Investigative teams from the fields of behavior analysis and physical activity/nutrition collaborated on a 10-year program of discovery and research to identify effective approaches to weight loss and maintenance by individuals with intellectual and developmental disabilities. Three phases are reported: (a) initial observations of dietary intake in a small sample of group-home residents, (b) a single-arm evaluation of a packaged-meal diet, and (c) a controlled clinical trial comparing the packaged meals with a conventional reduced-energy diet with an extended weight-maintenance phase. Conclusions regarding practical applications and recommendations for future research are provided.

BACKGROUND:The prevalence of obesity among individuals with intellectual and developmental disabilities (IDD) is equal to or greater than the general population.METHODS:Overweight/obese adults (BMI ≥25 kg/m2 ) with mild-to-moderate intellectual and developmental disabilities were randomized to an enhanced stop light diet (eSLD = SLD + portion-controlled meals, n = 78) or a conventional diet (CD, n = 72) for an 18 months trial (6 months weight loss, 12 months maintenance). Participants were asked to increase physical activity (150 min/week), self-monitor diet and physical activity and attend counselling/educational sessions during monthly home visits.RESULTS:Weight loss (6 months) was significantly greater in the eSLD (-7.0% ± 5.0%) compared with the CD group (-3.8% ± 5.1%, p < .001). However, at 18 months, weight loss between groups did not differ significantly (eSLD = -6.7% ± 8.3%; CD = 6.4% ± 8.6%; p = .82).CONCLUSION:The eSLD and CD provided clinically meaningful weight loss over 18 months in adults with intellectual and developmental disabilities.

BACKGROUND:Individuals with physical disabilities experience disparities in obesity; yet few interventions have incorporated accommodations necessary for weight loss in this population. OBJECTIVE/HYPOTHESIS:This project compared the effectiveness of two weight loss interventions among individuals with physical disabilities. METHODS:Adults with physical disabilities who were overweight or obese were randomized across two diet approaches: a modified version of the MyPlate diet (usual care (UC)) and a modified Stoplight Diet (SLDm) supplemented with portion-controlled meals. Project staff met monthly with each participant to measure weight, 24-recalls of diet intake, self-tracking of foods and beverages, and physical activity during the preceding month. RESULTS:Of 126 enrollees, 70% completed the initial 6-month diet phase and 60% of these completed a 6-month follow-up phase. Participants in the SLDm group reduced weight and BMI during the 6 month intervention, and maintained or lost more weight during the 6 month maintenance period. Alternately, the UC diet resulted in a reduction in weight and BMI only at 6 months. BMI from baseline was significantly more improved for SLDm than UC and, among those who lost weight, the SLDm group lost more weight at 6 and 12 months. CONCLUSIONS:These results demonstrate that interventions with proper design and accommodations can overcome the barriers to weight loss unique to individuals with mobility impairments with low income. Additionally, the results suggest that using portion control may be more effective than teaching portion sizes.

Five teenagers with severe intellectual impairments and no discernible communication skills were enrolled in training to teach a conditional request for assistance using a speech-generating device (SGD). All were either blind or severely visually impaired since birth. All learned to operate an adaptive switch to control sensory outcomes, next showed preferences among sensory outcomes, and then demonstrated the ability to use their switch to signal for assistance with an SGD when the sensory outcome was remotely disabled. During the signaling phase, or subsequent attempts to generalize its use outside the laboratory, three participants began vocalizing. Most notably, they began imitation of the word "song" or the word "help" emitted by the SGD. The potential role of cause-and-effect training with adaptive switches is discussed.

The study describes the adaptive-switch performances of 8 adults with severe multiple impairments. Each was given a series of progressively more difficult discrimination tasks that, if solved, would require the participant to close the switch to activate a device that was not operating or to stay away from the switch if the device was operating. Then in a 2-choice format, a preference test was conducted by providing 2 devices simultaneously that could be activated or deactivated by closure or release of the switch. Finally, a preferred device was activated and then surreptitiously deactivated. Switch closures in this contingency activated a speech-generating device that played the message, "Help me." All 8 participants learned to control devices using their adaptive switch, but only 4 participants learned to make a request for help. Reasons for the different performances across learners and nonlearners are discussed.

Portable music production devices, such as radios, cassette players and MP3 players have characteristics that make them less than ideal for teaching the cause-and-effect relationships that would enable children and adults with severe impairments to control them independently and appropriately. Even when adapted for control with adaptive switches, the relationship between switch closure and on-off operation results in contingency characteristics that can inhibit learning. Some solutions to these problems are described, and for those individuals who can learn with complex contingencies, some promising products are reviewed.

Of 79 overweight adults with intellectual or developmental disabilities who participated in a weight loss intervention, 73 completed the 6-month diet phase. The emphasis in the intervention was consumption of high volume, low calorie foods and beverages, including meal-replacement shakes. Lower calorie frozen entrees were recommended to control portion size. A walking activity was encouraged. Participants attended monthly meetings in which a small amount of cash was exchanged for self-recorded intake and exercise records completed on picture-based forms. Average weight loss was 13.2 pounds (6.3%) of baseline weight at 6 months, with weight loss shown by 64 of the 73 individuals enrolled. Those completing a 6-month follow-up phase showed weight loss of 9.4% of baseline. Increased choice and control are discussed as possible contributors to individual success.

In this study, we continued evaluation of a two-choice preference assessment aimed at identifying a hierarchy of reinforcers for individuals with only one voluntary motor sequence—closing and releasing an adaptive switch. We assessed preferences among types of sensory stimulation in 6 adults with multiple profound impairments using concurrent synchronous reinforcement contingencies. Pre-experimental assessments with various types of stimulation led to the selection of music (A), vibration (B), and either olfactory or visual stimulation (C) as the 3 modalities for continued testing. Each participant received opportunities for familiarization with each type of stimulation in blocks of six 20-min sessions in which the closure of an adaptive switch produced the stimulation for as long as the switch remained closed. Next, participants could choose between pairs of types of stimulation in blocks of 12 sessions. In the first 6 of the 12 sessions, switch closure activated one type (e.g., A) and switch release activated the contrasted type (e.g., B). In the second 6 sessions, the contingencies were reversed. Two additional 12-session blocks completed all possible contrasts (AB, BC and AC). Four of the 6 participants showed distinct preferences in these two-choice tests with indications of preference hierarchies. The results demonstrate a method for obtaining indications of relative preference for potentially reinforcing stimuli from individuals without communication and without the abilities to act on more than one switch.

Children and youth with intellectual and developmental disabilities (IDD) experience health disparities. What is unknown is if data collected from children and youth with IDD who participate in Special Olympics is representative of children and youth with IDD who do not.Aim 1: determine the feasibility of matching a database of registrants from Special Olympics Ontario (SOO), with population-based health services databases in Ontario, Canada housed at ICES. Aim 2: evaluate the differences between the database sources with regards to demographic variables and clinical status.Using deterministic and probabilistic matching, registration data from SOO were matched to administrative health databases. Established algorithms were used to determine the prevalence of asthma, diabetes, and mental disorder in addition to demographic variables.The matching rate was over 90%; 8404 were attributed to children and youth between the ages of 0–19 years. When comparing SOO participants with IDD to non-SOO participants with IDD, children and youth who participate in SOO were, on average, older with no further differences between groups on clinical or demographic variables. When comparing those previously not identified in the health services databases (from SOO) to those with IDD identified by ICES, the SOO participants appear to use the health system less, possibly indicating a better health status.Research conducted on child and youth who participate in Special Olympics Ontario can be generalized to the broader population of children and youth with IDD in Canada when adjusted for age; however, care should be taken when comparing levels of overall morbidity.

The objective of this study was to teach manual signs through an automated matching-to-sample procedure and to test for the emergence of new conditional relations and imitative behaviors. Seven adults with mild to severe mental retardation participated. Four were also hearing impaired. Relations between manual signs (set A) and pictures (set B) were initially taught, followed by the training of corresponding printed words (set C) and pictures (set B). Further presentations of conditional discriminations tested for the emergence of AC, followed by tests for the emergence of imitative signing behavior (D) in the presence of either pictures (B) or printed words (C). Each stimulus set was comprised of 9 elements. The stimuli were still pictures, printed words, and dynamic presentations of manual signs. A pretest was conducted to determine which signs the participants could make pre-experimentally. Teaching was arranged in a multiple baseline design across 3 groups of 3 words each. The purpose of the present study was to determine whether participants would emit manual signs in expressive signs tests as a result of observation (video modeling) during match-to-sample training in the absence of explicit training. Five of the 7 subjects passed tests of emergence and emitted at least 50% of the signs. Two were hearing impaired with signing experience, and 3 were not hearing impaired and had no signing experience. Thus, observation of video recorded manual signs in a matching-to-sample training procedure was effective at establishing some signs by adults with mental retardation.

Computer-based matching-to-sample teaching procedures were used to establish copying and spelling skills in preschool children. In Experiment 1, 5 participants were exposed to training with trigrams that formed familiar words. First, copying was taught followed by spelling the word (on the computer). All participants learned to copy and spell the words. They also showed the emergence of generalized spelling and printing skills on posttests. Experiment 2 replicated Experiment 1 with additional participants, but with trigrams that did not form words. Some, but not all participants in Experiment 2, showed generalized spelling and printing skills. In Experiment 3, 5 children and their mothers participated in an evaluation of table-top methods similar to the computer-based methods employed earlier. Following training, the mothers taught word spelling to their children. The teaching focused on correct spelling of complex morphemes. All children generalized the correct spelling of those morphemes to untrained word that contained them.Key words: printingspellingreadingconditional discriminationconstructed-response matching-to-sample (CRMTS)mothers

We conducted two studies to examine parameters of social attention in contingency awareness training using switch activation with individuals who had multiple profound disabilities. In Study 1 we compared leisure devices and social attention as reinforcing stimuli with 5 individuals. Results indicated the reinforcing qualities of social attention over leisure devices with 2 individuals and documented the importance of session length in training. In Study 2 we investigated idiosyncratic behaviors as indicators of responsiveness with 3 of the 5 original participants as they activated switches. Behavior changes during switch activation versus nonactivation times in the leisure device and social attention conditions suggested volitional movement supporting contingency awareness and preference. Implications for clinical practice are discussed.

In Experiment 1, 12 senior citizens from the community were trained with 18 sets of conditional discriminations. Training included 2-, 3-, and 4-choice matching-to-sample (MTS) configurations in linear series (LS), many-to-one (MTO), and one-to-many (OTM) training structures. Training structure order was counterbalanced across participants. The design permitted tests for class establishment ranging from 2 classes of 3 stimuli each to 4 classes of 4 stimuli each in the LS, MTO, and OTM structures. The experiment tested the hypothesis that 3- and 4-choice MTS would increase the probability of class establishment, relative to 2-choice MTS, by reducing the potential for sample/S- control to arise during training. Results showed, however, that training with 3- and 4-choice MTS did not significantly increase equivalence class establishment and unequivocal evidence of sample/S- control was found in only 1 instance of a 2-choice training and testing structure. Experiment 2 systematically replicated Experiment 1 with 6 additional senior citizens in a O-s delayed MTS paradigm. As in Experiment 1, equivalence class establishment was not related to number of choice stimuli. The delayed MTS paradigm, however, required fewer training trials to establish the conditional relations and led to more class establishment overall. The results are compared to data from previous studies with younger and older participants.

Potential relations between behavior state and switch use in 3 adults with profound multiple impairments were investigated. Observations were conducted during a regularly scheduled leisure activity. Each participant was provided with an adaptive switch that was connected to a preferred battery-operated leisure device. Closures of the adaptive switch produced activation of the device. Behavior states were measured using an abbreviated version of a state scale developed by Guess et al. [Guess, D., Roberts, S., Siegel-Causey, E., Ault, M. M., Guy, B., Thompson, B., and Rues, J. (1993). American Journal on Mental Retardation 97: 634–653]. Adaptive switch use was measured using an automated event recorder that recorded the time of each switch closure and release. Frequency and duration of switch closures were tallied using a computer software program, and then data on switch closures and ratings of behavior state were aligned in 1-min intervals. Results showed that although each of the 3 participants exhibited a predominant behavior state, changes in state within observation periods were common. Differences in rates and duration of switch closures were observed across behavior states, although interaction of state and adaptive switch use was idiosyncratic for each of the 3 participants.

In Experiment 1, 6 adults with mild mental retardation were taught 3 overlapping conditional discriminations in a linear series structure, establishing the possibility of the emergence of 2 stimulus equivalence classes of 4 stimuli per class. Training employed balanced trial types in which the discriminative stimuli were presented in fixed pairs across conditional discriminations (e.g., 81 and 82, C1 and C2). No participant.showed the emergence of equivalence classes in initial testing; 1 participant showed the establishment of classes with repeated testing, including tests for symmetry alone. In Experiment 2, 6 additional adults with mild mental retardation were similarly trained, with one methodological modification: Prior to testing, each comparison stimulus (e.g., 81) was presented in some trials with every stimulus from the opposing class (i.e., A2, 82, C2, and D2). With this modification, 4 of 6 participants showed the establishment of equivalence classes during initial testing. The results support hypotheses about the essential role of simple discrimination acquisition in equivalence class establishment.

Tonneau (2001) challenges stimulus equivalence researchers to state more clearly the purposes of their research and to show the relevance of their results to those stated purposes. The author infers that the analysis of symbolic functioning is the main goal of most of the extensive research on stimulus equivalence, but he concludes that the research methodology, conceptual underpinnings, and analytical conclusions have been generally off the mark. Tonneau further suggests that confusion over terminology exacerbates the problems (cf. R. R. Saunders & Green, 1992). Despite the author’s apparent good intentions, his confusion about what stimulus equivalence is and why it is studied prevent the paper from providing much in the way of clarifications or practical suggestions for readers. Too many points are at issue in the paper to address all of them here. Unfortunately, there are also some insightful observations that must pass without comment as well. I will address three points I deem most important. 1. Understanding symbolic functioning is not the primary agenda of every stimulus equivalence researcher. This researcher, for instance, is interested in how humans acquire knowledge, defined as learning relations among events (symbols or others) in the environment (Green, Mackay, McIlvane, Saunders, & Soraci, 1990; and cf. Rescorla, 1988; Sidman, 1978). Here learning refers to a relatively permanent change in behavior that is likely coupled with a change in physiology. (Skinner, 1974). Performances showing stimulus equivalence are evidence of relational learning. Stimulus equivalence is often inferred from matchto-sample (MTS) performances because MTS procedures are well suited for training and testing conditional relations among stimuli. The defining performances on tests for stimulus equivalence, however, are but one of several possible outcomes of MTS training. Such training could engender unsystematic performances, or performances that indicate other sources of stimulus control besides stimulus equivalence (e.g., R. R. Saunders, Wachter, & Spradlin, 1988). Tonneau finds it “hard to believe that equivalence class researchers are interested in matching to sample, as such” (p. 2). Probably many are not, since MTS is just one experimental preparation used by many researchers, and most stimulus equivalence researchers are interested primarily not in MTS procedures per se, but in the behavior they engender. Nevertheless, MTS procedures do have a kind of elegance and power that can render them very interesting in their own right. Further, within the context of stimulus equivalence research, MTS procedures are clearly not unidimensional. Three basic MTS training structures, as well as numerous variations thereof, have been employed in the analysis of stimulus equivalence (Green & Saunders, 1998). Structure here refers to arrangements and sequences of training trials across the interrelated conditional discriminations in a stimulus equivalence experiment (Fields & Verhave, 1987). Recent research has demonstrated that the number and size of classes interact with training structure to determine the probability of positive outcomes on tests for the properties of equivalence (Arntzen & Holth, 2000 a, b; Fields, Hobbie-Reeve, Adams, & Reeve, 1999; R. R. Saunders, Chaney, Saunders, Schroeder, & Tessel, 2001; R. R. Saunders, Drake, & Spradlin, 1999). That is, some researchers have explored why MTS training does not always lead to equivalence—functional, matching, mathematical, or otherwise—despite ubiquitous stimulusstimulus pairings that Tonneau invokes as causal in positive outcomes on tests (e.g., K. J. Saunders, R.R. Saunders, Williams, & Spradlin, 1993). Others have asked if equivalence might arise from On the infrastructure of stimulus equivalence research

The rates and durations of stereotypic behaviors in four adolescents with severe mental retardation were measured during two daily vocational training sessions and during contiguous periods of leisure in their special education classrooms. Vocational training was conducted in two different tasks, alternating across days. The task requirements for each participant were matched to each participant's learning and performance characteristics. The participants were exposed to a fixed ratio schedule of tokens exchangeable for food items on one task and to a variable interval schedule for the same consequences on the second task. The schedules were chosen as an initial test of a matching-law based prediction by Myerson and Hale (1984): Variable interval reinforcement for adaptive behavior will produce less allocation of responding to maladaptive behavior than will a ratio-based intervention. When work performances stabilized, the schedules of token delivery were reversed across the tasks and performances again stabilized. Results are reported for periods when work performances met stability criteria. Stereotypy occurred more during leisure than during vocational training under either schedule. The major differences in stereotypy between leisure and vocational training were differences in episode length rather than rate of onset. Onset of stereotypy in vocational training, however, occurred at higher rates under the interval schedule than under the ratio schedule in both tasks. The results are discussed in terms of Myerson and Hale's prediction and implications for further research and application.