a process for designing self-management programs for the developmentally disabled

Analysis and Intervention in Development Disabihties. VoL 4. pp 189-197, 1984 0270-4684/84 $ 3 0 0 + ,00 Printed in the USA. All rights reserved. Copyright ~ 1984 Pergamon Press Ltd.

A Process for Designing Self-management Programs

for the Developmentally Disabled

Alan J. Litrownik Karen White

San Diego State University

Elizabeth T. Mclnnis

Los Ninos Center, San Diego

and

Barbara G. Licht

Florida State University

Developmentally disabled individuals are seen as requiring a multitude of services over their entire lifetime as they evidence severe impairments that emerge during the developmental period. These services have traditionally taken the form of highly structured training programs aimed at developing self-help, social, and cognitive behaviors. Application of conditioning principles (e.g., behavior modification) has proved most successful in developing many of these specific skills, but with continued success has come a realization that this approach has its limits.

Requests for reprints should be sent to Alan J. Litrownik, Department of Psychology, San Diego State University, San Diego, CA 92182-0350.

189

190 A. J. Litrownik. K. White. E. T. Mdnnis, and B. G. Licht

Problems such as the lack of demonstrated maintenance and generalization (Stokes & Baer, 1977), limited effectiveness of one-at-a-time behavior modification (Hayes, Rincover, & Solnick, 1980), and thc development of reactive as opposed to active response repertoires (Litrownik, 1982), along with a concern for self-determination and social validity (Wolf, 1978), have led to a recent focus on self-management (Holman & Baer, 1979; O'Leary & Dubey. 1979; Rosen- baum & Drabman, 1979). Specifically. reports within the last several years indicate that an interest in developing more independent individuals is emerging as opposed to the more traditional aim of developing skills in an individual that are performed independently (Licht, in press; Litrownik, 1982).

Initial anecdotal reports suggested that retarded individuals could acquire self- management skills such as self-monitoring, self-reward, and self-instruction (e.g., Kurtz & Neisworth, 1976; Mahoney & Mahoney, 1976). There was even some evidence that acquisition of these skills and their subsequent performance could lead to acquisition, elimination, or maintenance of targeted behaviors (Helland, Paluck, & Klein, 1976; Guralnick, 1976; Nelson. Lipinski. & Black, 1976; Zegiob, Klukas, & Junginger, 1978).

Litrownik and Steinfeld (1982) described a programmatic effort to develop effective self-reintbrcement skills in a moderately retarded population. Specific component skills, such as self-monitoring, standard setting, self-evaluation, and self-reward required for self-reinforcement were first identified and operation- alized. After determining that these component skills could be developed indi- vidually (e.g., Litrownik & Freitas, 1980; Litrownik, Freitas, & Franzini, 1978), a criterion-based training program with identified prerequisite or entering behaviors was designed and applied. All of the moderately retarded persons exposed to the program completed the training with over three-quarters using these skills to manage their behavior on the training task and on two similar tasks (Litrownik & Steinfeld, 1982). In addition to evidencing limited transfer of these acquired sell-management skills, the moderately retarded adolescents displayed a higher rate of task output than peers who had not been exposed to the training program. Given this successful group intervention program conducted in a laboratory setting, Litrownik (1982, 1984) proposed a general 6-step process that could be applied elsewhere in designing self-management programs for developmentally disabled individuals. The process includes: (a) general assessment of the individual's level of functioning (verbal, cognitive, etc. ), (b) specifications of desired outcomes or behaviors to be controlled. Ic) identification of self-management processes (controlling responses) that are to be utilized, including a task analysis, (d) assessment of the individual's performance of specific outcomes and sell'- management process skills, (e) design of a step-by-step training program that incorporates task analyses performed at steps b and c and the assessment at step d, and (f) evaluation of the program in terms of acquisition of self-management skills, appropriate application of these skills, and achievement of desired outcomes.

Designing Self-Management Programs 191

The following case history is presented as an example of how this process can be applied, with a focus on systematic training procedures that insure the acquisition of self-management skills.

STEP 1: GENERAL ASSESSMENT

Joey, a 14-year-old male who attended Los Ninos Center, a special school for developmentally disabled school-aged children in San Diego, was targeted for self-management training. He had been diagnosed as aphasic with severe expressive and moderate receptive language deficits. In addition, he also exhib- ited an attention-deficit disorder with hyperactivity and a mild bilateral cerebral palsy. This disability appeared to be due to the contraction of encephalitis as an infant. Joey was essentially non-verbal up to the time of his enrollment at Los Ninos at age 12. At the onset of this training, he spoke in 2 - 5 word sentences but evidenced severe problems in sequencing and articulation.

STEP 2: SPECIFICATION OF OUTCOME

Specific problems that Joey had in the classroom were identified by his teacher. Subsequent direct observations in the classroom and a review of daily recorded performances confirmed that Joey (a) had difficulty retaining memorized math facts (addition of two single-digit numbers that summed to a total of 10 or less), (b) required external prompts from his teacher to stay on task during specified independent work times, and (c) often responded inappropriately (e.g., crying, whining, tantrums) when his work was corrected. Based on this infor- mation, it was decided that the targeted outcomes would be improved performance on math problems (accuracy and output) completed during independent work sessions without external prompts to stay on task. In addition, inappropriate responses that followed correction of his work were targeted for elimination.

Forty math worksheets, each containing 8 problems per page, were generated. Two, three, or four worksheets were selected at random and presented to Joey during each 2-minute independent session.

STEP 3: SPECIFICATION OF SELF-MANAGEMENT PROCESS

In order to accomplish these targeted outcomes with a minimum of external control, Joey was to take responsibility for programming his own behavior. Specifically, a self-reinforcement routine that included component monitoring, evaluation, and reward skills was to be acquired and then applied by Joey during independent work sessions. During these sessions Joey was presented with the math worksheets and a red folder. The folder contained duplicates of the task worksheets with the correct answers printed in red ink. In addition, an individual check sheet was provided so that Joey could (a) monitor the number of worksheets

192 A. J. Litrownik, K. White, E. T. Mclnnis. and B. G. Licht

he completed within a session, (b) monitor the number of correct problems he completed on each page, (c) compare his performance to a standard, and finally (d) indicate if he met this standard.

When Joey completed all of the problems, or after 2 minutes had elapsed, Joey was told to stop working and was instructed to "'check your work." He was to monitor first the number of worksheets that he completed by placing one apple-shaped sticker on the check sheet for each pagc he finished. Next he compared his answers to the correct answers that were provided in the session folder. A C representing a correct answer was to be placed next to each problem or item completed correctly. The number of problems solved correctly was indicated on each page. This was accomplished by having Joey circle the number on a scale from 0 to 8 which was included in the right hand margin of each page. A standard for each page, i.e.. the number of problems to be solved correctly, was indicated prior to a session by placing a vertical orange wavy line at the level of performance that Joey was to achieve. For example, a wavy line was placed between the 6 and 7 on the scale if his standard for that page was 7 correct problem solutions. Following this self-correction, Joey transferred his standard for the page and the number he completed correctly to his check sheet. If Joey met his standard for a given page of work, he indicated this by placing a shamrock-shaped sticker on his check sheet next to the apple-shaped sticker. Thus the apple-shaped stickers were either followed by a shamrock-shaped sticker, if Joey met his standard for correctly completed problems on a completed worksheet, or by nothing if he did not meet his standard on a completed worksheet. Finally, Joey rewarded himself by taking one edible for each shamrock-shaped sticker on his check sheet. These edibles (grapes, raisins, pieces of cheese, etc.) were selected by Joey prior to each session (e.g., "'What do you want as your treat for the session?").

STEP 4: SPECIFIC ASSESSMENT

Direct observations of Joey's performance in his classroom, especially during independent work times, preceded specification of targeted outcomes and the self-management process. Subsequent baseline sessions confirmed these initial observations. That is, Joey did not evidence improvement on the math task though he was correct on about half of the problems he completed. Additionally. when the adult who was to serve as the trainer corrected his work, he responded inappropriately (e.g., cried).

Joey had been taught previously to monitor his spontaneous verbal behavior. This prior successful training indicated that Joey could observe his own performance and record when a specified behavior occurred. Based on this observation, it was assumed that Joey could acquire additional self-reinforcement skills if the training procedures were designed appropriately.


STEP 5: TRAINING PROGRAM

As mentioned previously, the training of this self-reinforcement routine was patterned after procedures utilized in a prior group study with moderately retarded adolescents (see Litrownik & Steinfeld, 1982). The procedures included (a) breaking down the routine into its component skills, (b) providing demonstrations of these skills, (c) assessing performance of these skills, (d) providing additional demonstrations, prompts, and opportunities for rehearsal of these skills if a performance criterion was not met on assessments, and (e) moving to subsequent training steps only if criterion performance was attained on the targeted step.

The self-reinforcement routine described in the third step requires a number of component skills. The first monitoring skill includes observing completed problems on a page, discriminating between a completed and an uncompleted page, and self-recording by placing an apple-shaped sticker on the checksheet when the discriminative stimulus (S°L a completed page, was observed. A second monitoring skill that Joey was to perform required that he correct each problem completed (i.e., compare his answer to a standard and then place a C next to the problem if the two were the same--S°), count the number of correctly completed problems oll a page (Cs), and circle the number on the side of the page that matched his count.

The self-evaluation component included comparing the circled number to a standard (wavy line). If the circled number (correctly completed problems) was above the standard, Joey was to place a shamrock sticker on his checksheet. This component required that a standard be set and that a discrimination, circled number above versus below standard, be made with the circled number above serving as a S o for a positive evaluation (placing a shamrock sticker on the checksheet). Finally, Joey looked at his checksheet and took selected edibles for each shamrock sticker on his worksheet.

The training procedures that were developed focused on the acquisition of one or more of these component skills at each of four steps: (a) monitor completed pages, (b) monitor completed pages, correct completed problems, (c) monitor completed pages, correct completed problems, monitor correctly completed problems, evaluate performance based on a standard, and (d) add self-administered rewards to the other components.

Training procedures at each step followed the same general pattern (see Figure l). For example, at the third step, the entire sequence of skills was demonstrated twice by the trainer and then Joey was presented with completed worksheets for each of three individual assessment trials. If all components were performed correctly on each trial, training on the fourth step was begun. On the other hand, incorrect performance of any component on any of the assessment trials resulted in further training. This training consisted of demonstrations and practice with the trainer providing corrective prompts until two nonprompted trials were completed. Performance was then reassessed on three trials. Training progressed to the next step only if Joey correctly performed each component on all three of

194 A. J. Litrownik, K. White, E. T. Mcinnis, and B. G. Licht

FIGURE I. Criterion-Based Training Procedures

Step 1: Monitor Completed Worksheets

2 trials--trainer modeled correct component skills

Step 2:

Assess ~ If not correct 3 trials on all three

1 Monitor completed Worksheets, Correct Problems

Additional Training Demos, Rehearsal until 2 consecutive correct nonprompted trials

Demonstration 1

~ Assess ~ 3 trials •If not correCton all three • ] Additional Training

l Step 3:

<

Monitor Completed Worksheets, Correct Problems, Monitor Correct Problems, Evaluate Performance

Demonstration 1

i Assess ~ If not conrect I Additional Training

3 trials / on all three • I 1

Monitor Completed Worksheets, Correct Problems. Monitor Correct Problems, Evaluate Performance, Self-reward

Step 4:

I Demonstration 1

/ / if not co.ect on all four

Apply Acquired Skills

Additional Training

these assessment trials. Thus training at each step was criterion-based, with subsequent training given only following evidence that the prior skills had been acquired.


These 30 - to 40-minute training sessions were conducted in a mobile research laboratory. The 2 - m × 3 - m room contained a desk and two chairs. A one- way mirror located in the door allowed direct observation of these sessions by observers in an adjacent room.

STEP 6: EVALUATION

The final step requires that the training program be evaluated in terms of whether the targeted self-management skills were acquired, applied appropriately, and had the desired effect on targeted outcomes. In the present case example, an AB design with a partial withdrawal of the treatment was utilized to judge the effects of the program on math performance (output and accuracy). Although statements about the relationship between the intervention and performance are tenuous at best, given the lack of control for numerous alternative explanations, this design does indicate whether improvements were observed. The initial baseline and intervention sessions were conducted in the mobile lab where training also took place. During the last 9 sessions, Joey moved from the lab setting to his classroom with his regular teacher presenting the independent work session to him.

Before continuing to discuss the evaluation, it should be noted that Joey did reach criterion on the final training step. This was accomplished in less than 5 hours of training time (which included progression through the 4 steps two times, once with the math task and once with another academic task). In his subsequent performance, he correctly applied this routine to independent math work sessions on all but two occasions (some room for errors in self-correction and counting of Cs was made, +-- 1 the actual number correctly completed was considered correct self-monitoring).

Thus Joey not only acquired the self-management skills but also applied them appropriately during the independent work sessions. The routine required that Joey spend an additional 4 - 5 minutes interacting with the task material. He took responsibility for correcting his own work, not only allowing for additional exposure but also relieving the teacher of this responsibility. Additional opportunities for learning were provided, and it was observed that Joey no longer responded inappropriately to correction of his work. In fact, he appeared to enjoy it, often cheering himself with a "Good," "Right," and "Yeah" as he put a C next to a correctly completed problem. His adaptive responses to correction may have been a function of the focus on correct solutions and/or the shifting of control from others to Joey, but methodological limitations preclude making conclusive statements about functional relationships.

Similar caution must be exercised when looking at Joey's accuracy and output on the math task. Nevertheless, examination of Table 2 suggests that improvements in targeted outcomes followed introduction of the self-reinforcement run-

196 A. J. Litrownik, K. White. E. T. Mclnnis, and B. G. Licht

TABLE 2 Summary of Joey's Performance (Accuracy and Output Measure)

on the Math Task during Baseline, Self-reinforcement, and Partial Withdrawal Phases.

Baseline Self-rein forcemcnt Partial Withdrawal ( Self-reinforcement

( LabJ I Lab) in Classrc~om )

Sessions 21 25 9

Accuracy (Mean ~;~. 5 l C~ (~.1 ?~- 74~7, Correct)

Output (Mean Problems 9.5 13.0 12.2 Completed/Minute)

Output (Mean Problems Correctly Completed,' 4.8 8.7 9.1

Minute)

tine. In addition, these gains were maintained when the sessions were returned to the context of the classroom with the teacher monitoring Joey ' s performance.

C O N C L U S I O N S

In this case example, a developmentally disabled adolescent was taught to program his own behavior. This included acquisition of self-correcting skills as well as component skills required for application of a self-reinforcement routine.

A general 6-step process for designing self-management training programs was followed in this example. The process had previously been used to develop a training program which was applied to a group of moderately retarded adolescents (Litrownik & Steinfeld, 1982). In the present example, the objectives were more applied in nature; the previous application was incorporated in a series of theory-oriented studies. Regardless of the goals, applied and/or theoretical, specification of training objectives, procedures, and some evaluation are essen- tial. While the sophistication of the experimental design used to evaluate effects of self-management training can be varied, the training programs themselves must always be appropriate to the individual being trained, with targeted outcomes and self-management skills clearly defined and specified. The proposed 6-step process ,serves to direct such efforts.

R E F E R E N C E S

Guralnick, M. J. (1976). Solving complex discrimination problems: Techniques for the development of problem-solving strategies. American Journal of Mental Deficiem T, 81, 18 - 25.

Hayes, S. C., Rincover, A., & Solnick, J. V. (1980). The technical drift of applied behavior analysis. Journal of Applied Behavior Analysis, 13, 275- 285.


Helland, C. D., Paluck, R. J., & Klein, M. A. (1976). A comparison of self and external reinforcement with the trainable mentally retarded. Mental Retardation, 14 (5), 22-23.

Holman, J., & Baer, D. M. (1979). Facilitating generalization of on-task behavior through self- monitoring of academic tasks. Journal of Autism and Developmental Disorders, 9, 429-446.

Kurlz, D. D., & Neiswortho J. T. (1976). Self-control possibilities for exceptional children. Ex- ceptional Children, 42, 212-217.

Licht, B. G. (in press). Cognitive-motivational factors that contribute to the achievement of learning- disabled children. Journal of Learning Disabilities.

Litrownik, A. J. (1982). Special considerations in the self-management training of the developmentally disabled. In P. Karoly & F. H. Kanfer (Eds.). Self-management and behavior change: From theory to practice. New York: Pergamon.

Litrownik, A. J. (1984). Cognitive behavior modification with psychotic children: A beginning. In A. W. Meyers & W. E. Craighead (Eds.), Cognitive behavior therapy with children. New York: Plenum.

Litrownik. A. J. & Freitas, J. L. (1980). Self-monitoring in moderately retarded adolescents: Re- activity and accuracy as a function of valence. Behavior Therapy. II . 245-255.

Litrownik, A. J., Freitas, J. L., & Franzini, L. R. (1978). Self-regulation in retarded persons: As- sessment and training of self-monitoring skills. American Journal of Mental Deficiency, 82, 499- 506.

Litrownik, A. J., & Steinfeld, B. I. (1982). Developing self-regulation in retarded children. In P. Karoly & J. J. Steffen (Eds.L Advances in child behavior ana(vsis and therapy. (Vol. 1). Lexington: Heath.

Mahoney, M. J., & Mahoney, K. (1976). Self-control techniques with the mentally retarded. Ex- ceptional Children, 42, 338-339.

Nelson, R. O., Lipinski, D. P., & Black, J. LI (1976). The reactivity of adult retardates' self- monitoring: A comparison among behaviors of different valences, and a comparison with token reinforcement. Psychological Record, 26, 189-201.

O'Leary, S. G., & Dubey, D. R. (1979). Applications of self-control procedures by children: A review. Journal of Applied Behavior Analysis, 12, 449- 465.

Rosenbaum, M. S., & Drabman, R. S. (1979). Self-control training in the classroom: A review and critique. Journal of Applied Behavior Analysis, 12, 467-485.

Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349-367.

Wolf, M. M. (1978). Social validity: The case of subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, !1, 203-214.

Zegiob, L., Klukas, N., & Junginger, J. (1978). Reactivity of self-monitoring procedures with retarded adoleseents. American Journal of Mental Defic'iency, 83, 156-163.

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