خودمدیریتی نشانه های آموزش برای شغل: بررسی مطالعات با افراد معلول رشدی شدید و عمیق

Helping people with severe and profound developmental disabilities acquire and maintain constructive occupation is an objective of great practical importance. During the last 15–20 years, studies directed at this goal have largely relied on five strategies of self-management of instruction cues. Those strategies consist of the use of (1) picture cues presented on sets of cards, (2) picture cues stored in computer-aided systems, (3) object cues attached to cards, (4) verbal cues stored in audio recording devices, and (5) self-verbalizations. This paper reviews the aforementioned strategies and discusses their overall effectiveness and their suitability (practicality). The paper also points out some relevant issues for future research.

Developing strategies to help people with developmental disabilities acquire and maintain constructive occupation with minimal staff supervision has been an objective of great interest for many years Ackerman and Shapiro 1984, Anderson et al 1997, Connis 1979, Lancioni and Oliva 1988, Simmons and Flexer 1992 and Wacker and Berg 1983. Constructive occupation is considered to be important for promoting a number of valuable outcomes including: an increase in adaptive responding and physical exercise, a reduction in deviant behaviors, an improvement in general appearance and social status, and a successful preparation toward forms of domestic and community-related jobs Beyer et al 1995, Brown and Chamove 1993, Conley et al 1989, Duker et al 1989, Huang and Cuvo 1997, Lancioni and O’Reilly 1998, Martin et al 1988, Morgan et al 1995 and Rapley and Beyer 1996. During the last 15–20 years, the literature on establishing constructive occupation in people with developmental disabilities has largely relied on five strategies of self-management of instruction cues. Those strategies consist of the use of (1) picture cues presented on sets of cards, (2) picture cues stored in computer-aided systems, (3) object cues attached to sets of cards, (4) verbal cues stored in audio recording devices, and (5) self-verbalizations Berg and Wacker 1989, Ferretti et al 1993, Harchik et al 1992, Hughes and Agran 1993, Johnson and Miltenberger 1996, Lancioni et al 1998, Martin et al 1988, Steed and Lutzker 1999 and Wacker et al 1985. This paper is an attempt to review the application of the aforementioned strategies for people with severe and profound developmental disabilities. The reason for targeting these people is that they are known to have very serious difficulties achieving independent (or partially independent) occupation and apparently need, more than other individuals, the support of special strategies to approach such an objective Engelman et al 1999, Harchik et al 1992, Lancioni et al 1998, Montgomery et al 1996, Nailos et al 1994, Pettipher and Mansell 1993 and Spence and Whitman 1990. The first aim of the paper is to provide the reader with a general picture of the studies conducted with the various strategies. A second aim is to discuss (a) the effectiveness of the strategies for training, maintenance and generalization purposes, (b) the suitability (practicality) of the strategies, and (c) the possibility/desirability of withdrawing these strategies after the establishment of constructive occupation. Finally, the paper also points out some relevant issues for future research (e.g., adjusting the strategies as the persons’ engagement skills improve and assessing the persons’ and staff’s attitudes toward the strategies). The studies included in the review were identified through a computerized search of PSYCLIT, ERIC, and MEDLINE EXPRESS databases for journal articles from 1983 to 1999. A hand search was also conducted. Only studies that used the aforementioned strategies for establishing/supporting specific multistep tasks or the performance of activity schedules (i.e., sequences of familiar activities and simple tasks) were included in the paper. For example, studies that employed self-verbalizations to solve problem situations interfering with task performance were not included (e.g., Agran et al 1987, Hughes 1992, Hughes et al 1996 and Hughes and Rusch 1989). In Table 1we provide lists of studies reviewed which were divided according to the strategies employed (i.e., use of picture cues presented on cards, use of picture cues stored in computer-aided systems, use of object cues, use of verbal cues stored in recording devices, and self-verbalizations). The number of participants with severe or profound developmental disabilities, the participants’ age, the number of steps included in the tasks or the number of activities involved in the schedules, the findings for the training phase, and for the maintenance and generalization phases (if available), and the outcome of any momentary or permanent withdrawal of the instruction cues are reported by study. Table 1. Characteristics of the studies reviewed and Strategy/study No. ps. Age (years) No. steps/activities Training Mainten. Generaliz. T-A/S∗ Withdr. Ia. Picture cues on cards (tasks) Wacker & Berg (1983) 3 18–19 18–30 Positive Positive Mixed T Positive Wacker & Berg (1984) 1 19 18, 20 Positive — Positive T Negative Wacker et al. (1985) 3 13–19 12–22 Positive Mixed Positive S Mixed T Mixed Wilson et al. (1987) 1 36 — Positive Positive — Positive Giere et al. (1989) 3 19–21 — Positive — Mixed T — Thierman & Martin (1989) 4 22–39 — Mixeda Mixed — — Agran et al. (1992) 1 16 15 Mixeda — — — Pierce & Schreibman (1994) 1 8 — Positive Positive Positive S Mixed Singh et al. (1995) 3 44–49 16 Positive Positive Positive S — Steed & Lutzker (1997) 1 40 — Positive Positive Positive T Negative Lancioni et al. (1998) 3 20–36 18–32 Mixeda Mixed — — Lancioni, Van den Hof, et al. (1999a) 4 18–23 25–31 Mixeda Mixed — — Ib. Picture cues on cards (activity schedules) Sowers et al. (1985) 1 ±20 7 Positive Positive Positive A — Lancioni & Oliva (1988) 2 13,16 14 Mixeda Negative — — Lancioni et al. (1989) 3 14–17 12 Mixeda Mixed — — Irvine et al. (1992) 1 18 4,5 Positive Positive — — Krantz et al. (1993) 3 6–8 — Positive Positive — — Lancioni, Brouwer, et al. (1993) 1 35 6–10 Positive Positive — — MacDuff et al. (1993) 1 11 6 Positive Positive Positive A — Anderson et al. (1997) 2 21, 37 3–5 Positive — — — II. Picture cues stored in computer-aided systems Lancioni & Oliva (1988) 2 13, 16 14–22 Positivea–b Positiveb — — Lancioni et al. (1988) 2 7, 17 10–15 Positive Positive Positive A Positive S Mixed Lancioni et al. (1989) 3 14–17 12–28 Positivea–b Mixedb — — Lancioni, Oliva, et al. (1993) 1 20 10–18 Positive Positive — — Lancioni et al. (1998) 3 20–36 18–32 Mixeda–b Mixedb — — Lancioni, Van den Hof, et al. (1999) 4 18–23 25–31 Mixeda-b Mixedb — — Lancioni, O’Reilly, et al. (1999) 4 19–39 25–31 Mixeda Positive — Mixed III. Object cues Taylor (1987) 1 21 — Positive Positive — — Berg & Wacker (1989) 1 19 5 Positive Positive Positive S Mixed T Negative IV. Verbal cues stored in recording devices Alberto et al. (1986) 1 12 29, 52 Positive Positive — Positive Briggs et al. (1990 2 ±16 10–25 Positive Positive Negative T Negative S — Steed & Lutzker (1999) 1 37 — Positive Positive Positive T Mixed V. Self-verbalizations Moore et al. (1989) 4 19–21 — Positivec Positive — — Salend et al. (1989) 4 25–36 5 Positive Positive — — Agran et al. (1992) 1 16 15 Negativea — — — legend Note. ∗ T, A, and S stand for Tasks, Activities and Settings, respectively. a The length of the training was confined and/or yoked across strategies. b Overall levels of responding were higher with picture cues stored in computer-aided systems than with picture cues on cards. c Experimenter interventions may have been more powerful than self-verbalizations. legend — = Not available. Table options The findings for training, maintenance and generalization phases and for momentary or permanent withdrawal of the instruction cues were classified as positive, negative, and mixed. Positive findings mean that there was a satisfactory level of independent (correct) performance for all study participants. In many studies, this level amounted to performing independently of staff (experimenter) intervention and correctly 80% or more of the responses (task steps or activities) related to the instruction cues (e.g., Briggs et al 1990, Pierce and Schreibman 1994, Steed and Lutzker 1997 and Wacker and Berg 1983). In other studies, the satisfactory level was approximately a twofold increase of the response/engagement rate over the baseline level or an average of one response every 2 min against a zero baseline level (e.g., Anderson et al 1997, Krantz et al 1993, Lancioni and Oliva 1988 and Salend et al 1989). Negative findings mean that participants performed correctly and independently less than 35% of the responses related to the instruction cues or had a minimal improvement in the response/engagement rate compared to the baseline levels. Finally, mixed findings mean that performance data (a) reached satisfactory levels but not for all participants/situations or (b) were below satisfactory levels but remained mostly above failure values.

During the last 15–20 years, the literature on developing constructive occupation with people with severe and profound developmental disabilities has largely relied on five strategies of self-management of instruction cues. The strategies have consisted of the use of (1) picture cues presented on sets of cards, (2) picture cues stored in computer-aided systems, (3) object cues arranged on series of cards, (4) verbal cues stored in audio recording devices, and (5) self-verbalizations. The overall picture emerging from the studies reviewed may appear fairly encouraging as to the possibility of achieving independent occupation with these people. Nonetheless, several technical and social issues are still open to investigation and an answer to these issues may be essential to define more practical and satisfactory solutions for helping these people. Of the issues that need investigation, four could be pointed out here. For example, one issue may concern the aforementioned possibility of adjusting self-management strategies to performance mastery. Rather than continuing with cues used individually, one could group the cues in small clusters. A single instruction would therefore represent a series of steps or activities allowing the person a longer period of autonomous engagement. To date some work has been conducted to test whether picture cues stored in computer-aided systems could be presented in groups after the acquisition phase. Such grouping allows the persons to maintain a high level of correct performance and, at the same time, to have longer periods of instruction-free engagement (Lancioni, O’Reilly, et al., 1999). This preliminary work should be replicated and possibly extended to other strategies. For example, one could envisage a situation in which a walkman presents the verbal instructions for a task in groups of two (i.e., for two steps at a time) rather than individually. Similarly, cards could be made to include two picture cues rather than one. A second issue for investigation could be the comparative evaluation of some of the self-management strategies so as to (a) generate more knowledge about the relative strengths and weaknesses of those strategies in specific contexts and with specific persons, and thus (b) create a solid basis for providing recommendations and making predictions. So far most of the research efforts have been directed at comparing the use of picture cues presented on cards with the use of picture cues stored in computer-aided systems (e.g., Lancioni and Oliva 1988 and Lancioni et al 1998). Comparisons of picture cues presented on cards or stored in computer systems with verbal cues stored in recording devices or combinations of verbal and picture cues would also be relevant Agran et al 1992, Lancioni et al 1995, Mechling and Gast 1997 and Nailos et al 1994. A third issue for investigation could concern the assessment of staff and client attitudes toward different strategies Baer and Schwartz 1991, Christian and Poling 1997, Kern et al 1998 and Mechling and Gast 1997. For example, some staff may consider the use of self-verbalizations a preferable strategy because it does not require the clients to depend on external cues and allows them to appear more in charge of the situation and more autonomous Gow and Ward 1985 and Hughes and Agran 1993. Other staff may find the use of self-verbalizations a difficult and time consuming strategy and (in case of very poor language skills) a relatively artificial approach, which might damage more than help the clients’ social image Ferretti et al 1993, Johnson and Miltenberger 1996 and Storey and Provost 1996. Similarly, the clients may have specific preferences themselves, and these preferences may be correlated with the friendliness and efficacy of the strategies Kern et al 1998 and Lancioni et al 1999a. A fourth issue for investigation could consist of evaluating new solutions for pictorial and verbal cues. With regard to the pictorial cues, some debate has occurred in the past as to the best way to increase the similarity between the cues and the represented objects and thus facilitate responding Gow and Ward 1984 and Lignugaris/Kraft et al 1988. Yet, there is no clear direction as to how to represent single steps in complex tasks. The use of many details or of “isometric projection exploded view assembly drawings” may confuse the participants or lead them to overselective responding Fisher 1984, Lignugaris/Kraft et al 1988 and Martin et al 1990 whereas the oversimplification of the drawing may fail to provide clear information about the specific step to be performed. Perhaps, animated representations, through the use of video clips, could be a solution in these cases Le Grice and Blampied 1994 and Le Grice and Blampied 1997. With regard to verbal cues, virtually no data exist as to the best way of constructing the instruction sentences. Yet, the length and structure of the sentences may constitute critical aspects for determining discrimination and understanding and thus deciding a person’s success or failure Briggs et al 1990, Lancioni et al 1995, Mechling and Gast 1997 and Trask-Tyler et al 1994.