Using Extinction and DRA Procedure in Reducing Escape Behaviour During Task with ASD Child
By Farheen Saif, student
of the Master in Speech-Language Pathology and Learning Difficulties
Abstract
The purpose of this project is to identify a problem behaviour in a child with ASD (autism spectrum disorder) and use evidence-based practice to reduce the behaviour and teach a replacement behaviour. The behaviour identified is throwing and swiping materials during tasks, and the function maintaining this behaviour is escape from the task. Therefore, this applied study attempted to evaluate a procedure commonly used to decrease problem behaviours of the child with autism spectrum disorder by implementing extinction procedure and differential reinforcement for alternative behaviour. With this study, we alter the environment by reinforcing appropriate alternative behaviours and placing problem behaviours (throwing/swiping items, non-compliance) on extinction. Sessions were conducted for the participant 5 days in a week. A total of 14 sessions were organized including 3 baseline sessions. And the duration of the session was 30 minutes, which was divided into 15-15 minute’s conditions to calculate data. The child behaviour was scored during the sessions by calculating the occurrence and non-occurrence of challenging behaviour per session by partial interval recording on data sheet. The behavioural problem in child was gradually decreased over 14 sessions. Intervention ended for the target behaviours when problem behaviour was decreased and the child started responding to the task.
Keywords: autism spectrum disorder, differential reinforcement for alternative behaviour (DRA), extinction procedure, problem behaviour, functional analysis, partial interval recording.
Introduction
In the treatment of problem behaviour, implementation of extinction and differential reinforcement for alternative behaviour (DRA), these procedures result very effective to reduce problem behaviours. Using extinction effectively is to identify and implement all possible sources of reinforcement that maintain the target behaviour. The effectiveness of extinction depends on the correct identification of consequences that maintain the problem behaviour (Iwata, 1994). Extinction is a very effective singular intervention. An applied behaviour analyst always considers combining extinction with other treatments, especially the reinforcement of alternative behaviour (DRA). Two reasons support this recommendation. First, the effectiveness of extinction may increase when it is combined with other procedures, especially positive reinforcement. By combining extinction with the differential reinforcement of appropriate behaviours, the applied behaviour analyst alters the environment by reinforcing appropriate alternative behaviours and placing problem behaviours on extinction.
For example, Child A has a problem behaviour of mouthing non-food items (toys, pennies, fingers, etc.) to gain sensory stimulation. Every time child A attempts to place a non-food item in her mouth, you block this behaviour and redirect her to a sensory chewy toy. As the child places the chewy in her mouth, you provide verbal praise.
Child B has a problem behaviour of elopement from the work table to escape a demand. When child B attempts to stand up at the work table, you physically prompt her to sit down and immediately hand her an “I want a break” card. When child B gives the card back to you, you provide praise and allow child B a short break.
So ideally, the behaviour selected to be incompatible with or alternative to the inappropriate behaviour (a) already exists to the learner repertoire; (b) requires equal, or preferably less effort than the problem behaviour; (c) is being emitted at a rate prior to the DRA intervention that will provide sufficient opportunities for reinforcement; and (d) is likely to be reinforced in the learner’s natural environment after intervention is terminated. Behaviour meeting these criteria will increase the initial effectiveness of DRA and facilitate the maintenance and generalization of behaviour changes after intervention is terminated. The effectiveness of differential reinforcement as an intervention for problem behaviour depends on the alternative behaviour yielding a height rate of reinforcement than the problem behaviour. Maximizing the difference between rates of reinforcement obtained by the two response classes entails withholding all reinforcement for problem behaviours (i.e., extinction schedule). So, the alternative behaviour would always be reinforced at least initially and the problem behaviour would never be reinforced. As Vollmer et al. (1999) noted, perfect implementation of differential reinforcement entails providing reinforces as immediately as possible after an appropriate behaviour occurs (e.g., within 3 to 5 seconds). Treatment effect may degrade as the delay to reinforcement increases, especially if appropriate behaviour is occasionally reinforced.
If problem behaviour is maintained by escape from instructional demands, problem behaviour may be placed on extinction (e.g., working through the task) while an alternative behaviour is negatively reinforced with a brief escape period (Lali et al., 1995). When escape is reinforced as a reinforcer, the differential reinforcement application is sometimes called differential negative reinforcement of alternative behaviour (DNRA) (Vollmer & Iwata, 1992).
In controlled experimentation, it is important to ensure that treatments are conducted with prefer and near prefer integrity because otherwise any non-effects may be attributed to procedural failure rather than to limitation of the treatment itself. However, in application, many DRA procedures are likely to be a failure in integrity. It is unlikely, for example, that all instances of alternative behaviour will be reinforced or that all instances of problem behaviour will fail to produce access to reinforces. As such, appropriate and problem behaviour will likely to have intermittent access to reinforce. At one end of continuum, a perfect integrity failure would occur if appropriate behaviour will never reinforce and problem behaviour was always reinforced. An analogue to such failure is conducted in most baselines in functional analysis research: problem behaviour produces access to reinforces and appropriate behaviour explicitly does not produce access to such reinforces (e.g., Iwata et al., 1990; Hanley et al., 1997; Lalli et al., 1995; Vollmer et al., 1993). At the other end of continuum, perfect integrity of DRA would involve reinforcement of all appropriate behaviours (or at least reinforcement would occur systematically, according to a prescribed intermittent schedule) and extinction of all instances of problem behaviours. In the middle of the continuum, a therapist (or parents or teacher) might display good treatment implementation with one component (e.g., reinforcing all appropriate communication) but poor implementation with the other component (e.g., continuing to reinforce problem behaviour).
Extinction is the most direct method of reducing the frequency of the reinforced behaviour. In the case of negative reinforcement, extinction involves continuous presentation of the aversive events and its related cues while eliminating the possibilities of escape and avoidance. Procedure based on this kind of extinction were used by Heidorn and Jensen (1984) and Repp et al.(1988).
Behaviour maintained by negative reinforcement are placed on extinction (escape extinction). When those behaviours do not produce a removal of the aversive stimulus, it means that the person cannot escape from the aversive situation. Anderson and Long (2002) and Dawson et al. (2003) provided excellent examples of using escape extinction as a behaviour intervention.
Lerman and Iwata (1996) cautioned applied behaviour analysts that these clearly documented extinction effects may have limited generality in applied behaviour analysis. When a previously reinforced behaviour is emitted but not followed by the usual consequences, the occurrence of that behaviour should either gradually decrease to its pre-reinforced level or stop entirely.
Behaviour undergoing extinction are usually associated with a predictable characteristic in rate and topography of response. These extinction effects have strong generality across species, response classes and settings (Lerman and Iwata, 1995, 1996). Applied behaviour analysts however have not devoted much research effort to the basic extinction procedure beyond using extinction as a component in treatment procedures for problem behaviours (Lerman and Iwata, 1996).
Extinction is derived from applied behaviour analysis (ABA) and involves procedures aimed at withdrawing or terminating the reinforcement associated with an inappropriate behaviour. Because there may be a learning history in which the unwanted behaviour has been reinforced over a period of time, changing the consequence to no longer reinforce the behaviour may lead to an increase in the frequency and intensity of the behaviour. Thus, it is important to be mindful of the possible extinction burst that may result from no longer reinforcing previous behaviours. However, extinction has been used with other intervention strategies to successfully teach children and adults with ASD a multitude of functional, meaningful behaviours and responses that discourage the use of inappropriate behaviours.
Extinction procedures are combined with reinforcement procedures so that learners with ASD develop more appropriate skills in place of challenging or problematic behaviours that prevent the occurrence of more acceptable, purposeful behaviours. They can be used with other intervention strategies, including functional communication training, differential reinforcement, non-contingent reinforcement, and/or response interruption/redirection. Examples of specific skills that were the focus of extinction interventions in the evidence-based studies include: functional communication (Kelley et al., 2002); self-injurious behaviours (Kahn’s et al., 2002; Matson et al., 2008); sleep problems (Weiskopf et al., 2001); and eliminating challenging behaviour during classroom instruction (O’Reilly et al., 2007).
Learners who have ASD who exhibit behaviours that interfere with learning and achievement can benefit from extinction. The use of extinction is not limited to a particular behaviour or skill, but typically is used to address disruptive, aggressive, perseveration and stereotypical behaviours, or any other problematic behaviour that prevents developmental growth. It is recommended that extinction procedures are used after other more positive interventions have been tried and shown to not work (e.g., differential reinforcement, curriculum modification, etc.). This is mainly due to the extinction burst that might occur as the learner seeks to receive reinforces previously provided following the occurrence of the unwanted behaviour.
Extinction procedures can be implemented to decrease or eliminate problematic behaviours that interfere with or limit teaching opportunities. Typical extinction procedures include: ignoring the behaviour, removing reinforcing items or activities, and/or removing the learner from the environment.
In an extinction trial each time the target behaviour occurs one of these procedures is used.
The steps for implementing an extinction program include: identifying the unwanted behaviour, identifying data collection methods and gathering baseline data, determining the purpose of the unwanted behaviour, creating an intervention plan, implementing the intervention, collecting resulting data, and reviewing the intervention plan.
In the current study we evaluated the method similar to that used by Northup et al. (1997) to study differential reinforcement procedures (reinforcement and extinction) derived directly from the functional analysis. Following a functional analysis, problem behaviour and appropriate behaviour treated as concurrent operant that were reinforced all of the time, never or some of the time, depending on the condition. The specific purposes of study were (a) to demonstrate a methodology by which initially successful DRA effects may be evaluated in the face of treatment challenges (subsequent less than optimal implementation) and (b) to evaluate the effect of treatment challenges on appropriate and problem behaviour. If treatment procedures provide positive effects in the face of less-than-optimal implementation, the prognosis for long term efficacy and maintenance for differential reinforcement–based interventions is improved.
Method
Participant is 5 years old boy who has been diagnosed with mild autism by a paediatrician and a psychologist. He has some speech sounds and babbling but has no appropriate verbal behaviour. He does not respond appropriately to tasks. He displays problem behaviours like swiping and throwing objects during tasks and exhibits non-compliance behaviour to escape from work. He responds receptively to familiar names, objects, pictures and activities. He also responds to his name and demonstrates appropriate eye contact.
Sessions were conducted individually in a therapy room. He received 30 minutes sessions which were conducted five days a week. All sessions were conducted in a Centre-based setting in a small therapy room which contains a child size table and chair and relevant session material (e.g., instruction material and highly preferred tangible & edible items). The child and experimenter were seated facing each other at a table and one observer recorded data from behind. Only the therapists and the child were present during the session.
One therapist observed and recorded data and scored each challenging behaviour and compliant response. Challenging behaviour with the child included disruption and non-compliance.
We defined:
(a) Disruption as throwing objects (not at the therapist), swiping objects from the table top. Functional alternative behaviour included compliance.
(b) Compliance as completion of a demand within 5 to 10 seconds of task presentation with or without prompt.
We calculated:
(a) the rate of challenging behaviour per session by dividing the total number of challenging behaviour by the duration of the session in minutes.
(b) The percentage of compliances by dividing the total number of compliance responses by the total number of demands in each session and converting a quotient to a percentage.
The child behaviour was scored during the sessions. We calculated the occurrence and non-occurrence of challenging behaviour per session by using partial interval recording. Data are recorded when behaviour occurred at any time during the intervals.
i.e., if the problem behaviour occurs within a 30 second of interval, it is recorded as occurrence of problem behaviour and marked as (+) and if problem behaviour does not occur, it is recorded as a non-occurrence of problem behaviour and it was marked as (). Percentage was calculated as the total number of intervals with occurrences of problem behaviour divided by the total number of intervals with occurrence and non-occurrence of problem behaviour.
A second therapist simultaneously, but independently, recorded dependent measures during a portion of the treatment sessions. We divided these sessions into successive 1-1 minute intervals for calculating inter-observer agreement IOA. We scored an agreement with both observers’ data recording the same frequency of the target response in a given interval. We calculated IOA through total count inter-observer agreement coefficient by dividing the number of intervals with agreements by the total number of intervals with disagreements in the session and converting the quotient to percentage. We took IOA data of total 30% of the sessions. According to the inter-observer agreement data collected the total count IOA of total 30 percent sessions was 100%.
Initially, we assessed the child and his behaviour through functional analysis and identify that the function maintaining the behaviour is escape from task. Many easy task were presented during 20 minute of session in a single subject experimental design. In this design we use extinction procedure with differential reinforcement for alternative and appropriate behaviour. We paired each condition with a different therapist and a different setting to help the child to discriminate the conditions effectively in different environment.
In functional analysis 3-test conditions were conducted attention, escape and access to tangible. In which problem behaviour is expected to be low because reinforcement is freely available and no demands are placed on the child. The conditions are presented systematically one at a time and in an alternating sequence to identify which conditions result in problem behaviour. The therapist selected easy tasks and activities during the demand condition. The therapist presented an instruction to the child once every 30 seconds and provided praise like “very good”, “good job” and “you are amazing” (generalized conditioned reinforcement) for correct responses and provided 30 second time-out from the task (escape). We used continuous reinforcement schedules. During the play condition stage, the therapist provided the child access to preferred items, and delivered neutral comments on compliance. The therapist took care not to prevent disruptive responses while implementing physical guidance and the therapist also did not respond to challenging behaviour.
During the baseline condition, the child was observed and assessed with many challenging behaviours. Baseline condition during extinction evaluation was the same as functional analysis demand condition. the task used for baseline instructional sessions were matching to sample, building blocks, different wooden puzzles and sorting by colours. After giving instruction, the therapist waited for 5 to 10 seconds and if the child did not respond the therapist provided prompt for the appropriate response and reinforced.
The treatment was based on the outcome of functional analysis. After the functional analysis we identify that escape from task maintained the problem behaviours. Based on this, we used the extinction to diminish the problem behaviours that occurred while the child worked on task of matching, sorting and receptive language. The task consisted of varieties of activities, such as pointing, puzzle completion, stacking, sorting of objects, etc. The therapist presented these tasks in learning trials to the child approximately once in every 30 seconds while both were seated at the table. The therapist initiated each trial with an instruction. The therapist provided prompts during the tasks. Correct responses were followed by praise, which sometimes was paired with pats on the back. Contingent on an incorrect response or no response within 5 seconds the therapist modelled the correct response and, if necessary, we physically guided the child to complete the response during the learning trials. The therapist guided the child to task completion and reinforced him for an appropriate response. During the sessions, the therapist was also taking functional communication response while presenting demand condition as “if you don’t want to do this task, say no and node your head left-right to say no”, as the child has no on demand sounds, he does not speak words, so we consider “nnn..” For “no”. We focused on compliance during the sessions. Problem behaviours was placed on extinction and each appropriate alternative behaviour was reinforced with 30 seconds access to the reinforces on continuous reinforcement schedule (CRF). As child behaviour was reinforced by escape, differential negative reinforcement for alternative behaviour (DNRA) was implemented in which alternative behaviour was contingent on compliance. The therapist saying “take a break” and moving away from the child signalled the breaks. During all small breaks, work items remained on the table so that independent appropriate behaviour could occur. But contingent on the occurrence of problem behaviour, the therapist ignored the problem behaviour and keep the demand continue with the task. Alternative behaviour produced access to the reinforces on 100 percent of the trials with continuous reinforcement schedule and problem behaviour produced the reinforces on 0 percent of the trials (extinction procedure). This schedule arrangement represents treatment schedules that are characteristic of DRA and extinction at complete implementation. Complete implementation contingencies for compliances and non-compliances indicated as 100/0. This is the percentage of reinforcement for appropriate behaviour/ percentage of reinforcement for inappropriate behaviour.
Results
The outcome of the functional analysis shows that inappropriate behaviour (throwing and swiping objects and non-compliances) occurred most consistently in the escape condition. In addition, disruption rates were the highest in the escape condition, and problem behaviour occurred infrequently during the other conditions. These finding suggest that behaviour were maintained by escape.
Results presented in the figure show lower rates of problem behaviour (throwing and swiping items) during a DRA and extinction condition compared with the baseline condition for the child. Participant data shows the gradual decrease in disruptive behaviour, which eventually reached at very low level. During the baseline condition, the child task related compliance was zero, because escape was contingent on the response. Total 28 sessions of 15-15 minutes each were organized to decrease child’s disruptive behaviour in which data show the percentage during the baseline and intervention.
Table 1. Data collection and occurrence of percentage of throwing / swiping behaviour on the bases of baseline and treatment procedure.
No. of sessions | % of problem behaviour occur in condition duration of 15 minutes | |
baseline | 1 | 53% |
2 | 40% | |
3 | 56% | |
4 | 43% | |
5 | 56% | |
6 | 50% | |
intervention | 7 | 43% |
8 | 40% | |
9 | 43% | |
10 | 30% | |
11 | 43% | |
12 | 50% | |
13 | 37% | |
14 | 30% | |
15 | 26% | |
16 | 23% | |
17 | 33% | |
18 | 30% | |
19 | 30% | |
20 | 23% | |
21 | 20% | |
22 | 16% | |
23 | 20% | |
24 | 16% | |
25 | 16% | |
26 | 13% | |
27 | 13% | |
28 | 6% |
During baseline, compliance was low and escape behaviour was high but after implementing the intervention, the results show a significant reduction in the problem behaviour (throwing and swiping objects and non-compliance was reduced). Initially, the participant did not follow instructions and compliance, so in the treatment we applied extinction on all problem behaviour and DRA, in which the therapist reinforced him on every positive correct response with continuous reinforcement.
Figure 1. Graphical presentation of disruptive behaviour (throwing/swiping items). Percentage of responses per 15 minutes of problem behaviour training with extinction procedure and differential reinforcement.
Six parents and three teachers, all were sampled out purposefully and conveniently in this qualitative study. The total number of participants was nine, parents and teachers closely connected to children and rehabilitation centers although only five were interviewed. Leedy & Ormrod (2010) reminded the researchers that there must be careful selection of sample of participants and those directly experience with the phenomenon or situation being studied. The researcher was interested to know if parents and teachers are able to notice the relationship between auditory training and some factors that contribute to low parental involvement especially that children spend much time with parents and siblings at home than with teachers. The developmental age of children in terms of auditory, speech and receptive and expressive language skills can be determined through interview with their parents (Jeddi, 2019).
These participants were carefully selected based on the accessibility and convenience of the participants to the researcher. The centers were accessed without difficulties although the researcher was supposed to obtain permission from the department of Research and Methodology at African Bible College and from the administration and management of the centers. Creswell (2014) reminded the researchers that prior to the study, researchers need to obtain approval of individuals in authority (e.g., gatekeepers) to gain access to the sites and to study participants.
Results
The purpose of this study was to investigate the relationship between auditory training and parental or caretaker involvement. This will help parents, audiologists, speech therapists, special needs teachers, the community and also the government to come up with strategies that can increase participation of parents in auditory training of their hearing impaired child. It was important to study this topic because the participants who have encountered with this experience expressed themselves in different ways. In this chapter the researcher is analyzing data that has been collected through interviews.
The study used a qualitative method with phenomenological design and it was the best to use in this study because the study is dealing with people’s experiences and feelings. It is also the design that helped the researcher to use open-ended questions where the participants fully expressed themselves. The interviews were one on one and were conducted with 5 different participants. These were conducted at Sandi resource center, Children of Blessings Trust, Msambeta resource center and Area 23 respectively. The study areas were selected because they are accessible to the researcher. The researcher was also looking for a wide range of information from different participants who have different backgrounds and are experiencing the same situation in different angles of life.
The setting of this study provides the researcher with participants from different socioeconomic background. This assisted the researcher to vary the reasons of low participation of parents or caretakers in auditory training. The location also aided the researcher to get worthy and effective information because the special needs teachers have been assisting hearing impaired children for years. The interviews were very helpful in such a way that all the participants contributed to their capacity. All these participants experienced the phenomenon in different ways. The participants are of different age groups and with different status.
Participant | Age | Sex | Education Level | Marital Status | Occupation |
Participant 1 | 51 | Male | Degree | Married | Teacher |
Participant 2 | 42 | Male | Diploma | Married | Parent |
Participant 3 | 23 | Female | Degree | Single | Parent |
Participant 4 | 25 | Female | Degree | Single | Teacher |
Participant 5 | 33 | Male | Diploma | Married | Parent |
Figure 1. Demographic information of participants
The participants indicated that poverty is one of the major reasons for a connection between auditory training, education and parental or caretaker involvement. One of the participants explained that, “in our neighborhood there is a private rehabilitation center but most children are not from our area because their parents cannot afford to pay for the services”. The results revealed that auditory training centers available in local areas are private and parents are failing to go for sessions with their children in such centers because of the costs. The results are showing that most of these centers are private and those owned by government do not have resources. In agreement to this another participant said that, “poverty is the common
cause that makes most Malawian hearing-impaired children to miss auditory training sessions, hence missing formal education. They can be fitted with hearing aids but parents can hardly afford money for sessions which includes transport and consultation especially when other things will be required on top of normal sessions”. One of the participants also said that, “most of the times poverty delays hearing impaired children to go school hence delay with education”. At this age a child must eat frequently and even pack some snacks for the session breaks”. Lack of transport and food are some of the factors that hinder a good relationship between auditory training and parental involvement. This implies that poverty has affected parental or caretaker involvement in auditory training for hearing impaired children.
The results show that lack of resources hinders most parents to be much involved in auditory training sessions with their hearing-impaired children. One participant said that, “if government can establish rehabilitation centers, it must also provide resources to make work much easier”. The results indicate that there are a lot of things required in order for a child to start school and to learn well. This shows that without some resources, the progress of the child’s education can be disturbed. In agreement to this one participant said that, “when going to help children and parents, materials for different sessions must be available without repeating same things every time”. Another participant explained that it is boring for the child to be seeing same things over and over again. They become excited if there is a slight change in games or cards or activity from time to time. All this equally shows that resources play a significant role in conducting auditory training sessions. There is an indication that there can be an increase in number of children in pre-schools if parents have required resources needed for a pre-scholar.
The results also showed that attitude of parents towards auditory training and education is also one of the contributing factors for low involvement of parents or caregivers. One of the participants said that, “positive attitude towards auditory training sessions and education can help children to achieve their goal in life”. “As a teacher, I have seen some parents working so hard to bring their children to sessions and the outcome is impressive”. The results revealed that parents with a positive attitude towards education do not hesitate to help their children in whatever way they can manage. This shows that some parents have a good outlook on auditory training and education while others have a different viewpoint. Another participant explained that, “some parents develop a negative attitude towards auditory training because of different experiences concerning isolation of children with hearing impairment”. The participants indicated that positive or negative attitude and civic education of parents equally increases or decreases the number of children coming for auditory training.
Three of the participants said that it takes parents to have a positive attitude towards auditory training school so that they can also be fully involved. One of the three said that, “if parents know the goodness of school and want to invest in their children, they develop a positive attitude and they are eager to come together with their child for auditory training sessions”. The results shows that parents that had encountered the benefits of school are the ones that encourage their children to attend the sessions. The results imply that there are certain experiences contributed to parental involvement in auditory training sessions of their children.
The participants emphasized much on civic education especially to those that do not know any goodness of auditory training and education. One of the participants clarified that, “it is the duty of chiefs together with the community to conduct civic education and awareness campaign so that parents can gain more knowledge about auditory training. Some parents in Malawi do not register children with hearing impairment or other disabilities in schools not because of money but they lack knowledge”. This shows that some parents can enroll their children in schools if they can have enough knowledge about their role in their child’s education. Concurring to this another participant said that, “if the community is well knowledgeable about the significant of auditory training for our hearing impaired children, they can contribute willingly to the demands if required”. This is stating that civic education can play a big role in increasing the number of hearing-impaired children and their parents in auditory training sessions. The results from the study revealed that some parents failed to be involved in auditory training with their children because they do not know the significance of auditory training and education. This shows that most of the times, parents who are well educated are aware about the importance of auditory training. This also indicates that civic education is important to some parents because it enable them to know the importance of auditory training and education.
The participants also indicated that caring for children with hearing problems is the role of the community and involvement in auditory training and education has an influence for the whole community. The results show that the community should be very active in education issues even if its building rehabilitation canters before other stakeholders and government. However, the community must work hand in hand with the government and other stakeholders. Three of the participants explained that a lot of schools depend on their communities before any government assistance. One of the participants said that, “as teachers we have been assisted much by parents and the school committees which is comprised of the local people from the community. One of our school blocks was funded by this community”.
The participants revealed that special needs teachers should be motivated so that they can teach well and stay long at one school where hearing-impaired children are getting auditory training. The results show that special needs teachers who are not motivated they move a lot from one school to the other or from teaching to other jobs. One of the participants said that, “there is a need for the community and government to motivate special needs teachers by appreciating the work that they are doing. This can be done by concentrating much on the positives rather than on the negatives or criticize when they have done something wrong”. This shows that teachers must be appreciated. Despite the fact that teachers can be criticized, there is also a need to applaud them when necessary. Another participant explained that, “parent-teacher relationship is very important because teachers are able to express themselves”. In agreement to this, one of the participants said that, “overall, it seems that teachers’ contribution to the performance of children largely depends on parents, community and government”.
Interestingly, the results show that not only teachers need motivation but also children. Two of the participants said that motivation is an essential tool that can be used to inspire children to come have passion for auditory training sessions. One of the participants said that, “children love rewards. If children are doing well, we give the stars not real stars but a written one but they show tremendous happiness. Sometimes we give them sweets although not always but we could easily see the happiness”. This participant explained that, “A lot of children know that they are at school when they see swings, toys and all sorts of things to play with, these things give them a will to come to and they are attracted to those things”. The above statements are indicating that the number of hearing impaired children in auditory training sessions can increase if children are motivated by rewards and if they are provided with things they can play with.
The participants specified on the qualities and qualifications of an effective auditory training teacher. All the participants mentioned that an effective special needs teacher must be humble, gentle with children, patience, talented, with tender heart, caring and understanding. While this participant said that, “the auditory trainer must be humble in such a way of reducing oneself to the level of children in so doing, children feel comfortable with you”. Another participant explained that, “it takes patience to help the hearing impaired child”. One of the participants elaborated that, “to love and care for children, is not just teaching but it is a ministry”. All the participants emphasized on the qualifications of an auditory trainer. One of the participants explained that, “one must possess degree or masters but the problem here in Malawi is that they cannot pay good salary to that kind of a trainer”. Overall qualities and qualifications of an effective auditory trainer is also one of factors affecting parental involvement in auditory training.
The participants indicated that the government has a major role in contributing to the effectiveness of parental involvement in auditory training. The findings are showing that there is a need for more government owned auditory training centers and the government must control all including private rehabilitation centers. One of the participants said that, “there is a need for the government to establish more good rehabilitation centers for hearing impaired children in all regions here in Malawi. I believe that it is the responsibility of the government to make sure that special needs teachers are allocated in those centers and must be provided with proper housing and resources required in order to make them stay”. Another participant explains that, “as of now the government is not doing much to improve auditory training and education, this must be included in the government budget”. The results are indicating that the government is not doing much to improve auditory training programs for hearing impaired children in Malawi.
Discussion
In this study, we observed an inverse relationship between participant’s appropriate responses and problem behaviours. In this study, a low rate of problem behaviours were maintained throughout the treatment phases. In addition, we observed gradual increases in the compliance throughout the study. These findings suggest that combining extinction and DRA in problem behaviour reduction is an effective way to maintain low rates of problem behaviour, while increasing the child’s appropriate behaviour during tasks.
In this study, differential reinforcement was implemented (all appropriate behaviour was reinforced and no problem behaviour was reinforced). As a whole, the results suggest that, at the implementation of the differential reinforcement and extinction procedure, inappropriate behaviour was virtually replaced by appropriate behaviour; lower rates of implementation eventually reduced the treatment efficacy if the schedule of reinforcement favoured inappropriate behaviour.
Escape extinction procedures often pose a difficult challenge to educators. When a student uses a problem behaviour to communicate refusal to complete an academic task, it is important to remember that practitioners cannot make a student read, solve math problems, comprehend a history lesson, etc. However, educators might consider restricting a student’s ability to leave the learning setting (e.g., her desk, the classroom, the lab, etc.) until the task is initiated or completed. For some students, this approach can be very effective, especially if the student will follow verbal redirection versus requiring physical redirection. Extinction procedures are combined with reinforcement procedures so that learners with ASD develop more appropriate skills in place of challenging or problematic behaviours that prevent the occurrence of more acceptable, functional behaviours.
The treatment consisted of a structured routine with different activities and easy task with implementing extinction procedure and DRA to reduce problem behaviour. It is significant that the results of our intervention transferred to teachers and parents who were unaware and untrained to the procedures because a major consideration for behaviour change intervention is training personnel. This may be particularly true if we are successful in teaching a child a form of the response that other will respond to in a desired way.
It is important to determine whether a child can be taught to behave appropriately and effectively in their community and generalized settings such as movies, buses, stores, market etc., and if this would result in reducing a challenging behaviour, we must extend our criteria of what constitutes a successful intervention to include behaviour improvements in any settings.
A child may encounter with any person with whom he or she may interact. Only then we will be able to say that we have initiated meaningful change in the behaviour of our children.
Conclusion
All in all, clinicians need to move away from the one size fit all treatment approach towards any individualized, targeted therapy. Every child is different, they have different learning styles, different behaviours and different responses to the given task. The clinician should observe, understand and handle the patient patiently and then should go for intervention. If right techniques are used, results are going to be excellent.
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