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Snoezelen multi-sensory environments:

Task engagement and generalization


H. Kaplan
a,
*
, M. Clopton
a
, M. Kaplan
b
,
L. Messbauer
a
, K. McPherson
a
a
Lifespire, 84-03 96th Street, Woodhaven, NY 11421, USA
b
Downstate Medical Center, Brooklyn, NY, USA
Received 20 December 2004; received in revised form 2 May 2005; accepted 9 May 2005
Abstract
These experiments explored whether behavioral improvements observed during Snoezelen OT
treatment sessions carried over to two different settings for three people with moderate/severe
intellectual disability, autism and severe challenging behaviors. Experiment 1 explored engagement
during a functional task immediately following the treatment sessions while experiment 2 explored
changes in the frequencies of challenging behaviors on the days after treatment sessions. Investi-
gators found carryover for two of the three participants to both post-session engagement as well as to
the daily frequency of challenging behaviors on days following the OT sessions.
# 2005 Elsevier Ltd. All rights reserved.
Keywords: Snoezelen multi-sensory environments; Autism; Challenging behaviors; Intellectual disability;
Occupational therapy
1. Introduction
Snoezelen is a multisensory environment that allows a person to select and receive
sensory input in the type and amount he or she desires. Different pieces of equipment can
provide visual, auditory, olfactory, tactile, vestibular and proprioceptive sensory input. This
type of sensory environment has been used with adults with intellectual disabilities who
Research in Developmental Disabilities 27 (2006) 443455
* Corresponding author. Tel.: +1 718 441 9142; fax: +1 718 343 5125.
E-mail address: howiedr@aol.com (H. Kaplan).
0891-4222/$ see front matter # 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ridd.2005.05.007
have a variety of challenging behaviors. Some evidence exists that Snoezelen intervention
can decrease aggressive and/or self stimulatory behaviors and increase time on task during a
Snoezelen session (Cuvo, May, & Post, 2001; Shapiro, Parush, Green, & Roth, 1997).
Evidence of carryover of these effects to other settings is limited (Ashby, Lindsay, Pitcaithly,
Broxholme, & Geelen, 1995; Cuvo et al., 2001; Houghton et al., 1998). A recent study by
Singh et al. (2004) was the rst to explore whether changes observed during a Snoezelen
session actually carried over to an activity, which immediately followed the session. They
founda signicant carryover effect onself-injurywhen the Snoezelen sessions were followed
by either vocational activity or training in activities of daily living skills (ADL), and a
clinically but not statistically signicant effect on aggression. Several of these articles
(Cuvo et al., 2001; Singh et al., 2004) suggest that further investigation of carryover effects
would be an important step in the research agenda for multi-sensory environments.
A study by Pfeiffer and Kinnealey (2003) found that relaxation in adults could lower
anxiety levels measurably. One possible consequence of lowered anxiety levels might be a
decrease in anxiety-driven challenging behaviors such as biting, tantrums and crying/panic
attacks, the behaviors examined in the current study.
The current experimenters attempted to investigate whether observed changes in
engagement carried over to a post-session functional activity and whether there was further
generalization, as measured by a reduction in the frequency of challenging behaviors,
during the hours/days following the Snoezelen session.
2. Methods
2.1. Experiment 1
2.1.1. Setting
The setting for these two experiments was a Day Habilitation program for persons with
intellectual disabilities and severe challenging behaviors. Many of the people served in this
Day Habilitation program are people with autistic spectrum disorders who were previously
at home or institutionalized for extended periods of time. The agency providing these
services offers a wide range of occupational therapy interventions, including Snoezelen
based services, in several of its other sites and has had anecdotal success using this
modality with other individuals exhibiting similar functional proles. This Day
Habilitation program differs from others in that there is a much higher staff to consumer
ratio, more space per individual and smaller group sizes, allowing it to be more person
centered and exible in its approaches to assisting consumers in the process of integrating
into their local communities.
2.1.2. Participants
Participants in these two experiments were three adults with autism, intellectual
disability and severe challenging behaviors. At the time of the experiment, they had been
attending the above Day Habilitation program for individuals with severe challenging
behaviors for more than 6 years. For all three participants, the occupational therapist
remained the same throughout the period of time covered by the experiment.
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 444
Ann: a 31-year old person with moderate intellectual disability and autism. Her
challenging behaviors were spitting, elopement, physical and verbal aggression. Ann is in
good physical health. She was not taking any psychotropic medications at the insistence of
her mother. She had been living in an apartment with her mother all of her life. She was on a
behavior plan for the above challenging behaviors, which remained constant for the entire
study. Functional analysis (Carr et al., 2000, p. 31) of her challenging behaviors indicated
that she was primarily seeking attention and secondarily seeking to escape from non-
preferred tasks. She was verbal but often used grunts and gestures to communicate her
needs and desires unless prompted by staff. Her receptive language skills were good and
she could follow multiple step directions. She related mainly to staff rather than other
consumers in the program. Prior to participating in the experiment, she was not receiving
any occupational therapy services
Kit: a 52-year old person with profound intellectual disability, autism and major
depression. His challenging behavior was frequent crying incidents during which he
occasionally became panicked and aggressive towards others around him. During the
experiment, he was taking the following psychotropic medications: paxil, seroquel and
risperdol. Dosage and type of medication did not change during this series of experiments.
Kit had a long history of institutionalization and was living in a group home for persons
with intellectual disability for the 10-year period prior to the experiments. His physical
health was frail and he was being treated for severe periodontal disease and constipation.
He was on a behavior plan for the above challenging behavior, which also remained
unchanged during the study. Functional analysis of his challenging behavior indicated that
it was performed primarily for the purpose of escape from task demands and secondarily to
obtain tangible reinforcers. He was minimally verbal, speaking mainly in one or two word
utterances. He was also echolailic. His receptive language skills were also poor, but he
could follow one-step directions if accompanied by physical and gestural prompts.
Jay: a 47-year old person with profound intellectual disability and autism. His challenging
behavior was biting, both himself as well as others. During the experiment he was taking the
following psychotropic medications: atarax, zyprexa, haldol and neurontin. Dosage and type
of medication did not change during this time period. Jay has a long history of
institutionalizationand was living in a grouphome for persons with Intellectual Disability for
the 6-year period prior to the experiments. His physical health was frail and he was being
treatedfor aseizure disorder, chronic cellulitis andconstipation. Hewas ona behavior planfor
this challengingbehavior, whichremainedunchangedduringthestudy. Functional analysis of
his challenging behavior indicated that it was performed primarily for the purpose of
obtaining tangible reinforcers and secondarily for the purpose of escape from task demands.
He was almost completely non-verbal, using a fewsigns and two or three recognizable words
relating to food and one phrase, dont want, by which he would indicate refusal. His
receptive language skills were poor, although he could follow one-step directions if he was
motivated and if they were accompanied by physical and gestural prompts.
2.1.3. Design
The experimental design used in this experiment was visual analysis of graphs using an
alternating treatment or reversal design (Cook & Campbell, 1979) also referred to as an
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 445
ABA design (Kazdin, 1982). In this design, the participant received occupational therapy
services in a Snoezelen room for the rst phase of the study lasting several sessions, then
received non-Snoezelen occupational therapy for several sessions with other reversals
between Snoezelen and non-Snoezelen occupational therapy phases following system-
atically. Hence, the ABA sequence, where Snoezelen was the A phase and occupational
therapy without using Snoezelen was the B phase. If there was some effect of the use of
Snoezelen room, then there should be some discontinuity between phases A and B in
the data, and then another discontinuity between phase B and A at the end of the
experiment. Further, the data should trend in the same direction during the two A phases
and should show a different trend during the B phases. Sessions occurred on an average
of twice per week.
2.1.4. Procedure
Experiment 1 investigated whether generalization from the Snoezelen session took
place during a 5-min task immediately after the end of the OT session. For Ann, the task
was a color bingo game she liked to play. For Kit, the task was a peanut butter and jelly
sandwich making and eating task. For Jay, the task was playing catch using a ball with a
preferred staff member. These were goals selected by either the family or the residence and
were also being used at home/residence. Therefore, they had extensive experience with the
task prior to this series of experiments, decreasing potential threats to internal validity due
to learning. They were videotaped during this task and the number of prompts required to
complete the task was recorded for two of the participants, while for the third participant,
Jay, the dependent measure was the number of intitiations Jay made in the ball playing task.
2.1.5. Operational denition of the dependent measure
The dependent measure for Ann and Kit was the number of prompts required to
complete the task, while for Jay, it was the number of times he initiated throwing the ball to
his preferred staff member. For the purpose of Experiment 1, prompt was operationally
dened as any gesture or vocalization which cued the participant to remain engaged in the
task for Ann and Kit. For Jay, initiation is operationally dened as throwing the ball to his
preferred staff member without being prompted.
Sessions took place on an average of twice per week for 30 min at a time. For the purpose
of both experiments 1 and 2, Snoezelen occupational therapy treatment was operationally
dened as treatment of the participants proprioceptive and vestibular systems through
directed auditory, tactile and visual sensory input to effect arousal change. The participants
and the OTalternately adjusted the input through the use of bean bag chair, stationary rocker,
projector, light box, ceiling and oor chase lights, ber optic spray, bubble tube, black lights
and new age music synchronized to the light box. Non-Snoezelen OT treatment is
operationally dened as proprioceptive and vestibular calming exercises which preceded the
use of rubber stamps and colored pens to make picture communication boards. Therapeutic
focus in both situations was to improve visual tracking, attention and midline crossing.
2.1.6. Reliability of the dependent measure
Two occupational therapy students and one certied occupational therapy assistant
(COTA) who were unfamiliar with the participants and unaware of which type of
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 446
occupational therapy treatment preceded the videotape, independently counted the number
of prompts or initiations provided during each taped session. It was hoped that by capturing
the participants behavior on videotape immediately after participating in either a
Snoezelen session or regular occupational therapy session, we could maximize the
probability of nding any post-session carryover that might occur in their level of
engagement in the assigned task. By ensuring that the raters were blind to the nature of the
preceding type of therapy, we also minimized the probability that their expectations would
bias their ratings. Attempts were made throughout the process of reviewing the tapes by the
blind raters to ensure that their level of agreement remained above 80% for occurrence/
non-occurrence agreement, and any observations that did not meet this criteria meant
retraining for the observers. This retraining was not necessary during the experiment. Inter-
observer agreement among the three raters (using the intraclass correlation coefcient) on
the number of prompts for Ann and Kit was 84.4%, d.f. = 32 and 83.3%, d.f. = 36,
respectively and for Jay on the number of initiations was 88.1%, d.f. = 59. Intraclass
correlation coefcient is used because it is the one type of correlation that can
simultaneously compare three raters. The version used is the two-way mixed effects model
for comparing k raters, who are the only raters of interest (Shrout & Fleiss, 1979).
3. Results
Fig. 1 above displays the data for participants during their 5-min post-Snoezelen tasks.
The top graph, labeled Ann, represents the number of prompts required to keep her
engaged in playing picture bingo with the rst author for 5 min immediately after
participating in either a Snoezelen room based OT treatment session or alternate, non-
Snoezelen based OT treatment session. The number of prompts ranged between 20 and 100
during the rst phase of the experiment, which consisted of the rst 20 sessions with the OT
and represented post-Snoezelen based sessions. The number of prompts required during
the next four phases of the experiment for Ann ranged between 20 and 55, which was
substantially lower than the previous 20 sessions, but there was no systematic difference
between the Snoezelen and non-Snoezelen phases of the experiment, suggesting that there
was no differential effect across phases. The gradual decrease in number of prompts
required to remain engaged in the task can easily be explained as the effects of learning,
with fewer prompts required over time. The alternation of treatment conditions seemed to
have no apparent effect on Anns on-task behavior.
The second graph of Fig. 1 represents the number of prompts required to keep Kit
engaged in a 5 min sandwich making and eating task with the rst author immediately after
participating in either a Snoezelen room based OT treatment session or an alternate, non-
Snoezelen based OT treatment session. The number of prompts ranged from 25 to 53
during the rst phase of the experiment, which consisted of the rst 17 sessions with the OT
and represented post-Snoezelen based sessions. The next three data points represent non-
Snoezelen based sessions and are all higher than any of the previous phases session totals.
When services revert to being Snoezelen based for the next four sessions, prompt
frequency declines precipitously to between 20 and 25 per session and then increases again
to between 30 and 40 for the next two non-Snoezelen sessions. A nal return to Snoezelen
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 447
based sessions for the last eleven data points sees the reduction of prompts required to
below 30 for all but two of the sessions during that phase, and only one session where Kit
required more prompts to remain engaged than during the previous non-Snoezelen phase.
This pattern of requiring more prompts to remain engaged in the task when it was preceded
by a non-Snoezelen OT session than when preceded by a Snoezelen based OT session
supports the observation of a latent or carry-over effect of Snoezelen upon post-session task
engagement for Kit, the second participant in experiment 1.
The third graph of Fig. 1 represents the number of initiations made by Jay during a
5-min game of catch with his preferred staff member immediately after participating in
either a Snoezelen room based OT treatment session or an alternate, non-Snoezelen based
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 448
Fig. 1. Prompts/initiations to remain on task.
OT treatment session. The rst 28 sessions, all post-Snoezelen, range fromthe mid-teens to
the high 30s in terms of initiations by Jay. The next three data points are post non-
Snoezelen sessions and are lower in magnitude than all but three of the sessions during the
previous Snoezelen phase. When sessions return to being Snoezelen based for the next 18
sessions, initiation frequency jumps to between 45 and 80 for the rst two sessions and then
settles down to approximately the same level as the rst Snoezelen phase for the remainder
of the phase. Achange back to non-Snoezelen based interventions for the next two sessions
results in the lowest level of initiations for the entire series (both under 10). A nal reversal
back to Snoezelen based interventions for the next eight sessions results in between 20 and
42 initiations per session. This pattern of more initiations during Snoezelen based as
opposed to non-Snoezelen based interventions also supports the observation of a latent or
carryover effect of Snoezelen upon post-session task engagement for Jay, the third
participant in experiment 1.
4. Discussion
Two of the three graphs (those for Kit and Jay) provide support for the proposal that
there is a latent or carryover effect of Snoezelen based sessions upon subsequent on-task
behavior, which was our measure of engagement, during the performance of a post-
session functional task. For Kit, this was measured by the number of prompts required to
complete a sandwich making and eating task. For Jay, this was measured by the number
of times per session that he initiated throwing a ball to a staff person without prompting.
Data for Ann indicate no systematic pattern of responding across experimental
conditions and therefore no differential effect of Snoezelen as opposed to non-Snoezelen
based interventions.
Strengths of the design are the frequent reversals of experimental conditions, each
subsequent reversal reducing the probability that observed changes are the result of chance,
and the use of single subject design methodology which enables readers to look in detail at
the interaction of participant variables and their effect on treatment outcomes. Weakness of
the design are the small number of data points in the non-Snoezelen phases of the
experiment (which limit the ability to infer long term patterns from data), and the absence
of a baseline prior to beginning the rst Snoezelen session (which weakens the possibility
of demonstrating an effect because we cannot observe what would happen to the data in the
absence of any intervention).
A possible explanation for the difference between responding participants and the one
participant who did not respond may come from differences in their characteristics and in
the function of their challenging behaviors. While Kit and Jay engage in frequent behaviors
performed primarily for the purposes of sensory reinforcement (Kit carries around coins
and bottle tops in one hand during the day and manipulates them constantly, becoming
agitated when his hand is free of these objects, Jay spends much time spinning and twirling
around and exhibiting hand stereotypies), Ann does not engage in any of these types of
stereotypies. Ann is also a person with a moderate intellectual disability while both Kit and
Jay are people with a severe/profound level of intellectual disability. Finally, functional
analysis of challenging behaviors for Kit and Jay indicate that they are performed for the
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 449
purpose of escape from task demands and to obtain tangible reinforcers, while Anns are
primarily for the purpose of obtaining attention and secondarily for escape.
4.1. Experiment 2
4.1.1. Participants and setting
Participants for experiment 2 were the same as described above for experiment 1.
4.1.2. Design
The design for experiment 2 was the same as that for experiment 1, except a baseline
phase was added with data collected prior to the initiation of any occupational therapy
sessions.
4.1.3. Procedure
Procedure was identical to that used in experiment 1. Experiment 2 attempts to extend the
ndings of experiment 1 by examining whether the change observed in experiment 1 (more
engagement during the post-Snoezelen task) is further carried over to the rest of the
participants day and week. The dependent measure here is the frequency of challenging
behaviors exhibited by the participants during the next few days until the next occupational
therapy session. Day Habilitation program staff routinely collect data on the frequency of
challenging behaviors exhibited by each consumer on a daily basis. As a reliability measure,
inter-observer agreement was measured once per week, or 20% of the time. Here, a second
staff member, who was familiar with the participant was asked to independently report the
frequency of targeted challenging behaviors for the participants in these experiments. This
reliability check occurred throughout the course of the experiment. Further, day program
staff were unaware and therefore blind towhich occupational therapy method was being used
at the time for the participant. For the current participants, the following challenging
behaviors were being exhibited: Ann, tantrums, Kit, crying incidents, Jay, biting incidents.
Therefore, data for these three behaviors were collected and graphed in a manner similar to
the number of prompts/initiations required to complete the functional task.
4.1.4. Reliability of the dependent measure
For the rst challenging behavior (Ann; number of tantrums per day), the level of inter-
observer agreement between staff members counting the number of tantrum incidents when
sampling 20% of occasions was 76.8%, calculating the number of agreements divided by
total number of occasions. For the second challenging behavior (Kit; number of crying
incidents per day), the level of inter-observer agreement under the same sampling strategy
was 77.8%. For the third challenging behavior (Jay; frequency of biting incidents per day),
the level of inter-observer agreement under the same sampling strategy was 83.2%.
5. Results
Fig. 2 above displays the behavioral data for participants during the hours/days
following their treatment sessions. The top graph, labeled Ann, represents the number of
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 450
times per day she engaged in tantrum behavior. This behavior is operationally dened as
verbal, gestural or physical aggression or elopement. The graph represents data for three
quarters of a years attendance in the Day Habilitation program. The rst 90 days of
program attendance is depicted in the phase labeled baseline. During this phase, the
target behavior ranges from a minimum of zero episodes per day to a maximum of ve, and
there are two clusters of data points separated by long periods of time where the behavior
does not occur, suggesting the cyclic nature of her outbursts. During the middle of the
second cluster, at day 91, the OT began having sessions in the Snoezelen room with Ann
and there were several days where the behavior was not exhibited. Then at day 97, the
behavior began again, taking place intermittently over the next few months. Whether she
received Snoezelen or non-Snoezelen based interventions seemed to have little effect on
the frequency of target behavior. The clusters of behavior continued to occur regardless
of the experimental phase. Therefore, there does not seem to have been any effect of
treatment on the frequency of her tantrums. It should be noted that the level of frequency
seems to be declining over time.
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 451
Fig. 2. Behavior frequency.
The second graph, labeled Kit, represents the number of times per day he engaged
in crying incidents. The graph represents data for three quarters of a years attendance in
program. The behavior occurs between zero and 20 times per day. During the rst 89
days in program, the baseline period, the behavior is quite variable, but there are few days
when the behavior is at the zero level. On day 90, he begins Snoezelen based OT
treatment sessions begin and the behavior frequency never exceeds ve times per day,
with more than one third of the phases data points falling at the zero level. For the next
phase, he is given non-Snoezelen sessions and the level increases to a maximum of 10 per
day, with only 1 out of 17 days where no crying occurred. During the next phase, where
Snoezelen based sessions were used, the maximum level never exceeds ve per day and
more than half the days are at the zero level. A brief reversal to non-Snoezelen sessions
sees the data increase above the ve per day level again, with very few days where zero
behaviors occur. A nal reversal to Snoezelen based sessions accompanies a decrease in
behavior frequency again, with all days below ve incidents and half of this phases data
points are again at the zero level. The change from baseline to treatment accompanies a
radical decrease in the number of crying incidents. The difference between Snoezelen
and non-Snoezelen based sessions is also readily observable, with many more incidents
occurring on days following non-Snoezelen than following Snoezelen sessions. There is
also a marked decrease in target behavior frequency over time, suggesting that either
type of OT intervention has had a positive effect by reducing the frequency of this
behavior.
The third graph represents the number of biting incidents per day for Jay with
approximately 1 years worth of data on the daily frequency of biting incidents for this
participant. The graph includes incidents where he either bites or attempts to bite himself or
others around him. Data ranges in frequency between zero and 13 incidents per day. During
baseline, the frequency seems to be increasing gradually, although there are more 0 days
toward the end of this phase. On day 73, he began Snoezelen based OT sessions and there
was an immediate series of almost 15 days where the daily frequency was zero, with the
maximum never exceeding four per day. On day 140, he began non-Snoezelen sessions and
there were three out of the next 5 days where the daily frequency increased to six incidents
per day. This increase actually began a few days before the increase during the previous
Snoezelen based phase, indicating a change that may not be directly a result of the type of
treatment. In spite of any clear association between increases and phase changes, a
majority of the days during this non-Snoezelen phase are well above zero and the level is
substantially higher than the level for the previous Snoezelen phase. On day 153, Jay began
Snoezelen based sessions and the daily frequency remained at the zero level with only ve
exceptions until day 198, when he reverted to non-Snoezelen based sessions. Although the
increase observed here actually began a fewdays before he changes phases, and therefore is
not exclusively associated with the change in phases, 3 of the next 16 data points are non-
zero, with a peak of four during this phase, again slightly higher than the level of the
previous Snoezelen based phase. Finally, a reversal back to Snoezelen based sessions
occurred and was followed by a long string of days in which the target behavior did not
occur at all until day 223 where it occurred twice before returning to the zero for the last
string of days. Note again that there was a change between the baseline frequency of this
behavior and the level for the period after OT treatments begin, supporting the idea that
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 452
either type of OT treatment (Snoezelen or non-Snoezelen based) had a positive effect of
reducing the frequency of this behavior over time.
6. Discussion
There seems to be a slight but noticeable difference between the level of challenging
behaviors exhibited during baseline and non-Snoezelen phases as opposed to the Snoezelen
phases for both responding participants. The difference is in the direction of fewer
challenging behaviors on days following Snoezelen treatment as opposed to days following
non-Snoezelen treatments. Again, either type of OT treatment had a positive effect on the
frequency of these behaviors as compared to the baseline period.
7. Conclusion
The current experiments attempted to explore whether behavioral improvements
observed during Snoezelen based occupational therapy treatment sessions for three people
with moderate to severe/profound intellectual disability, autism and severe challenging
behaviors, carried over beyond the session to two different settings: increases in
engagement with tasks immediately following the treatment sessions as well as to reducing
the frequencies of challenging behaviors on the days after treatment sessions.
As discussed above, the experiments provide support for the hypothesis that these
effects generalize to both post-session engagement in a task (color bingo, sandwich making
or playing catch) as well as to the frequency of challenging behaviors on days
subsequent to the OT sessions.
Maintenance data are not presented here. We anticipated that the observed effects would
be short-lived, and therefore attempted to help maximize the effect by continuing sessions
on a more frequent basis with a trained non-clinical Snoezelen companion replacing the
OT. This maintenance data will be presented in a separate study.
Systematic differences between the two participants who seem to have responded (Kit
and Jay) and the one who did not (Ann) are interesting. A sensory processing evaluation of
all three participants (Reisman & Hanschu, 1992) revealed that they have difculty
modulating sensory input, particularly sensation. All participants had adverse reactions to
light tactile input and could be described as tactile defensive (Ayres, 1972). However, Kit
and Jay seemed to respond to their poor ability to modulate input by seeking out specic
sensory experiences that helped regulate their adverse response to light touch (Dunn,
1997). Kit liked to manipulate coins or bottle tops in his hand and was agitated when these
were not available. Jay engaged in frequent spinning and twirling behaviors giving himself
intense vestibular input that seemed to calm him. Ann reacts differently to this
hypersensitivity to tactile input. She developed a strategy of hitting, pushing or jumping
aggressively to keep others away from her.
Other contrasts between responders and non-responders were that Kit and Jay were
people in the severe to profound range of intellectual disability. Ann had a moderately
intellectual disability. Functional analysis of challenging behaviors for Kit and Jay indicate
H. Kaplan et al. / Research in Developmental Disabilities 27 (2006) 443455 453
escape and tangible reinforcers as the motivations, while for Ann, targets were attention
and escape motivated.
Since the strength of the observed connection was increased with each reversal. Thus
several reversals were included. Each reversal yielded a similar pattern in the data for the
two participants who responded positively to the treatments. A weakness of the current
experiments was the small number of data points during the non-Snoezelen based
treatment phase. This increased the difculty of observing and extrapolating trends.
This experiment is the rst exploration of Snoezelen multi-sensory environments, which
presents data suggesting carryover effects to the frequencies of challenging behaviors on
the days following treatment sessions. (Singh et al., 2004, found carryover effects to
activities immediately following the treatment sessions.) The study should be replicated
with additional participants, representing a wider selection of challenging behaviors whose
functions range more widely than do those persons in the current study (escape and tangible
reinforcers). Additional participants whose functional analysis of challenging behaviors
suggest attention as the primary function of the target behavior should be included in any
further studies in order to determine the importance of this variable. Statistical
experimental designs, such as the Singh et al. (2004) study, could also extend the
generalizability of the current ndings.
Acknowledgements
The authors acknowledge the invaluable assistance of Mr. Marcus Banks, Day
Habilitation Aide at Lifespire, without whose efforts in data collection this study would not
have been possible. Finally, we gratefully acknowledge the assistance of the late John
Jacobson, Ph.D., whose review and comments on our initial pilot study helped to
strengthen the design of the experiment.
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