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Division on Autism and Developmental Disabilities

Effects of a Positive Support Approach to Enhance Communicative Behaviors of Children


with Mental Retardation who have Challenging Behaviors
Author(s): Orit E. Hetzroni and Tali Roth
Source: Education and Training in Developmental Disabilities, Vol. 38, No. 1 (March 2003), pp.
95-105
Published by: Division on Autism and Developmental Disabilities
Stable URL: http://www.jstor.org/stable/23880188 .
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Education

and

Effects of a Positive

Communicative

in Developmental
Division

Training

Support

Disabilities,
on

2003,

95-105

38(1),

Disabilities

Developmental

to Enhance

Approach

Behaviors of Children with Mental

Retardation who have Challenging Behaviors


Orit E. Hetzroni
University
Abstract:

effects of a positive
intervention

Tali

Roth

by an augmentative
support plan accompanied
on the reduction of challenging
behaviors manifested by
was used for
children with moderate and severe mental retardation. A multiple-probe design across participants
data
on
various
behaviors
exhibited
students
behaviors,
including:
self-injurious
collecting
challenging
by
assessment, followed by
pinching, pulling, screaming, and crying. All behaviors were assessed using functional
a positive AAC support plan created by the school team. Participants
were taught to use more appropriate
and

This study investigated


communication

and

of Haifa

alternative

alternative

means to communicate.
Results indicated a reduction in the percentage of intervals of challenging
communicative
The positive support plans created by the whole school staff used AAC for enhancing
This plan provided students with alternatives,
which also enabled them to enhance the learning of

behaviors.
behaviors.
class

material.

difficulties

Communication
with

disabilities

developmental

foos,

Pennel,

behaviors

include

may

tantrums,

and

self-injury,

erty. These

behaviors

aggression,
destruction

may appear
remain

stages and
developmental
the school
years (Sigafoos,
can be
of these behaviors
vidual's

and

These

may also result in disruptions


as
room
environment
and,
to the

challenges
present
ing the classroom
between
errant

difficulties

the
behaviors

Horner

& Day,

(e.g.,
that

supportrelation
have

the existence
& Durand,

A recent

1991).

revealed

developbehaviors

a strong

Carr

many

early

of positive
classa consequence,

children

and

communication

(Mirenda,
five

the indi-

personnel

(Sigafoos).
have
found

Researchers

the

or challenging
behaviors
func
of functional
and
analysis
as the primary
tional communication
training
behaviors
to reduce
strategy
inappropriate

review

interventions

with

Education,
Haifa,

Mount

Faculty
Carmel,

of

Education,
Haifa,

were

strategies

use

31905,

of

messages
depicting
behaviors.
For
appropriate
ing

(AAC)

the intervention
during
Some
of these
strategies
with
switches
accompanied

symbols
with

augmenta

in
replaced
switch
a
example,
that

a repeated
was used for attract
message
with
attention
of an adult
by a toddler

behaviors
aggressive
demonstrates
search
were

behaviors

(Peck

assessed

and

intervention

munication
demonstrated

fewer
their

Re

1996).

inappropriate
corn
a functional

was applied,

children
behaviors

challenging
communicative

behaviors

ad

1985;

(e.g.,

of re-

& Hearthfield,
O Brien,
1990).
Sprague,
includes
a system
intervention
Functional

re-

increased

et al.,

that when

of ab-

should

Special
of
University

Israel.

studies,

communication

used

(Mirenda).

process
included

Carr

& Durand;

atic assessment

this article
Correspondence
concerning
to Orit E. Hetzroni,
addressed
Ph.D.,

In some

1997).

alternative

and

E-mail:

a%

Positive

of the function

& Day;

Horner,

of the problem

followed

equivalent

Durand
sessment

Hetzroni@construct.haifa.ac.il.

Horner

proce
by an intervention
the inappropriate
dure intended
to substitute
.'.
.
...
,
, ,
and function
behavtors
with more acceptable
behaviors

be

aberrant

use

included

of prop-

throughout
The impact

to impede

to

lating

extreme

during

2000).

learning
progress
of social
relationships.

ment

their

individuals
place
at risk for de-

behavior
(Sigasignificant
problems
& Graves,
1999).
Challenging

veloping

search

behavior

(AAC)

AAC Support

ones.

(1985),

In the study

for example,

evaluated

for Reducing

the

by Carr

communicative

Challenging

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All use subject to JSTOR Terms and Conditions

and
as

a systematic

Behaviors

func

95

of four

tions
who

with mental

students

in significant

engaged

behav-

municative

destruciors including
self-injury and property
tion. Once
the functional
was comanalysis
and
the communicative
function
was
pleted
identified

adult

(i.e.,

attention

seeking),

was implemented
intervention
with posto replace
the challenging
behaviors
itive communicative
(Carr & Durand).
phrases
communication

use

The

of challenging

and

tigate

treat

McDowell,
that

These

1992).

served

as

the messages,
were
childhood
(Sigafoos,
individuals
with
Providing

transmit

possibly
2000).

in new,

to inves-

strategies
means
to

inappropriate
most
efficient

the

in early
engage

attenin sev-

behaviors
&
(Carr
problem
Hall & Belfiore,
1997; Taylor

1980;

& Carr,

as an

behavior

strategy was demonstrated


analysis
using functional

tion-getting
eral studies

learned
to

opportunities
and more
efficient,

more

apis an ef

means
to obtain
attention
propriate
fective
for reducing
bestrategy
challenging
haviors.
the need
to use elaborate
However,
measures

to analyze
the functions
of the be
the need
to follow rigorous
pro
used
to eliminate
behaviors
previous

cedures

them with new appropriate


by substituting
has been
difficult for teachers
haviors,
son,

Bamburg,
Positive
behavior

Cherry,

(Mat-

&

1999).
Paclawskyj,
has the potential
for
for altering
behaviors
man-

communication
inappropriate
ifested
with mental
by children

retardation

& Horner,
1999).
(Sugai,
Sprague,
Positive
behavior
is defined
as
support
for reducing
behavior
approach
problems
sociated

with deficits

Positive

behavior

ior.

After

iors

and

an
as-

the environment.

uses
support
to identify the function

sessment

functional

as-

of the behav-

the challenging
behavidentifying
their
a
functionality,
systematic
is created
to assist the enviplan

instruction
ronment

(i.e.,

in

staff)

within

teachers

providing
substitute

students

and

positive

other
support

support
to help

behaviors
inappropriate
that are appropriate
1997).
(Weigle,
is based
on team activities
that
approach

with ones
This

evaluate

the

intervention
plan.

The

curs

within

behaviors
using

positive

and

a positive
behavior

plan a systematic
behavior
support
support
plan oc-

a long-term
lifeplan using broad
style intervention.
This study was designed
to use the positive

96

Education

and Training

in Developmental

mental

ers and

staff with

goal
to develop

intervention

team

se

teach
pro
The

classroom.

with tools

assessment

and
to
plan,
own classrooms.

their

to provide
intervention

the school

the functional

and

moderate

and

a positive
within the

applicable
was to provide

within

with

retardation,

cedure

and

the

them
implement
The intervention

AAC
applied
strategies
using voice
devices
with
recorded
output
accompanied
and appropriate
messages
symbols
depicting
the substitute
The
of this
messages.
purpose

strategies

effects of training
teach
Study was to examine
ers and the school
team to identify and use a
AAC
chal
positive
system to replace
support
behaviors
lenging
cative behaviors
ate

and

severe

with appropriate
students
among
mental
retardation,

communi
with

moder

Method

Children

be-

support
a systematic
framework

providing

by children

exhibited
vere

Participants

and

haviors,

com
to identify
support
approach
functions
of challenging
behaviors

behavior

retardation

challenging

with

mental

retardation

lected

to participate
in the study
the following
criteria:
(a) formal

moderate

or

severe

mental

were

se
to

according

of

diagnosis

retardation,

(b)

between

12-19 years of age,


ac
(c) classified
to school
records
as having
a history
cording
of challenging
behaviors
for at least
three
(d) use
years, and,
tion for requesting.
collected
through
school
reports,
and interviews

formal

gists and classroom


came
from a school
ate

mental

cated

(with

in a medium

mental

size

dren

attended

prior

to this intervention,
a

the

patholo
participants
with moder

some

children

retardation)

city in Israel.

school

14-year-old
boy,
mental
retardation,

was

diagnostic
observation,

for children

with severe

Larry,
moderate

direct

speech-language
teachers.
All

retardation

diagnosed

information
clinical

records,
with

verbaliza

and/or

gestures
Selection

for

several

diagnosed

All

lo
chil
years
with

used

and

touching
and
rejecting

for requesting
and
gestures
to use only a few one- or two-word
utterances.
He
manifested
behaviors
usually

was

able

such

as

down,

peers,

and

diagnosed

Disabilities-March

a staff member,

his
pulling
classroom
biting
a 12-year-old
Hank,
screaming.
boy,
with moderate
mental
retardation,

tugging

pants

pulling

and

2003

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All use subject to JSTOR Terms and Conditions

with

no

disabilities,
physical
and
vocalization
to

tures

and

questing
behaviors
and

such

the

hair

boy,

was

pulling

16-year-old
mental

He
rejecting.
as pushing,

retardation

used
indicate

mosdy
basic

gesre-

usually

manifested

usually

with severe
diagnosed
and
cri-du-chat syndrome

aggressive

items,

throwing

including
away

running

pushing
from the

a list of challenging

the

they

time

lasted;

and,

behaviors

and

a procedures

(e)

form.

pinching,
spitting,
of peers
and staff. Al, a

and other voice


Single switches
munication
devices
(with 2, 12,

and

com
output
and
16 mes

with picture
communica
used for augmenting
interven
participants'communication
during
sages)
accompanied
tion symbols
(PCS)

He
used
vocalization,
("cat-cry").
pointing,
and only a few one- or two word utterances
to
indicate
and rejection.
His behaviors
requests
were

included

were

tion.

Design

class

and
that typibehaviors
room,
self-injurious
cally included
lying on the floor while banging
his head.
a 19-year-old
Dan,
boy, diagnosed

with

in which
as percentage
of intervals
the chal
behaviors
occurred.
Data
collection
lenging

moderate

mental

retardation

and

Down

used
such as pointing
to
syndrome,
gestures
and
indicate
manifested
behaviors
requests,
such crying, laughing,
passivity, and ignoring.
boy,
Jo, also a 19-year-old
vere
mental
retardation,

with

diagnosed
used

se-

vocalization,

and
a few oneor two-word
utterpointing
anees
and rejecting.
for requesting
Jo's chaiin school
behaviors
included:
sitting
lenging
on the floor while banging
his head,
screamon
jumping
of paper.
pieces

and

chairs,

ing,

manipulating

across
was
multiple
probe
design
subjects
& LeSage,
used
1982; Poling, Methot,
(Kazdin,
The dependent
variable
was calculated
1995).

was

based

on

a direct

observation

behaviors.
challenging
Specific
of:
corded
included
instances

of

(a)

re

screaming,

(e)
kicking,
(f) lying on the floor, (g)
destroying
property,
lying on the floor and hitting head on ground,
(b)

pushing,

(h)

sitting

(c)

checklist
behaviors

on

(d)

pinching,

the

floor

and

on

(i) jumping
ground,
hair, and (k) all other

head

hitting

furniture,

behaviors.

on

(j) pulling
Observations

once
a day, three
times
a
for 20 min
30-second
intervals,
using
A positive AAC support
utes each session.
plan
. ,
,
,
team was the mde
the
classroom
compiled
by
this
variable
Table
(see
1). Using
pendent

were

conducted

week,
_
. ,
...
Setting and Materials
All

students

rooms

(Larry,
Dan and Jo were
had
participant
with

materials
Each

schedule.

with

students
Several
during

in

worked

approach,

in another

analyses
function

an

were

communicative
culties;
to

(b)

record

(c)

attended

the

for the study:

abilities,

and

level

tion,
a
to

of abilities,

behavioral

information

formation,

(a)

form used

information

form

a direct

observation

form

Prior

lectures

used

to

record

antecedents,
consequences
responses,
and their length
of all challenging
behaviors,
that
checklist
of time; (d) a direct observation

Positive

the team

determined,
behavior
the

Once

identified

for the

substitute

was

challeng
created
as a
mes

communicative

were

messages
to gain attention,

to acquire

used

in

to express

rejec

requests.

and

of

determining
behaviors,

AAC Support

and

use

behaviors,
functional

functions

were

for Reducing

about

communication

Teach
support.
na
to the communicative

and

the

in

behavior

challenging

assessment

staff was

program
for teaching

alternative

positive
introduced

ers were
tional

simulations
and

entire

that included

in a school-wide

augmentative
and
(AAC)
ture

the

to intervention

used

challenging
of the varthe description
ocbehaviors
in which
those

behavior.

,
n
JrT0C6CLUT6

volved

and

functional

conducted
child's

each

or to indicate

diffi-

behaviors,

activities,

was

The

sages.

classroom
instruction

for specific

team

This
ing behavior.
means
to transmit

or eight
assistant.

one

the
to assess

a communicative

stacked
classroom

seven

and

information,

a general

staff responses,
ious situations
curred;

had

created

personal

desk

for the

teacher

Each

classroom).

individual

appropriate
classroom
one

participant
record
personal

class-

respective

schedules
regular
while
Al in one classroom

professionals
the school
day

periods.
Five forms

their

their

following
Hank
and

taught

Challenging

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dents

functional

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challengreinproviding
positive
of instruction,
teachers

while
ing behaviors
forcements.
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were

asked

to bring students'
and school
programs

cation

the preliminary
Following
school
staff (i.e., teacher,
assis-

section).

with
meeting
tant teacher,
counselor,

speech
and
therapist,

thologist,

physical
a functional
therapist),
was implemented
(see

to baseline

language

pa-

forms

sessions

team

in

information

communication

during

the school

team

classroom
regular
setting
with the stuteam working
the prosessions
implementing
were

enrolled
enrolled
data

enrolled

Larry,
classroom

in

in classroom

collection

Hank,

and
and

Al

were

Jo
observations

were

Dan

were

procedures
observers

two

in two differ-

1.

2. All

the

classroom's

collected

data

teachers

in the

forms

daily

by
to the

came

procedures
and
classroom

for procedural
measures
three

participants

regular

during
iors were
(see

form

times

measured
d in Setting

Once

a clear

room

staff met

used

a week
the

baseline

All behavform

checklist

classand

es-

findings
intervena systematic
positive
support
appropriate
plan using AAC to enhance

tablish
tion

functional

classroom

from

classroom

respective

The

communication.

from

1 (Larry)
2 (Dan)

staff. During

and
were

for

classroom
included
a

Appropriate
child
to

each

activities

Table

(see

messages
use

during

1).

Messages
recorded
on

words or short phrases


communication
device/aid
output
with PCS symbols
the mes
depicting
The
team
selected
the symbols
and

voice

the

first

the meeting,

child

first child

assessed

with

messages

the

assistance

of

the

child's
mem
the

the meeting,
was used
During
role-playing
to practice
the intervention
with the staff, to
all team members
teach
how to use the de
and

to practice
how to introduce
uses
with
the participant.
messages
staff
learned
to recognize
ing practice,

vices,

first indicators

the

by the
a positive

Positive

of the communicative

for each

typical
tional

child

assessment

student

appropriately.
tified before

the

the
the

the staff. Teachers

to use

the

the VOCA's

toward

verbal

the appropriate

rein
to the

a proce
with 3 sec

with

prompt

to use
a

the

gesture

on the switch;

message

the verbal
physical
prompt
a gesture;
and,
(d) full physical
hand
to
the participant's
leading
was
used
the message
last
(the
prompt

a partial
and
prompt
(c)

guidance
activate

only once
twice with

with

with

and

the

three

of the

participants

and

the assessment

ter

two of them).

Intervention
and

natural

using the following


hierarchy
intervals:
(a) a verbal
prompt
(b)

ap
in

students

immediately
included

by responding
Assistance
message.

switch;

func

to assist

for communicat
used

forcement

ond

how

behaviors

challenging
staff assisted

learning
ing with

dure

the

function

in using
the substitute
messages
were iden
The first indicators

and

child's

Dur

to the

according
learned

and

peared,

minated

section).

established,

the

to refine

the

for all five

Materials

was

the

for 20 minutes

activities.

using
and

also

by
out

filled

integrity.
were obtained

classroom

were
based

Observers

plan.

on

Baseline

and

conducted

who

independent
Times
school
scheduled
times.
during
the day
selected
randomly
throughout
on

children.

created

and

the

gram. Participants
ent classrooms.

of those

All team
speech-language
pathologist.
bers were responsible
for implementing
intervention
with the child,

and

with the classroom


dent

ment
were

Interviews

with the children


a proworking
developed
a positive
AAC
gram for implementing
supwith each
child.
All sessions
were
port plan
conducted

created

(VOCA)

to gain

meeting
and

was
established.
plan
Messages
based
on the functional
assess

were

sage/s.

in the classroom

discussed,

were
pants
munication

procedure
b and c in Set-

each of the students


in the
participating
and observations
were then
study. Interviews
used to prepare
a functional
assessment
to be
used
intervention
(see Table
1). Durduring
ing a following
were
patterns

was planned.
Challenging
by the first two partici
evaluated
and
a functional
corn

support
system
behaviors
exhibited

occupational

assessment

Materials
section).
ting and
observations
were conducted
prior
about

edu-

concernreports
of students
in
patterns
form a in Setting
and

ing communication
their classroom
(see
Materials

individual

AAC

once

began
the team

agreed

communication

(see

plan

Table

in using

were

Students

on the messages
1).

the

de

independent
was used to intro
hierarchy
prompt
to the first pair of
duce
the new messages
needed
and
was used
students
only when

vices.

The

were

(prompts
1-2 sessions).
ted,

the

AAC Support

needed

Once

only

the message

staff responded

for Reducing

was

first

transmit

immediately

Challenging

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All use subject to JSTOR Terms and Conditions

the

during

Behaviors

to the

99

the
by the student
activating
in baseline,
all challenging
behavas inappropriate
(identified
messages)
voiced

message
device.
iors
were

Data were
ignored.
intervention
sessions.
Criterion
30%
three

33%,

As

was

collected

and

of challenging
sessions
(20%

behaviors
for Dan,

for

of his challenging
behavwas met for the first pair
a meeting
was set to evaluate
functions

of the

messages

Once

analysis.

ing analyzed
ments, and

criterion
the third

the third

sessions

low-up
after ending
six weeks

each

child's

was met,

second

second

set of functional
intervention

were

the intervention

after

and

the last follow-up

message,

Two

again

familiar

no

he

initiation,

re

reverted

behaviors.

to his initiations,

response
decreased.

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were
students)
(graduate
trained
to collect
data using the direct obser.

c
.,
, ,
vation forms. One observer
collected
data dur.
.
. ,

, ..
, ,
while the second
observed
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ing all sessions
.

,
, r
nr.r
r ,
classrooms
tor 20%
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randomly
.
.
_
r
tor mterobserver
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purposes.
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observer
data
were
calculated
agreement
by

.
,
,
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the overall
number
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dividing
by'
.
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,
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,
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and
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, r
...
r>
i
i
100.
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indicated
ments,
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0h,oi
c
-u
for the percentage
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.

,
i oyifw r
u u
and
behaviors
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in
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lenging

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-n
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identification
of the behavior
Procetypes.
j
r n
i
, nam
r .
dures
were
followed
of the
92%
accurately

and

the

behaviors

Data

of all procedures
recording
that
the response
re
procedure
consistent
for the
three
students.

mained

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Those

results

low-up

sessions.

remained

steady

during

fol

,
2 presents
of challenging
figure
percentage
00
.
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/
.
,
behaviors
ior each participant
from classroom
_ ^
.
.
,
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,
2. During
levels
of challenging
be
baseline,
.
.
, T
haviors
were 30%
and 52%
for Dan
and To.
_
, T
,
,
Dan and |o demonstrated
noticeable
changes
. ,
.
?
,
and reduction
in the amount
of challenging
o
o
.
, .
,
,
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,
behaviors
demonstrated
m the classroom
after
.
.
.
_
,
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intervention
was implemented.
Results
for the
.
.
_ ,
, r.
,

level of change
obtained
were 22%
for Dan
and 37% for To. The new level of challenging
. .
r
x
r
behaviors
was 7% for Dan and 16% for To after
.
.
.
J,
intervention
was
Results
re
implemented.
r
.....
,
mained
similar
the follow-up
sessions
during
that

took

cording

Results

the

the

During

detected

Larry

switch

to

of chal

with staff, and after un


procedures
the importance
of consistency,
derstanding
staff started
to demonstrate
in their
stability

session.

observers

level

by Larry were
in responses

not

messages.
once

15%.

performance
at first. The

refreshing

indicated
Interobserver

his

immediately

assess-

then

to

sponse

meet-

Folbegan.
one
week

conducted

to Larry's
and

ately

and

the
starting
immedi
respond
After activating
the

staff did

intervention,

functional
a team

at 6%

with the inconsistency


in the classroom.
staff
by
and fourth sessions
after

made

of participants,
to select
the appropriate
and to begin
intervention.
As with
messages,
the first participants,
the team
the
selected
on

intervention

consistent

pair

based

after

of behaviors
and
inconsistency
behaviors
demonstrated
lenging

to the passive
nature
criterion
iors). Once
of participants,
the communicative

at
challenging
but only after 5 sessions,
while for Hank
were faster and stabilized
im
Al, changes
stabilized

Changes
demonstrating
Larry's
were
and
inconsistent
gradual

due

that for

indicated

behavior

mediately
of at least

set as a reduction

in frequency
consecutive

all

during

Results

39%.

the

Larry,
13%,

and

41%,

place
of the

several

months

later.

indicated

procedures

Data

re

that

the

and the responses


remained
con
for the students
all
sessions.
during
Teachers
recorded
information
the
during
school
the students'
behaviors,
year regarding
procedures

Results

for the

participants
ure 1 indicate
haviors
All

multiple
for classroom

for each

participant

participants
in the amount

demonstrated
tion

was

behaviors

tively.

across

in Figof challenging
beacross all sessions.

demonstrated

a reduc-

of challenging
behaviors
in the classroom
after intervenLevels

implemented.
baseline

during
for Larry,
Reductions
for

>, and

100

percentage

three

tion

probe
design
1 presented

54%

Education

of challenging
were 36%,

sessions
Hank,
these

and Training

and

Al, respecstudents
were

in Developmental

sistent

interactions

with

time

peers,

ademic

on

task,

and

All

ac
used

performance.
participants
their messages
for all activities
the
throughout
school
Teachers
recorded
day.
changes
the school
all aca
throughout
day during
demic

and

changes
served:

Disabilities-March

social

activities.

After

in other

students'

behaviors

the behaviors

changed

2003

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intervention,

and

were

ob

the partic

Baseline

~lI

1I

Intervention

/A

1r~

Larry

Follow-up

~iiir~

ii

1r

Hank

-i

1ii

1i 1i

rii

T+

~i

Al

11
Figure

1. Percentage

13

15

and

more

19

21

Number of Sessions

of challenging

academic

on

the

efof this study was to investigate


purpose
behavior
fects of a positive
plan using
support

Positive

moderate

and

intervention

demonstrated

results

for all students

iors and

AAC Support

behaviors

support

the functions

for Reducing

severe
exposed

33

to the

to

as they learned

devices.
plan

mental

decreases

noticeable

communication
AAC

r~

31

manifested

behaviors

challenging

All five participants

their

1ii

29

and Al.

retardation.

positive

The

27

with

use

r*-!i

25

by children

n their challenging

Til Cpi 1CGIAVI

1i

23

for Larry, Hank,

behaviors

AAC

behaviors
their
decreased
aggressive
ipants
initiwith their class peers;
began
participants
more
in social
behaviors;
ating and engaging
time on task was apparent
were recorded.
behaviors

17

Use

provided

regardless

of the
effective

of their behav

they served.

Challenging

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Behaviors

101

Intervention

Baseline

Follow-up

Dan

Jo

As

in

Table

and

the

presented

1, the

communica-

devices

used

varied

messages
after inthe five participants.
However,
tervention
became
consistent
and
the staffs

across

was

all

response
steady,
their
inappropriate
tir strategy used.
switch to indicate
him.

When

he

needed

for him

material
the switch

to call

Larry was the


and prompting
of

edgment

her.

sions.

the

of
his

to come

teacher

to

to

activity, he
this goal
Achieving

along

add
used
with

and

the procedures
some
during
As a result, Larry's challenging

At

did

not

of the sesbehavior

returned

the

new

sult

in the desired

communicative

understand

102

the

Education

effect.
direct

messages
It took

relation

and Training

did

not

staff time
between

27

25

31

29

33

and Jo.

behavior.
Larry's
to be consistent

to his

sponded
means

When
and
used

Larry

request,
transmit
his

staff's
they re
his new

for getting
messages
as they were proved
to be both ef
and efficient.
These
results are consis
to

fective

that found
research
previous
their goal using
students
achieved
in an effective
and
efficient
behaviors
tent

replace
Hank
the

tance

was

it was

efficient

desired
that
He

tent

attention
The

Disabilities-March

with

"I

effective,

recognition
in

engaged

will

and

go

no

times,

on

approval

interruptions

2003

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only
did it
from

on-task

careful

through
at critical

to him

to use,

easy

or

assis
how

working"
from

staff participated
in the
to the statement
and

reaction

worked

frequent
he was

learned,

provided
the sentence

regain
teacher.

and

also

consistendy
the previous
behavior,

teacher

of
to

their

way,
to adopt
the new and appropriate
they tended
behaviors
1980; Hor
(e.g., Carr & McDowell,
ner & Day, 1991).
More
so, even if the new

use

re-

that

with

when

as

their

in Developmental

started

behaviors.

to his

appeared
immediately.
Larry
old patterns
of attention
as soon
seeking
there was no response
and the indication

and

response
behavior

when

initiated.

inconsistent

for Dan

behaviors

behavior

communicative

appropriate
time
they were

23

21

attention,

of using
demonstration
with consistent
acknowl-

each
attempts,
staff was
first, school
follow

teacher

to resume

result
his

reduced

participants
behaviors
regardless
For example,
Larry used
to the

17
15
19
Number of Sessions

of challenging

2. Percentage

Figure

tion

13

11

to
to
the

consis
Hank

inappropri

ate

behaviors.

sistent

With

of the

the

Hank,

at all times.

team

was

an informal

During

con-

review

team's

response
type, they indicated
the need
for consistency
observing
to remain
conLarry, they were careful

that

after

with
sistent

with

other

They indicated
eralized
to the
ture

research

effects

students

that

in

towards

should

the other

Al's

desire

classroom.

this consistency
also
classroom
students.

other

look

genFu-

at the

generalized
method
of inter-

of using
a preferred
with one
student

vention

the

on the responses
in the classroom.

students

the room
for specific
by using a single switch
and a communication
chart with a few symbols. The symbols provided
the possible
places
reasons

to leave

was addressed

he

wanted
usually
room
the
(i.e.,
the

stroom,

and

switch

destination
trams.

to select

when

he

office,

principal's

office).

secretary's

the symbols
to indicate
in a reduction
resulted

Previous

research

the

in

their

his

passivity

changed
and crying

behavior
to active

activities
using
initiating
on it. Once
several messages
his VOCA
he began
members

the
Using
his desired
in

tan-

use

of

challenging

and

the several

he learned

the
ous

positive

screaming
inappropriate
All these behaviors
behaviors.
effective

and

efficient

for the staff, who

other
to

tent responding.
occurred
Changes
the
throughout
were responsible

across

ac-

all

change
account

of atmosphere
for consistent

time

not

activities

day. As the teachers


the interfor implementing

school

Positive

the children
rather

results,

than
an

although

could

recorded,

signify the
classroom
and

in the
use

of the strategy over


Further
research

2000).

(Sigafoos,

students
behaviors,

side effects of this


clarify the positive
on the behaviors
of the
systematic
approach
communi
communication
The
new
partners.
cative

behavior

during

school

messages

to

activities,

and

tion

to all activities
generalized
their
hours.
Students
carried
other

classrooms

challenging
other
activities.
the

investigating

in

and

the

during

should

effects

to

other
de

behaviors
Previous

re

of functional

to reduce
challeng
training
in new settings was also success
Future
research
& Carr,
1991).

the effects
investigate
other
environments

of this interven
such

as

in

the

and at home,
community
The present
to incorpo
study was designed
that uses positive
behav
rate use of the model
to enable
as a systematic
paradigm
intervention
for
of
an
AAC
implementation
ior support

behav

children
nent

consis-

the

should

to

students

their

and

iors.

reduce

These

ecdotal

to

self-injuriwere found

for the

maintained

issues.

ing behaviors
ful (Durand

espewant"

and

behaviors
and

to be
and

the

time

communication

started

oc
changes
the partici

as

peers

were

had

an
for taking a break
or changing
to his needs
and indicating
tivity. Referring
him the time left for each
activity seemed
enhance

class

decreased
their
behaviors
pants
aggressive
with their class peers and began
and
initiating
in social
more
behaviors.
Second,
engaging

to use

active
began
taking
spontaneously,
for
roles, and accepted
greater
responsibility
tasks.
classroom
completing
dally
switch

tasks,

behavioral

First,
other

search

available,
and

with Jo were
apparent
changes
to use the "Don't
when he learned

with

and

initiate

The

observed.

curred

creased

patterns

messages

were

from

participation
a VOCA
that

to the teacher
responding
in the classroom.
He also

academic

behavioral

re-

behaviors.
Dan

different

the participant's
behavior
Following
change
and reduction
in challenging
addi
behaviors,
tional
in other
students'
behaviors
changes

the

investigating

decrease

across

sages

left the

communication
for reductraining
behaviors
the finding
of
supports
ing escape
this study (Lalli,
&
Future
Kates,
1995).
Casey,
the impact
of the
research
should
address
students'
the staff of their
ability to inform
on

they were able to put the intervention


with school
staff for all classroom
practice
activities.
Teachers
observed
in stu
changes
dents'
behaviors
and spontaneous
use of mes
into

on task was apparent,


as
in inappropriate
less engaged
the staff began
to address
Third,
more
in reference
to academics

functional

desires

vention

challenging
demonstrating
most
first, and
important
this study
during
implemented

The

functional
the

lishing
the children
iors
in

were
the

nature

could

assessed

study.

AAC Support

clear

of the

that had

clear
strating
the student's
not

that

assessment

challenging

all

behav

the

functions

communicative
a

communicative

not be identified

one

behaviors,

challenging

for Reducing

estab

Thus,

for potential
participation
demon
seven
students

Of

and

in

assisted
behavior.

clear

compo
was the

and

Challenging

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All use subject to JSTOR Terms and Conditions

of
was

alternative
stu

an additional

Behaviors

103

dent

was

due

institution

to the

traumatic

who

again
by
as having

her

dents

to an

with his chal


family to cope
was later
behaviors.
The first student

lenging
evaluated
nosed

moved
of the

inability

diag
psychiatrist
a psychotic
reaction
to a
in her past. For all other stu

event

the communicative
func
participating,
of their behaviors
was clearly established,

tion

in

of an intervention
development
team. Thus, challenging
plan by the classroom
behaviors
be associated
with
may not always
resulting

should

assess

a meaningful
municative
alternative
Once

was

student
ence

it was

means,

communicate

be

these

support
Horner
1991;
of

achieved

to

trying

it will be used.

could

It should
tion

individual

Additionally,
is easy to manipulate
(i.e., an
to activate
a switch accompanied
the previous
means
to
output),

easy method
with a voice

Day,

used

to an

convey
if that alternative

studies

to each

more frequently
and
of challenging
behav
that when
an effective
alter

is provided
a message,

be

findings

et al.,

noted

Previous

replaced.

Horner

(e.g.,

elimina

complete
behaviors

inappropriate
at any of the

&

1990).

that

for any partici


stages
in which they
pant. Each had several occasions
reverted
to their previous
of behav
patterns
iors. For example,
Hank
liked hands-on
activ
ities

and

cation

the new

However,

he would

others

of communi
and

art

had

circle

not wait for his turn or listen

verted

communicating.
to challenging

search

should

sessments

methods

work
during
when
the class

successfully

activities.
time,

used

At those

times,

he

to
re

behaviors.

Further

re

the

of other

as

investigate

use

for

an understanding
establishing
of positive
solutions
to these frustrating
mo
ments of multiple
interactions
and turn taking
in larger groups.
This study poses
itive

behavior
the

enhancing
communication
mental

104

Education

along

who

for using
AAC

with

pos
for

of

functionality
manifested

retardation

possibilities

support

appropriate
with
by children
demonstrate

and Training

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