اثرات آموزش آرام سازی پیشرونده بر رفتار مخرب یک پسر مبتلا به اوتیسم

This study examined the effects of progressive relaxation training on the disruptive behaviors of a boy with autism. Moreover, his overt relaxed behaviors before and after relaxation training were measured using the Behavioral Relaxation Scale Poppen 1988 and Poppen 1998. After the participant received training in progressive relaxation procedures a multielement design with three conditions was utilized to determine the effects of the procedures on the duration of the boy’s disruptive behaviors during leisure activity sessions. The conditions were: (a) relaxation prior to a leisure activity session; (b) cued relaxation; and (c) no relaxation prior to the session, which represented a baseline condition. Results indicated that the participant acquired progressive relaxation skills, displayed more relaxed behaviors after performing the procedures, and showed a decrease in the duration of his disruptive behaviors upon completing progressive relaxation training prior to a leisure activity session. Implications for future research are discussed.

1.1. The effects of progressive relaxation training on the disruptive behavior of a boy with autism Since pioneered by Edmund Jacobson (1938), progressive relaxation procedures have benefited many individuals without disabilities. Although not as widely researched, progressive relaxation also has been shown to benefit individuals with autism and other developmental disabilities Calamari et al 1987, Harvey et al 1978, Lindsay et al 1989, Lindsay et al 1994, McPhail and Chamove 1989 and To and Chan 2000. Of particular interest has been the use of progressive relaxation as a behavior reduction strategy for individuals with developmental disabilities. McPhail and Chamove (1989), for example, found that progressive relaxation procedures were more effective in reducing the disruptive behavior of adults with developmental disabilities than was the control condition of reading individuals a story and asking them to sit quietly. The physical state of relaxation was not measured, however, to determine whether the degree of relaxation differed between groups. Disruptive behavior, therefore, might have decreased because the relaxation procedure functioned as a replacement behavior rather than because the individuals achieved a deeper state of relaxation. More recently, To and Chan (2000) evaluated the effects of relaxation training on the aggressive behaviors of 10 individuals residing in a mental hospital using a pre and posttest design. Findings indicated that the frequency of some aggressive behaviors decreased by 14.7% after the relaxation training; however, the results were not statistically significant. Based on these findings, it was suggested that future research include the use of prompting to facilitate acquisition of relaxation skills, and that the variables maintaining aggressive behavior be identified to determine whether relaxation procedures are an appropriate component of an intervention plan. As part of a multi-component treatment package, Harvey and colleagues (1978) combined relaxation training with timeout and reinforcement for positive, appropriate self-statements to reduce the frequency of violent temper outbursts displayed by a woman with moderate mental retardation. Results indicated that relaxation effectively reduced the problem behavior. Conclusions about the effects of relaxation alone could not be made, however, because components of the treatment package were not analyzed separately. Additionally, progressive relaxation procedures have been found to be very successful in reducing autistic and stereotypic behaviors that are seemingly coupled with the stress and anxiety experienced by individuals who do not possess effective coping skills Borkovec and Sides 1978 and Groden et al 1994. In fact, when a physiological stress response is a component of a behavioral or physical problem, it is hypothesized that progressive relaxation procedures will successfully reduce those behaviors. Caution must be taken, however, before concluding that a behavior is caused by stress or anxiety simply because it decreases when relaxation training is implemented. Identification of the environmental stressors that trigger the behavior, evidence that relaxation training is effective in the presence of these stressors, and that hypothesized biological mechanisms are altered following relaxation training are necessary to support this claim. Physiological measures of relaxation, such as the EMG, have been used with individuals with disabilities to determine the effects of progressive muscle relaxation. Fejes and Prieto (1987), for example, reported that progressive relaxation training resulted in reduced EMG levels for a child with hyperkinesis and mental retardation. Of concern, however, is that although the EMG device was hidden from the child, he tore off the electrodes during the baseline phase. Consideration must be given then to the intrusiveness of such measures with individuals with autism or other developmental disabilities. Although research indicates that progressive relaxation has contributed to reductions in disruptive behaviors and a variety of other problems Armstrong et al 1988, Calamari et al 1987, Harvey et al 1978, LaGrone et al 1988, McPhail and Chamove 1989 and To and Chan 2000, researchers often have failed to analyze whether relaxation actually was achieved. This lack of relaxation measurement in research has been criticized repeatedly Borkovec and Sides 1978, Luiselli et al 1979 and Luiselli et al 1982. Since progressive relaxation training is intended to decrease overall muscle tension and activity, it is necessary to measure overt relaxed behaviors and covert visceral response (i.e., “relaxed state”). Without such a measure, it is impossible to functionally define how to achieve muscle relaxation. To address this criticism, a variety of measurement systems and devices have been used to determine whether a relaxed state was achieved after a participant performed progressive relaxation procedures, including the Behavior Relaxation Scale (BRS) Poppen 1988 and Poppen 1998. The BRS is a valid indicator of relaxation as evidenced by a positive correlation between BRS scores, electromyograph (EMG) recordings, and self-report measures Norton et al 1997 and Poppen and Maurer 1982. In addition to being validated and used with the general population, the BRS also has been used to measure the overt relaxed postures of individuals with developmental disabilities in response to Behavioral Relaxation Training (BRT) and other relaxation procedures (see Poppen, 1998 for a review). Lundervold (1986), for example, demonstrated that BRT was effective in teaching relaxation skills to a woman with mild mental retardation and that the BRS was an effective assessment tool. Lindsay and his colleagues (Lindsay, 1989) also used the BRS while investigating the effects of BRT compared with progressive relaxation training with individuals and groups of individuals with mental retardation. Their findings indicated that a modified BRS was effective in measuring relaxed postures for both BRT and progressive relaxation. These studies indicate that validated behavioral rating scales, such as the BRS, are acceptable alternative measures of relaxation for individuals with developmental disabilities. The purpose of the present study was to investigate the effects of progressive relaxation on the disruptive behavior of a child with autism. Moreover, the child’s overt relaxed behaviors before and after relaxation training were measured using the BRS to determine whether relaxation was actually being achieved. By employing a single-case experimental design and selecting a direct measure of the child’s ongoing behavior, this study represents an extension of and improvement upon other evaluations of the effects of progressive relaxation training with individuals with autism and other developmental disabilities. This study represents an important step in exploring the therapeutic benefits of progressive relaxation training with individuals with autism and other developmental disabilities because it answers the questions, “Can individuals with autism and other developmental disabilities acquire and use progressive relaxation skills?” and “Can progressive relaxation decrease the disruptive behavior of children with autism?” Moreover, this study extends the research by exploring the sensitivity of the BRS in assessing the effects of progressive muscle relaxation training for a child with autism.