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Microswitch technology to promote adaptive responses and reduce mouthing in two children with multiple disabilities.

Abstract: This study assessed the viability of using microswitch clusters (combinations of microswitches) plus contingent stimulation to promote adaptive responding and to reduce aberrant behavior in two children with multiple disabilities. The results revealed that both children increased their adaptive responses, learned to perform these responses free from aberrant behavior, and maintained this level of performance three months later.

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Persons with multiple disabilities, such as severe to profound mental retardation combined with motor and visual impairments, may have few adaptive responses and fail to engage in constructive activity and to control environmental stimuli (Holburn, Nguyen, & Vietze, 2004; Mechling, 2006). They may also engage in aberrant behavior, such as protruding their tongues, mouthing their hands, or poking their eyes, which hampers their social image and overall social acceptance (Lancioni et al., 2002; Lancioni, Smaldone et al., in press; Luiselli, 1998; Saloviita & Pennanen, 2003).

Microswitch-based programs can be valuable tools to help these persons increase their adaptive responses and produce preferred stimuli (Lancioni et al., 2006; Lancioni, Singh et al., in press). Once these persons have consolidated their adaptive responses, they may learn to combine them with the control of their aberrant behavior. For example, a person may be initially taught to perform hand or foot movements to produce preferred stimuli. Subsequently, he or she may be able to produce the stimuli only if the hand or foot movements occur in the absence of aberrant behavior (such as mouthing a hand) (Lancioni et al., 2004).

This dual goal of promoting adaptive responses and reducing aberrant behavior may be pursued through a novel intervention technology that is based on microswitch clusters (combinations of microswitches that concurrently monitor adaptive and aberrant responses) and preferred stimuli that are available for adaptive responses that occur in the absence of aberrant ones (see, for example, Lancioni et al., 2006). Three single-case studies were recently conducted to investigate this opportunity, and their results were satisfactory (Lancioni et al., 2006; Lancioni, Singh et al., in press; Lancioni, Smaldone et al., in press). All three participants in the studies increased their adaptive responding (hand, head, and leg movements or all three) and reduced their aberrant behavior (mouthing their fingers or hands, poking their eyes, or hiding their faces).

The study presented here served as a replication and extension of the previous three studies. It assessed the effectiveness of microswitch cluster technology with two new participants: Children who had some functional or residual vision or were blind and had an intellectual disability and a motor impairment. The children's adaptive responding consisted of manipulating or moving an object that was attached to a wobble microswitch or knocking objects on the table to activate a vibration microswitch. The children's aberrant behavior consisted of mouthing their hands or objects.

Method

PARTICIPANTS

The participants, Ginny and Kirk, were aged 7.6 and 12.3 years, respectively, and were considered to function in the profound intellectual disability range, although no IQ scores were available. They presented with encephalopathy related to premature birth, general hypotone or spastic tetraparesis, epilepsy (largely controlled through medication), and the lack of speech. Ginny had residual vision that allowed her to control stimuli in the immediate proximity (within less than 1 meter, or about 3.3 feet) and at the center of her visual field, and Kirk was totally blind (see Morse, Teresi, Rosenthal, Holmes, & Yatzkan, 2004; Sakai et al., 2002). They did not have self-help or constructive occupational skills and spent most of their waking time sitting. Ginny had minimal interaction with objects and tended to mouth her hands. Kirk's use of objects consisted mainly of bringing them to his mouth and holding them against his lips or teeth or putting them inside his mouth. Both participants lived at home with their parents and attended daily educational programs that focused on physiotherapy and general stimulation. Their parents and teachers had provided informed consent for this study.

RESPONSES AND MICROSWITCH CLUSTERS

The responses recorded for Ginny were manipulating an object (pushing or pulling a ball or moving it sideways) and mouthing her hands (bringing her fingers or other parts of her hand into or over her mouth). The first response activated a wobble microswitch to which the ball was fixed. The second response activated a small optic sensor, a photocell, that was held below Ginny's chin through a wire originating from her hat and passing behind her right ear. The responses recorded for Kirk were knocking familiar objects (on a tabletop or against the sides of the box in which they were displayed) and mouthing objects (bringing objects against his lips and teeth or putting them inside his mouth). The first response activated a vibration microswitch, that is, a minishock absorber that responded to the vibration caused by the knocking action (see, for example, Lancioni et al., 2002). The second response activated an optic sensor (a photocell) that was held to the left side of Kirk's face, at the level of his mouth, by a light wire structure that rested on Kirk's ears and neck. The combination of the microswitches for each child (the wobble plus optic sensor or vibration microswitch plus optic sensor) constituted the microswitch clusters.

CONTROL SYSTEM, DATA COLLECTION, AND PREFERRED STIMULI

The microswitch clusters were connected to a battery-powered, electronic control system that turned on preferred stimuli contingent on the manipulation and knocking responses (according to the procedural conditions described later) and recorded the data. The data were recorded via special counters that were linked to the system. The recording concerned the frequency of manipulation or knocking responses per session, the frequency of these responses performed correctly in the absence of aberrant behavior, the length of time that aberrant behavior remained absent during the stimulation period following the latter correct responses, and the amount of time during the session that was free of aberrant behavior.

Preferred stimuli were selected through screening for stimulus preferences (Crawford & Schuster, 1993; Lancioni et al., 2004). The screening covered multiple stimuli; each stimulus was presented 15-35 nonconsecutive times. Only the stimuli that were followed by the children's positive reactions (alerting, orienting, and smiling) in 70% or more of the presentations were selected for the study. Such stimuli included various types of music, recordings of familiar persons talking to the child, various noises, videocassettes, songs, and vibratory inputs.

EXPERIMENTAL CONDITIONS

The study was conducted according to an [ABB.sup.1] [AB.sup.1] design in which A represented the baseline, B represented the intervention focusing on manipulation responses (Ginny) or knocking responses (Kirk), and [B.sup.1] represented the intervention focusing on these responses and aberrant behavior together (Richards, Taylor, Ramasamy, & Richards, 1999). A post-intervention check occurred three months after the second [B.sup.1]. Sessions lasted five minutes, a duration that was recommended by the staff members and parents of the children, and occurred 7 to 15 times a day, depending on the availability of the children.

Phases of intervention

Baseline (A phases). The two baseline phases included 13 and 11 sessions for Ginny and 9 and 18 sessions for Kirk. The microswitch cluster and the control system were available for each child during the baseline phase, but no stimuli were scheduled for the manipulation or knocking responses. At the start of the sessions, each child was guided to perform one response with no stimulus consequence for it.

Intervention for manipulation or knocking responses (B phase). The B phase included 112 sessions for Ginny and 147 sessions for Kirk. The conditions were the same as in the baseline phase except that manipulation or knocking responses activated preferred stimuli for eight seconds, regardless of whether such responses occurred in the absence of aberrant behavior and this behavior remained absent while the stimulus was presented.

[FIGURE 1 OMITTED]

Intervention for manipulation or knocking responses and aberrant behavior ([B.sup.1] phases). The two [B.sup.1] phases included 77 and 149 sessions for Ginny and 89 and 63 sessions for Kirk. During these phases, two changes occurred compared to the B phase. First, only manipulation or knocking responses that were performed in the absence of aberrant behavior produced preferred stimuli. Second, the stimuli lasted the eight-second interval only if aberrant behavior did not occur during that interval. The occurrence of aberrant behavior led to interruption of the stimulus (see Lancioni, Singh et al., in press; Lancioni, Smaldone et al., in press). Postintervention check. The children continued to undergo sessions, such as those of the last [B.sup.1] phase, regularly. Twenty-nine and 24 of those sessions, recorded three months after the end of the second [B.sup.1] phase, served as the postintervention check for Ginny and Kirk, respectively.

Results

The data for Ginny and Kirk are summarized in Figures 1 and 2, respectively. The upper graph of each figure shows the mean frequencies of manipulation and knocking responses that occurred for all the blocks of sessions and the mean frequencies of those responses performed in the absence of aberrant behavior (that is, correct responses). The lower graph of each figure shows the mean time per session that remained free from aberrant behavior over the same blocks of sessions and the mean stimulation time per correct response without the appearance of aberrant behavior within the B and B (1) blocks of sessions. During the initial baseline, Ginny's mean frequency of manipulation responses was about 12 per session, and Kirk's mean frequency of knocking responses was about 7 per session. Most of Ginny's responses and nearly all of Kirk's responses were correct (performed in the absence of aberrant behavior). The mean time per session without aberrant behavior amounted to about 3 and 2.7 minutes for Ginny and Kirk, respectively. During the B phase, the mean frequencies of manipulation or knocking responses increased to about 21 and 19 per session, for Ginny and Kirk, respectively. About four-fifths of these responses were correct. The mean session time without aberrant behavior amounted to about 3.2 and 3 minutes for Ginny and Kirk, respectively. The mean stimulation time per correct response without the appearance of aberrant behavior was 4.3 and 4.7 seconds for the two children, respectively.

[FIGURE 2 OMITTED]

During the first [B.sup.1] phase, the mean frequencies of manipulation or knocking responses per session were about 25 and 29 for Ginny and Kirk, respectively. These responses were mostly correct. The mean session time without aberrant behavior was about 4.1 and 3.9 minutes for the two children, respectively. The mean stimulation time per correct response without the appearance of aberrant behavior increased to 6.7 and 6.4 seconds, respectively. The children's performance declined during the next A phase and increased again during the second [B.sup.1] phase and the postintervention check. During these periods, nearly all the responses were correct. The mean session time that was free from aberrant behavior reached 4.8 and 4.5 minutes for Ginny and Kirk, respectively. The mean stimulation time per correct response without aberrant behavior reached 7.6 and 7 seconds for Ginny and Kirk, respectively.

The Kolmogorov-Smirnov test (Siegel & Castellan, 1988) showed statistically significant differences (p < .01) between the A and the B and [B.sup.1] phases in the frequencies of manipulation or knocking responses. Similarly significant differences were found between the second half of the B phase and the [B.sup.1] phases in the frequencies of responses and correct responses, the amount of session time without aberrant behavior, and the amount of stimulation time for correct responses without the appearance of such behavior.

Discussion

These findings, which add to the previous evidence available in this area (Lancioni et al., 2006; Lancioni, Singh et al., in press; Lancioni, Smaldone et al., in press), suggest that children who are visually impaired and have motor disabilities and mental retardation can learn to increase their adaptive responses and control aberrant behavior through the use of microswitch cluster technology. The first consideration from this evidence may concern the presumed desirability of the approach that was used. The main reasons why one may reckon this approach desirable are that it gives staff and parents the possibility of pursuing two basic goals of the children's educational program simultaneously, rather than separately (for example, at different times and through separate procedures) and enables children to rely on self-management, self-control, and positive contingencies to reduce their aberrant behavior and thus to avoid external containment and negative strategies (see, for example, Algozzine, Browder, Karvonen, Test, & Wood, 2001; Lancioni et al., 2006; Lancioni, Singh et al., in press; Wehmeyer & Schwartz, 1998). The latter point could be deemed of great value for a child in relation to self-determination, personal dignity, and ultimately quality of life (Algozzine et al., 2001; Lachapelle et al., 2005; Vermeer, Lijnse, & Lindhout, 2004).

The second consideration may concern the aspects of the [B.sup.1] phases that accounted for the satisfactory outcomes of the study. One could underline the apparently strong reinforcing value of the stimuli used for adaptive responding, the children's ability to discriminate responses performed with and without aberrant behavior (and their different consequences), and the impact of interrupting preferred stimuli when their presentation is encroached on by aberrant behavior (Borrero & Vollmer, 2002; Kazdin, 2001). With regard to the influence of the last variable, informal observations suggested that the interruption of a stimulus might have served as a form of prompting for the children to break the aberrant behavior and start a new adaptive response.

The third consideration may concern the usability and practicality of the microswitch cluster technology applied in this study. In this regard, different views can be presented. On the one hand, it may be argued that the clusters appear relatively affordable (in terms of complexity and cost) and thus that their use could be viewed as plausible and practical (Ripat & Booth, 2005). On the other hand, one could stress that differences among participants would require adjustments in the way the single microswitches and the cluster need to be set up. In this study, for example, the optic sensors were arranged differently for Ginny and Kirk to suit their conditions. These adjustments may not always be easy to determine and manage for parents or rehabilitation personnel on their own. Such an outlook suggests that forming work teams that combine the efforts of parents and educational or rehabilitation experts may be the best way to ensure a profitable, generalized use of this technology in daily contexts (see, for example, Davies & Hastings, 2003; Parette, Brotherson, & Blake Huer, 2000).

The fourth consideration may concern the fact that the sessions with the two children were fairly short (5 minutes). Only if they are repeated numerous times during the day can the sessions cover a meaningful portion of the day and have a visible impact on the children's general performance, overall appearance, and social acceptance (see, for example, Saloviita & Pennanen, 2003; Siperstein, Leffert, & Widaman, 1996; Vermeer et al., 2004). To avoid the mere repetition of the same sessions, one could introduce a second cluster for a second adaptive response and alternate sessions with the two clusters (Lancioni, Singh et al., in press).

In conclusion, new research would seem warranted to further knowledge and the effective application of microswitch cluster technology for promoting adaptive responses and reducing aberrant behavior. Research could introduce such technology with new persons to determine its level of applicability and generality, as well as potential adaptation limits. It could tackle the issues of the increased frequency of sessions and the dual-cluster solution to ensure a relevant effect of the intervention on the persons' performance and appearance. Finally, it could assess ways of linking the research activity with work teams in daily contexts to ensure a positive transfer or application of the technology to practical situations.

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Giulio E. Lancioni, Ph.D., professor, Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy; e-mail: <g. lancioni@psico.uniba.it>. Nirbhay N. Singh, Ph.D., senior scientist, ONE Research Institute, P.O. Box 4657, Midlothian, VA 23112; e-mail: <nirbsingh52@aol.com>. Mark F. O'Reilly, Ph.D., professor, Department of Special Education, University of Texas at Austin, Mail Code D5300, Austin, TX 78712; e-mail: <markoreilly@mail. utexas.edu>. Jeff Sigafoos, Ph.D., professor, Faculty of Education, University of Tasmania, Hytten Hall 502, Hobart 7001, Australia; e-mail: <jeff sigafoos@utas.edu.au>. Doretta Oliva, M.A., research coordinator, Lega F. D'Oro Research Center, via Montecomo 1, 60027 Osimo, Ancona, Italy; e-mail: <oliva.d@legadelfilodoro.it>. Laura Severini, B.A., research associate, Lega F. D'Oro Research Center; e-mail: <lauraseverini@virgilio.it>. Angela Smaldone, M.A., research assistant, Department of Psychology, University of Bari; e-mail: <ansmaldone@yahoo.it>. Manuela Tamma, B.A., research assistant, Department of Psychology, University of Bari; e-mail: <manuelatamma@libero.it>.
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Author:Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Oliva, Doretta; Severini,
Publication:Journal of Visual Impairment & Blindness
Geographic Code:1USA
Date:Oct 1, 2007
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