Jeffrey M. Chan

Examining the function of problem behavior in Fragile X Syndrome: preliminary experimental analysis

Fragile X syndrome is the most common inherited cause of intellectual and developmental disability. The influence of environmental variables on behaviors associated with the syndrome has received only scant attention. The current study explored the function served by problem behavior in fragile X syndrome by using experimental functional analysis methodology with 8 children with fragile X. No child met criteria for attention-maintained problem behavior, 5 children met criteria for escape-maintained problem behavior, and 4 children met criteria for tangible-maintained problem behavior. Results are discussed and compared with previous findings on the function of problem behavior in fragile X syndrome, and implications for intervention are discussed. It is noted that the external validity of these findings is limited by the small sample size.

The effects of a weighted vest on aggressive and self-injurious behavior in a child with autism

Objective: Analyse the effects of a weighted vest on the aggressive and self-injurious behavior of a young boy with autism. Methods: The effects of the weighted vest were examined during a functional analysis utilizing an ABAB design with an embedded multielement design, in which the participant wore a five pound weighted vest or no vest. Results: The results do not suggest the existence of a functional relationship between the use of a weighted vest and challenging behavior, as the weighted vest had no marked effect on levels of aggression and self-injurious behavior. Conclusions: Weighted vests are a commonly implemented form of sensory integration therapy, frequently used as a treatment for disruptive behaviors associated with autism spectrum disorder [Stephenson J, Carter M. The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism and Developmental Disabilities 2009;39:105–114]. However, the current findings support previous literature which states that the use of weighted vests does not appear to decrease challenging behavior.

Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) vs. Training-as-Usual (TAU): A Randomized Controlled Trial

Caregivers of individuals with intellectual and developmental disabilities (IDD) often end up having their medical and psychological well-being compromised due to the stressful nature of caregiving, especially when those in their care engage in aggressive behavior. In this study, we provided caregivers with mindfulness-based training to enable them to better manage their psychological well-being and, through this, to also enhance specific indices of quality of life of the individuals in their care. Thus, the aim of the present study was to evaluate in a randomized controlled trial (RCT) the comparative effectiveness of Mindfulness-Based Positive Behavior Support (MBPBS) and Training-as-Usual (TAU) for caregivers in a congregate care facility for individuals with severe and profound IDD. The comparative effects of the two training conditions were assessed in terms of caregiver variables care recipient variable (number of aggressive events), and agency variables Results showed that MBPBS was significantly more effective than TAU in enabling the caregivers to manage their perceived psychological stress, and to reduce the use of physical restraints and stat medications for aggressive behavior of the individuals in their care. In addition, there were significant reductions in aggressive events by the individuals in their care, 1:1 staffing of individuals with aggressive behavior, and staff turnover. Furthermore, the MBPBS training was significantly more cost-effective than the TAU training. If replicated in future RCT studies, MBPBS may provide an effective means of enhancing socially acceptable bidirectional engagement of caregivers and care recipients within a person-centered context.

Comparative Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) and Positive Behavior Support (PBS) in a Randomized Controlled Trial

Caregivers of individuals with intellectual and developmental disabilities are often stressed due to the demands of the job, including the nature and severity of challenging behaviors of the clients, work conditions, degree of management support for the staff, and the demands of implementing some interventions under adverse conditions. Mindfulness-Based Positive Behavior Support (MBPBS) and PBS alone have been shown to be effective in assisting caregivers to better manage the challenging behaviors of clients with intellectual and developmental disabilities. The aim of the present study was to undertake a head-to-head assessment of the effectiveness of MBPBS and PBS alone in a 40-week randomized controlled trial. Of the 123 caregivers who met inclusion criteria, 60 were randomly assigned to MBPBS and 63 to PBS alone, with 59 completing the trial in the MBPBS condition and 57 in the PBS alone condition. Results showed both interventions to be effective, but the caregiver, client, and agency outcomes for MBPBS were uniformly superior to those of PBS alone condition. In addition, the MBPBS training was substantially more cost-effective than the PBS alone training. The present results add to the evidence base for the effectiveness of MBPBS and, if independently replicated, could provide an integrative health care approach in the field of intellectual and developmental disabilities.

Preference for language of instruction of an English language learner with autism

Abstract Objective: To use a preference assessment to identify the preferred language of instruction (English or Spanish) for a child with autism living in a Spanish-speaking home and receiving school services in English only. Methods: We used a concurrent chains method to evaluate the participant’s preference for English or Spanish instruction. Colored microswitches represented English instruction, Spanish instruction and no instruction (control). Switch presses resulted in instruction and reinforcement in either English or Spanish, or no instruction and no reinforcement. After session 10, switches were reprogrammed to control for color bias. Results: The participant chose Spanish instruction most frequently. Conclusions: The participant preferred to receive instruction in Spanish. These data support previous research indicating the importance of child preference when individualizing educational programs for children with autism and that language of instruction is an important variable when working with children with autism who experience multiple languages across home and school.

Mindfulness: An Application of Positive Psychology in Intellectual and Developmental Disabilities

Mindfulness-based interventions teach participants how to go within oneself, engage in inner transformation through mindfulness meditation and other informal mindfulness activities, and learn how to respond to daily life events in a calm, accepting, and nonjudgmental manner. By focusing on what one can do by being present helps the development and strengthening of human social functioning regardless of one’s current personal circumstances, such as disease, disorder, dysfunction, or disabilities. In this sense, mindfulness and positive psychology provide similar pathways for developing human potential. This chapter presents a comprehensive, but not exhaustive, narrative review of the applications of mindfulness-based interventions in the field of intellectual and developmental disabilities. The chapter covers procedures and practices that have been used to instill mindfulness in children, adolescents, and adults with intellectual and developmental disabilities and their support providers, including family members, direct support staff, and teachers. Although most of the mindfulness research in this field is in the early stages, data from several studies indicate that mindfulness-based interventions may have immediate and long-term benefits for people with intellectual and developmental disabilities and their support providers.

Comparing self-directed video prompting to least-to-most prompting in post-secondary students with moderate intellectual disabilities

Objectives: This study compared the effects of self-directed video prompting with error correction using an iPod Touch to least-to-most prompting on teaching vocational skills to two post-secondary students with moderate intellectual disabilities. Methods: Students were first taught to use the inPromptu mobile application on the iPod Touch. They were then taught to collate and pack a large envelope and to tri-fold papers and pack a business envelope. The two tasks were counterbalanced across students in an adapted alternating treatments design. Students were instructed to use self-directed video prompting with error correction to teach themselves one skill, and an instructor used least-to-most prompting to teach the second skill. Data were also collected on sessions to criterion and maintenance of the skills over time. Results: Results demonstrated that both instructional techniques were effective in teaching the skills, and students generalized their use of the technology to learn a new skill with no additional instruction. These results were replicated with one of the students. Conclusions: Self-directed video prompting with error correction and least-to-most prompting were nearly equivalent in terms of acquisition efficiency and maintenance. These findings suggest that self-directed video prompting with error correction could be used in vocational settings, allowing job coaches to fade more quickly and for adults with intellectual and developmental disabilities to be more independent.

Tele-health training of teachers to teach a mindfulness-based procedure for self-management of aggressive behavior to students with intellectual and developmental disabilities

Objective: The objective of this study was to assess the feasibility of using Tele-health technology to teach three teachers in a rural school district the basics of a mindfulness-based procedure, measure the fidelity of the teachers teaching the procedure to a student in their class, and to assess the effectiveness of the students’ use of the procedure, in terms of their physical and verbal aggression. Methods: A multiple-baseline design across participants was used, with a 12-month follow-up. Tele-health technology was used to teach teachers meditation on the Soles of the Feet (SoF) procedure. The students were able to use the procedure to downregulate their emotions associated with the earliest precursors to verbal and physical aggression. We measured the fidelity of the teachers’ and the students’ SoF training, as well as behavioral outcomes for the students in terms of frequency of physical and verbal aggression. Results: The Tele-health technology was used successfully to teach the teachers how to personally use and then teach the SoF procedure to their students in a face-to-face school setting. The fidelity of teacher and student training in the SoF procedure was high. The students were able to learn how to downregulate their emotional reactions to rising anger and aggression, thereby reducing physical aggression to near-zero levels and verbal aggression to close to zero levels in the follow-up period. Conclusions: Tele-health may be an effective approach to providing training and therapy to caregivers in remote locations that cannot readily access specialist services.

Activity schedules for individuals with disabilities appear to be effective, but deeper analysis is required

Koyama, T., & Wang, H. (2011). Use of activity schedule to promote independent performance of individuals with autism and other intellectual disabilities: A review. Research in Developmental Disabilities, 32, 2235–2242. doi: 10.1016/j.ridd.2011.05.003. Source of funding and disclosure of interest: No source of funding reported, and no conflicts of interest reported by the original authors of this research report.