided with observed indices. Subsequently, classroom staff increased happiness indices through presentation and contingent withdrawal of activities. Results suggested that a behavioral approach can enhance happiness as one aspect of quality of life among people with profound disabilities. Research directions are offered that focus on using a behavioral approach to investigate other private events that are important among people with disabilities.     

Helping a child with multiple disabilities endure a demanding physical posture through self-managed access to preferred stimuli

This study assessed whether a child with multiple disabilities would endure a difficult (standing) position more easily if allowed to access preferred stimuli while in that position. The study included an ABAB sequence with 2- and 3-mo. postintervention checks. Data showed that self-managed access to preferred stimuli during the B phases of the study and the postintervention checks reduced the child's indices of unhappiness, frowning and crying, while increasing his object contact and smiles as indices of happiness.     

Assessing indices of happiness and unhappiness in individuals with developmental disabilities: a review

The behavioral deficits of individuals with profound multiple disabilities (PMD) make it difficult to assess their satisfaction and quality of life. To address this problem, researchers have recently evaluated affective behavior (i.e., indices of happiness and unhappiness) to document the effects of therapeutic interventions and to assist with clinically relevant decisions. We review the recent literature on indices of happiness and unhappiness and discuss its major themes. In addition, potential concerns with this technology are discussed and clinical recommendations are provided. Copyright © 2007 John Wiley & Sons, Ltd.     

Persons with acquired brain injury and multiple disabilities access stimulation independently through microswitch-based technology

The possibility of enabling two adults with acquired brain injury and profound multiple disabilities to use microswitch-based technology to attain preferred environmental stimuli on their own was assessed. Each of the participants was provided with two microswitches that could be activated by right and left head-turning or head-bending responses. The microswitches were introduced sequentially according to a multiple probe design across microswitches (responses) and allowed access to different sets of auditory or visual stimuli. Eventually, the two microswitches were made available simultaneously. Sessions lasted 5 min. Each participant learned to use the two microswitches successfully and maintained consistent levels of responding when they were simultaneously available. During this phase, both participants showed large within-session variations in their right and left response frequencies, with one of them showing an overall prevalence of the left-side response. The importance of assistive technology within programs for persons with acquired brain injury and multiple disabilities is discussed.     

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.     

TEACHING CHOICE MAKING DURING SOCIAL INTERACTIONS TO STUDENTS WITH PROFOUND MULTIPLE DISABILITIES

We taught 4 students with profound multiple disabilities to use a microswitch communication system to request a change in recreational stimuli during social interactions with nondisabled peers. In Study 1, we conducted a preference assessment across a range of stimuli for each student. The most and least preferred stimuli were incorporated into microswitch communication system training in Study 2. During the second study, 3 of the 4 students (a) learned to use the microswitch communication system to control stimulus presentation, (b) more clearly differentiated their time among stimuli, and (c) increased their level of general alertness. Study 3 extended the use of the microswitch communication system to social interactions with nondisabled peers. Two students were more engaged in interactions when they chose when to change stimuli; 1 student was more alert when a peer chose when to change activities; a 4th student showed an undifferentiated pattern. The outcomes of the investigation are discussed in terms of the effects of controlling stimulus presentation on the behavior of students with profound multiple disabilities and the stability of preference hierarchies over time.     

A microswitch‐based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities

We assessed the use of a microswitch‐based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.     

Enabling two adolescents with multiple disabilities to choose among environmental stimuli through different procedural and technological approaches

Two single-case studies were carried out using different procedural and technological approaches to enable two adolescents with multiple disabilities to choose among environmental stimuli. Study I focused on replicating a recently developed procedure, which relied on samples of the auditory stimuli available as cues for choice responses. Study II assessed a new procedural and technical setup relying on the use of pictorial representations of the stimuli available as cues for choice responses. The auditory samples and the pictorial representations were presented through computer systems. The participants' choice responses relied on microswitches connected to the computer systems. The data of Study I fully supported previous findings with the same procedural approach. The participant learned to choose preferred stimuli and bypass nonpreferred ones. The data of Study II showed that the participant learned to concentrate his choice. responses on a few stimuli, suggesting that these stimuli were actually preferred and that responding was purposeful. Implications of the results were discussed.     

EFFECTS OF REINFORCEMENT CHOICE ON TASK RESPONDING IN INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

The effects of reinforcement choice on task performance were examined with 6 individuals who had been diagnosed with severe to profound mental retardation. Five highly preferred items were identified for each participant via stimulus preference assessments. Participants then were exposed to choice and no-choice conditions that were alternated within reversal and multielement designs. During choice sessions, participants were permitted to select between two preferred stimuli contingent on responding. During no-choice sessions, the therapist delivered a single item contingent on responding. Preference for the stimuli was held constant across conditions by yoking the items delivered during no-choice sessions to those selected during the immediately preceding choice sessions. All participants exhibited similar rates of responding across choice and no-choice conditions. These findings indicate that for individuals with severe disabilities, access to choice may not improve task performance when highly preferred items are already incorporated into instructional programs.     

A microswitch program to foster simple foot and leg movements in adult wheelchair users with multiple disabilities

This study assessed a microswitch program to foster simple foot and leg movements in 2 adult wheelchair users with multiple disabilities. The participants' mood (indices of happiness) was recorded throughout the study. Data showed that participants rapidly increased the target foot and leg movements and maintained those movements during the course of the study, which lasted about 4.5 months. With regard to indices of happiness, 1 participant showed a fairly modest increase during the intervention while the other participant showed a substantial increase. Implications of the findings are discussed.     

Effects of choice of stimuli as reinforcement for task responding in reinforcement for task responding in preschoolers with and without developmental disabilities

The effects of choice and no choice of stimuli as reinforcement for task responding were investigated across preschoolers with and without disabilities. Five less preferred stimuli were identified for each participant using a stimulus preference assessment. No differences were found for choice and no-choice conditions when the less preferred stimuli were used as reinforcers.     

Further examination of discriminated functional communication

One child with developmental disabilities was taught to mand for attention by saying "excuse me." Treatment effects were extended to multiple training contexts by teaching the participant to attend to naturally occurring discriminative stimuli through differential reinforcement of communication during periods of the experimenter's nonbusy activities (e.g., reading a magazine). Results are discussed in terms of future research on the generalization and maintenance of functional communication in the natural environment.     

Examination of the influence of contingency on changes in reinforcer value

This study examined how the amount of effort required to produce a reinforcer influenced subsequent preference for, and strength of, that reinforcer in 7 individuals with intellectual disabilities. Preference assessments identified four moderately preferred stimuli for each participant, and progressive-ratio (PR) analyses indexed reinforcer strength. Stimuli were then assigned to one of four conditions for 4 weeks: fixed-ratio (FR) 1 schedule, escalating FR schedule, yoked noncontingent (NCR) delivery, and restricted access. Preference assessments and PR schedules were then repeated to examine changes in selection percentages and PR break points. Selection percentages decreased for all NCR stimuli but increased for most of the restricted stimuli. There were no systematic changes in selection percentages for either of the contingent stimuli. Break points increased, on average, for all conditions, but the increase was highest for the restricted stimuli and lowest for the NCR stimuli. These results are discussed in relation to recent basic research addressing the influence of effort on stimulus value.     

A comparison of presession and within-session reinforcement choice.

Single- and concurrent-operants procedures were used to evaluate the effects of two reinforcement conditions on the free-operant responding of 3 individuals with developmental disabilities and 1 with attention deficit disorder. In the presession choice condition, prior to each session the participant chose one item from an array of three different highly preferred stimuli. This item was delivered by the experimenter on each reinforcer delivery during that session. In the within-session choice condition, each reinforcer delivery consisted of placing an array of three different highly preferred stimuli in front of the participant, who was allowed to select one. Only one of the two reinforcement conditions was in effect for any particular session in single-operant phases. Buttons associated with each reinforcement condition were present, and the participant could allocate responses to one or the other in concurrent-operants phases. Data showed substantially more responding to the button associated with within-session choice than presession choice during concurrent-operants phases. This effect was not as apparent during single-operant phases, suggesting that a concurrent-operants procedure provided the more sensitive evaluation of within-session and presession reinforcer choice effects.     

Promoting fluency of performance during morning dressing by two persons with multiple disabilities

This study investigated the possibility of promoting fluency of performance, i.e., a performance independent of caregiver's guidance and without serious interruptions, during morning dressing in two adults with multiple disabilities. The intervention program relied on the use of assistive technology including optic and pressure sensors to monitor the participants' task responding and tape players to present preferred stimuli in relation to such responding, as well as messages of encouragement. Analysis showed that the intervention program was effective with both participants. In fact, they became capable of performing the dressing sequence with only occasional guidance from research assistants, and the time they required for dressing dropped significantly from baseline levels. Implications of the results are discussed.     

A COMPREHENSIVE EVALUATION OF REINFORCER IDENTIFICATION PROCESSES FOR PERSONS WITH PROFOUND MULTIPLE HANDICAPS

We evaluated comprehensively a preference assessment for identifying reinforcers for persons with profound multiple handicaps. Four experiments were conducted involving 18 individuals. Results of Experiment 1 replicated previous findings in that the assessment identified student preferences for respective stimuli, and caregiver opinion of preferences did not coincide with the systematic assessment. Results of Experiment 2 indicated highly preferred stimuli were likely to function as reinforcers in training programs, whereas stimuli not highly preferred did not function as reinforcers. Results of Experiment 3 suggested the 12 stimuli used in the assessment represented a comprehensive stimulus set for identifying preferences, although the utility of the set sometimes could be enhanced by caregiver opinion. Results of Experiment 4 indicated the assessment identified preferences likely to be maintained over time. Overall, results are discussed in terms of identifying limits and alternatives to a behavioral teaching technology when applied to persons with profound multiple handicaps.     

Examination of variables that affect the efficacy of instructive feedback

Instructive feedback is a procedure in which additional, nontarget stimuli are presented during instructional trials for students with a wide array of disabilities. This preliminary investigation examined whether participant behavior during instructive feedback, including attending and echoic behavior, altered the efficacy of instructive feedback for 2 children with autism. Results showed that participant behavior during instructive feedback related to training outcomes for both participants and treatment modifications based on participant behavior influenced acquisition. Future directions of research and implications for practice are discussed.     

Teaching 'Yes' and 'No' responses to children with multiple disabilities through a program including microswitches linked to a vocal output device

The present study introduced two children (a boy and a girl of 9.2 and 12.3 yr. of age, respectively, with multiple disabilities) to an intervention program for establishing Yes and No responses in relation to preferred and nonpreferred stimuli and assessed the acquisition and generalization of those responses. The program involved the use of microswitches, which monitored the nonverbal Yes and No responses performed by the children and ensured that these responses produced the matching verbal utterances via a vocal output device. Analysis showed children acquired Yes and No responses in relation to the stimuli used for the intervention and, to a comparable degree, to the stimuli used for generalization checks as well. An interview of 30 educational staff of a center for persons with multiple disabilities indicated that they considered the presence of Yes and No verbal utterances preferable to the absence of such utterances, and thought that the utterances could be helpful for the children's response acquisition and would be useful and pleasing for staff and parents. General implications of the findings were discussed.