ANALYZING ALERTNESS AMONG PEOPLE WITH PROFOUND MULTIPLE DISABILITIES: IMPLICATIONS FOR PROVISION OF TRAINING

We investigated whether variations in alertness among individuals with profound multiple disabilities affected subsequent responsiveness to training programs. Three experiments were conducted involving 5 people. In Experiment 1, results indicated that alertness of 3 individuals increased with provision of skill-acquisition training programs. Results also indicated no predictive relationship between alertness levels prior to training and subsequent responsiveness to training. Experiment 2 replicated results of Experiment 1 with 2 participants from Experiment 1 and an additional participant. Results of Experiment 2 also indicated that the increased alertness levels accompanying provision of training were not a function of the participants simply being in an inactive environment prior to training. Results of Experiment 3 indicated that alertness of an additional participant increased through provision of another training intervention, involving a systematic preference assessment. Responses during the preference assessment appeared to be unrelated to previously existing alertness levels. These findings suggest the need for caution when considering the withholding of scheduled training because an individual appears to be nonalert.     

THE UNIT PLAY MANAGER AS FACILITATOR OF PURPOSEFUL ACTIVITIES AMONG INSTITUTIONALIZED PROFOUNDLY AND SEVERELY RETARDED BOYS

Child care workers were trained in specified techniques (play manager routines) in an effort to increase purposeful activity among a group of profoundly and severely retarded institutionalized boys. A system of prompts, increasing the availability of toys and regular staff monitoring, were alternated with normal institutional routines in an ABA reversal design. On the average, activity level increased from 10% to a mean of 70% during treatment conditions. Correspondingly, stereotyped or harmful behaviors decreased from an average of 20% to 70% during treatment.     

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.     

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.     

People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.     

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.     

TEACHING PERSONS WITH PROFOUND MULTIPLE HANDICAPS: A REVIEW OF THE EFFECTS OF BEHAVIORAL RESEARCH

The behavioral research on teaching individuals who have profound multiple handicaps is reviewed. The primary focus is on determining the degree to which behavioral research has demonstrated the teaching of meaningful skills to this population. Results of the review indicate that investigations have demonstrated, albeit inconsistently, that behavior change has resulted from contingency management interventions with persons who have profound multiple handicaps. However, there is little evidence that such interventions have resulted in meaningful behavior change according to currently accepted criteria for beneficially affecting the quality of life of persons with serious handicaps. Potential explanations for the lack of such evidence are offered, including the relative lack of research attention given to this issue, the possible ineffectiveness of the components of the technology applied, and possible ineffective application of the potentially effective technology. Suggestions for future research are discussed in terms of developing more effective educational and habilitative services for persons with profound multiple handicaps. In particular, we suggest research on a wider variety of behavioral teaching procedures, providing more comprehensive evaluations of the applications of procedures and developing treatment programs that do not focus solely on traditional skill acquisition.     

Dignity,Capability, and Profound Disability

Martha Nussbaum has sought to establish the significance of disability for liberal theories of justice. She proposes that human dignity can serve as the basis of an entitlement to a set of capabilities that all human beings either possess or have the potential to develop. This article considers whether the concept of human dignity will serve as the justification for basic human capabilities in accounting for the demands of justice for people with profound learning difficulties and disabilities. It examines the relationship between dignity and capabilities, suggesting that Nussbaum fails to distinguish between several conceptions of human dignity, whilst also identifying one of these conceptions as coming close to meeting several of her demands. It is difficult enough, however, to show how dignity is related to just one of our basic entitlements, and even that requires more than the resources available in Nussbaum's approach.     

Assessing choice-making and preference in adults with profound mental retardation across community and center-based settings

We examined choice and preference in four adults with profound mental retardation within the context of a community-based and center-based location. Prior to the preference analysis, an independent selecting response was empirically assessed and validated for each adult. Results of the preference analysis showed that in the community site there was a higher cumulative frequency of choice-making responses towards beverages for all participants, and an indication of beverage preference for two of the four participants. Conversely, in the center-based setting, there were fewer responses made towards the beverages, and no indication of preference for any of the four adults. These results remained consistent during maintenance checks at 2, 4, 6, and 8 weeks post-intervention.