Friday, January 15, 2010
* noted as presenting author
BACKGROUND AND PURPOSE: Empirically supported treatments for oppositional defiant disorder (ODD) include anger control therapy, multisystemic therapy (MST), parent management training (PMT), and problem-solving skills training. Additionally, behavioral interventions are widely used to help manage problem behaviors in developmentally delayed adults. The objective of this study was to evaluate an evidence-based practice to treat a 21-year-old mentally retarded female client with oppositional behavior. The author chose to implement a modified form of PMT because of its clinical success with a wide age-range of children. With a cognitive age of 4.5 years, it was hypothesized that modifying PMT for this mentally retarded young adult client in both school and home settings would be an effective intervention for reducing negative behaviors. METHODS: An intervention was created that incorporated principles of PMT. Specific activities included helping parents and teachers collaboratively define specific behaviors to change, coaching parents and teachers to reinforce positive behaviors, creating a modified time-out as punishment for negative behaviors by excluding the client from group activities, and using prompts to shape final behavior. Direct behavioral observation by teachers was the primary data source for measuring the client's progress. The Social-Emotional Skills Rating Scale – Adult Form (SESRS-A) was used to substantiate findings. An A-B method was used due to time constraints. RESULTS: During baseline, the client averaged 1.57 episodes of negative behavior per day (SD=.78) The intervention period lasted for 5 school weeks, and improvement was evidenced by an average daily episode count of .63 (SD=.71) during the intervention period. A t-test indicated that the findings were significant (t = 2.83, p = .01). SESRS-A scores rose from a mean of 75 (SD=1.41) at baseline, indicating a moderately low level of social emotional functioning, to a mean of 141 (SD=1.41) during the intervention period, indicating a moderately high level of functioning. A t-test with this data was also significant (t = -46.67, p = .000), although this data was simply used to corroborate findings. CONCLUSIONS AND IMPLICATIONS: Use of this modified form of PMT was effective during the treatment period. Anecdotal follow-up with the client's family indicate sustained improved functioning in her adult residential placement one year after the intervention was discontinued. Consideration should be given to using principles of PMT to create a formal plan for modifying problem behavior across settings with other developmentally delayed adult clients.