Academic journal article British Journal of Occupational Therapy

Evaluating the Effectiveness of Different Environments on the Learning of Switching Skills in Children with Severe and Profound Multiple Disabilities

Academic journal article British Journal of Occupational Therapy

Evaluating the Effectiveness of Different Environments on the Learning of Switching Skills in Children with Severe and Profound Multiple Disabilities

Article excerpt


Individuals diagnosed with severe and profound multiple disabilities (SPMDs) have a profound intellectual disability combined with a significant or severe physical disability, and may have visual or hearing impairments (Vlaskamp et al 2003). Of the Australian population, 20% have a disability and 15% and 18% of these have profound and severe disabilities respectively (Australian Bureau of Statistics 2004).

Children with SPMDs are unable to engage in constructive activity and are rewarded less in their efforts to explore their world and manipulate toys; they are thereby frustrated by a lack of success and inability to contribute to positive roles in their daily contexts (Hutchinson 1994, Lancioni et al 2004) and, in turn, feel helpless and incompetent as their environment seems unresponsive (Langley 1990). The child fails to develop cause and effect skills and associated choice making, leading to passivity, dependency (Giangreco 1985, Langley 1990, Sullivan and Lewis 2000), apathy, lack of interest, learned helplessness (Hutchinson and Haggar 1991), frustration, boredom and challenging behaviours, and fails to reach his or her potential (Hutchinson 1994).

Children with SPMDs are thought to learn through contingent learning and employing their sensory system (Sullivan and Lewis 2000, Shull et al 2004). Contingent learning is 'an effect that is dependent on the operational activity of the individual, thereby providing consequences said to be reinforcing' (Bunning 1997a, p98), so that when the child performs a motor action it produces a response or sensory feedback. Systematic variation in contingency experience can promote the retention and generalisation of learning, therefore a variety of sensory stimulus responses within a multisensory environment (MSE) can be used to enhance learning and to maintain interest (Bunning 1997a, Sullivan and Lewis 2000). According to Sullivan and Lewis (2000, p38) 'responsivity, or the contingency level of the environment, seems to be one of the significant features of the child's early environment that facilitates attention and cognitive skills'.

Basic assistive technology, such as switches, helps to compensate for limited motor skills. A correctly selected switch enables independent activation, engagement, interaction and environment control (Sullivan and Lewis 2000). The literature provides some evidence that children with SPMDs can develop switching skills using contingency responses. Murphy (1984) reported that children with severe multiple disabilities learned to control a lever switch when a sensory reinforcement response was elicited. Daniels et al (1995) conducted a study in which children with severe and multiple disabilities responded with more frequent activation of the switch and attention to the stimulus when they activated the switch independently.

Switching is important for the child with SPMDs because it motivates exploration and stimulates attention, thereby facilitating the child's discovery of contingencies and environmental control, promoting empowerment and selfefficacy (Daniels et al 1995, Sullivan and Lewis 2000, Lancioni et al 2002). According to Sullivan and Lewis (2000, p35) 'switches can make the difference between learning to learn versus learning to be helpless, or the difference between learning that the environment can be acted on versus learning about frustration'. Additionally, these skills underpin developing higher level cognitive skills and communication (Giangreco 1985), providing longer-term access to voice communication devices, environmental control and computers.

A relatively unexplored method for teaching initial switching skills to children with SPMDs is the use of an interactive MSE. The most common features of MSEs are bubble tubes, effect projectors, fibreoptic tail lights and other musical, sound and light equipment. The room is separate from surrounding areas, thereby removing most external distractions, and provides a dark cocoon-like environment full of exciting sensory effects (Long and Haig 1992, Mount and Cavet 1995, Hirstwood and Smith 1996). …

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