Facilitated communication: Better education through applied ideology

Facilitated communication (FC), or the provision of graduated assistance by staff in the selection of keys on a communication device by people with developmental disabilities, has become a widely used training technique. Although widespread anecdotal accounts of substantial training benefits and unanticipated communicative competence have been reported, controlled experimental and single subject studies have disclosed little evidence of unexpected competencies. We review research on FC, identify cognitive factors that may stimulate acceptance of this as a training method, and suggest procedures to be employed in individual validation situations when critical communications occur.     

A RESPONSE-RESTRICTION ANALYSIS OF STEREOTYPY IN ADOLESCENTS WITH MENTAL RETARDATION: IMPLICATIONS FOR APPLIED BEHAVIOR ANALYSIS

The behavior of 4 adolescents with severe or profound mental retardation was evaluated in the presence of four sets of materials during periods of unstructured leisure activity. Functional engagement with the materials, stereotypic engagement with the materials, stereotypy without interaction with the materials, and other aberrant behaviors were recorded. Across a series of experimental conditions, the number of sets of materials was reduced from four to one by eliminating the set most frequently manipulated in each preceding condition. In the final condition, four sets of materials were again made available for manipulation. The procedures replicated Green and Striefel's (1988) response-restriction analysis of the activity preferences and play behaviors of children with autism. In general, the results of the present experiment replicate those of Green and Striefel in that reallocation of responding was idiosyncratic and unpredictable as sets of materials were removed. Nevertheless, the results provided insight into how responding might be reallocated if it were restricted through behavioral interventions rather than by restriction of access. Thus, the results are discussed with respect to how response-restriction analyses may be useful in identifying topographies of behavior that could be included in differential reinforcement contingencies that are designed to affect stereotypic behavior and in the selection and arrangement of environmental stimuli to minimize the presence of evokers of stereotypy.     

Self-injurious behavior in institutionalized,severely/profoundly retarded adults—Prevalence data and staff agreement

Staff agreement on the identification of 18 different types of self-injurious behavior (SIB) and the prevalence of SIB were assessed in a population of 91 severely and profoundly retarded residents in a large facility for mentally retarded people in West Germany (FRG). The survey included 27 direct care staff; groups of three to five rated the behavior of 8 to 27 residents from their own wards. Agreement was calculated with two different formulas for multiple raters. The data suggest that the standard definition of SIB [Tate, B. G.,& Baroff, G. S. (1966).Behavior Research and Therapy, 4, 281–287], together with a list of the most common SIB topographies, yields variable and generally low staff agreement. The data for the prevalence statistics were derived from cases in which at least 50% of the staff had indicated the occurrence of an SIB topography in a resident. Sixty of the 91 residents exhibited some form of SIB; of these, 15 demonstrated only one type, 12 two, and 33 three or more SIB topographies. The data corroborate the notion of the two taxonomic classes of social and nonsocial SIB. Contrary to other classifications the data indicate that ruminative vomiting belongs to the social SIB class.The author wishes to express his gratitude to Dr. Udo Lück, chief psychologist of the Diakoniezentrum Hephata, who made this study possible by his interest and support. The help of Walter Edlinger in collecting the data and of Prof. Hartmann Scheiblechner in giving methodological advice is also greatly appreciated.     

SELF-MONITORING AND WORK PRODUCTIVITY WITH MENTALLY RETARDED ADULTS

We examined the use of self-monitoring to increase the productivity of five mentally retarded adults in a sheltered workshop. Data were collected daily during a 30-minute intervention and 30-minute generalization period. Following baseline, verbal praise, prompts, and physical encouragement were administered contingent on productive behavior on a specific task during the intervention period. In the next phase, self-monitoring was trained during the intervention period. During both phases, baseline conditions prevailed in the generalization periods. In the final phase, self-monitoring was extended across the intervention and generalization periods. Results showed that increased productivity levels, evident when praise and prompting were being administered, maintained with self-monitoring alone. Minimal generalization across time was observed until self-monitoring was begun in the generalization period.     

STRATEGIES TO INCREASE EXERCISE-REPORT CORRESPONDENCE BY BOYS WITH MODERATE MENTAL RETARDATION: COLLATERAL CHANGES IN INTENTION-EXERCISE CORRESPONDENCE

Correspondence between verbal and nonverbal behavior in an exercise room was taught to 4 13-year-old boys diagnosed with moderate mental retardation. Participants were asked prior to each exercise session which exercise machine(s) they intended to use. No contingencies on stating intentions (promising) were applied. Following the exercise session, participants were asked to say (report) which machine(s) they had used. Following the baseline condition, do-report correspondence training was introduced sequentially across participants. During do-report correspondence training, accurate reporting was reinforced. High rates of both do-report and promise-do correspondence were observed. Data were analyzed via a multiple baseline across subjects design and contingency-space analysis. Results are discussed with regard to observed changes in promise-do correspondence subsequent to observed changes in do-report correspondence.     

SOCIAL VALIDATION OF COMPONENT BEHAVIORS OF FOLLOWING INSTRUCTIONS,ACCEPTING CRITICISM,AND NEGOTIATING

This study evaluated whether behaviors often taught as part of social skills training are judged favorably by others. Community judges evaluated the performances of people in various situations requiring one of three social skills: following instructions, accepting criticism, and negotiating to resolve conflicts. These skills were displayed in videotaped scenes by actors with and without mental retardation who acted out roles that had different types of authority relationships, and when different components or clusters of behavior (nonverbal, specific verbal, or general verbal behaviors) were performed well or poorly. The highest ratings by judges were of videotaped scenes that depicted correct use of all behaviors, regardless of which skill was being examined, whether or not the actor had mental retardation, or what the relationship was between the two actors. The lowest ratings were of videotaped scenes that depicted poor performance of all behaviors, and intermediate ratings were obtained when only some of the behaviors were performed poorly. These results, as well as the verbal responses of judges to questions, indicated that the different behaviors commonly used in teaching the skills of following instructions, accepting criticism, and negotiating are relevant to judgment of social performance, and are likely to be reinforced and maintained by social contingencies.     

PROTECTIVE EQUIPMENT: CONTINUOUS AND CONTINGENT APPLICATION IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

This study evaluated the use of protective equipment in treating self-injurious behavior (SIB) exhibited by three retarded persons. In Experiment 1, the equipment was first applied continuously during 20-min sessions in individual multiple baseline designs across settings. Results showed substantial reductions in head hitting, eye gouging, and hand biting. Brief periods of time-out with the protective equipment were later made contingent on SIB and combined with a differential reinforcement procedure. Reduced levels of SIB was maintained with all subjects. Additionally, the amount of time during which the equipment was applied decreased as the SIB diminished. Experiment 2 evaluated the use of contingent protective equipment (the final condition in Experiment 1) when applied directly in the subjects' living uints during the day. During Experiment 2, SIB remained at or below the levels found at the termination of Experiment 1. Finally, in an effort to assess the long-term effectiveness of the procedure, responsibility for implementation was given to the staff who were typically assigned to provide therapy to the subjects. Follow-up probe observations conducted up to 104 days after termination of the final experimental condition showed continued low levels of both SIB and equipment usage. Results of these experiments suggest that contingent protective equipment and differential reinforcement may be effective in reducing chronic self-injury.     

Custody and Access Evaluations: Issues for Mental Health Professionals Conducting Assessments withMentally Disordered or Mentally Retarded Parents

Mental health professionals are increasingly beingcalled upon by the courts to offer their expertise inchild custody and access disputes. This paperaddresses the specialized role mental healthprofessionals have in custody and access hearings,particularly in cases wherein one or both parents havereceived a mental diagnosis (i.e., of mental disorderor mental retardation). The focus upon thispopulation of parents is warranted, as there is adearth of both empirical literature and professionalguidelines to provide direction to the mental healthprofessional that is offering his or her expertise tothe court regarding these parents. Additionally,there are specific issues that the mental healthprofessional needs to remain cognizant of, above andbeyond general issues associated with conductingcustody and access assessments, when conductingassessments on parents with mental diagnoses. Theliterature on the parenting behaviors and risk ofchild abuse and neglect associated with mentallydisordered and mentally retarded parents is reviewed,and the limitations in our empirical knowledge ofthese areas are highlighted. Recommendations formental health professionals conducting custodyevaluations in hearings where one or both parents havea mental diagnosis are provided.     

Quantitative and Qualitative Integration of Lurian Procedures

This article reviews contemporary Russian research aimed at integrating and combining qualitative and quantitative evaluation approaches using Luria's procedures of neuropsychological assessment. A scoring system for rating and evaluating cognitive disturbances in different functional areas is described. The advantages of application of this system are discussed, using as examples the neuropsychological follow-up of neurosurgical patients, as well as neuropsychological research into the cognitive disturbances in patients with Parkinsonism and in children who are mentally retarded. The effectiveness of these updates to Luria's approach is demonstrated.     

INCREASING HABILITATIVE SERVICES FOR PERSONS WITH PROFOUND HANDICAPS: AN APPLICATION OF STRUCTURAL ANALYSIS TO STAFF MANAGEMENT

We evaluated a structural analysis methodology for enhancing the utility of a staff management program. In Experiment 1, a structural analysis of direct-care staff behavior in a mental retardation facility revealed differences in work patterns over time. Specific times were identified when few basic care duties were necessary and staff engaged in nonwork activity. In Experiment 2, a management program was implemented to increase staff members' training activities during periods identified through the structural analysis. The program was accompanied by increases in training activities and decreases in nonwork behavior. The improvements were maintained during a 43-week period while the most labor-intensive component of the program was withdrawn. Staff acceptability measures indicated a positive response to the management intervention, although responses varied across components within the multifaceted program. The increased training was accompanied by beneficial changes among clients with profound handicaps. Results are discussed regarding practical considerations for improving staff performance and for adopting innovations resulting from applied research.