Working with People with Learning Difficulties Who Self-Injure: A Review of the Literature

Effectiveness of an Occupational Therapy Programme Based on Sensory Integration Theory for Adults with Severe Learning Disabilities

The purpose of this 2-year research project was to seek an effective intervention to address the needs of adults with severe learning disabilities. The authors, funded by the North Thames Regional Health Authority, drew on sensory integrative (SI) theory and practice to carry out this work. This article details the first year of research.

A pre-test, post-test two-group experimental design was used. Thirty subjects aged from 23 to 50 years were assigned to an experimental or a control group (that is, 15 subjects in each group). The subjects lived in an institutional setting, were without speech, had minimal attention and concentration and presented with tactile defensiveness and/or aversive response to movement. Members of the experimental group received a weekly SI-based treatment session and members of the control group received weekly sensory stimulation. Sessions varied from a few minutes to one hour and generally lengthened with the subjects' increasing adjustment to the new environment.

Three types of checklist were used for assessment at the pre-test and post-test stages. Analysis of data from the 28 subjects who completed the study showed a statistically significant improvement in both groups, a statistically significant greater improvement in the experimental than in the control group in some areas only, and no negative correlation between age and improvement in either group. The research indicates that SI-based treatment can benefit this client group.

Rules of engagement: toward an analysis of staff responses to challenging behavior

Through observational analysis, the actions of care staff have frequently been identified as sources of socially mediated reinforcement capable of developing and maintaining challenging behavior. Accordingly, behavioral interventions have often sought to train care staff as behavioral change agents. As yet, however, there have been few attempts to conduct full functional analyses of the behavior of care staff working with people with mental retardation and challenging behaviors. We argue that although direct contingency-shaping of staff behavior has rightly been emphasized, it is possible that many aspects of staff conduct are under the indirect control of verbal formulations. If staff behavior is rule-governed (Skinner, 1969), a range of different sources of control must be considered in a complete analysis. Using this framework, we interpret existing literature on staff behavior and identify research strategies that will extend our understanding of why staff act as they do.