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

Abstract

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.

Keywords

automatic prompting positive attention inappropriate behavior intellectual disabilities

Get full access to this article

View all access options for this article.

References

Alter, P.J. , Conroy, M.A. , Mancil, G.R. , & Haydon, T. ( 2008). A comparison of functional behavior assessment methodologies with young children: Descriptive methods and functional analysis. Journal of Behavioral Education, 17, 200-219.

Barlow, D.H. , Nock, M. , & Hersen, M. ( 2009). Single-case experimental designs (3rd ed.). New York, NY: Allyn & Bacon.

Beare, P.L. , Severson, S. , & Brandt, P. ( 2004). The use of a positive procedure to increase engagement on-task and decrease challenging behavior. Behavior Modification , 28, 28-44.

Britton, L.N. , Carr, J.E. , Kellum, K.K. , Dozier, C.L. , & Well, T.M. ( 2000). A variation of noncontingent reinforcement in the treatment of aberrant behavior. Research in Developmental Disabilities , 21, 425-435.

Catania, A.C. ( 2007). Learning (4th Interim ed.). New York, NY: Sloan Publishing. Cunningham, E. , & O’Neill, R.E. (2000). A comparison of results of functional assessment and analysis methods with young children with autism . Education and Training in Mental Retardation and Developmental Disabilities, 35, 406-414.

Cunningham, J. , McDonnell, A. , Easton, A. , & Sturmey, P. ( 2003). Social validation data on three methods of physical restraint: Views of consumers, staff and students. Research in Developmental Disabilities, 24, 307-316.

Davis, C.A. , Brady, M.P. , Williams, R.E. , & Burta, M. ( 1992). The effects of self-operated auditory prompting tapes on the performance fluency of persons with severe mental retardation. Education and Training in Mental Retardation, 27, 39-50.

Duker, P.C. , & Schaapveld, M. (1996). Increasing on-task behaviour through interruption-prompting. Journal of Intellectual Disability Research, 40, 291-297.

Filter, K.J. , & Horner, R.H. ( 2009). Function-based academic interventions for problem behavior . Education and Treatment of Children, 32, 1-19.

10.

Hagopian, L.P. , Paclawskyj, T.R. , & Kuhn, S.C. ( 2005). The use of conditional probability analysis to identify a response chain leading to the occurrence of eye poking. Research in Developmental Disabilities, 26, 393-397.

11.

Hartley, S.L. , & MacLean, W.E. ( 2007). Staff-averse challenging behaviour in older adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 20, 519-528.

12.

Hawkins, R.O. , & Axelrod, M.I. ( 2008). Increasing the on-task homework behavior of youth with behavior disorders using functional behavioral assessment. Behavior Modification, 32, 840-859.

13.

Holburn, S. , Nguyen, D. , & Vietze, P.M. ( 2004). Computer-assisted learning for adults with profound multiple disabilities. Behavioral Interventions, 19, 25-37.

14.

Iwata, B.A. , & Worsdell, A.S. (2005). Implications of functional analysis methodology for the design of intervention programs. Exceptionality, 13, 25-34.

15.

Kazdin, A.E. ( 2001). Behavior modification in applied settings (6th ed.). New York, NY: Wadsworth.

16.

Kern, L. , Carberry, N. , & Haidara, C. ( 1997). Analysis and intervention with two topographies of challenging behavior exhibited by a young woman with autism. Research in Developmental Disabilities, 18, 275-287.

17.

Lancioni, G.E. , Campodonico, F. , & Mantini, M. ( 1998). An automatic prompting system for improving the performance of a woman with multiple disabilities. Scandinavian Journal of Behaviour Therapy, 27, 145-148.

18.

Lancioni, G.E. , O’Reilly, M.F. , Brower-Visser, G. , Groeneweg, J. , Bikker, B. , Flameling, T. , & Van den Hof, E. (2001). Frequent versus nonfrequent prompts and task performance in persons with severe intellectual disability . Scandinavian Journal of Behaviour Therapy, 30, 134-139.

19.

Lancioni, G.E. , O’Reilly, M.F. , Singh, N.N. , Sigafoos, J. , Oliva, D. , Antonucci, M. , . . . Basili, G. ( 2008). Microswitch-based programs for persons with multiple disabilities: An overview of some recent developments. Perceptual and Motor Skills, 106, 355-370.

20.

Lancioni, G.E. , Singh, N.N. , O’Reilly, M.F. , & Sigafoos, J. ( 2009). An overview of behavioral strategies for reducing hand-related stereotypies of persons with severe to profound intellectual and multiple disabilities. Research in Developmental Disabilities, 30, 20-43.

21.

Lancioni, G.E. , Singh, N.N. , O’Reilly, M.F. , Sigafoos, J. , Oliva, D. , Gatti, M. , . . . Groeneweg, J. ( 2008). A microswitch-cluster program to foster adaptive responses and head control in students with multiple disabilities: Replication and validation assessment. Research in Developmental Disabilities, 29, 373-384.

22.

Lancioni, G.E. , Smaldone, A. , O’Reilly, M.F. , Singh, N.N. , & Oliva, D. ( 2005). Automatic prompting to reduce persistent tongue protrusion in a woman with severe to profound mental retardation. Perceptual and Motor Skills, 101, 515-518.

23.

Lindberg, J.S. , Iwata, B.A. , Roscoe, E.M. , Worsdell, A.S. , & Hanley, G.P. ( 2003). Treatment efficacy of noncontingent reinforcement during brief and extended application. Journal of Applied Behavior Analysis, 36, 1-19.

24.

Lovaas, O.I. ( 2003). Teaching individuals with developmental delays: Basic intervention techniques. Austin, TX: Pro-Ed.

25.

Matson, J.L. , & LoVullo, S.V. ( 2008). A review of behavioral treatments for self-injurious behaviors of persons with autism spectrum disorders. Behavior Modification, 32, 61-76.

26.

Matson, J.L. , Minshawi, N.F. , Gonzalez, M.L. , & Mayville, S.B. (2006). The relationship of comorbid problem behaviors to social skills in persons with profound mental retardation . Behavior Modification, 30, 496-506.

27.

Miltenberger, R.G. ( 2004). Behavior modification: Principles and procedures (3rd ed.). New York, NY: Wadsworth.

28.

Mueller, M.M. , & Kafka, C. ( 2006). Assessment and treatment of object mouthing in a public school classroom. Behavioral Interventions, 21, 137-154.

29.

Murdock, S.G. , O’Neill, R.E. , & Cunningham, E. (2005). A comparison of functional behavioral assessment procedures with a group of middle school students with emotional/behavioral disorders. Journal of Behavioral Education , 14, 5-18.

30.

Piazza, C.C. , Adelinis, J.D. , Hanley, G.P. , Goh, H.L. , & Delia, M.D. ( 2000). An evaluation of the effects of matched stimuli on behaviors maintained by automatic reinforcement. Journal of Applied Behavior Analysis, 33, 1-27.

31.

Pitman, M.J. ( 2007). Functional analysis and treatment of socially stigmatizing ambulation. Behavior Analyst Today, 8, 284-297.

32.

Purdy, A.H. , Deitz, J.C. , Harris, S.R. ( 1987). Effects of two treatment approaches to reduce tongue protrusion of children with Down syndrome. Developmental Medicine and Child Neurology, 29, 469-476.

33.

Rapp, J.T. ( 2007). Further evaluation of methods to identify matched stimulation . Journal of Applied Behavior Analysis, 40, 73-88.

34.

Rapp, J.T. , & Vollmer, T.R. ( 2005). Stereotypy: A review of behavioral assessment and treatment . Research in Developmental Disabilities, 26, 527-547.

35.

Rudrud, E.H. , Ziarnik, J.P. , & Colman, G. ( 1984). Reduction of tongue protrusion of a 24-year old woman with Down syndrome through self-monitoring. American Journal of Mental Deficiency, 88, 647-652.

36.

Siegel, S. , & Castellan, N.J. (1988). Nonparametric statistics (2nd ed). New York, NY: McGraw-Hill.

37.

Sigafoos, J. , Arthur-Kelly, M. , & Butterfield, N. (2006). Enhancing everyday communication for children with disabilities. Baltimore, MA: Paul H. Brookes Publishing Co.

38.

Sparrow, S.S. , Balla, D.A. , & Cicchetti, D.V. (2005). Vineland-II Adaptive Behavior Scales (2nd ed.). Minneapolis , MA: Pearson.

39.

Taylor, B.A. , Hoch, H. , & Weissman, M. ( 2005). The analysis and treatment of vocal stereotypy in a child with autism. Behavioral Interventions, 20, 239-253.

40.

Vermeer, A. , Lijnse, M. , & Lindhout, M. ( 2004). Measuring perceived competence and social acceptance in individuals with intellectual disabilities. European Journal of Special Needs Education, 19, 283-300.

41.

Vollmer, T.R. , Ringdahl, J.E. , Roane, H.S. , & Marcus, B.A. ( 1997). Negative side effects of noncontingent reinforcement . Journal of Applied Behavior Analysis, 30, 161-164.