Technology-Based Programs to Support Adaptive Responding and Reduce Hand Mouthing in Two Persons with Multiple Disabilities

  • Giulio E. LancioniEmail author
  • Mark F. O’Reilly
  • Nirbhay N. Singh
  • Jeff Sigafoos
  • Doretta Oliva
  • Gloria Alberti
  • Luigina Carrella
  • Robert Didden
  • Russell Lang


These two single-case studies assessed the use of microswitch clusters to support adaptive responses and reduce problem behavior with two adults with multiple disabilities. Study I involved a man whose adaptive responses consisted of touching color shapes appearing on a computer screen in front of him and the problem behavior was hand mouthing. Study II involved a woman whose adaptive response consisted of using a napkin to wipe her mouth to reduce drooling effects. Her problem behavior, like for the man, was hand mouthing. Initially, the intervention focused on the adaptive responses, which were followed by preferred stimulation. Then the intervention was extended so that the stimulation for the adaptive responses would be interrupted if the problem behavior appeared during its occurrence. The data of the two studies suggest that the intervention was effective in helping the participants engage in consistent rates of adaptive responses and curb their problem behavior. These findings were analyzed in relation to the characteristics of the intervention approach and its practical implications.


Technology-based programs Microswitch clusters Adaptive responses Problem behavior Hand mouthing Multiple disabilities 


  1. Barlow, D. H., Nock, M., & Hersen, M. (2009). Single-case experimental designs: Strategies for studying behavior change (3rd ed.). New York: Allyn & Bacon.Google Scholar
  2. Britton, L. N., Carr, J. E., Kellum, K. K., Dozier, C. L., & Well, T. M. (2000). A variation of noncontingent reinforcement in the treatment of aberrant behavior. Research in Developmental Disabilities, 21, 425–435.PubMedCrossRefGoogle Scholar
  3. Britton, L. N., Carr, J. E., Landaburu, H. J., & Romick, K. S. (2002). The efficacy of noncontingent reinforcement as treatment for automatically reinforced stereotypy. Behavioral Interventions, 17, 93–103.CrossRefGoogle Scholar
  4. Brosnan, J., & Healy, O. (2011). A review of behavioral interventions for the treatment of aggression in individuals with developmental disabilities. Research in Developmental Disabilities, 32, 437–446.PubMedCrossRefGoogle Scholar
  5. Callahan, K., Henson, R., & Cowan, A. K. (2008). Social validation of evidence-based practices in autism by parents, teachers, and administrators. Journal of Autism and Developmental Disorders, 38, 678–692.PubMedCrossRefGoogle Scholar
  6. Carr, J. E., Dozier, C. L., Patel, M. R., Adams, A. N., & Martin, N. (2002). Treatment of automatically reinforced object mouthing with noncontingent reinforcement and response blocking: Experimental analysis and social validation. Research in Developmental Disabilities, 23, 37–44.PubMedCrossRefGoogle Scholar
  7. Catania, A. C. (2007). Learning (4th Interim ed.). New York: Sloan.Google Scholar
  8. Ditterline, J., Banner, D., Oakland, T., & Becton, D. (2008). Adaptive behavior profiles of students with disabilities. Journal of Applied School Psychology, 24, 191–208.CrossRefGoogle Scholar
  9. Eldevik, S., Jahr, E., Eikeseth, S., Hastings, R., & Hughes, C. J. (2010). Cognitive and adaptive behavior outcomes of behavioral intervention for young children with intellectual disability. Behavior Modification, 34, 16–34.PubMedCrossRefGoogle Scholar
  10. Felce, D., Perry, J., Lowe, K., & Jones, E. (2011). The impact of autism or severe challenging behaviour on lifestyle outcome in community housing. Journal of Applied Research in Intellectual Disabilities, 24, 95–104.CrossRefGoogle Scholar
  11. Fernell, E., Hedvall, Å., Westerlund, J., Carlsson, L. H., Eriksson, M., Olsson, M. B., et al. (2011). Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Research in Developmental Disabilities, 32, 2092–2101.PubMedCrossRefGoogle Scholar
  12. Gerber, F., Baud, M. A., Giroud, M., & Galli Carminati, G. (2008). Quality of life of adults with pervasive developmental disorders and intellectual disabilities. Journal of Autism and Developmental Disorders, 38, 1654–1665.PubMedCrossRefGoogle Scholar
  13. Hanley, G. P. (2010). Toward effective and preferred programming: A case for the objective measurement of social validity with recipients of behavior-change programs. Behavior Analysis in Practice, 3, 13–21.PubMedGoogle Scholar
  14. Harries, J., Guscia, R., Nettelbeck, T., & Kirby, N. (2009). Impact of additional disabilities on adaptive behavior and support profiles for people with intellectual disabilities. American Journal on Intellectual and Developmental Disabilities, 114, 237–253.PubMedCrossRefGoogle Scholar
  15. Hassiotis, A., Canagasebey, A., Robotham, D., Marston, L., Romeo, R., & King, M. (2011). Applied behaviour analysis and standard treatment in intellectual disability: 2-year outcomes. The British Journal of Psychiatry, 198, 490–491.PubMedCrossRefGoogle Scholar
  16. Hayes, S., McGuire, B., O’Neill, M., Oliver, C., & Morrison, T. (2011). Low mood and challenging behaviour in people with severe and profound intellectual disabilities. Journal of Intellectual Disability Research, 55, 182–189.PubMedCrossRefGoogle Scholar
  17. Jennett, H., Jann, K., & Hagopian, L. P. (2011). Evaluation of response blocking and representation in a competing stimulus assessment. Journal of Applied Behavior Analysis, 44, 925–929.PubMedCrossRefGoogle Scholar
  18. Kates-McElrath, K., Agnew, M., Axelrod, S., & Bloh, C. L. (2007). Identification of behavioral function in public schools and a clarification of terms. Behavioral Interventions, 22, 47–56.CrossRefGoogle Scholar
  19. Kazdin, A. E. (2001). Behavior modification in applied settings (6th ed.). New York: Wadsworth.Google Scholar
  20. Lambrechts, G., & Maes, B. (2009). Analysis of staff reports on the frequency of challenging behaviour in people with severe or profound intellectual disabilities. Research in Developmental Disabilities, 30, 863–872.PubMedCrossRefGoogle Scholar
  21. Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., Baccani, S., et al. (2006). Microswitch clusters promote adaptive responses and reduce finger mouthing in a boy with multiple disabilities. Behavior Modification, 30, 892–900.PubMedCrossRefGoogle Scholar
  22. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., Pidala, S., et al. (2007a). Promoting adaptive foot movements and reducing hand mouthing and eye poking in a boy with multiple disabilities through microswitch technology. Cognitive Behaviour Therapy, 36, 85–90.CrossRefGoogle Scholar
  23. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., Severini, L., et al. (2007b). Microswitch technology to promote adaptive responses and reduce mouthing in two children with multiple disabilities. Journal of Visual Impairment and Blindness, 101, 628–636.Google Scholar
  24. Lancioni, G. E., Smaldone, A., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., et al. (2007c). Promoting adaptive hand responding and reducing face hiding in a woman with profound developmental disabilities using microswitch technology. Behavioural and Cognitive Psychotherapy, 35, 225–230.CrossRefGoogle Scholar
  25. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Didden, R., Oliva, D., et al. (2008a). A girl with multiple disabilities increases object manipulation and reduces hand mouthing through a microswitch-based program. Clinical Case Studies, 7, 238–249.CrossRefGoogle Scholar
  26. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Didden, R., Smaldone, A., et al. (2008b). Helping a man with multiple disabilities increase object-contact responses and reduce hand stereotypy via a microswitch cluster program. Journal of Intellectual and Developmental Disability, 33, 349–353.Google Scholar
  27. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., & Sigafoos, J. (2009a). An overview of behavioral strategies for reducing hand-related stereotypies of persons with severe to profound intellectual and multiple disabilities: 1995–2007. Research in Developmental Disabilities, 30, 20–43.CrossRefGoogle Scholar
  28. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Didden, R., & Oliva, D. (2009b). A technology-based stimulation program to reduce hand mouthing by an adolescent with multiple disabilities. Perceptual and Motor Skills, 109, 478–486.CrossRefGoogle Scholar
  29. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Didden, R., & Oliva, D. (2009c). Two boys with multiple disabilities increasing adaptive responding and curbing dystonic/spastic behavior via a microswitch-based program. Research in Developmental Disabilities, 30, 378–385.CrossRefGoogle Scholar
  30. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Alberti, G., Scigliuzzo, F., & Oliva, D. (2011a). Promoting mouth drying to reduce the effects of drooling in a woman with multiple disabilities: A new evaluation of microswitch-programme conditions. Developmental Neurorehabilitation, 14, 185–190.CrossRefGoogle Scholar
  31. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., & Sigafoos, J. (2011b). Assistive technology for behavioral interventions for persons with severe/profound multiple disabilities: A selective overview. European Journal of Behavior Analysis, 12, 7–26.Google Scholar
  32. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., Smaldone, A., et al. (2011c). Promoting mouth-drying responses to reduce drooling effects by persons with intellectual and multiple disabilities: A study of two cases. Research in Developmental Disabilities, 32, 477–482.CrossRefGoogle Scholar
  33. Lancioni, G. E., O’Reilly, M., Singh, N., Sigafoos, J., Oliva, D., Campodonico, F., et al. (2012a). Persons with multiple disabilities exercise adaptive head and hand-eye responses using technology-aided programs: Two single-case studies. Journal of Developmental and Physical Disabilities, 24, 415–426.CrossRefGoogle Scholar
  34. Lancioni, G. E., Sigafoos, J., O’Reilly, M. F., & Singh, N. N. (2012b). Assistive technology: Interventions for individuals with severe/profound and multiple disabilities. New York: Springer.Google Scholar
  35. Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Ricci, I., Buonocunto, F., et al. (2012c). Access to environmental stimulation via eyelid responses for persons with acquired brain injury and multiple disabilities: A new microswitch arrangement. Perceptual and Motor Skills, 114, 353–362.CrossRefGoogle Scholar
  36. Lanovaz, M. J., & Argumedes, M. (2010). Immediate and subsequent effects of differential reinforcement of other behavior and noncontingent matched stimulation on stereotypy. Behavioral Interventions, 25, 229–238.Google Scholar
  37. LeBlanc, L. A., Patel, M. R., & Carr, J. E. (2000). Recent advances in the assessment of aberrant behavior maintained by automatic reinforcement in individuals with developmental disabilities. Journal of Behavior Therapy and Experimental Psychiatry, 31, 137–154.PubMedCrossRefGoogle Scholar
  38. Leher, D. L., & Ott, D. (2009). Treatment outcomes for individuals with developmental disabilities and challenging behavior and psychiatric hospitalizations referred to an interdisciplinary clinic. Mental Health Aspects of Developmental Disabilities, 12, 23–28.Google Scholar
  39. Leung, G. P. K., Chan, C. C. H., Chung, R. C. K., & Pang, M. Y. C. (2011). Determinants of activity and participation in preschoolers with developmental delay. Research in Developmental Disabilities, 32, 289–296.PubMedCrossRefGoogle Scholar
  40. Lindberg, J. S., Iwata, B. A., Roscoe, E. M., Worsdell, A. S., & Hanley, G. P. (2003). Treatment efficacy of noncontingent reinforcement during brief and extended application. Journal of Applied Behavior Analysis, 36, 1–19.PubMedCrossRefGoogle Scholar
  41. McDonald, J. E., Wilder, D. A., & Dempsey, C. (2002). Brief functional analysis and treatment of eye poking. Behavioral Interventions, 17, 261–270.CrossRefGoogle Scholar
  42. McDougall, J., Evans, J., & Baldwin, P. (2010). The importance of self-determination to perceived quality of life for youth and young adults with chronic conditions and disabilities. Remedial and Special Education, 31, 252–260.CrossRefGoogle Scholar
  43. Moir, L. (2010). Evaluating the effectiveness of different environments on the learning of switching skills in children with severe and profound multiple disabilities. The British Journal of Occupational Therapy, 73, 446–456.CrossRefGoogle Scholar
  44. Myrbakk, E., & Von Tetzchner, S. (2008). The prevalence of behavior problems among people with intellectual disability living in community settings. Journal of Mental Health Research in Intellectual Disabilities, 1, 205–222.CrossRefGoogle Scholar
  45. Neidert, P. L., Dozier, C. L., Iwata, B. A., & Hafen, M. (2010). Behavior analysis in intellectual and developmental disabilities. Psychological Services, 7, 103–113.CrossRefGoogle Scholar
  46. Nota, L., Soresi, S., Ferrari, L., & Wehmeyer, M. L. (2011). A multivariate analysis of the self-determination of adolescents. Journal of Happiness Studies, 12, 245–266.CrossRefGoogle Scholar
  47. Oikawa, K., Derby, K. M., McLaughlin, T. F., & Fisher, W. W. (2011). Using functional analysis to assess alertness and seizures in a 24-year-old woman with intellectual disabilities: A case report. Journal of Developmental and Physical Disabilities, 23, 433–438.CrossRefGoogle Scholar
  48. Oliver, C., Hall, S., Hales, J., Murphy, G., & Watts, D. (1998). The treatment of severe self-injurious behavior by the systematic fading of restraints: Effects on self-injury, self-restraint, adaptive behavior, and behavioral correlates of affect. Research in Developmental Disabilities, 19, 143–165.PubMedCrossRefGoogle Scholar
  49. Oliver, C., Petty, J., Ruddick, L., & Bacarese-Hamilton, M. (2012). The association between repetitive, self-injurious and aggressive behavior in children with severe intellectual disability. Journal of Autism and Developmental Disorders, 42, 910–919.PubMedCrossRefGoogle Scholar
  50. Palmen, A., Didden, R., & Lang, R. (2012). A systematic review of behavioral intervention research on adaptive skill building in high-functioning young adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 6, 602–617.CrossRefGoogle Scholar
  51. Piazza, C. C., Adelinis, J. D., Hanley, G. P., Goh, H. L., & Delia, M. D. (2000). An evaluation of the effects of matched stimuli on behaviors maintained by automatic reinforcement. Journal of Applied Behavior Analysis, 33, 1–27.CrossRefGoogle Scholar
  52. Poon, K. K. (2012). Challenging behaviors among children with autism spectrum disorders and multiple disabilities attending special schools in Singapore. Research in Developmental Disabilities, 33, 578–582.PubMedCrossRefGoogle Scholar
  53. Poppes, P., van der Putten, A. J. J., & Vlaskamp, C. (2010). Frequency and severity of challenging behavior in people with profound intellectual and multiple disabilities. Research in Developmental Disabilities, 31, 1269–1275.PubMedCrossRefGoogle Scholar
  54. Scherer, M. J., Craddock, G., & Mackeogh, T. (2011). The relationship of personal factors and subjective well-being to the use of assistive technology devices. Disability and Rehabilitation, 33, 811–817.PubMedCrossRefGoogle Scholar
  55. Shillingsburg, M. A., Lomas, J. E., & Bradley, D. (2012). Treatment of vocal stereotypy in an analogue and classroom setting. Behavioral Interventions, 27, 151–163.CrossRefGoogle Scholar
  56. Vrijmoeth, C., Monbaliu, E., Lagast, E., & Prinzie, P. (2012). Behavioral problems in children with motor and intellectual disabilities: Prevalence and associations with maladaptive personality and marital relationship. Research in Developmental Disabilities, 33, 1027–1038.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Giulio E. Lancioni
    • 1
    Email author
  • Mark F. O’Reilly
    • 2
  • Nirbhay N. Singh
    • 3
  • Jeff Sigafoos
    • 4
  • Doretta Oliva
    • 5
  • Gloria Alberti
    • 5
  • Luigina Carrella
    • 5
  • Robert Didden
    • 6
  • Russell Lang
    • 7
  1. 1.Department of Neuroscience and Sense OrgansUniversity of BariBariItaly
  2. 2.Meadows Center for Preventing Educational RiskUniversity of TexasAustinUSA
  3. 3.American Health and Wellness InstituteRaleighUSA
  4. 4.Victoria University of WellingtonWellingtonNew Zealand
  5. 5.Lega F. D’Oro Research CenterOsimo and LesmoItaly
  6. 6.Radboud University NijmegenNijmegenThe Netherlands
  7. 7.Texas State UniversitySan MarcosUSA

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