Automatic Prompting to Reduce Persistent Tongue Protrusion in a Woman with Severe to Profound Mental Retardation

Automatic Prompting and Positive Attention to Reduce Tongue Protrusion and Head Tilting by Two Adults With Severe to Profound Intellectual Disabilities

This study assessed a simple behavioral strategy for reducing stereotypic tongue protrusion and forward head tilting displayed by a woman and a man with severe to profound intellectual disabilities. The strategy involved (a) auditory prompting (i.e., verbal encouragements to keep the tongue in the mouth or the head upright) delivered automatically at fixed intervals via a portable device, and (b) social approval delivered by a research assistant at adjustable intervals for the absence of the inappropriate behavior. The intervals arranged for the delivery of approval were extended if the inappropriate behavior occurred in concomitance with the expected delivery. Data showed that the intervention strategy was effective in reducing the stereotypic tongue protrusion and forward head tilting. Their occurrences dropped from above 40% (tongue protrusion) and close to 80% (head tilting) of the observation instances during the initial baseline to around or slightly above 10% of those instances during the second intervention period and the 3-month postintervention check.

A Girl With Multiple Disabilities Increases Object Manipulation and Reduces Hand Mouthing Through a Microswitch-Based Program

The study was an effort to help a girl with multiple disabilities increase object manipulation responses and reduce hand mouthing, carried out according to an ABAB sequence (in which A represented baseline phases; B, treatment phases) and including a 3-month follow-up. During the baseline phases, a microswitch cluster (i.e., a combination of microswitches) was used to monitor the girl's object manipulation responses and hand mouthing. Indices of happiness were also recorded. During the treatment phases and follow-up, the microswitch cluster was combined with the use of preferred stimuli for object manipulation responses. The stimuli lasted an 8-s period at each response if the girl remained free from hand mouthing through that period, but were interrupted if hand mouthing appeared. The results show that the girl increased object manipulation responses, learned to refrain from hand mouthing for most of the session time, maintained this performance over time, and showed an increase in indices of happiness.

Enabling two persons with multiple disabilities to access environmental stimuli and ask for social contact through microswitches and a VOCA

This study assessed the combination of two microswitches with a voice output communication aid (VOCA) with two persons (an adolescent and a young adult) with multiple disabilities. The microswitches allowed the participants to obtain direct access to preferred environmental stimuli; the VOCA enabled them to ask for caregiver's attention. Initially, the participants were taught to use each of the two microswitches individually and then together. Next, they were taught to use the VOCA and, eventually, this was available together with the microswitches. Results showed that the participants learned to operate the microswitches and the VOCA and used all three of them consistently when they were simultaneously available. Implications of these findings and the potential role of a VOCA combined with conventional microswitches were discussed.

Promoting Adaptive Foot Movements and Reducing Hand Mouthing and Eye Poking in a Boy with Multiple Disabilities through Microswitch Technology

This study assessed the viability of a microswitch cluster (i.e. a combination of microswitches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behavior in a boy with profound multiple disabilities. The boy was initially taught an adaptive foot-movement response that activated a motion microswitch and produced preferred stimuli. Subsequently, his foot response led to preferred stimuli only if it occurred in the absence of aberrant behavior (i.e. hand mouthing and eye poking which were detected through optic microswitches). Moreover, full access to the stimuli required that the boy refrain from aberrant behavior during their presentation as well. The study also included a 3-month post-intervention check and a social validation assessment. Data showed that the boy (i) increased his adaptive responding, (ii) learned to perform this responding largely free from aberrant behavior and refrained from that behavior for most of the session time, and (iii) maintained this performance at the post-intervention check. The social validation ratings of 40 teachers and teacher assistants significantly favored the last intervention period (in which aberrant behavior was reduced) over the initial period.

Promoting fluency of performance during morning dressing by two persons with multiple disabilities

This study investigated the possibility of promoting fluency of performance, i.e., a performance independent of caregiver's guidance and without serious interruptions, during morning dressing in two adults with multiple disabilities. The intervention program relied on the use of assistive technology including optic and pressure sensors to monitor the participants' task responding and tape players to present preferred stimuli in relation to such responding, as well as messages of encouragement. Analysis showed that the intervention program was effective with both participants. In fact, they became capable of performing the dressing sequence with only occasional guidance from research assistants, and the time they required for dressing dropped significantly from baseline levels. Implications of the results are discussed.