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Activities to Reduce Inappropriate Behaviors Displayed by Children With Autism and Other Developmental Disabilities
The purpose of this dissertation study is to test the effectiveness of an everyday activities-based protocol (Holm, Santangelo, Fromuth, Brown & Walter, 2000) for managing challenging and disruptive behaviors of 13- to 23-year-old residential students (male and female) with Autism who live at Melmark Homes, Inc., of southeastern Pennsylvania, and attend school or adult day programs. Applied behavior analysis and a focus on everyday occupations (activities) will be combined during the intervention phase. Reinforcement will be for subtask completion and duration of participation, NOT for absence of target maladaptive or disruptive behaviors. Behavior analysts, however, will document the frequency/duration of the target behaviors during each condition. Interventions will occur daily, Monday through Friday. A single-subject, multiple-baseline, across-subjects design with nine subjects will be used to evaluate change in behaviors under alternating conditions. Data will be analyzed using graphical, semi-statistical, and statistical techniques, including celeration lines, slopes, 2 standard deviation bands, and the C-statistic. The projected outcome of the study is the validation of an activities-based protocol to enable greater participation of individuals with Autism in everyday activities (WHO, 2001), and in their communities, be they residential or non-residential (home-based) communities.
Use of Everyday Activities to Reduce Inappropriate Behaviors Displayed by Children with Autism
Historically, documented disruptive behaviors displayed by residential students diagnosed with autism and other developmental disabilities include noncompliance, physical and verbal aggression, inappropriate verbalizations not characterized as aggression, poor social skills, as well as deficits in attention to task (Green, 1996; Luce, 1981; Maurice, 1996). These behaviors require residential treatment and preclude participation in community based activities, (Luce, 2004). Educators generally agree that deficits in academic skills result from a decrease in on-task behaviors because of disruptive off-task behaviors (Skinn, Ramsey, Walker, Stieber, & O'Neill, 1987).
Frequently used techniques to decrease these disruptive behaviors include reinforcers such as verbal praise, token economies, time out, and self-contained classrooms. Autism affects one in 1,000 individuals in the United States (World Health Organization, 2001) and warrants further investigation to examine the use of daily activities to decrease these inappropriate behaviors. This quantitative dissertation study will examine the effectiveness of an everyday activities-based protocol (Holm, Santangelo, Fromuth, Brown & Walter, 2000) for managing challenging and disruptive behaviors of 13- to 23-year-old residential students (male and female) with Autism and other developmental disabilities to reduce two out of three inappropriate behaviors as identified by residential staff.
The purpose of this quantitative dissertation study is to test the effectiveness of an everyday activities-based protocol (Holm et al., 2000) for managing challenging and disruptive behaviors of 13 to 23-year-old residential students (male and female) (dependent variable) with autism and other developmental disabilities who live at Melmark Homes, Inc., of southeastern Pennsylvania, and attend school or adult day programs. Applied behavior analysis and a focus on everyday occupations (activities) (independent variable) will be combined during the intervention phase. Reinforcement will be for subtask completion and duration of participation, not for absence of target maladaptive or disruptive behaviors. A single-subject, multiple-baseline, across-subjects design with 50 subjects will be used to evaluate change in behaviors under alternating conditions. Data will be analyzed using graphical, semi-statistical, and statistical techniques, including celeration lines, slopes, 2 standard deviation bands, and the C-statistic.
Will participation in Activities of Daily Living (ADLs) reduce or extinguish inappropriate behaviors displayed by individuals with autism or other developmental disorders who currently reside in residential facilities?
Clinically significant behavioral changes in this area have the potential to lead to the expansion of residential programs, implementation of new programs, and the identification of, and access to, additional community funding resources for curriculum improvement and development; in addition to the development of more comprehensive community-based programs. The proposed dissertation study replicates the results found by Holm et al. (2000), which successfully combined behavioral and occupational therapy interventions with dually diagnosed subjects in community living arrangements (CLA)/school environments. Should a study such as this be successful, a full protocol can be developed for residential staff so that they too can be taught how to break down everyday tasks into manageable units so that residents with autism are able to increase their participation in everyday activities at school and in their communities whether they are residential or non-residential (home-based) living communities (WHO, 2001).
When evaluating community-based programming for individuals with Autism and other developmental disabilities, community, school, and healthcare leaders, must utilize data that is not only clinically significant but data that will drive cost effective programming to ensure the appropriate utilization of private and governmental financial resources (McConnell, 2004). The study will have significance to the consumer community because of the intervention's potential to enable greater participation of individuals with Autism in lived in environments. The study will have significance to the care-giving community because it promotes a novel approach to care-giving, using an intervention that combines a behavioral approach with enabling of everyday activities. To community healthcare leaders, this reduces the financial resources needed for community-based programming (WHO, 2001).
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a model for describing and studying functioning (positive state) and disability (negative state) of individuals and populations, including residential students diagnosed with autism and other conditions. ICF performance qualifiers differentiate between performance in the actual or "lived in" home environment, and the student's ability to execute tasks or actions in a standard or uniform environment such as the classroom (WHO, 2001). Thus, the ICF provides a guide for examining and documenting a student's functioning and disability and the impact of the environment and participation on the functional outcomes of everyday activities-based behavioral interventions.
Because autism creates a disabling impact on functioning and full participation, in February 2002 the National Institutes of Health (NIH) and the Department of Health and Human Services prepared a report to Congress addressing Autism and Pervasive Developmental Disorders (PDD); the report authorized both money and research to "conduct activities relevant to Autism and Pervasive Developmental Disorders." It indicates, "Families coping with this devastating illness are searching for answers about these causes, diagnoses, prevention, and treatment" (NIH, 2002; Strock, 2004).
Historically documented disruptive behaviors displayed by residential students diagnosed with autism and other developmental disabilities include noncompliance, physical and verbal aggression, inappropriate verbalizations not characterized as aggression, poor social skills, as well as deficits in attention to task. Educators generally agree that deficits in academic skills result from a decrease in on-task behaviors because of disruptive off-task behaviors (Skinn, Ramsey, Walker, Stieber, & O'Neill, 1987). These behaviors continue to be seen today in educational and residential programs. Frequently used techniques to decrease these disruptive behaviors include reinforcers such as verbal praise, token economies, time out, and self-contained classrooms (Luce, 2004).
In order to increase the frequency of an individual's appropriate behavior, it is most often recommended that such behaviors be praised or otherwise rewarded when they occur (e.g., with a natural consequence). Attempts to increase the frequency of positive behaviors are based on the belief that, by doing so, behaviors that are more appropriate will gradually replace less desirable (e.g., disruptive) behaviors. The literature suggests that teacher or caregiver consideration should provide attention to the individual when he/she is engaged in positive rather than negative behaviors (Green, 1996). Token economy systems involve awarding tokens, stickers, points, or other items to individuals who demonstrate targeted behaviors. Students usually exchange tokens for rewards, which may consist of preferred food or other activities. Token economies can be effective for those individuals who are resistant to other types of behavior management techniques. The benefits to using this system are ease of administration, immediate reinforcement (tokens) while teaching delayed gratification (holding tokens until trade in time), satiation for the student due to the availability of a variety of back-up reinforcers, as well as lack of competition between students as they compete only against themselves (Society of Treatment for Children, 1998).
Over the last several years, Applied Behavioral Analysis (ABA) has become the most preferred and utilized behavioral intervention. ABA, in brief, "involves a breakdown of all skills into small, discrete tasks, taught in a highly structured and hierarchical manner." This is accompanied by differential reinforcement, and data are recorded systematically and regularly so that interventions can be adjusted as needed based on the student's progress or lack thereof. ABA is designed to help those with Autism learn how to learn (Luce & Christian, 1981; Maurice, 1996, p. 8).
Consistent with the ICF (WHO, 2001) view of the impact of the environment on functioning and disability, another perspective is that "the origin of challenging, disruptive behaviors is not within the person with the disability, but rather the interaction of the person, environment, and task" (Holm et al., 2000, p. 362). In fact, one profession, namely occupational therapy, "was founded on the belief that engaging in occupation (everyday activities) brought about mental and physical health" (Trombly, 1995, p. 970). One of the tenets of occupational therapy related to disruptive behaviors…[continue]
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