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

tion, this rate <strong>in</strong>creased to 66% <strong>and</strong> to 93% <strong>in</strong>
the BC2 condition. In the BC condition, the
mean rate of accurate responses decreased by
33% to 60%. Total ga<strong>in</strong> from the basel<strong>in</strong>e
condition (A) through the BC condition was
56% for Goal 2. Additionally, Anna began
us<strong>in</strong>g her napk<strong>in</strong> to make attempts to wipe
her face dur<strong>in</strong>g the BC condition.
Reliability Data
Data relat<strong>in</strong>g to <strong>in</strong>terrater agreement on participant
performance <strong>and</strong> <strong>in</strong>terventionists’
procedural fidelity were collected simultaneously
dur<strong>in</strong>g at least 20% of all sessions <strong>and</strong>
across all conditions (Bill<strong>in</strong>gsley et al., 1980;
Tawney & Gast, 1984). These data were collected
by videotape <strong>and</strong> by on-site raters (graduate
students), who were <strong>in</strong>dividually tra<strong>in</strong>ed
<strong>in</strong> the <strong>and</strong> – scor<strong>in</strong>g system <strong>and</strong> <strong>in</strong> the
<strong>in</strong>terval record<strong>in</strong>g system. These two methods
yielded both <strong>in</strong>terrater agreement coefficients
for participant performance data <strong>and</strong> procedural
reliability coefficients.
Mean <strong>in</strong>terrater agreement on participant
performance was .93 (range: .89-.98) <strong>and</strong> considered
acceptable. A total of 45 <strong>in</strong>terrater
reliability rat<strong>in</strong>gs were recorded via videotape
<strong>and</strong> 61 on-site rat<strong>in</strong>gs were completed by the
graduate students. Procedural reliability
agreement data (Bill<strong>in</strong>gsley et al., 1980) were
recorded across all <strong>in</strong>terventionists. A procedural
reliability coefficient of .98 was calculated
for graduate student <strong>in</strong>terventionists
<strong>and</strong> a coefficient of .90 was calculated for
school staff <strong>in</strong>terventionists <strong>in</strong> the BC condition.
Discussion
Limitations
A number of limitations were identified <strong>in</strong> this
study. First was the <strong>in</strong>ability to control feed<strong>in</strong>g
methods or environments outside of the
school sett<strong>in</strong>gs. It is not known how alternative
feed<strong>in</strong>g environments <strong>and</strong>/or methods affected
outcomes of this study. It is possible
that poor feed<strong>in</strong>g techniques occurr<strong>in</strong>g <strong>in</strong>
other sett<strong>in</strong>gs may have limited <strong>in</strong>dividual participants’
progress toward feed<strong>in</strong>g skill or positive
mealtime behavior goals.
Second was that only observable feed<strong>in</strong>g
skills <strong>and</strong> mealtime behaviors were measured.
Researchers did not have access to videofluoroscopic
evaluations of swallow<strong>in</strong>g for pre<strong>and</strong>
post<strong>in</strong>tervention measures of swallow<strong>in</strong>g.
The SOMA evaluation was not st<strong>and</strong>ardized
for use with older children <strong>and</strong> youth. Therefore,
an objective pre- <strong>and</strong> post<strong>in</strong>tervention
assessment of all phases of swallow<strong>in</strong>g was not
conducted.
Discussion of Research F<strong>in</strong>d<strong>in</strong>gs
94 / <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
A functional relationship was established between
the dysphagia treatment program <strong>and</strong>
development of feed<strong>in</strong>g skills for all participants.
A mean ga<strong>in</strong> of 6% was achieved across
all <strong>in</strong>dividuals <strong>and</strong> groups across <strong>in</strong>dividualized
feed<strong>in</strong>g skill goals dur<strong>in</strong>g the dysphagia
treatment condition (B). Individual participants
(i.e., Denver, Jessica) made ga<strong>in</strong>s of over
10% dur<strong>in</strong>g the B condition toward their feed<strong>in</strong>g
skill goals. A mean ga<strong>in</strong> of a 6% performance
rate by children with moderate to severe
disabilities that affect motor, sensory, <strong>and</strong>
cognitive arenas supports use of dysphagia
treatment methods for development of feed<strong>in</strong>g
skills. These f<strong>in</strong>d<strong>in</strong>gs support previous research
regard<strong>in</strong>g effects of dysphagia treatment
programs on improvement of feed<strong>in</strong>g
skills (Domaracki & Sisson, 1989; Gaebler &
Hanzlik, 1996; Helfrich-Miller, Rector, &
Straka, 1986).
No overall functional relationship was
found between the PRBMP <strong>and</strong> improvement
of feed<strong>in</strong>g skills. A mean decrease of 1% occurred
<strong>in</strong> feed<strong>in</strong>g skill acquisition <strong>in</strong> the C
condition across all participants. While <strong>in</strong>dividual
results varied (i.e., Brett <strong>and</strong> Stacy’s
goals), positive re<strong>in</strong>forcement for exhibit<strong>in</strong>g a
desired feed<strong>in</strong>g skill did not appear to be
generally effective <strong>in</strong> facilitat<strong>in</strong>g development
of feed<strong>in</strong>g skills. However, a functional relationship
was established between PRBMP <strong>and</strong>
development of positive mealtime behaviors.
A mean ga<strong>in</strong> of 13% was measured across all
participants for positive mealtime behavior
goals dur<strong>in</strong>g the C condition. Two <strong>in</strong>dividual
participants’ results (i.e., Dust<strong>in</strong> <strong>and</strong> Anna)
were especially promis<strong>in</strong>g, with mean ga<strong>in</strong>s of
20% <strong>and</strong> 46% respectively (see Table 3).
These results confirm previous research regard<strong>in</strong>g
effects of systematic positive re<strong>in</strong>forcement
on improvement of positive mealtime
behaviors (Kahng, Tarbox, & Wilke,
2001; Kerw<strong>in</strong>, 1999; O’Brien et al., 1991).