Outcomes of a nonaversive behavior intervention in intellectually impaired individuals using goal attainment scaling

Intellectually impaired individuals with severe behavior problems pose a challenge to caregivers in treatment and management. The use of behavioral intervention techniques, for example, differential reinforcement of other behavior (DRO), has been shown the most effective with this client group type. Studies suggest that DRO is effective and may result in generalization of treatment effects.

To test which of three behavior interventions (DRO, mutual goal setting [MGS], and routine care) improve self-care behaviors in moderately intellectually impaired individuals with behavioral problems, and to examine whether the use of goal attainment scaling (GAS) in evaluating interventions reflects improvement in self-care behavior.

A quasi-experimental design with small-group and single-subject repeated measures were used. The participants (15 congenitally moderately intellectually impaired residents with inadequate self-care behaviors) were randomly assigned to one of the three interventions for fostering self-care behaviors. To evaluate the outcome of treatment, GAS was used. Staff in the DRO and MGS groups developed and evaluated rehabilitation plans with each participant. Participants in the DRO group, but not the MGS group, were positively reinforced immediately. Staff in the routine care group assisted residents. The intervention continued for 22 weeks; follow-up was 16 weeks.

A change score was calculated from the GAS for each participant and group. The expected range of mean GAS scores for individuals and groups was between 23 and 77, with 23 (-2) representing less than and 77 (+2) much more than expected improvement.

Findings showed DRO to be more effective than the other interventions in improving self-care behaviors. Comparisons of the GAS mean baseline and mean intervention scores in all three interventions demonstrated the actual improvement in the self-care behaviors.