Education and Training in Developmental Disabilities - Division on ...

occurrences. Observations dur<strong>in</strong>g a m<strong>in</strong>imum
of three lunchtime meals were used to collect
basel<strong>in</strong>e data for each participant prior to
<strong>in</strong>troduction of sequential treatment conditions.
Intervention Conditions
Interventions were provided by graduate students
at the lunchtime meal four days per
week for a total of 11 weeks. School staff provided
the <strong>in</strong>terventions dur<strong>in</strong>g the f<strong>in</strong>al three
weeks of the study. Prior to <strong>in</strong>troduction of all
<strong>in</strong>terventions, graduate students <strong>and</strong> school
staff received tra<strong>in</strong><strong>in</strong>g together <strong>in</strong> use of positive
re<strong>in</strong>forcement behavior management
strategies, data collection methods, methods
for adm<strong>in</strong>istration <strong>and</strong> evaluation of preference
assessments, procedural reliability, <strong>and</strong>
the dysphagia treatment techniques. All persons
provid<strong>in</strong>g <strong>in</strong>terventions were supervised
by licensed, certified SLPs dur<strong>in</strong>g the study.
Prior to each treatment session us<strong>in</strong>g behavior
management programs, a pre-session assessment
of re<strong>in</strong>forcer preferences (Gast et
al., 2000) was conducted for each participant.
Students with moderate disabilities who had
<strong>in</strong>tact communication systems or who could
gesture toward actual re<strong>in</strong>forcers or visual representations
of them <strong>in</strong>dicated their preferred
re<strong>in</strong>forcer for each session by verbally stat<strong>in</strong>g
or po<strong>in</strong>t<strong>in</strong>g to it. The PRBMP <strong>in</strong>cluded sensory
<strong>and</strong> social re<strong>in</strong>forcers or token re<strong>in</strong>forcement
systems (O’Brien, Repp, Williams, &
Christophersen, 1991). Participants <strong>in</strong> Group
1 used a sticker re<strong>in</strong>forcement chart <strong>and</strong> token
exchange system as their positive re<strong>in</strong>forcement
program. Immediate sensory <strong>and</strong>
social re<strong>in</strong>forcers were used as the positive
re<strong>in</strong>forcement program for Groups 2 <strong>and</strong> 3.
Sequence of Conditions
Each group was exposed to each of the six
conditions, which were counterbalanced by
groups <strong>in</strong> order to reduce both maturational
<strong>and</strong> sequence effects. The basel<strong>in</strong>e condition
(A) <strong>in</strong>volved assessment of current performance
levels for target feed<strong>in</strong>g skills <strong>and</strong> positive
mealtime behaviors. Graduate students
recorded occurrence of target skills <strong>and</strong> behaviors
for three mealtimes prior to <strong>in</strong>troduction
of any <strong>in</strong>terventions.
The (BC) condition consisted of a com-
86 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-March 2005
b<strong>in</strong>ed dysphagia treatment program (B) with
the PRBMP (C). The dysphagia treatment
program package consisted of a 5-m<strong>in</strong> oralmotor
stimulation program (OMSP) described
by Gaebler <strong>and</strong> Hanzlik (1996) <strong>and</strong>
modified by the PI for use with older children.
The same OMSP was used for each child. Additional
components of the dysphagia treatment
program package <strong>in</strong>cluded a group
oral-motor exercise program <strong>and</strong> direct <strong>in</strong>struction
<strong>and</strong> model<strong>in</strong>g of target skills <strong>and</strong>
behaviors.
Position<strong>in</strong>g for optimal swallow<strong>in</strong>g, modification
of foods <strong>and</strong> consistencies to meet participants’
abilities, use of adaptive equipment,
therapeutic feed<strong>in</strong>g methods, <strong>and</strong> nutrition
enhancement were considered absolutely necessary
for ensur<strong>in</strong>g each participant’s safety
<strong>and</strong> needs were implemented as a part of
every feed<strong>in</strong>g session. These components of
the dysphagia treatment program were not
withdrawn at any time dur<strong>in</strong>g the study. The
BC condition was implemented four days per
week for three weeks.
The (B) condition (dysphagia treatment
program) <strong>in</strong>volved remov<strong>in</strong>g the PRBMP (C).
The (B) condition consisted of adm<strong>in</strong>ister<strong>in</strong>g
the OMSP <strong>and</strong> group oral-motor exercise program
as a part of every <strong>in</strong>tervention session.
The OMSP was completed on an <strong>in</strong>dividual
basis with each participant prior to the mealtime.
Oral-motor exercises were completed after
each meal so as not to fatigue the system
prior to eat<strong>in</strong>g. The dysphagia treatment program
also <strong>in</strong>cluded a direct <strong>in</strong>structional component,
with verbal <strong>and</strong> visual model<strong>in</strong>g of
target skills <strong>and</strong> positive mealtime behaviors
<strong>and</strong> an oral-hygiene program (i.e., tooth
brush<strong>in</strong>g). The B condition was implemented
four days per week for two weeks.
The behavior management withdrawal condition
(C) <strong>in</strong>volved remov<strong>in</strong>g the dysphagia
treatment program. The (C) condition consisted
of positive social, sensory, or tangible
re<strong>in</strong>forcement as determ<strong>in</strong>ed dur<strong>in</strong>g the presession
m<strong>in</strong>i preference assessment for performance
of target skills <strong>and</strong> behaviors. The (C)
condition occurred four days per week for two
weeks.
The (BC) condition was then repeated for
an additional 3-week time period, us<strong>in</strong>g the
same <strong>in</strong>terventions as <strong>in</strong> the previous (BC)
condition <strong>and</strong> was identified as (BC2).
Prior to the <strong>in</strong>itiation of the f<strong>in</strong>al phase