Increasing adaptive responses and reducing finger mouthing in an adolescent with multiple disabilities: Evaluation of an upgraded microswitch-cluster program.

Abstract

Persons with profound and multiple disabilities may frequently fail to engage in constructive activity and, instead, may display high levels of problem behavior (e.g., tongue protrusion and hand mouthing), which complicates their situation further and hampers their social image (Holburn, Nguyen, & Vietze, 2004; Kurtz et al., 2003; Luiselli, 1998; Matson, Minshawi, Gonzalez, & Mayville, 2006; Saloviita & Pennanen, 2003). Educational intervention with these persons needs to target both constructive responding and problem behavior to produce a clinically relevant outcome, with clear personal and social benefits (Lancioni, Singh et al., 2007). To pursue both these goals, microswitch clusters (i.e., combinations of microswitches monitoring concurrently adaptive and aberrant responses) may prove very helpful (Lancioni, O'Reilly, Singh, Sigafoos et al., 2006, Lancioni, Smaldone et al., 2007). For example, a microswitch cluster consisting of a pressure device on the participant's headrest and an optic sensor directed at his or her mouth may be used to ensure that adaptive head responses are followed by positive stimulation only when they occur free from finger mouthing. Although a program such as that just mentioned may be adequate in fostering adaptive responding and reducing problem behavior, an upgraded (stronger) version of it may also be conceived for the longer term. Such version could ensure that the stimulation for adaptive responses occurring free from problem behavior (a) lasts the scheduled time if the person refrains from the problem behavior during all that time and (b) is interrupted if the problem behavior appears during that time (cf. Lancioni, Singh et al., 2007). The new version could also include extra stimulation arrangements in concomitance with adaptive responses to (a) maintain high response motivation and (b) possibly promote some proper use of body parts (e.g., hands) involved in problem behavior. This study evaluated an upgraded program version similar to the one just described (i.e., with stimulation interrupted at the appearance of the problem behavior and extra stimulation arrangements). The participant was an adolescent who had received a basic microswitch-cluster program such as that delineated earlier (i.e., without the aforementioned new features) to promote adaptive foot and head responses and reduce finger mouthing (Lancioni, O'Reilly, Singh, Sigafoos et al., 2006). Method Participant The participant (Vincent) was 13.9 years old at the start of this study. He had congenital encephalopathy with spasticity, reduced visual acuity, and lack of speech. He was in a wheelchair and received antiepileptic medication. Although no IQ scores were available, he was rated in the profound intellectual disability range. His participation in the basic microswitch-cluster program had increased the frequencies of his adaptive responses (foot and head movements, targeted in separate sessions) and ensured that about 80% of those responses occurred free from finger mouthing and thus were followed by preferred stimulation. This lasted the scheduled time regardless of whether finger mouthing appeared during that time. Responses, Microswitch Clusters, Control System, and Stimuli The responses recorded during the present study were foot movements (i.e., moving one or both feet upward or sideward), head movements (i.e., moving the head backward or sideward), finger mouthing (i.e., bringing fingers into or over the mouth), and object contact (i.e., bringing one or both hands in contact with objects). The microswitch clusters (see Lancioni, O'Reilly, Singh, Sigafoos et al., 2006) included (a) tilt devices for foot movements combined with an optic sensor for finger mouthing and (b) a pressure device for head movements combined with the aforementioned optic sensor. The optic sensor was held a few centimeters to the side of Vincent's mouth through a light wire fixed to his eyeglasses. …