Behavior Modification in Mental Retardation

The Education and Rehabilitation of the Mentally Retarded Adolescent and Adult

William Gardner

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138519329
• eBook ISBN: 9781351314503
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

In this important book, one of the most exciting and promising developments in clinical psychology-behavior modification is applied to the treatment of the mentally retarded, particularly those whose behavior poses difficult problems for institutions. Professor Gardner presents an easily intelligible yet detailed account of the concepts and practices of behavior modification and the underlying learning systems, with numerous clinical illustrations of applying specific techniques to various educational and rehabilitation problems. A thorough discussion of the inadequacies of the psychological evaluation systems normally used in education and rehabilitation is offered, along with an alternative behavior analysis approach that provides a method of translating evaluation data into treatment practices. In explaining behavior analysis, the author takes into account the limited behavioral repertoire of the retarded and environmental deficits. Individual chapters on respondent, operant, and observational learning, and a detailed discussion of a functional analysis approach to evaluation, are included. Proven behavior modification strategies are presented along with a review of related research and clinical studies. The book closes with a detailed description of a research program for the design and testing of sheltered workshop systems for the retarded and emotionally disturbed. The positive approach inherent in the belief that behavior is modifiable-even in the severely limited retarded-is in marked contrast to the pessimism of other systems of therapy, education, and training. Also, the author has concentrated throughout on making the book understandable to clinicians and students with no previous knowledge of behavior modification. Besides serving as a valuable handbook for all treatment personnel, the book can also be used as a basic text for various courses dealing with mental retardation.

PART ONE

Problems of Education and Rehabilitation of the Mentally Retarded Client

CHAPTER ONE

Introduction

With the intensive special education and rehabilitation programs provided in numerous communities, most mildly retarded adolescents and young adults are able to enter into a productive vocational life without undue difficulty. The percentage of such persons in any given community is more dependent upon social and economic conditions of the community than upon any pronounced personal deficiencies of the retarded. If sufficient work opportunities are available, most mildly retarded young adults have the basic occupational and personal-social characteristics to make them capable of at least a minimal degree of success in independent work and living without excessive assistance from community educational and rehabilitation resources. Additionally, many moderately and severely retarded persons are able to attain satisfactory adjustment in simple competitive and sheltered workshop environments. The number and quality of rehabilitation programs for this group are growing steadily.

There remain, however, a large number of retarded adolescents and adults with the general intellectual capabilities for educational, vocational, and social adjustment who do not gain satisfactory competitive or sheltered employment because they do not benefit sufficiently from educational and rehabilitation resources that are available. These individuals utilize an excessive amount of the efforts of educational and rehabilitation agencies and are typically viewed as “difficult rehabilitation” clients. These retardates are often viewed as having “limited feasibility” for vocational placement and are referred from one evaluation, counseling, social, or work adjustment or training program to another in the vague hope that someone or something will make a sufficiently suitable impression on the client to insure more satisfactory adjustment.

The factors identified as underlying the educational and rehabilitation failures of these retardates are viewed basically as personal in nature rather than being related primarily to negative social or economic conditions in the environment. Behavior problems, emotional disturbances, personality difficulties, poor social behaviors, poor motivation, erratic work behavior, and immaturity are all examples of the types of factors that are used to account for these failures. In numerous cases, the basic problems are viewed as emotional or personality ones and not as primary deficits in cognitive or learning factors.

Recent changes in legal, philosophic, and treatment concepts have included in this group of difficult rehabilitation clients a large number of moderately and severely retarded persons who previously had been viewed as possessing only limited and at best, unpredictable, vocational adjustment possibilities. Recent trends in rehabilitation programs present rehabilitation personnel with a multitude of new problems as efforts are being directed toward the more severely handicapped. Educational and rehabilitation personnel are confronted with numerous behavioral deficits in clients who respond only minimally to the typical treatment services provided. These services may include vocational and personal counseling, individual tutoring, social adjustment and vocational training programs, extended sheltered workshop placement, and the like. As a small percentage of the moderately and severely retarded does make a minimal adjustment in the simple competitive and/or sheltered employment and in general life adjustment, the rehabilitation agency is confronted with the problem of providing those effective and efficient programs which hold promise of contributing to the rehabilitation of much larger segments of these groups.

The efforts brought to bear on the problems of development, learning, and behavior adjustment which are presented by these retarded clients are varied and frequently ill-conceived and implemented. In too many instances the general conceptual and technological approaches used with the less difficult clients are categorically utilized with the more atypical difficult problems. The programs are aimed generally at creating a structured therapeutic work experience and are based on general psychodynamic and group dynamic conceptions of behavior development and change. Success is too infrequent and expenditures of personnel and program resources are typically excessive when viewed in terms of output.

Internal Causation Model

In dealing with the behavioral limitations of these clients, the total rehabilitation effort frequently assumes that the major deficits lie within the individual, with the result that the program focus is on modifying the internal causes. As suggested, such factors as emotional disturbance, mental retardation, minimal brain damage, personality problems, special learning disability, social immaturity, and poor motivation are viewed as the primary causes of the learning and work adjustment difficulty. Although it is recognized by educational and rehabilitation personnel that present environmental and social factors are of importance in behavior change, the major concepts providing direction to the rehabilitation effort are those denoting internal pathology. “He doesn’t have a desire to work,” “His attitude is generally poor,” “He wants to remain dependent,” “His passive-aggressive personality interferes with his handling stress satisfactorily,” “His self-concept is too poor for satisfactory inter-personal contacts,” are examples of these concepts. The program efforts are directed toward modifying these internal mental states or deficiencies—the “desire,” “dependency,” “personality,” “self-concept,”—in order to render possible more satisfactory personality adjustment to the demands or requirements of the world of work and social living. In cases involving central nervous system impairment, it is usually routine to view much of the impulsive, erratic, distractible behavior seen in many problem retarded clients as being a direct result of the damage and to adapt the program requirements to these presumably “irreversible” behaviors. Little effort is directed toward changing these behaviors to any great extent, although there is some evidence that these behaviors are subject to modification by psychological means.

A frequent consequence of the assumption that the major causes of behavioral inadequacies reside within some internal pathology or deviation is the position that treatment should be undertaken only by highly trained mental health specialists. Further, this treatment usually takes place in a special location such as an office or hospital away from the environment in which the behavioral difficulties occur. Parents, teachers, and others in the natural environment of the client are typically warned not to attempt to “treat” the client as they may serve to intensify his condition due to a lack of understanding of or sensitivity to the complex and often subtle factors which are presumed to underlie the overt symptomatic behavioral difficulties. The client is referred from the natural environment of home and school to the artificial one of the expert’s office or residential unit.

Six brief examples are presented to illustrate this general conceptual orientation. These examples will demonstrate how assumptions concerning behavior functioning influence program decisions by educational and rehabilitation personnel. Each of these cases subsequently was provided a program based on a behavior modification orientation. Aspects of these programs will be presented later in the chapter and at appropriate places throughout the book.

Case 1. John is an eighteen-year-old male attending a social adjustment work training program. He is functioning within a borderline range of intelligence, had been previously hospitalized as a simple schizophrenic, and had been dismissed from a work training program of a sheltered workshop because of disruptive outburst and generally poor progress. In the social adjustment program he is described as displaying little interest in the program, of engaging in frequent disruptive “silly” talk, and of leaving classes frequently without permission. In his workshop training, attention is poor, persistence minimal, and rate of task completion low. The staff views his poor behavior and minimal progress as being manifestations of his “schizophrenia” and are fearful that program demands which require consistent active participation would be too stressful and would involve the possibility of precipitating an additional hospitalization. In short, in view of the internal causation assumptions, the staff is somewhat helpless because the client is not responding to the free “therapeutic” environment nor to the group program provided all clients in the program.

Case 2. Barnard is a seventeen-year-old mildly retarded male who is presently attending a secondary special education program. He is highly disruptive in class, often refusing to comply with teacher requests. He cries when confronted with demands, falls out of his chair in “fainting like” spells without warning, is afraid of loud noises, and exhibits shouting episodes when frustrated. During these episodes he may throw chairs and desks or physically attack his peers or teacher. After these episodes, he verbalizes guilt and apologizes for his “bad behavior.” He has been diagnosed as being emotionally disturbed and has been provided a series of psychotherapy sessions without noticeable effect. The teacher is fearful of requiring him to adhere to the program activities because “I might contribute to his emotional disturbance.” Because she is not a “mental health expert” and thus does not feel that she can treat emotional disturbance and because the mental health experts were unable to modify the emotional disturbance, the teacher has no specific plan for dealing with the problems presented other than to send him to the principal’s office or to send him home whenever he becomes unmanageable in the classroom.

Case 3. Sally is a moderately retarded twenty-year-old who has been placed in a sheltered workshop on a trial basis. She displays little interest in her work or social environment and is viewed as having limited motivation. She displays some seizure activity which medical authorities describe as being related to her diagnosed central nervous system damage. It is noted that when urged to conform to the workshop routine and to produce at a rate commensurate with that of her peers, she is prone to seizure activity. Observation by workshop personnel suggests that some of the seizures are fake but they do not know how to deal with the problems. The low motivation and general low frustration tolerance are viewed as being related to her brain damage and emotional immaturity. The workshop “rehabilitation” program is designed to teach work behaviors, and because the client will not work, no specific plans are available to treat her work-related deficits.

Case 4. David, a twenty-two-year-old moderately retarded male, attends a social development and work adjustment program. He displays only minimal and erratic interest in aspects of the program. Program personnel report that they have “tried everything” to motivate him but with no effect. As a result, he is viewed as “not feasible due to his low motivation” and is being considered for termination. The motivational deficit or lethargy resides within him, it is assumed, and this internal deficit is viewed as the reason for his poor performance.

Case 5. Paul, a twenty-five-year-old adult who resides in a residential facility, spends most of his waking hours sitting or lying on the floor engaged in a complex variety of stereotyped behaviors. Efforts to get him involved in social and work behaviors have not produced results. He is viewed as a severely retarded, chronic stereotyper, with psychotic-like behavior patterns, and “not feasible for further rehabilitation efforts” due to these internal limitations.

Case 6. Bill, a nineteen-year-old and mildly retarded is an active client of a vocational rehabilitation program. He has attended a special education program for a number of years, has spent a few months in a residential setting for his delinquent behavior, and displays little interest in schoollike matters. He was described as being impulsive, socially difficult, and easily influenced by others in engaging in undesirable behavior. The vocational counselor reported that he displayed poor judgment in social situations, had difficulty maintaining acceptable work behavior, demonstrated only limited persistence at a task, and had limited work or achievement motivation. He frequently became aggressive and refused to cooperate in his training program. Because he was unable to read even simple instructions, he was referred for education and psychological evaluation as a basis for development of a remedial reading experience. The counselor viewed the illiteracy as a distinct vocational handicap. In view of the fact that he had been unable to develop reading skills during years of special education class attendance and considering his high anxiety response to educational testing, it was recommended that “a reading program be postponed until after psychotherapy has reduced the high anxiety and general emotional blocking” that is present. It was assumed that the illiteracy is caused by emotional factors and that these must be dealt with prior to the initiation of a reading program.

Behavior Modification Model

While such a psychodynamic or internal causation treatment or rehabilitation orientation may prove valuable in some cases, it may not be as effective and efficient as other educational and rehabilitation approaches in dealing with severe learning and behavioral difficulties presented by mentally retarded adolescents and adults. Alternatives to this internal causation approach should be developed and evaluated if education and rehabilitation programs are to meet the challenge of the difficult mentally retarded client. The orientation presented in this book represents one such alternative. This orientation has a primary behavior focus. It studies the person’s behavior as it is observed to occur under defined environmental conditions. It is in agreement with the emphasis of Tharp and Wetzel (1969) that:

… the most effective point of intervention with the individual displaying behavioral disturbances is most likely the disturbing environment rather than the disturbing set of internal conditions [p. 11].

The major conceptual system for behavior development and change is that of learning theory, although other principles of behavior development and change which have evolved out of the behavioral sciences are utilized. The major concepts are based on well established relationships which indicate that much behavior is influenced by the changes which the behavior produces in the environment. Behavior that produces positive consequences or removes or decreases the intensity of unpleasant ones is strengthened. It is more likely to occur under similar circumstances in the future. If the relationship between the behavior and the consequence is a reliable one, the consequence may be said to be contingent upon the behavior. The consequences come to control the occurrence or nonoccurrence of the related behavior in a given environment or situation on the basis of the likelihood that the behavior will produce the consequence. The retarded adolescent learns to complete his reading assignment as this results in his being permitted to participate in recreational activities in the gymnasium. An in-completed assignment results in his remaining in the classroom. Completion of assignment becomes a strong behavior as it produces a positive consequence. The positive consequence is not forthcoming if the assignment is not completed. Behavior that results in consequences that are unpleasant or aversive, under usual circumstances, is less likely to occur for a period of time in the future. A frown from the teacher, threats from the boss, or a ticket from a traffic monitor will typically render the behavior that preceded these unpleasant events less likely to occur under similar circumstances in the future. This relationship, as the examples suggest, includes presentation of unpleasant events, a frown, as well as removal of desirable events, a fine of $10 for traffic violation. In general terms both are viewed as punishment and exert a similar effect—that of decreasing the likelihood of the behavior which produced these unpleasant consequences. These and many other specific relationships between behavior and environmental characteristics or events form the basis for a technology of behavior change. These principles tell us what we must do if we wish to influence behavior in a certain manner. These principles also provide some basis for estimating the amount of change that can be expected within a given period of time. A behavior pattern, for example, that has been followed by a desirable consequence on numerous occasions typically will be more difficult to eliminate than behavior that has just begun to produce a favorable consequence. At the same time, behavior that has resulted in a highly preferred consequence on only a few recent occasions may be stronger than behavior that has resulted in a low preference consequence on numerous previous occasions. These examples illustrate both the simplicity and the complexity of the concepts which are available.

The general application of these learning and related concepts to problems of human functioning is that of behavior therapy, or more general, behavior modification. Behavior, regardless of its kind or intensity, is viewed as being at least partially a result of learning processes. The role of abnormal physical, sensory and neurological factors in deviant or problem behavior is recognized. Whenever possible these factors should be corrected in order to insure a normal basis for behavior development. Little behavior, however, is directly related to and completely determined or controlled by physical factors. In the absence of suitable evidence to the contrary, most learning and behavior problems are assumed to be determined or at least influenced by learning variables. This orientation provides the rehabilitation personnel with a viable position which encourages an active treatment involvement. Again, behavior is viewed as the result of learning experiences. Principles of behavior development and function are used to account for behavioral inadequacies in the same manner as these principles are viewed as being involved in the development of appropriate socially desirable behaviors. Behavior is not viewed as being symptomatic of underlying psychic difficulties but as resulting from a history of an individual interacting with an environment. Thus the treatment of behavior patterns which have been termed neurotic, disruptive, behavior disorders, personality problems, emotional disturbances, and the like is viewed as involving the same general set of factors as would be involved in the task of increasing the work rate, reading skill, social graces, or achievement motivation of the same person. Therefore behavior development, maintenance, or modification, whether it be “neurotic” behavior or, for example, reading behavior, is viewed as being related to a common set of variables. Various behavior patterns do indeed involve different combinations of these basic factors but it is assumed that the same general set of factors is involved in each.

One aspect of the behavior modification approach which recommends it to those interested in developing a positive rehabilitation environment is that specific procedures which can be followed to modify behavior can be derived from the behavior model. Although there is no magical assurance that the derived procedures will in fact have the desired effect, the rehabilitation specialist can draw on considerable experimental data and on the clinical experiences of others to provide some comfortable support for what he has devised. Additionally, he has a method for evaluating the effectiveness of his procedures and for changing to an alternative treatment strategy. These characteristics of the behavior modification model render it a great deal more valuable than does a similar adherence to other systems of behavior change such as those associated with, for example, psychoanalytic, client-centered, need-centered, or ego-centered models.

An example will illustrate the position that problem behaviors are not merely symptoms of some underlying pathology or deficit which must be dealt with in order to influence the problem behaviors. Also, the example demonstrates that the behavior approach provides direction as to what behavior change procedures might be utilized in given instances. In a recent project, the disruptive and bizarre behaviors of six young adult retardates were studied in an effort to identify factors which could exert control over the behaviors. Presently attending a basic social and work development program, all had been excluded from sheltered work programs because they failed to follow directions, worked very slowly if at all, attended little to the quality of their work, and engaged frequently in disruptive behaviors. In...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Preface
• Part I Problems of Education and Rehabilitation of the Mentally Retarded Client
• Part II Behavior Modification: Concepts and Principles
• Part III Psychological Evaluation of the Mentally Retarded Client
• Part IV Methods of Producing Behavior Change
• References
• Index