Embedded evaluation of preferences sampled from person-centered plans for people with profound multiple disabilities

We investigated a brief, embedded assessment for evaluating preferences sampled from person-centered plans. After developing person-centered plans for individuals with multiple disabilities, systematic assessments were conducted with preferences sampled from the plans. An assessment of sampled preferences was then embedded within the participants' daily routines. The two assessments identified similar preferences based on participant approach responses. Both assessments also indicated inconsistencies with reported preferences in the person-centered plans. Overall, results suggested the embedded assessment may be an alternative means of evaluating some preferences reported through person-centered planning.     

Increasing the happiness of individuals with profound multiple disabilities: replication and extension

A multielement design was used to compare the effects of three treatments on the happiness of 3 individuals with profound multiple disabilities. The conditions were typical programming using materials selected by staff, presentation of preferred materials plus social interaction, and social interaction alone with no materials present. Both the presentation of the preferred items with social interaction and social interaction alone resulted in higher happiness indicators than typical programming. The combination of preferred items and social interactions was somewhat superior to social interaction alone.     

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.     

Reducing indices of unhappiness among individuals with profound multiple disabilities during therapeutic exercise routines.

A program was developed to reduce indices of unhappiness that accompanied therapeutic exercise routines among people with profound multiple disabilities. Indices of unhappiness were recorded, using an observation system that had been validated through previous research involving happiness-related variables, while support personnel conducted exercises with 3 participants. A multicomponent program was then implemented that involved presenting highly preferred stimuli before, during, and after each exercise session. Results indicated that the program was accompanied by reduced indices of unhappiness for each participant relative to the traditional method of conducting the exercises, although changes in the preferred stimuli used with 1 participant were required before consistent reductions occurred. Results are discussed regarding the importance of reducing unhappiness indices as a means of enhancing aspects of the daily quality of life for people with profound multiple disabilities. Areas for future research are also discussed, focusing on expanding the unhappiness-reduction procedures to other routine events that may occasion indices of unhappiness.     

Predicting the relative efficacy of three presentation methods for assessing preferences of persons with developmental disabilities

Choices were presented to 9 individuals with developmental disabilities using a two-choice format. Each pair of items, selected based on prior preference assessment, was presented to each participant in three conditions (actual items, pictures of the items, and spoken-name presentation) using a reversal design. The evaluation was conducted using food items, and was then repeated using nonfood items. The participants were also given a test to measure their skills on discrimination tasks ranging in difficulty from simple to conditional discriminations. The participants' abilities to make consistent choices with food and nonfood items were predicted, with 94% accuracy, by their discrimination skills. The findings suggest that presentation methods can affect the accuracy of a choice assessment, and that the systematic assessment of basic discrimination skills can be used to predict the effectiveness of different presentation methods in this population.     

Indoor travel and simple tasks as physical exercise for people with profound multiple disabilities

2 to 4 30-min. periods of indoor travel and simple tasks were arranged daily as physical exercise for two women with profound mental retardation, deafness, and profound visual impairment. The questions were whether (a) the women could manage this fairly extensive exercise regimen (over about 9 and 4.5 mo.) with support technology and only minimal staff supervision and (b) the exercise could affect aspects of the women's physical condition. Data indicated that both women could successfully manage the exercise regimen with support technology, and the exercise seemed to have some beneficial effects on physical aspects such as bone metabolism and step width.     

Examination of ambiguous stimulus preferences with duration-based measures

Items that produced ambiguous results in an approach-based preference assessment were reassessed using a duration-based assessment. The reinforcing effects of three items on free-operant responding were subsequently tested. The results suggested that the duration-based assessment produced slightly more differentiated results and that predictions about reinforcer value, based on this assessment, were accurate.     

Examination of relative reinforcement effects of stimuli identified through pretreatment and daily brief preference assessments.

Several brief preference assessments have recently been developed to identify reinforcers for individuals with developmental disabilities. One purported advantage of brief assessments is that they can be administered frequently, thus accommodating shifts in preference and presumably enhancing reinforcement effects. In this study, we initially conducted lengthy paired‐choice preference assessments and identified a hierarchy of preferred items for 5 individuals with developmental disabilities. Subsequently, brief multiple‐stimulus‐without‐replacement assessments using the same items were completed each day prior to work sessions. On days when results of the daily brief assessment differed from the one‐time lengthy assessment, the relative reinforcing effects of the top items from each assessment were compared in a concurrent‐schedule arrangement. The results revealed that when the two assessments differed, participants generally allocated more responses to the task associated with the daily top‐ranked item.     

Community-referenced leisure skill clusters for adolescents with multiple disabilities

We evaluated the effectiveness of a training package used to teach student-selected community-referenced leisure skill clusters — ordering a pizza-to-go and renting a video from a local vendor — to two adolescents with multiple disabilities. The adolescents were taught the leisure skills (e.g., ordering the pizza) as well as related behaviors necessary to perform those leisure skills (e.g., using a phone, interacting with the delivery person, cutting and serving pizza, cleaning up). The students were taught functional skill clusters, problem-solving skills, and assistance-seeking skills. Training consisted of didactic instruction, feedback, a least intrusive prompting procedure for incorrect responses, and verbal praise and natural consequences for correct responses. Simulation training was conducted at school and in vivotraining was conducted in the local community. A multiple baseline design demonstrated the controlling effects of treatment. Also, follow-up probes conducted up to five months after treatment showed these students maintained treatment gains. Applied issues related to the efficiency of the training package, general and specific skills training, and factors influencing skill maintenance are discussed.     

Technological aids to promote basic developmental achievements by children with multiple disabilities: evaluation of two cases

Technological aids such as microswitches may be critical to foster learning and development in children with multiple disabilities. In study I, a child with minimal motor behavior was provided with a microswitch for chin movements to assess whether he could learn to use these movements to activate environmental stimuli. In study II, a child with dystonic (difficult-to-control) behavior was provided with microswitches for two motor responses and two vocal utterances. We wanted to assess whether he could use both types of responses effectively (varying within each pair, consistent with choice performance). The results were highly encouraging with both children. In study I, there was a significant increase in the childs responding, suggesting learning and contingency awareness. In study II, there was a significant increase in responding as well as response variation that suggested choice behavior. The importance of microswitch devices in promoting new learning/developmental objectives and improving quality of life is discussed.     

A pilot study exploring the use of a telephone-assisted planning intervention to promote parental support for physical activity among children and youth with disabilities

Parent support is an important contributor to physical activity (PA) among children and youth with disabilities (CYD). Although many parents of CYD are motivated to provide parent PA support, CYD remain insufficiently active. The multi-process action control model has been applied to understand parent PA support and highlights behavioral regulation strategies such as action and coping planning as critical for translating intentions into behavior. Parents may struggle to create and carryout planning without support. There is no known research examining telephone support as a tool to promote planning and subsequent parent PA support behavior.MethodParents (43 mothers and 6 fathers) of CYD (child M_age = 12.53 years ± 5.53; 75% male; 38.6% developmental disability) completed a baseline questionnaire and were subsequently randomized to a telephone-assisted planning experimental group twice over four weeks (n = 23) or a control group who had access to planning tools but no telephone assistance (n = 26).ResultsNo significant main or interaction effects emerged for parent PA support behavior. However, a significant time × condition interaction was found for behavioral regulation strategies (i.e., action and coping planning and self-monitoring; F(1,44) = 5.05, p = 0.03) indicating a significant increase in the use of behavioral regulation strategies for parent PA support from baseline, for parents assigned to the telephone-assisted intervention.ConclusionThese findings suggest potential for planning support as a tool to enhance behavioral regulation strategies related to parent PA support among parents of CYD.     

Microswitch programs for persons with multiple disabilities: an overview of the responses adopted for microswitch activation

Background: To introduce a person with multiple disabilities to a microswitch-aided program, one has to select a plausible response(s), that is, a response(s) that can be performed reliably and without excessive effort by the person and can successfully activate the microswitch(es) available (producing preferred stimuli). This paper provides an overview of the responses adopted for microswitch activation in research studies during the last 20 years. Method: Computerized and manual searches were carried out to identify the studies published between 1986 and 2005. Forty-eight research studies were identified. They concerned the use of (1) a single (typical) response, (2) a single (non-typical) response, (3) multiple (typical and non-typical) responses, and (4) multiple (vocal) responses. Results and discussion: The results showed that 151 of the 190 participants involved in the studies had a positive outcome (i.e., clear increases in their responding, which suggested that they had learned the association between responding and consequent preferred stimuli). Failures were largely concentrated in the first group of studies. The discussion focused on (a) the importance of selecting plausible responses for increasing the chances of success, (b) the need of non-typical responses for persons with minimal motor behavior, (c) implications of programs with multiple responses on engagement and choice, and (d) relevance of using vocal utterances. Some suggestions for future research concerning these points were also examined.     

A multisource exploration of the friendship patterns of children with and without learning disabilities

Friendship patterns of 117 children with learning disabilities (LD) and 115 children without LD in Grades 4–8 were examined. In comparison with children without LD, boys with LD had fewer mutual friends, children with LD had more friends with learning problems and more younger friends, and children with LD in Grades 4–6 had less stable relationships. With regard to friendship quality, children with LD reported higher levels of conflict, lower levels of validation, and more problems with relationship repair than did children without LD. The findings were discussed in terms of factors that have been found to enhance friendship such as proximity and similarity, and the social skills difficulties that have been associated with learning disabilities.     

A review of behavioral procedures to teach motor skills to individuals with severe disabilities

Behavioral procedures are one approach to teaching or improving the fluency of motor skills of individuals with severe disabilities. This article provides a review of behavioral procedures by highlighting antecedents, consequences, and multifaceted techniques. Investigations are reviewed in each area according to (a) replicability of the intervention, (b) experimental control, (c) maintenance, (d) generalization, and (e) social validation. Practitioner implications address selection of reinforcers, reinforcement schedules, and teaching within meaningful routines. Future research recommendations highlight the need for documenting that stimuli are actually reinforcers. Additional research needs emphasize targeting maintenance, generalization, and social validation.     

A systematic review of interventions for anxiety in people with HIV

People with human immunodeficiency virus (HIV) show elevated anxiety levels compared to the general population. Anxiety can predate HIV infection or be triggered by HIV diagnosis and the many stresses that emerge during the course of HIV disease. Many psychological and pharmacological therapies have been shown to treat anxiety in the general population but a systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review examines all published intervention studies on anxiety and HIV from 1980 to 2009 covered by the databases MedLine (1980-2009) and PsycINFO (1980-2009) for a definitive account of effectiveness of interventions and an indication of prevalence of HIV-related anxiety and measurement within studies. Standard systematic research methods were used to gather quality published papers on HIV and anxiety, searching published data bases according to quality inclusion criteria. From the search, 492 papers were generated and hand searched resulting in 39 studies meeting adequacy inclusion criteria for analysis. Of these, 30 (76.9%) were implemented in North America (the USA and Canada), with little representation from developing countries. Thirty-three (84.6%) studies recruited only men or mostly men. A total of 50 interventions were investigated by the 39 studies; 13 targeted HIV, symptoms or associated outcomes/conditions, 20 directly targeted anxiety and another 17 indirectly targeted anxiety. Twenty-four (48%) interventions were effective in reducing anxiety (including 11 indirect interventions), 16 (32%) were ineffective and 10 (20%) had an unknown effect on anxiety. Sixty-five percent of interventions directly targeting anxiety were effective. Psychological interventions (especially cognitive behavioural stress management interventions and cognitive behavioural therapy) were generally more effective than pharmacological interventions. Only three studies provided prevalence rates - these ranged from 13% to 80%. Anxiety was measured using 16 different instruments. Our detailed data suggest that interventions are both effective and available, although further research into enhancing efficacy would be valuable. Also, the vast majority of studies were Western-based, no studies looked at children or adolescents and few looked specifically at women. An international effort to harmonise measurement of anxiety is also missing. There is a need to routinely log anxiety in those with HIV infection during the course of their disease, to provide specific data on women, young people and those in diverse geographic areas and incorporate management into care protocols.     

Discrimination of picture requests for missing items among young children with developmental disabilities

Two experiments were conducted to assess discrimination of picture requests for missing items among young children with developmental disabilities. In Experiment 1, three children were first taught to request one object when it was missing from a set of two related leisure items. In Experiment 2, two children were taught to request one object belonging to a set of three leisure items. In both studies the requesting response consisted of pointing to a photograph of the missing item. After acquisition of the initial request, discrimination of picture requests was assessed when the second item (Experiment 1) and second or third item (Experiment 2) was missing. Requests for the untrained items emerged in the presence of natural maintaining contingencies and in the absence of instructional prompts for all but the third child in Experiment 1. This child required continued intervention on the initial request. The results suggest that for some children a sequence of intervention and the programming of natural maintaining contingencies may prove effective in promoting the discrimination of picture requests for missing items among young children with developmental disabilities.     

Preconceptional family health evaluation: A regional education program for family planning clients and health professionals

The Preconceptional Family Health Evaluation Program was a regional project developed and funded for 2 years by the New England Regional Genetics Group (NERGG) to educate family planning health professionals about genetics, and to offer family planning clients preconceptional identification of genetic and environmental exposure risks. To meet these goals, genetic education was provided on a regional basis to 45 family planning professionals. A self-administered family health risk questionnaire adaptable to individual family planning settings was developed. Five hundred and twenty-nine family planning clients voluntarily completed the questionnaire. Cigarette smoking (35%) and alcohol use (57%) were two major categories of risks identified. The Preconceptional Family Health Evaluation Program was well received by all participants and provided an effective means for regional education of family planning health professionals. As a result of the program, state program planners, clinical genetics services, and family planning health professionals developed a strong relationship that will serve future educational and genetic risk screening efforts.     

A cascade of disparities: health and health care access for people with intellectual disabilities

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.     

The psychometric properties of the center for epidemiological studies-depression scale (ces-d) when used with adults with physical disabilities

Abstract

Psychometric properties of the Center for Epidemiological Studies Depression Scale (CES-D) were examined in a sample of 790 adults with physical disabilities and compared to the responses obtained from non-disabled samples (Craig and Van Natta, 1976; Radloff, 1977). Findings suggested the CES-D is a valid measure of depressive symptoms among adults with physical disabilities. Scores on the CES-D scale were not elevated by somatic issues related to physical disability as evidenced by the lack of statistically significant differences in the persistence percentages reported by adults with physical disabilities and non-disabled adults for four of the seven items composing the somatic dimension of the CES-D. Moreover, the factor structure obtained via principal components analysis was highly similar to that obtained with non-disabled adults. Likewise, the Cronbach alpha value for the total score was within acceptable ranges and scores on the CES-D scale were moderately correlated with scores on a number of related but putatively distinct constructs.