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Target Behavior Hand mouthing was defined as <strong>the</strong> insertion of any part of <strong>the</strong> hand into <strong>the</strong> mouth or <strong>the</strong> protrusion of <strong>the</strong> tongue out of <strong>the</strong> mouth onto <strong>the</strong> hand. For a new occurrence of hand mouthing to be recorded, Mat<strong>the</strong>w’s hand had to be completely removed from his mouth <strong>the</strong>n reinserted or <strong>the</strong> tongue completely removed from <strong>the</strong> hand and <strong>the</strong>n reapplied to <strong>the</strong> hand. Data Collection and Interobserver Agreement Data were collected in real time using a scatterplot data collection system (Touchette, MacDonald, & Langer, 1985). Data were collected during two different time blocks during <strong>the</strong> day. Time Block A (i.e., 11:30–1:00) was broken into six 15 min intervals, and Time Block B (i.e., 1:00–2:45) was broken into seven 15 min intervals. During each interval, <strong>the</strong> occurrence of hand mouthing was indicated for <strong>the</strong> first three occurrences for ease of data collection and interpretation (Touchette et al.). Therefore, hand mouthing could be scored 18 times in Time Block A and 21 times in Time Block B. To determine inter-observer agreement, two observers (i.e., <strong>the</strong> first author and a graduate student) independently scored data on <strong>the</strong> target behavior for at least 30% of all sessions. Data from <strong>the</strong> two observers were compared for agreements and disagreements. An agreement was scored if both observers recorded <strong>the</strong> occurrence or non-occurrence of hand mouthing within each 15 min interval. In <strong>the</strong> intervention, an agreement was scored if each observer recorded <strong>the</strong> same number of occurrences of hand mouthing within each 15 min interval. Any discrepancy between <strong>the</strong> two observers was counted as a disagreement. Interobserver agreement on <strong>the</strong> dependent measure was calculated on an interval-by-interval basis using <strong>the</strong> formula: Agreements/(Disagreements Agreements) 100%. Inter-observer agreement data were collected for 33% of <strong>the</strong> sessions and overall agreement was calculated to be 96.7% (range 83.3–100%). Experimental Design A combination reversal and alternating treatments design across two time blocks was used (Kazdin, 1982). During Time Block A, <strong>the</strong> reversal design utilized an ABAB reversal pattern, while Time Block B utilized a non-reversal ABC pattern. Intervention 362 / Education and Training in Developmental Disabilities-September 2008 During baseline, Mat<strong>the</strong>w’s arm splints were removed and occurrences of hand mouthing were recorded within his natural settings (e.g., classroom, gymnasium, library, etc.). His teachers were asked to do what <strong>the</strong>y would normally do, but were asked not to put his arm splints on. The first author sat in a corner of <strong>the</strong> room and observed Mat<strong>the</strong>w. During each 15 min interval, <strong>the</strong> first three occurrences of hand mouthing were recorded on <strong>the</strong> scatterplot data sheet. Once three occurrences of hand mouthing occurred in an interval, no fur<strong>the</strong>r data were collected during that interval, and data recording resumed at <strong>the</strong> beginning of <strong>the</strong> next 15 min interval. Baseline data were collected from 11:30 a.m. to 2:45 p.m. (i.e., Time Blocks A and B). During most baseline sessions, Mat<strong>the</strong>w was placed in a bean bag or on a mat on <strong>the</strong> floor and provided ei<strong>the</strong>r free access to <strong>the</strong> television or switch activated access to <strong>the</strong> radio or a book on tape. Very little interaction typically occurred with Mat<strong>the</strong>w. The intervention consisted of <strong>the</strong> provision of curricular activities and a brief hands down procedure. During intervention, <strong>the</strong> first author placed curricular materials within Mat<strong>the</strong>w’s reach and waited 10 s for him to initiate appropriate engagement with <strong>the</strong> materials. If he did not engage in <strong>the</strong> activity within 10 s, a least-to-most prompting hierarchy was used to prompt engagement. Specifically, <strong>the</strong> <strong>the</strong>rapist would first provide a verbal prompt (e.g., “Ok Mat<strong>the</strong>w, let’s work on <strong>the</strong> puzzle.”), <strong>the</strong>n a gestural prompt (e.g., pointing to <strong>the</strong> puzzle), <strong>the</strong>n a model prompt (e.g., placing one puzzle piece in place), and finally a physical prompt (e.g., guiding his hand to pick up and place a puzzle piece). Curricular activities presented to Mat<strong>the</strong>w included reading books to him while he turned <strong>the</strong> pages, having him complete his choice of non-interlocking puz-
Figure 1. Intervention results for Mat<strong>the</strong>w across Time Blocks A and B. zles, going for walks while he pushed himself in his wheelchair, and playing games in <strong>the</strong> gymnasium. Mat<strong>the</strong>w was provided a choice of what activity he wanted to engage in by showing him <strong>the</strong> activities in an array of photographs and having him point to <strong>the</strong> activity he wanted. All activities were part of his individualized educational plan. When <strong>the</strong> class engaged in group activities, <strong>the</strong> first author provided one-on-one assistance to Mat<strong>the</strong>w as needed within <strong>the</strong> group setting. When <strong>the</strong> class engaged in center activities, <strong>the</strong> first author provided Mat<strong>the</strong>w with an array of curricular activities to choose from and followed <strong>the</strong> previously described procedures. If Mat<strong>the</strong>w engaged in hand mouthing, <strong>the</strong> first author immediately removed Mat<strong>the</strong>w’s from his mouth, said “hands down”, and held his hands in his lap for 10 s. Following <strong>the</strong> 10 s, Mat<strong>the</strong>w was prompted to engage with <strong>the</strong> curricular materials. In <strong>the</strong> reversal back to baseline in Time Block B, <strong>the</strong> teachers began to interact with Mat<strong>the</strong>w in a manner different than in all o<strong>the</strong>r baseline phases. Therefore, this phase was relabeled as <strong>the</strong> teacher intervention. Dur- ing this phase, <strong>the</strong> classroom teacher and her teaching assistants began to include Mat<strong>the</strong>w in regular small group (SG) and one-to-one (1:1) instruction, which <strong>the</strong>y had not done in any of <strong>the</strong> o<strong>the</strong>r baseline sessions. While <strong>the</strong> teachers did provide curricular activities, <strong>the</strong>y did not implement <strong>the</strong> brief hands down procedure. Additionally, he was not placed in a beanbag or on a mat during this phase, and he was no longer given free access to <strong>the</strong> television or switch-activated access to <strong>the</strong> radio or books on tape. During 10 of <strong>the</strong> 31 intervals, Mat<strong>the</strong>w was given an independent task and was not engaged with <strong>the</strong> teacher, her assistants, or his peers. The teachers shifted <strong>the</strong>ir instruction independently and without prompting from <strong>the</strong> researcher. As in all o<strong>the</strong>r baseline conditions, <strong>the</strong> teachers did not apply Mat<strong>the</strong>w’s splints, even when he did engage in hand mouthing. Results Figure 1 shows <strong>the</strong> number of occurrences (up to three per interval) of hand mouthing for <strong>the</strong> two time blocks in which daily sessions Combined Curricular Intervention / 363
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Page 79 and 80: Figure 2. Bob’s performance data.
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