Muriel D. Saunders

Unprompted Mechanical Switch Use in Individuals with Severe Multiple Disabilities: An Evaluation of the Effects of Body Position

Eight women with severe multiple disabilities were provided with simple mechanical switches that when depressed, activated battery-operated leisure items. Switches were provided for 1 hr during recreation when participants were sitting in wheelchairs and for 2 hr during therapeutic positioning when participants were lying on their beds or on wedges. No instructions or physical prompts were used to teach or maintain depression of the switch. Duration of switch depression in each session was recorded in 2 experimental conditions: (a) sessions when switch depression produced immediate activation of the leisure device and (b) sessions when switch depression produced no activation. Seven of eight participants showed higher rates of switch depression during conditions of immediate activation of the leisure device than in no-activation conditions. Seven of eight participants also showed similar rates of switch depression across conditions in both sitting and nonsitting positions.

Evidence of contingency awareness in people with profound multiple impairments: response duration versus response rate indicators.

Evidence of contingency awareness in people with profound multiple impairments is often elusive due to numerous variables that impede learning and contribute to performance variability. Recent research has shown that measuring duration of responding rather than rate has promise for more accurate inferences. Duration measures of adaptive-switch use were obtained with 50 participants during empirical tests for contingency awareness. Nearly 80% had test performance patterns indicative of cause-and-effect learning or contingency awareness. Rate data were obtained concurrent with duration measures for 33/50 participants. Although statistical analysis indicated an interaction of test condition and rate of responding, the performance pattern indicative of contingency awareness was observed in only about 50% of the sets of rate data. Further, rate-based indications of contingency awareness were not consistently confirmed by the duration data. The results strongly support inclusion of response duration measures in evaluation of adaptive-switch use and contingency awareness.

Evaluation of an Approach to Weight Loss in Adults with Intellectual or Developmental Disabilities.

Of 79 overweight adults with intellectual or developmental disabilities who participated in a weight loss intervention, 73 completed the 6-month diet phase. The emphasis in the intervention was consumption of high volume, low calorie foods and beverages, including meal-replacement shakes. Lower calorie frozen entrees were recommended to control portion size. A walking activity was encouraged. Participants attended monthly meetings in which a small amount of cash was exchanged for self-recorded intake and exercise records completed on picture-based forms. Average weight loss was 13.2 pounds (6.3%) of baseline weight at 6 months, with weight loss shown by 64 of the 73 individuals enrolled. Those completing a 6-month follow-up phase showed weight loss of 9.4% of baseline. Increased choice and control are discussed as possible contributors to individual success.

Teaching Manual Signs to Adults With Mental Retardation Using Matching-to-Sample Procedures and Stimulus Equivalence

The objective of this study was to teach manual signs through an automated matching-to-sample procedure and to test for the emergence of new conditional relations and imitative behaviors. Seven adults with mild to severe mental retardation participated. Four were also hearing impaired. Relations between manual signs (set A) and pictures (set B) were initially taught, followed by the training of corresponding printed words (set C) and pictures (set B). Further presentations of conditional discriminations tested for the emergence of AC, followed by tests for the emergence of imitative signing behavior (D) in the presence of either pictures (B) or printed words (C). Each stimulus set was comprised of 9 elements. The stimuli were still pictures, printed words, and dynamic presentations of manual signs. A pretest was conducted to determine which signs the participants could make pre-experimentally. Teaching was arranged in a multiple baseline design across 3 groups of 3 words each.The purpose of the present study was to determine whether participants would emit manual signs in expressive signs tests as a result of observation (video modeling) during match-to-sample training in the absence of explicit training. Five of the 7 subjects passed tests of emergence and emitted at least 50% of the signs. Two were hearing impaired with signing experience, and 3 were not hearing impaired and had no signing experience. Thus, observation of video recorded manual signs in a matching-to-sample training procedure was effective at establishing some signs by adults with mental retardation.

Discovering indices of contingency awareness in adults with multiple profound disabilities

We conducted two studies to examine parameters of social attention in contingency awareness training using switch activation with individuals who had multiple profound disabilities. In Study 1 we compared leisure devices and social attention as reinforcing stimuli with 5 individuals. Results indicated the reinforcing qualities of social attention over leisure devices with 2 individuals and documented the importance of session length in training. In Study 2 we investigated idiosyncratic behaviors as indicators of responsiveness with 3 of the 5 original participants as they activated switches. Behavior changes during switch activation versus nonactivation times in the leisure device and social attention conditions suggested volitional movement supporting contingency awareness and preference. Implications for clinical practice are discussed.

THE REDUCTION OF SELF INJURY IN TWO ADOLESCENTS WITH PROFOUND RETARDATION BY THE ESTABLISHMENT OF A SUPPORTED ROUTINE

Two experiments applied a conceptualization of competence to the treatment of self injury in two adolescents with profound retardation. In Experiment 1, a multiple baseline design across two activity periods was used to assess the effects of reinforcing completion of a five-step packaging routine on repetitious facial hitting in one participant. The rate of facial hits decreased when teachers reduced the latency between a pause by the participant and a prompt from the teacher to continue, pauses having been observed to be followed often by sequence errors, and sequence errors by facial hitting. In Experiment 2, a reversal design was used to compare the effects on head hitting and hand biting by substituting a premeal and dining routine in a second participant. The new routine replaced a largely instructional routine that required discriminations, receptive language, and motor performances not likely to emerge in the participants repertoire. Discontinuation of the instructional routine reduced self injury; institution of the new routine permitted the development of a highly independent series of performances without reoccurrence of self injury. The combined results of the two experiments point to the potentially evocative nature of common teaching approaches and techniques, and the habilitative effects of designing performance expectations with greater prognosis for acquisition.

Comparison of reinforcement schedules in the reduction of stereotypy with supported routines.

The rates and durations of stereotypic behaviors in four adolescents with severe mental retardation were measured during two daily vocational training sessions and during contiguous periods of leisure in their special education classrooms. Vocational training was conducted in two different tasks, alternating across days. The task requirements for each participant were matched to each participants learning and performance characteristics. The participants were exposed to a fixed ratio schedule of tokens exchangeable for food items on one task and to a variable interval schedule for the same consequences on the second task. The schedules were chosen as an initial test of a matching-law based prediction by Myerson and Hale (1984): Variable interval reinforcement for adaptive behavior will produce less allocation of responding to maladaptive behavior than will a ratio-based intervention. When work performances stabilized, the schedules of token delivery were reversed across the tasks and performances again stabilized. Results are reported for periods when work performances met stability criteria. Stereotypy occurred more during leisure than during vocational training under either schedule. The major differences in stereotypy between leisure and vocational training were differences in episode length rather than rate of onset. Onset of stereotypy in vocational training, however, occurred at higher rates under the interval schedule than under the ratio schedule in both tasks. The results are discussed in terms of Myerson and Hales prediction and implications for further research and application.

A comparison of two weight management programs for adults with mobility impairments

BACKGROUND Individuals with physical disabilities experience disparities in obesity; yet few interventions have incorporated accommodations necessary for weight loss in this population. OBJECTIVE/HYPOTHESIS This project compared the effectiveness of two weight loss interventions among individuals with physical disabilities. METHODS Adults with physical disabilities who were overweight or obese were randomized across two diet approaches: a modified version of the MyPlate diet (usual care (UC)) and a modified Stoplight Diet (SLDm) supplemented with portion-controlled meals. Project staff met monthly with each participant to measure weight, 24-recalls of diet intake, self-tracking of foods and beverages, and physical activity during the preceding month. RESULTS Of 126 enrollees, 70% completed the initial 6-month diet phase and 60% of these completed a 6-month follow-up phase. Participants in the SLDm group reduced weight and BMI during the 6 month intervention, and maintained or lost more weight during the 6 month maintenance period. Alternately, the UC diet resulted in a reduction in weight and BMI only at 6 months. BMI from baseline was significantly more improved for SLDm than UC and, among those who lost weight, the SLDm group lost more weight at 6 and 12 months. CONCLUSIONS These results demonstrate that interventions with proper design and accommodations can overcome the barriers to weight loss unique to individuals with mobility impairments with low income. Additionally, the results suggest that using portion control may be more effective than teaching portion sizes.

Weight management for individuals with intellectual and developmental disabilities: Rationale and design for an 18 month randomized trial

Weight management for individuals with intellectual and developmental disabilities (IDD) has received limited attention. Studies on weight management in this population have been conducted over short time frames, in small samples with inadequate statistical power, infrequently used a randomized design, and have not evaluated the use of emerging effective dietary strategies such as pre-packaged meals (PMs). Low energy/fat PMs may be useful in individuals with IDD as they simplify meal planning, limit undesirable food choices, teach appropriate portion sizes, are convenient and easy to prepare, and when combined with fruits and vegetables provide a high volume, low energy dense meal. A randomized effectiveness trial will be conducted in 150 overweight/obese adults with mild to moderate IDD, and their study partners to compare weight loss (6 months) and weight maintenance (12 months) between 2 weight management approaches: 1. A Stop Light Diet enhanced with reduced energy/fat PMs (eSLD); and 2. A recommended care reduced energy/fat meal plan diet (RC). The primary aim is to compare weight loss (0-6 months) and weight maintenance (7-18 months) between the eSLD and RC diets. Secondarily, changes in chronic disease risk factors between the eSLD and RC diets including blood pressure, glucose, insulin, LDL-cholesterol, and HDL-cholesterol will be compared during both weight loss and weight maintenance. Finally, potential mediators of weight loss including energy intake, physical activity, data recording, adherence to the diet, study partner self-efficacy and daily stress related to dietary change will be explored.

An analysis of stereotypy during prevocational instruction of an adolescent with severe mental retardation

An adolescent with severe retardation was observed during participation in several vocational tasks. The vocational tasks were comprised of repeating sequences of work-related responses. Across two experiments, conditions that are typical in the training of vocational tasks in special education and adult vocational programs were manipulated and the effects of these conditions on rates of vocational sequences completed and rates of stereotypic behavior were assessed. In Experiments 1 and 2, the adolescent was reinforced with a food item following the completion of vocational sequences under two alternating reinforcement contingencies. Under one contingency, the adolescent performed with frequent errors and under the other, often performed without errors. In Experiment 3, the adolescent participated with another student in a different vocational task on alternating days and in an alternating sequence of work conditions in each task. In one condition, both adolescents had vocational materials nearly continuously present and the teacher prompted and reinforced both adolescents as needed. In the other condition, the vocational materials were presented to the adolescents on an alternating basis, and the teacher prompted and reinforced first one and then the other. Across both experiments, increased competence reflected as high rate, error free, and consistent vocational performances were associated with low rates of stereotypic behavior when compared to conditions with less competent performances, and with leisure periods in Experiment 3.