Using Self-Management, Video Feedback, and Graphic Feedback to Improve Social Behavior of Youth with Mild Mental Retardation

The purpose of the present study was to investigate effects of a training package on appropriate and inappropriate behaviors of residents with mental retardation with internalizing or externalizing behavior problems and the responses of staff to these behavior problems. The training procedure included resident training with video feedback and self-management procedures and staff training with video and graphic feedback. A multiple baseline design across residents was used. Results show increased appropriate social behavior for residents with internalizing behavior problems and decreased inappropriate social behavior for residents with externalizing behavior problems. The provision of video and graphic feedback also successfully improved performance of direct-care staff members. Recommendations are made for further investigation of variables related to behavior change of staff and residents. When compared to people without mental retardation, social-skill deficits have been found to occur at a disproportionately high rate among people with mental retardation (e.g., Andrasik & Matson, 1985). Several variables have been found to account for these high rates. On the one hand, environmental factors such as avoiding demands and tasks may contribute to poor social performance. On the other hand, the behavioral and cognitive limitations associated with mental retardation may account for the observed social deficits. Recognition of the fact that social-skill deficits during childhood and adolescence can have implications for current and future adjustment has prompted research into the remediation of such deficits (e.g., Amish, Gesten, Smith, Clark, & Stark, 1988). The relevant research has also moved from the development of skill acquisition procedures to designing procedures to promote generalization and maintenance. Use of selfmanagement procedures — which include goal setting, self-monitoring, self-evaluation, and self-reinforcement — has been found to promote generalization of behavioral changes. Furthermore, self-management treatment packages have been used with various populations and for various behaviors (for reviews, see Harchik, Sherman, & Sheldon, 1992). Embregts (2000, 2002) used self-management procedures with video feedback to modify appropriate and inappropriate social behavior of adolescents with mild mental retardation. The video feedback procedures involved videotaping an activity and having residents then observe and evaluate their performance. In the first study (Embregts, 2000), intervention consisted of: (a) videotaping inappropriate behavior, (b) having residents monitor and record their own behavior, (c) prompting residents to evaluate their behavior against a set criterion, and (d) having residents reinforce themselves for occurrence of appropriate behavior. This study was conducted as part of the dissertation research project of the author. The project was supported by a research grant from the Residential Facility Jan Pieter Heye, Oosterbeek, The Netherlands. The author thanks the youth and staff members of the institution. Thanks are also extended to P. Duker for his comments and to Daisy Lemmens for her assistance with the data collection. Correspondence concerning this article should be addressed to Petri Embregts, Department of Special Education, University of Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. E-mail: [email protected]. Education and Training in Developmental Disabilities, 2003, 38(3), 283–295 © Division on Developmental Disabilities Self-Management, Video Feedback, and Graphic Feedback / 283 Results showed a statistically significant decrease in percentage of inappropriate social behavior while the procedure was in effect. In the second study (Embregts, 2002), a training procedure involving self-management, video feedback, and graphic feedback was utilized to assess effects of intervention on both inappropriate social behaviors of youth with mild mental retardation and interactions of staff members with this youth. The procedure was found to successfully modify the performance of direct-care staff. Results showed an increase in occurrence of appropriate behavior on the part of the youth. However, inconsistent changes were found for inappropriate social behavior. While the results of these studies are encouraging, it must be noted that all residents in the studies exhibited behaviors that can be characterized as externalizing: aggression, arguing, bullying, defiance of authority, temper tantrums, and intimidation of others. Children with mild mental retardation and social deficits that can be characterized as internalizing also exist. Internalizing behavior patterns include: refraining from interactions with others, shyness and unassertiveness, acting fearfully, not responding to social initiatives by others, and not standing up for oneself. Falk, Dunlap, and Kern (1996) assessed the effects of self-evaluation involving video feedback on inappropriate and appropriate peer interactions of children with normal intelligence and either externalizing or internalizing behavior problems and found the procedure to indeed increase rate of appropriate interactions and decrease rate of both internalizing and externalizing behaviors, respectively. In residential programs, behavioral mediators are most frequently the direct-care staff, which has generated considerable research (e.g., Seys & Duker, 1988). Only a few studies in the staff training literature have measured maintenance (e.g., Belfiore & Browder, 1992; Demchak & Browder, 1990) or generalization of such behavior changes (e.g., Ducharme & Feldman, 1992; Suda & Miltenberger, 1993). In the present study, it is, therefore, attempted to extend the results obtained by Embregts (2000, 2002) along two different lines. First, as residents in the previous studies exhibited behaviors that can be characterized as externalizing, it was decided to include residents who also exhibit internalizing behaviors. Second, it was decided to undertake longterm, follow-up measures of effects of the intervention.