Education and Training in Developmental Disabilities - Division on ...
Education and Training in Developmental Disabilities - Division on ...
Education and Training in Developmental Disabilities - Division on ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
vidually identified feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill deficits us<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
the SOMA scor<str<strong>on</strong>g>in</str<strong>on</strong>g>g sheet descripti<strong>on</strong>s <str<strong>on</strong>g>and</str<strong>on</strong>g> a<br />
written descripti<strong>on</strong> of normal development of<br />
feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skills (Guerra & Vaughn, 1994). The<br />
PI <str<strong>on</strong>g>and</str<strong>on</strong>g> additi<strong>on</strong>al SLP <str<strong>on</strong>g>in</str<strong>on</strong>g>dividually listed feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
skill deficits that each identified as primary<br />
for each participant. These two <str<strong>on</strong>g>in</str<strong>on</strong>g>dividuals<br />
met <str<strong>on</strong>g>and</str<strong>on</strong>g> compared their lists of primary<br />
feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill deficits. When a feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill deficit<br />
was identified by both the PI <str<strong>on</strong>g>and</str<strong>on</strong>g> the<br />
additi<strong>on</strong>al SLP, it was added to a list of potential<br />
feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill goals for that participant. The<br />
PI <str<strong>on</strong>g>and</str<strong>on</strong>g> additi<strong>on</strong>al SLP reviewed tapes together<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> discussed potential goals until the two<br />
came to an agreement regard<str<strong>on</strong>g>in</str<strong>on</strong>g>g the primary<br />
feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill deficit for each participant. The<br />
SOMA evaluati<strong>on</strong> was used as a structured<br />
method for assist<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> identificati<strong>on</strong> of feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
skill deficits <strong>on</strong>ly. SOMA scores were not<br />
computed because the test was devised for<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>fants <str<strong>on</strong>g>and</str<strong>on</strong>g> young children.<br />
Behavior goals were identified by <str<strong>on</strong>g>in</str<strong>on</strong>g>terviews<br />
with teachers, related services staff, <str<strong>on</strong>g>and</str<strong>on</strong>g> parents/caregivers<br />
of the participants. Follow<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terviews, the PI completed <str<strong>on</strong>g>in</str<strong>on</strong>g>formal observati<strong>on</strong>s<br />
of mealtimes to c<strong>on</strong>firm presence of<br />
behaviors. Next, a list of potential behavior<br />
goals was created for each participant. The PI<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> Co-PI (a university Department of Special<br />
<str<strong>on</strong>g>Educati<strong>on</strong></str<strong>on</strong>g> faculty member <str<strong>on</strong>g>and</str<strong>on</strong>g> behavior specialist)<br />
used the list to determ<str<strong>on</strong>g>in</str<strong>on</strong>g>e a primary<br />
positive mealtime behavior goals for each participant.<br />
Design<br />
An A-BC-C-BC2-BC multiple treatment design<br />
across three groups of three participants<br />
(Baer, Wolf, & Risley, 1968) with brief withdrawal<br />
c<strong>on</strong>diti<strong>on</strong>s (Birnbrauer, Peters<strong>on</strong>, &<br />
Solnick, 1974; Hers<strong>on</strong> & Barlow, 1976) was<br />
used to evaluate the effectiveness of an <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong><br />
package (B – a dysphagia treatment<br />
program <str<strong>on</strong>g>and</str<strong>on</strong>g>C–aPRBMP) <strong>on</strong> the dependent<br />
variables (<str<strong>on</strong>g>in</str<strong>on</strong>g>dividually identified feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> positive mealtime behavior goals) of <str<strong>on</strong>g>in</str<strong>on</strong>g>dividuals<br />
with moderate, severe, or multiple disabilities.<br />
C<strong>on</strong>sider<str<strong>on</strong>g>in</str<strong>on</strong>g>g the ethical implicati<strong>on</strong>s<br />
of a withdraw<str<strong>on</strong>g>in</str<strong>on</strong>g>g all treatments for children<br />
with severe feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g problems, the researchers<br />
chose to implement a brief withdrawal of <strong>on</strong>e<br />
of the two <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g the withdrawal<br />
c<strong>on</strong>diti<strong>on</strong>s. With<str<strong>on</strong>g>in</str<strong>on</strong>g> this design, the dependent<br />
variables were measured under basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e c<strong>on</strong>-<br />
diti<strong>on</strong>s, <str<strong>on</strong>g>and</str<strong>on</strong>g> the <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s were <str<strong>on</strong>g>in</str<strong>on</strong>g>troduced<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g> a counterbalanced sequence to three<br />
groups of children <str<strong>on</strong>g>and</str<strong>on</strong>g> youth. The multiple<br />
treatment design was chosen as it has been<br />
reported as useful <str<strong>on</strong>g>in</str<strong>on</strong>g> ask<str<strong>on</strong>g>in</str<strong>on</strong>g>g, “Would X <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong><br />
work better than Y <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>” (Holcombe,<br />
Wolery, & Gast, 1994). Individual performance<br />
data were recorded for each<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong> sessi<strong>on</strong>. Individual <str<strong>on</strong>g>and</str<strong>on</strong>g> comparative<br />
group results were obta<str<strong>on</strong>g>in</str<strong>on</strong>g>ed across each<br />
study c<strong>on</strong>diti<strong>on</strong>.<br />
Each participant group was exposed to six<br />
c<strong>on</strong>diti<strong>on</strong>s. Basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e c<strong>on</strong>diti<strong>on</strong> (A) c<strong>on</strong>sisted<br />
of a SOMA evaluati<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> pre-<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong><br />
observati<strong>on</strong>s. The BC c<strong>on</strong>diti<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>volved a<br />
dysphagia treatment program comb<str<strong>on</strong>g>in</str<strong>on</strong>g>ed with<br />
a PRBMP. For the B <str<strong>on</strong>g>and</str<strong>on</strong>g> C c<strong>on</strong>diti<strong>on</strong>s, either<br />
the dysphagia treatment program al<strong>on</strong>e or the<br />
PRBMP al<strong>on</strong>e was implemented (i.e., either B<br />
or C was withdrawn). The B <str<strong>on</strong>g>and</str<strong>on</strong>g> C c<strong>on</strong>diti<strong>on</strong>s<br />
were counterbalanced across groups. The BC2<br />
c<strong>on</strong>diti<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>volved a return to the dysphagia<br />
treatment program comb<str<strong>on</strong>g>in</str<strong>on</strong>g>ed with the<br />
PRBMP. The BC c<strong>on</strong>diti<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>volved the dysphagia<br />
treatment program comb<str<strong>on</strong>g>in</str<strong>on</strong>g>ed with the<br />
PRBMP implemented by the tra<str<strong>on</strong>g>in</str<strong>on</strong>g>ed classroom<br />
staff <str<strong>on</strong>g>and</str<strong>on</strong>g> pers<strong>on</strong>nel.<br />
Basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e C<strong>on</strong>diti<strong>on</strong><br />
The PI <str<strong>on</strong>g>and</str<strong>on</strong>g> graduate students with<str<strong>on</strong>g>in</str<strong>on</strong>g> a university<br />
Department of Speech Pathology <str<strong>on</strong>g>and</str<strong>on</strong>g> Audiology<br />
charted basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e percentages of accurate<br />
resp<strong>on</strong>ses. Dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e c<strong>on</strong>diti<strong>on</strong>,<br />
participants were fed by the same school staff<br />
as dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g the SOMA evaluati<strong>on</strong>s. The graduate<br />
students were tra<str<strong>on</strong>g>in</str<strong>on</strong>g>ed <str<strong>on</strong>g>in</str<strong>on</strong>g> the use of a plus ()<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> m<str<strong>on</strong>g>in</str<strong>on</strong>g>us (-) system to chart accurate performance<br />
of target skills <str<strong>on</strong>g>and</str<strong>on</strong>g> behaviors. In this<br />
system, graduate students recorded a plus ()<br />
sign if participants performed the target skill<br />
or behavior <str<strong>on</strong>g>and</str<strong>on</strong>g> a (-) sign if participants did<br />
not perform the target behavior for each bite<br />
or opportunity. Graduate students dem<strong>on</strong>strated<br />
a functi<strong>on</strong>al underst<str<strong>on</strong>g>and</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g of the <br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> – system prior to <str<strong>on</strong>g>in</str<strong>on</strong>g>itiati<strong>on</strong> of the first<br />
basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e sessi<strong>on</strong>. One of Denver’s goals required<br />
an <str<strong>on</strong>g>in</str<strong>on</strong>g>terval record<str<strong>on</strong>g>in</str<strong>on</strong>g>g method. For this<br />
method, graduate students were <str<strong>on</strong>g>in</str<strong>on</strong>g>structed to<br />
use a stopwatch <str<strong>on</strong>g>and</str<strong>on</strong>g> make a slash mark for<br />
number of events that occurred dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g each<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terval. At the end of each sessi<strong>on</strong>, marks<br />
were tallied <str<strong>on</strong>g>and</str<strong>on</strong>g> divided by the number of<br />
m<str<strong>on</strong>g>in</str<strong>on</strong>g>utes <str<strong>on</strong>g>in</str<strong>on</strong>g> the sessi<strong>on</strong> to yield the rate of<br />
Feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g Skills <str<strong>on</strong>g>and</str<strong>on</strong>g> Mealtime Behaviors / 85