Teaching Manding Through Functional Communication Training to a 53-Year-Old Man With Cerebral Palsy Literature Review Chapter

Teaching Manding Through Functional Communication

Teaching Manding Thorugh Functional Communication Training To A 53-year-old Man With Cerebral Palsy

Self-injurious behavior (SIB) usually occurs in mentally retarded persons. There are certain genetic syndromes which are more likely to cause self-injury as part of the behavioral phenotype of the condition. SIB can be quite devastating since it is a characteristic of several mental disorders. About 5-17% of all people who have intellectual disabilities and developmental disabilities usually engage in self-injurious behavior in a repetitive nature with some having the number of incidences of self-injurious behavior being quite high. The incidence of self-injurious behavior in those who are mentally retarded can exceed 50%. SIB is a chronic problem Mikhail & King, 2001.

Emerson (1995)

found that out of 95 individuals who were mentally retarded, about 71% of them still showed signs of self-injurious behavior up to 7 years later. Functional communication is one of the methods of reduction of occurrence of self-injurious behavior.

SIB in cerebral palsy patients

A good number of patients with cerebral palsy usually have developmental and intellectual disabilities which causes them to have severe cognitive impairment. For this reason, they are unable to understand their environment well and thus they exhibit self-injurious behavior especially when they are unable to communicate with ease. There are three major risk factors which act as indicators of self-injurious behaviors in cerebral palsy patients. These are the damage to the nervous system, epilepsy and their learning disability. Other risk factors include age - research has shown that the incidence of SIB is at peak in patients between 15-34years, gender -- research has shown that men exhibit more incidence of SIB than women. Other factors include communication difficulties and multiple impairments Scope ()

Functional communication

Lingraphica News (2006)

states that functional communication is a term which refers to the capability of a person to receive a message or convey it regardless of the mode used to pass the message in order to make sure communication is effective and independent of the environment. This is the definition of functional communication as given by the American Speech-Language-Hearing Association. In simpler terms, functional communication is basically making oneself understood by whatever means possible even though it may include the use of aid devices such as communications boards or speech generators. It also involves the person being able to communication in this way without being assisted. Simply responding to a question using yes or no does not include functional communication Schieltz et al., 2010()

Functional communication has been recognized in the field of psychology as one of the methods that has been used to help individuals who have behavioral problems. It is used to prevent the escalation of wild behavior such as self-injury or aggression from previously mild behaviors. It is often an intervention measure taken by the people in charge of the care of the patient. All that needs to be done is to educate them on this method. Functional communication has come to be praised greatly by both practitioners and researchers because of its huge success Sternberg, 1991()

Functional communication and extinction

Extinction is an important variable in the use of functional communication in the treatment of self-injurious behavior. Extinction means that functional communication is combined with time-out.

In a research study conducted by Shirley, Iwata, Kahng, Mazaleski, and Lerman (1997)

it was found that when functional communication was combined with extinction or time-out, it was more effective in decreasing the occurrence of self-injurious behavior. The study was conducted on two participants, Rick and Sue. The former was used to test the use of extinction while the latter was testing functional communication without extinction. For Rick's case, it was found that when functional communication was combined with extinction, the incidence of self-injurious behavior increased at the initial stage but this decreased thereafter. At the beginning of the experiment, the average number of responses of self-injurious behavior was 2.54 per minute which then reduced to 0.08 per minute during the last five sessions which were combined with extinction. At this point, when extinction was removed, the number of responses continued to reduce to 0.02 per minute. For Sue who did not have time-out, the initial number of responses increased before decreasing to 0.19 responses per minute during the last five sessions. This goes to show that extinction is quite important in the reduction of incidences and treatment of self-injurious behavior Shirley et al., 1997()

Manding

Manding is a form of functional communication that is mostly used by adults to teach their children.It basically is asking a question which requires more than a simple yes or no answer. When the teacher uses mands, it gives them a leading role in the learning opportunity so presented and when they offer a mand, they expect a response from the other person. Because of this back and forth nature of manding, the teacher is easily able to find out whether the student understands them and whether they are capable of performing the request Murphy & Barnes-Holmes, 2010()

In a situation where the student understands the mands, they are able to do as they asked and when they are not capable of understanding it, two things can be assumed. First is that the mand was not understood or second is that the task was too difficult for the student. If either of these two assumptions comes to be true, then it is possible to change the request to make it more understandable and easier to perform by the student.

Use of functional communication to intervene in self-injurious behaviors

Sara

In a study that was reported in the Journal of Visual Impairment & Blindness, functional communication was used to intervene on the self-injurious behaviors of a blind girl who also had several other severe disabilities. In a two-level program, the girl was offered to choose among several preferred activities and she was able to use a communication board and this resulted in the decrease of incidence of the self-injurious behaviors Gerra & Dorfman, 1995()

In the study, the blind girl, known as Sara, had suffered the complications as a result of her premature birth. She has average weight and height for her age and her physique is sturdy. She prefers active physical activities. Though her hearing ability was within the normal limits, her oral skills were inadequate to enable her express herself effectively. However, the major concern that made her the subject of the study was the self-injurious behavior which included screaming, face punching, crying, hitting her face and head with both fists and biting Gerra & Dorfman, 1995()

She was attending a program which served visually impaired students who also have other cognitive difficulties and disabilities. The program teaches the students to use alternative methods of communication such as sign language, communication boards, tangible cue systems as well as other augmentative equipment. The students are allowed to determine their daily schedules through the choice of their preferred activities Gerra & Dorfman, 1995()

Level 1 of the program is designed to encourage the participation in classroom activities that do not maximize the student's ability to learn communication skills as an alternative to the self-injurious behaviors. Level 2 of the program was designed to be a refinement of the first level. It involved integrating functional communication with choice Gerra & Dorfman, 1995()

Data was collected for the study for 114 weekdays, 57 days for level 1 and 57 for level 2. Sara was seen to have a mean of 36.2 self-injurious minutes every day during level 1 of the program which then reduced to 11.3 minutes during the second level of the program. In the level 1 of the program, she had 22 days which she did not exhibit any self-injurious behavior while for 30 days in the second level, she did not exhibit any such behavior Gerra & Dorfman, 1995()

Before Sara joined this program, her behavior did not allow her to participate in many activities in the school program. However, after the improvement in her behavior, she was not able to go on school trips, community outings and other recreational activities. She was also now able to make better choices and to communicate better. She also gathered the virtue of tolerance and experienced an overall improvement in the quality of her life Gerra & Dorfman, 1995()

Manding

Functional communication and especially manding has been known to be most effective in autistic children. In autistic researches, functional communication training was essentially found to be a way to replace the inappropriate behaviors with more effective and appropriate modes of communication and skills

ADDIN EN.CITE

(Padilla Dalmau et al., 2011; Reichow, Volkmar, Doehring, & Cicchetti, 2010; Yamamoto & Mochizuki, 1988)

Functional communication was essentially found to be most effective with children without any discrimination on their level of cognition or their communication abilities regarding expressions. In the many researches that have been conducted on manding, it was found that it is.....