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Using background music to reduce problem behavior during assessment with an adolescent who is blind with multiple disabilities.

Problem behaviors displayed by children with developmental disabilities include stereotypies, noncompliance, aggression, and self-injury (Griffith, Hastings, Nash, & Hill, 2010). As many as 40% of children with disabilities exhibit these behaviors (Lowe et al., 2007), with higher rates for those with visual impairments (Poppes, van der Putten, & Vlaskamp, 2010). Children who are visually impaired (that is, those who are blind or have low vision) commonly engage in stereotypic behaviors such as rocking and repetitive hand movements to gain sensory stimulation produced by the behavior (Gourgey, 1998; Rapp, 2004; Warren, 1984). A means of quickly and easily reducing problem behaviors is important to maximize individuals' learning gains and increase the accuracy of assessments.

Presenting background music may quickly lower individuals' problem behavior. For instance, music was used to decrease the self-injurious behavior displayed by a boy with severe intellectual disabilities (Carey & Halle, 2002), and the vocal stereotypy of two children with autism (Lanovaz, Sladeczek, & Rapp, 2011). Moreover, in an experimental investigation of background music, Lancioni et al. (2010) found that vocal stereotypy was reduced and adaptive behavior increased in two children with visual impairments and severe disabilities.

Similarly, playing background music may also improve desired behavior, such as ontask performance, with children in the classroom (Hallam & Price, 1998; Hallam, Price, & Katsarou, 2002). Robb (2003) used an experiment to demonstrate the use of background music to increase attentive behavior of preschool children with visual impairments.

In contrast, other researchers have found that music may increase individuals' problem behaviors. For instance, the presence of music increased stereotypy displayed by a boy with Down syndrome and moderate intellectual disability (Rapp, 2004), and increased disruptive behaviors (ear covering and screaming) displayed by a seven-year-old boy with pervasive developmental disorder (Buckley & Newchok, 2006).

Further research is needed to evaluate the use of background music to reduce problem behaviors for persons with visual impairments. Music may be a particularly salient and preferred stimulus for these individuals, given their restricted sensory input (Gourgey, 1998; Robb, 2003). Furthermore, a contrasting quiet environment may be unpleasant and may increase stereotypies, avoidance behaviors, or both.

The effect of music on behaviors interfering with assessment procedures (that is, self-stimulatory behaviors and standing up) was evaluated using a single-participant research design. A comparison of background music versus no music was performed on the problem behaviors of an adolescent with visual and intellectual disabilities during an assessment.

Method

PARTICIPANT

The participant was "Yaffa," a 13-year-old girl with severe-profound intellectual disability, blindness due to bilateral congenital anophthalmia, and mild conductive hearing disorder. She can hear soft speech in a quiet room but may have difficulty in a noisy environment. Yaffa is monitored for seizure activity, which is controlled by medication (Depakote), and showed no signs of seizure during the study.

Yaffa was selected to participate in the research because staff reported it was difficult to teach her new skills due to problem behaviors. She was nonverbal, and although typically compliant, cheerful, and responsive to adult attention, Yaffa would make whining sounds, stand up, or turn away in her seat to avoid tasks. Classroom observations and staff reports also indicated that Yaffa engaged in frequent stereotypies involving tapping.

Following approval of the research by the Institutional Review Board at The College at Brockport, State University of New York, parental informed consent for the child's research participation was obtained. Yaffa's ongoing assent to participate was required throughout this study.

SETTING AND MATERIALS

Sessions were held in a small room, approximately 11 x 6 feet. The researcher and participant sat next to one another on plastic chairs at a small table. To better determine the effects of background music on behavior, the assessment environment--like a typical testing environment--was very quiet, with only occasional muted background sounds (for example, staff walking or quietly talking in the hall). In contrast, her classroom setting was rich in auditory stimulation provided by staff member-student interaction, ongoing student vocalizations, and sounds of student-activated devices.

Materials included a cassette player used to play Wee Sing and Play during the music condition, and a completed preassessment questionnaire was delivered to parents and staff members, which indicated that Yaffa preferred the Barney musical toy. In the classroom, Yaffa selected the Barney music toy even though she had access to a wide range of musical toys and devices. Yaffa was being taught to use a cassette player with age-appropriate music but had not yet mastered the switches, whereas she could press the button switch to activate the Barney music toy. All sessions were video recorded to allow later scoring of problem behaviors.

DEPENDENT VARIABLES

The participant's "head up" behavior was defined as any occurrence in which she raised her chin up from her upper chest by at least three inches. Head up was chosen to be reinforced because it infrequently occurred and was viewed as a socially desirable behavior. Problem behaviors included standing up, hand hitting, and mouth tapping. Standing up was any occurrence of the participant lifting her buttocks at least five inches from the chair. Hand hitting included either hand repeatedly hitting or tapping the other hand, any part of the table, or the wall with one second or less between each tap or hit. Mouth tapping was touching her mouth one or more times with one or both hands or moving her finger up and down across the surface of her lips.

The participant's head up and standing up behaviors were recorded by the experimenter during the ongoing assessment sessions, whereas hand hitting and mouth tapping were recorded from the videotaped sessions using a 10-second interval recording procedure. The percentage of intervals in which a self-stimulatory behavior occurred in each assessment phase across three days was tabulated.

PROCEDURE

Research design

A multielement experimental research design involving the rapid alternation between conditions to control for confounding variables was used. Following conventions of single-participant research designs, visual analysis of the data was performed (Morgan & Morgan, 2001). A treatment effect is noted if consistent differences in levels of behavior occur in each condition.

The effects of background music versus no background music conditions on levels of the participant's problem behaviors during a reinforcer assessment were compared. Two 8-minute sessions separated by a 10-minute break were held during three days within a period of a week. The order of presentation of music and no music conditions was alternated across days to lessen order effects.

Reinforcer assessment

A series of ABAB phases were conducted during the reinforcer assessment to experimentally evaluate the effectiveness of a Barney musical toy to increase the participant's desired behavior (that is, head up). During the two-minute "A" or baseline phase, frequency of head up and standing up were recorded without any consequences provided by the experimenter. At the start of the two-minute "B" or reinforcer phase of the assessment, the researcher announced "Barney Time" to alert the participant to reinforcer availability. The researcher guided Yaffa's hand to the toy and gave her five seconds of play time. After each instance of head up during the reinforcer phase, the experimenter immediately guided the participant's hand to the musical toy and allowed her to play with the toy for five seconds. The reinforcer delivery time was not included in the two-minute session time to allow equal opportunity for the desired behavior in both the A and B phases.

Independent variable

The music condition began with 30 seconds of loud (that is, slightly above conversational level) music followed by the reinforcer assessment conducted concurrently with low background music, and ended with 30 seconds of loud music. The no music condition began with 30 seconds of no music, was followed by the reinforcer assessment with no music, and ended with 30 seconds of no music. The same amount of interaction with the researcher occurred in both conditions.

Interobserver reliability

Interobserver reliability was performed by a second observer on a randomly chosen videotaped session. The interobserver reliability score was calculated by dividing the total number of agreements in occurrences of behaviors between independent observers over agreements plus disagreements times 100. Average interobserver reliability scores were 94% for stereotypy (range: 87-100%), 100% for standing up, and 98% for head up behavior (range: 96-100%).

Results

As shown in Figure 1, the participant consistently engaged in more stereotypic behaviors when background music was absent compared to when it was present. This finding occurred across both A and B phases of the reinforcer assessment (no music condition [M.sub.A] = 54 and [M.sub.B] = 50, music condition [M.sub.A] = 21 and [M.sub.B] = 14). Although self-stimulatory behaviors were evident during the no music condition, they were substantially less frequent during the music condition, with no overlapping data points between conditions.

Music appeared to have a positive effect on the participant's standing up behavior. Although the standing up behavior was infrequent, it occurred less often during the music condition relative to the no music condition (see Figure 2). This behavior was most likely to occur in the no music condition during the reinforcer assessment A phase. Moreover, no standing up behavior occurred during the B phase or when the musical toy was presented following the participant's head raising behavior in both the music and no music conditions.

Also in Figure 2, Yaffa's frequency of head-raising behavior was slightly higher in both the A and B phases during the music condition (A phase M = 9.67, B phase M = 19.00) compared to the A and B phases in the no music condition (A phase M = 9.50, B phase M = 17.50). The musical toy was demonstrated to be a positive reinforcer for Yaffa's head up behavior in that her head up behavior occurred more frequently when the musical toy was delivered as a consequence (B phase M = 18.20) compared to when it was not (A phase M = 7.0).

Discussion

Background music was effective in reducing problem behaviors and increasing desirable behavior of an adolescent who is blind with multiple intellectual disabilities during a reinforcer assessment. The finding that music is a beneficial tool to curb problem behaviors adds to past research conducted with children with visual impairments (Clark-Bischke & Crowley, 2011; Lancioni et al., 2010; Robb, 2003) and sighted children (Carey & Halle, 2002; Hallam & Price, 1998; Hallam et al., 2002). This research also supplements past research findings that an individual's problem behaviors may vary depending on the assessment procedures employed (Kang et al., 2010). Notably, background music did not interfere with the participant's reinforcer assessment even though a musical toy in the same auditory domain was assessed.

Music may be a particularly effective environmental modification for someone with a visual impairment. Quiet conditions may have been aversive for Yaffa, given that her standing up and stereotypic behaviors were more frequent during the no music condition compared to the music condition.

Although the consequences of these behaviors were not directly manipulated, Yaffa's stereotypic behaviors may have served to provide automatic reinforcement (or maintain the behavior in the absence of social consequences) when other sources of sensory stimuli were absent (Gourgey, 1998; Warren, 1984). Conducting assessments under quiet conditions may increase stereotypic behavior compared to doing so under noisy conditions.

Future research should be conducted to clarify the relationship between levels of sensory stimuli and the function of an individual's stereotypic behaviors. Research comparing the stereotypic behavior of two groups--with and without visual impairment--under conditions of quiet versus an auditorily rich environmental context would also be informative. The type of music may be another important variable to explore.

One limitation of this study is that, by necessity, it was conducted across a brief time period and during assessments with only one individual. Whether similar results would occur long term or during training sessions is unknown. Another drawback is that this technique may be ineffective with others, especially those who do not prefer music, and may not be applicable in different settings.

Our results suggest that background music may be a viable intervention to improve an individual's behavior during assessment. Further research is needed to investigate the generality of this finding and clarify the conditions under which music is most effective.

The authors gratefully acknowledge the support and assistance of administrators and staff at the New York State School for the Blind in Batavia, New York, most especially instructors Jamie Wallace and Elizabeth Saleh.

REFERENCES

Buckley, S. D., & Newchok, D. K. (2006). Analysis and treatment of problem behavior evoked by music. Journal of Applied Behavior Analysis, 39, 141-144.

Carey, Y. A., & Halle, J. W. (2002). The effect of an idiosyncratic stimulus on self-injurious behavior during task demands. Education & Treatment of Children, 25, 131-141.

Clark-Bischke, C., & Crowley, E. P. (2011). Applied behavior analysis and students with visual impairments: A literature review. Research & Practice in Visual Impairment & Blindness, 4, 2-14.

Gourgey, C. (1998). Music therapy in the treatment of social isolation in visually impaired children. RE:view, 29, 157-62.

Griffith, G. M., Hastings, R. P., Nash, S., & Hill, C. (2010). Using matched groups to explore child behavior problems and maternal well-being in children with Down syndrome and autism. Journal of Autism & Developmental Disorders, 40, 610-619.

Hallam, S., & Price, J. (1998). Can the use of background music improve the behavior and academic performance of children with emotional and behavioral difficulties? British Journal of Special Education, 25, 88-91.

Hallam, S., Price, J., & Katsarou, G. (2002). The effects of background music on primary school pupils' task performance. Educational Studies, 28, 111-122.

Kang, S., Lang, R. B., O'Reilly, M. F., Davis, T. N., Machalicek, W., Rispoli, M. J., & Chan, J. M. (2010). Problem behavior during preference assessments: An empirical analysis and practical recommendations. Journal of Applied Behavior Analysis, 43, 137-141.

Lancioni, G. E., O'Reilly, M. F., Singh, N. N., Sigafoos, J., Didden, R., Oliva, D., & Campodonico, F. (2010). Two children with multiple disabilities increase adaptive object manipulation and reduce inappropriate behavior via a technology-assisted program. Journal of Visual Impairment & Blindness, 104, 714-719.

Lanovaz, M. J., Sladeczek, I. E., & Rapp, J. T. (2011). Effects of music on vocal stereotypy in children with autism. Journal of Applied Behavior Analysis, 44, 647-651

Lowe, K. K., Allen, D. D., Jones, E. E., Bro phy, S. S., Moore, K. K., & James, W. W. (2007). Challenging behaviours: Prevalence and topographies. Journal of Intellectual Disability Research, 51, 625-636.

Morgan, D. L., & Morgan, R. K. (2001). Single-participant research design: Bringing science to managed care. American Psychologist, 56, 119-127.

Poppes, P. P., van der Putten, A. J., & Vlaskamp, C. C. (2010). Frequency and severity of challenging behaviour in people with profound intellectual and multiple disabilities. Research in Developmental Disabilities, 31, 1269-1275.

Rapp, J. T. (2004). Effects of prior access and environmental enrichment on stereotypy. Behavioral Interventions, 19, 287-295.

Robb, S. L. (2003). Music interventions and group participation skills of preschoolers with visual impairments: Raising questions about music, arousal, and attention. Journal of Music Therapy, 40, 266-282.

Warren, D. H. (1984). Blindness and early childhood development (Rev. ed.). New York: American Foundation for the Blind.

Marcie N. Desrochers, Ph.D., B.C.B.A., associate professor of psychology, The College at Brockport, State University of New York, 350 New Campus Drive, Brockport, NY 14420; e-mail: <mdesroch@ brockport.edu>. Rebecca Oshlag, Ph.D., behavior specialist instructor (retired), New York State School for the Blind, 2 A Richmond Avenue, Batavia, NY 14020; e-mail: <rebeccaoshlag@gmail.com>. Angela M. Kennelly, B.S., caseworker, Genesee County Department of Social Services, 6002 Lake Road, Bergen, NY 14416; e-mail: <angela. kennelly2@dfa.state.ny.us>.
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Title Annotation:Research Reports
Author:Desrochers, Marcie N.; Oshlag, Rebecca; Kennelly, Angela M.
Publication:Journal of Visual Impairment & Blindness
Article Type:Report
Date:Jan 1, 2014
Words:2560
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