Case Studies in Abnormal Psychology, 10th Edition 10th Edition, (Ebook PDF)
https://ebookmass.com/product/case-studies-inabnormal-psychology-10th-edition-10th-editionebook-pdf/
More products digital (pdf, epub, mobi) instant download maybe you interests ...
Case Studies in Abnormal Psychology 2nd Edition, (Ebook PDF)
https://ebookmass.com/product/case-studies-in-abnormalpsychology-2nd-edition-ebook-pdf/
Abnormal Psychology in a Changing World 10th Edition, (Ebook PDF)
https://ebookmass.com/product/abnormal-psychology-in-a-changingworld-10th-edition-ebook-pdf/
Health Psychology 10th Edition, (Ebook PDF)
https://ebookmass.com/product/health-psychology-10th-editionebook-pdf/
ISE Abnormal Psychology: Clinical Perspectives on Psychological Disorders 10th Edition Whitbourne Professor
https://ebookmass.com/product/ise-abnormal-psychology-clinicalperspectives-on-psychological-disorders-10th-edition-whitbourneprofessor/
Business Ethics: Case Studies and Selected Readings, 10th Edition Marianne M. Jennings
https://ebookmass.com/product/business-ethics-case-studies-andselected-readings-10th-edition-marianne-m-jennings/
Abnormal Psychology 17th Edition, (Ebook PDF) https://ebookmass.com/product/abnormal-psychology-17th-editionebook-pdf/
Physics, 10th Edition 10th Edition, (Ebook PDF) https://ebookmass.com/product/physics-10th-edition-10th-editionebook-pdf/
Using MIS (10th Edition) 10th Edition (Ebook PDF) https://ebookmass.com/product/using-mis-10th-edition-10thedition-ebook-pdf/
Financial Accounting, 10th Edition 10th Edition, (Ebook PDF) https://ebookmass.com/product/financial-accounting-10thedition-10th-edition-ebook-pdf/
CaseStudiesinAbnormal Psychology TenthEdition
ThomasF.Oltmanns
WashingtonUniversityinSt.Louis
MicheleT.Martin
WesleyanCollege
JohnM.Neale
StonyBrookUniversity
GeraldC.Davison UniversityofSouthernCalifornia
“ToPresley,Riley,andKinley” —TFO “ToMatt,Caroline,Grace,andThomas” —MTM “ToKathleen,Eve,andAsher” —GCD InMemoryofJohnNeale VICEPRESIDENT&EXECUTIVEPUBLISHERGeorgeHoffman
EXECUTIVEEDITORChristopherJohnson
SPONSORINGEDITORMarianProvenzano
PROJECTEDITORBrianBaker
ASSOCIATEEDITORChristinaVolpe
SENIOREDITORIALASSISTANTJacquelineHughes
EDITORIALASSISTANTKristenMucci
MARKETINGMANAGERMargaretBarrett
ASSOCIATEPRODUCTIONMANAGERJoycePoh
SENIORPRODUCTIONEDITORYeeLynSong
PRODUCTIONSERVICESSangeethaParthasarathy/Laserwords COVERDESIGNERKenjiNgieng
COVERPHOTOCREDIT©MarinaKoven/Shutterstock
Foundedin1807,JohnWiley&Sons,Inc.hasbeenavaluedsourceofknowledgeandunderstandingformorethan 200years,helpingpeoplearoundtheworldmeettheirneedsandfulfilltheiraspirations.Ourcompanyisbuiltona foundationofprinciplesthatincluderesponsibilitytothecommunitiesweserveandwhereweliveandwork.In 2008,welaunchedaCorporateCitizenshipInitiative,aglobalefforttoaddresstheenvironmental,social,economic, andethicalchallengeswefaceinourbusiness.Amongtheissuesweareaddressingarecarbonimpact,paper specificationsandprocurement,ethicalconductwithinourbusinessandamongourvendors,andcommunityand charitablesupport.Formoreinformation,pleasevisitourwebsite:www.wiley.com/go/citizenship.
Copyright©2015,2012,2009,2007JohnWiley&Sons,Inc.Allrightsreserved.Nopartofthispublicationmay bereproduced,storedinaretrievalsystemortransmittedinanyformorbyanymeans,electronic,mechanical, photocopying,recording,scanningorotherwise,exceptaspermittedunderSections107or108ofthe1976United StatesCopyrightAct,withouteitherthepriorwrittenpermissionofthePublisher,orauthorizationthroughpayment oftheappropriateper-copyfeetotheCopyrightClearanceCenter,Inc.222RosewoodDrive,Danvers,MA01923, websitewww.copyright.com.RequeststothePublisherforpermissionshouldbeaddressedtothePermissions Department,JohnWiley&Sons,Inc.,111RiverStreet,Hoboken,NJ07030-5774,(201)748-6011,fax(201) 748-6008,websitehttp://www.wiley.com/go/permissions.
Evaluationcopiesareprovidedtoqualifiedacademicsandprofessionalsforreviewpurposesonly,foruseintheir coursesduringthenextacademicyear.Thesecopiesarelicensedandmaynotbesoldortransferredtoathirdparty. Uponcompletionofthereviewperiod,pleasereturntheevaluationcopytoWiley.Returninstructionsandafreeof chargereturnmailinglabelareavailableatwww.wiley.com/go/returnlabel.Ifyouhavechosentoadoptthis textbookforuseinyourcourse,pleaseacceptthisbookasyourcomplimentarydeskcopy.OutsideoftheUnited States,pleasecontactyourlocalsalesrepresentative.
LibraryofCongressCataloging-in-PublicationData
Oltmanns,ThomasF.,author.
Casestudiesinabnormalpsychology/ThomasF.Oltmanns[andthreeothers].–Tenthedition. pagescm
Revisionof:Casestudiesinabnormalpsychology/ThomasF.Oltmanns...[etal.].2011.9thed. Includesbibliographicalreferencesandindex.
ISBN978-1-118-83629-3(paperback)
1.Psychology,Pathological–Casestudies.2.Psychiatry–Casestudies.I.Title. RC465.O472015 616.89–dc23
2014034453
PrintedintheUnitedStatesofAmerica
10987654321
PREFACE Mosttextbooksonabnormalpsychologyincludeshortdescriptionsofactualclinicalcases.However,thosepresentationsarenecessarilybriefandtoofragmented forstudentstogainaclearunderstandingoftheuniquecomplexitiesofaperson’s troubledlife.Theycannotdescribetheclient’sdevelopmentalhistory,themannerinwhichatherapistmightconceptualizetheproblem,theformulationand implementationofatreatmentplan,orthetrajectoryofadisorderoveraperiodof manyyears.Incontrasttosuchbriefdescriptions,adetailedcasestudycanprovideafoundationonwhichtoorganizeimportantinformationaboutadisorder. Thisenhancesthestudent’sabilitytounderstandandrecallabstracttheoretical andresearchissues.
Thepurposeof CaseStudiesinAbnormalPsychology,10eis,therefore,threefold:(a)toprovidedetaileddescriptionsofarangeofclinicalproblems,(b)to illustratesomeofthewaysinwhichtheseproblemscanbeviewedandtreated,and (c)todiscusssomeoftheevidencethatisavailableconcerningtheprevalenceand causesofthedisordersinquestion.Thebookisappropriateforbothundergraduateandgraduatecoursesinabnormalpsychology.Itmayalsobeusefulincourses inpsychiatricsocialworkornursingandcouldbehelpfultostudentsenrolled invariouspracticumcoursesthatteachhowbesttoconceptualizemental-health problemsandplantreatment.Itmaybeusedonitsownorasasupplementtoa standardtextbookinabnormalpsychology.
Inselectingcasesforinclusioninthebook,wesampledfromavarietyof problems,rangingfrompsychoticdisorders(e.g.,schizophreniaandbipolardisorder)topersonalitydisorders(e.g.,paranoidandborderline)tovariousdisorders ofchildhoodandaging(e.g.,attention-deficit/hyperactivitydisorder).Wefocused deliberatelyoncasesthatillustrateparticularproblemsthatareofinteresttostudentsofabnormalpsychology.Wedonotmeantoimply,however,thatallthe casesfitneatlyintospecificdiagnosticmolds.Inadditiontodescribing“classic” behavioralsymptoms(e.g.,hallucinations,compulsiverituals,orspecificfears), weemphasizedthesocialcontextinwhichthesedisordersappearaswellaslife problemsthataresignificantindeterminingtheperson’soveralladjustment,even thoughtheymaynotberelevantfromadiagnosticstandpoint.Severalofthecases includeaconsiderationofmaritaladjustmentandparent–childrelationships.
Ourcoverageextendstoexamplesofeatingdisorders,dissociativeidentity disorder,genderdysphoria,autismspectrumdisorder,andposttraumaticstressdisorder(followingrape).Eachofthesedisordersrepresentsanareathathasreceived considerableattentioninthecontemporaryliterature,andeachhasbeenthefocus oftheoreticalcontroversy.
Wehaveaddedonenewchaptertothistenthedition.Itdescribesawomanwho experiencedsignificantproblemswithhoarding.Thenewcaseprovidesimportant coverageofanewcategorythathasbeenaddedtothediagnosticsystemwiththe introductionof DSM-5.Hoardingdisorderaffectslargenumbersofpeople,has manycostsforfamiliesandcommunitiesofaffectedindividuals,andhasreceived increasedattentionintheprofessionalliterature.
Ourcognitive-behavioralperspectiveisclearlyevidentinmostofthesecase discussions.Nevertheless,wealsopresentanddiscussalternativeconceptualpositions.Thecasescan,therefore,beusedtoshowstudentshowagivenproblemcan bereasonablyviewedandtreatedfromseveraldifferentperspectives.Although mostoftheinterventionsdescribedillustrateacognitive-behavioralapproachto treatment,wehavealsodescribedbiologicaltreatments(e.g.,medication,electroconvulsivetherapy,andpsychosurgery)whentheyarerelevanttothecase.In somecases,theoutcomewasnotpositive.Wehavetriedtopresentanhonestview ofthelimitations,aswellasthepotentialbenefits,ofvarioustreatmentprograms. Notealsothatsomeofthecaseswereaboutpeoplewhowerenotintreatment.We believethatitisimportanttopointoutthatmanypeoplewhohavepsychological disordersdonotseetherapists.
Eachcasestudyconcludeswithadiscussionofcurrentknowledgeabout causalfactors.Someofthesediscussionsarenecessarilybrieferthanothers.More researchhasbeendoneonschizophrenia,forexample,thanongenderdysphoria orparanoidpersonalitydisorder.Wehadtwogoalsinmindforthesediscussions. First,wehavetriedtousethecasematerialtoillustratetheapplicationofresearch toindividualclients’problems.Second,wealertreaderstoimportantgapsinour knowledgeofabnormalpsychology,ourabidingbeliefbeingthatrealizingwhat wedonotknowisasimportantasappreciatingwhatwedoknow.Allthesediscussionshavebeenrevisedinthetentheditiontoincludenewideasandempirical evidencethatarechangingthewaythatparticulardisordersareviewedandtreated.
Wehaveincludeddiscussionsofissuesassociatedwithgender,culture,and ethnicityinallthepreviouseditionsofthisbook.Attentiontotheseissues,particularlythoseinvolvinggender,havebeenstrengthenedinthistenthedition.For example,thecaseonparasomnia(nightmaredisorder)discussesimportantissues relatedtoraceandgender.Ourdescriptionofposttraumaticstressdisorderfollowingrapetraumaincludesmanyissuesthatareparticularlyimportantforwomen (e.g.,helpfulandharmfulwaysinwhichotherpeoplereacttothevictim;decisions bythevictim,hertherapist,andherprofessoraboutwhethertoreporttherapist; andsoon).Ourdiscussionofthecausesofmajordepressionincludesconsiderationofpossibleexplanationsforgenderdifferencesinthisdisorder.Thechapters ondissociativeidentitydisorderandborderlinepersonalitydisorderbothdiscuss
theimpactofpriorsexualabuseonsubsequentdevelopmentofpsychopathology. Bothcasesofeatingdisorderinvolveextendedconsiderationofculturalattitudes thataffectwomen’sfeelingsandbeliefsaboutthemselves.Theseareonlyafew oftheinstancesinwhichwehaveattemptedtoaddressgenderissuesinrelation totheetiologyandtreatmentofmentaldisorders.WearegratefultoPatriciaLee Llewellyn(UniversityofVirginia)formanyhelpfulcommentsontheseissues.
Allthecasesinthisbookarebasedonactualclinicalexperience,primarilyourown,but,insomeinstances,thatofourcolleaguesandstudents.Various demographiccharacteristics(names,locations,andoccupations)andsomeconcreteclinicaldetailshavebeenchangedtoprotecttheanonymityofclientsand theirfamilies.Insomeinstances,thecasesarecompositesofclinicalproblems withwhichwehavedealt.Ourintentisnottoputforthclaimsofefficacyandutilityforanyparticularconceptualizationorinterventionbutinsteadtoillustratethe wayscliniciansthinkabouttheirworkandimplementabstractprinciplestohelp aclientcopewithlifeproblems.Thenamesusedinthecasestudiesarefictitious; anyresemblancetoactualpersonsispurelycoincidental.
Asinthefirstnineeditionsofthisbook,wehavenotidentifiedtheauthors ofspecificcasestudies.Thisprocedurehasbeenadoptedandmaintainedtopreservetheclients’anonymity.WearegratefultoAmyBertelson,SerritaJane,Ron Thompson,KevinLeach,andKimbleRichardson,whoprovidedextensiveconsultationonsixofthesecases.WealsothankElanaFaraceandSarahLiebmanfor draftingtwoothers.
Wewouldliketothankthefollowingreviewersfortheirhelpfuland constructivecomments:EynavE.Accortt,WrightStateUniversity;Dorothy Bianco,RhodeIslandCollege;MiaSmithBynum,PurdueUniversity;Bernardo Carducci,IndianaUniversitySoutheast;RonEvans,WashburnUniversity;Jan Hastrup,SUNYatBuffalo;RussellJones,VirginiaPolytechnicInstituteand StateUniversity;KatherineM.Kitzmann,UniversityofMemphis;PatriciaLee Llewellyn,UniversityofVirginia;RichardMcNally,HarvardUniversity;Janet MorahanMartin,BryantCollege;LindaMusunMiller,UniversityofArkansas atLittleRock;MarkPantle,BaylorUniversity;EstherRothblum,University ofVermont;GarySterner,EasternWashingtonUniversity;SondraSolomon, UniversityofVermont;andJohnWixted,UniversityofCalifornia–SanDiego.
WealsowanttoexpressoursincereappreciationtothesuperbstaffatWiley, especiallyChristopherJohnson,ExecutiveEditor,Psychology;MarianProvenzano,SponsoringEditor;BrianBaker,ProjectEditor;KristenMucci,Editorial Assistant;andYeeLynSong,SeniorProductionEditor.Theirconscientiousefforts wereessentialtothesuccessfulcompletionofthisrevision.
WenotewithgreatsadnessthatJohnNealepassedawayin2011.John’s passionforteachingandscholarshipplayedacrucialroleinshapingthisbook throughitsfirstseveraleditions.Hewastrulyaclinicalscientistinthebestsense ofthatterm,blendingakeeninterestinthenatureofpsychologicalproblems withanenduringdevotiontorigorousresearchandaseriouscommitmentto trainingstudentswhowoulddelivereffectiveformsoftreatmentforpatients
andtheirfamilies.Thebreadthofhisresearchinterestsspannedmostofthetopics coveredinthisbook.Hewonseveralprestigiousawardsforhisresearchandforhis remarkablerecordofmentoringgraduatestudents.Johnwillalwaysbemissedby hisformercolleaguesandthemanystudentsforwhomheservedasaninvaluable rolemodelandlifelongsourceofacademicandpersonalsupport.
Finally,weremaingratefultoourfamiliesfortheircontinuedloveandencouragement.GailOltmannsandMattMartinhavebothprovidedinvaluablesupport throughoutthepreparationofthisnewedition.
ThomasF.Oltmanns, MicheleT.Martin,and GeraldC.Davison
Prefaceiii
1.AutismSpectrumDisorder1
2.Attention-Deficit/HyperactivityDisorder14
3.SchizophreniawithParanoidDelusions26
4.Substance-InducedPsychoticDisorder,OpioidUseDisorder,and Violence40
5.BipolarDisorder52
6.MajorDepressiveDisorder63
7.PanicDisorder,Agoraphobia,andGeneralizedAnxietyDisorder76
8.ObsessiveCompulsiveDisorder92
9.HoardingDisorder107
10.PosttraumaticStressDisorder:RapeTrauma118
11.DissociativeIdentityDisorder132
12.SomaticSymptomDisorder149
13.EatingDisorder:AnorexiaNervosa162
14.EatingDisorder:BulimiaNervosa174
15.Parasomnia:NightmareDisorderandIsolatedSleepParalysis191
16.SexualDysfunction:FemaleOrgasmicDisorderandPremature Ejaculation204
17.GenderDysphoria219
18.OppositionalDefiantDisorder236
19.AlcoholUseDisorder250
20.ParanoidPersonalityDisorder261
21.BorderlinePersonalityDisorder277
22.ParaphilicDisorders:ExhibitionisticandFrotteuristicDisorders290
23.AntisocialPersonalityDisorder:Psychopathy(Online)
References(Online) Index303
CHAPTER1 AutismSpectrumDisorder SamWilliamswasthesecondchildofJohnandCarolWilliams.Thecouplehad beenmarriedfor5yearswhenSamwasborn;JohnwasalawyerandCarola homemaker.Samweighed7pounds,11ouncesatbirth,whichhadfollowedan uncomplicated,full-termpregnancy.DeliveredbyCaesareansection,hecame homeafter6daysinthehospital.
HisparentsreportedthatSam’searlydevelopmentseemedquitenormal.He wasnotcolicky,andhesleptandatewell.Duringhisfirst2years,therewereno childhoodillnessesexceptsomemildcolds.BySam’ssecondbirthday,however, hisparentsbegantohaveconcerns.Hehadbeensomewhatslowerthanhisolder sisterinachievingsomedevelopmentalmilestones(suchassittingupaloneand crawling).Furthermore,hismotordevelopmentseemeduneven.Hewouldcrawl normallyforafewdaysandthennotcrawlatallforawhile.Althoughhemade babblingsounds,hehadnotdevelopedanyspeechanddidnotevenseemtounderstandanythinghisparentssaidtohim.Simplerequestssuchas“Come”or“Do youwantacookie?”elicitednoresponse.
Initially,hisparentsthoughtthatSammightbedeaf.Later,theyvacillated betweenthisbeliefandtheideathatSamwasbeingstubborn.Theyreportedmany frustratingexperiencesinwhichtheytriedtoforcehimtoobeyacommandorsay “Mama”or“Dada.”SometimesSamwouldgointoatantrumduringoneofthese situations,yelling,screaming,andthrowinghimselftothefloor.Thatsameyear, theirpediatriciantoldthemthatSammighthaveanintellectualdisability.
Ashenearedhisthirdbirthday,Sam’sparentsnoticedhimengaginginmore andmorestrangeandpuzzlingbehavior.Mostobviouswerehisrepetitivehand movements.Manytimeseachday,hewouldsuddenlyflaphishandsrapidlyfor severalminutes(activitieslikethisarecalled self-stimulatorybehaviors).Other timesherolledhiseyesaroundintheirsockets.Hestilldidnotspeak,buthe madesmackingsoundsandsometimeshewouldburstoutlaughingfornoapparent reason.Hewaswalkingnowandoftenwalkedonhistoes.Samhadnotbeentoilet trained,althoughhisparentshadtried.
Sam’ssocialdevelopmentwasalsoworryinghisparents.Althoughhewould letthemhugandtouchhim,hewouldnotlookatthemandgenerallyseemed
indifferenttotheirattention.Healsodidnotplayatallwithhisoldersister, seemingtopreferbeingleftalone.Evenhissolitaryplaywasstrange.Hedidnot engageinmake-believeplaywithhistoys—forexample,pretendingtodrivea toycarintoagasstation.Instead,hewasmorelikelyjusttomanipulateatoy, suchasacar,holdingitandrepetitivelyspinningitswheels.Theonlythingthat reallyseemedtointeresthimwasaceilingfanintheden.Hewascontentto sitthereforaslongaspermitted,watchingintentlyasthefanspunaroundand around.Hewouldoftenhavetempertantrumswhenthefanwasturnedoff.
Attheageof3,thefamily’spediatricianrecommendedacompletephysical andneurologicalexamination.Samwasfoundtobeingoodphysicalhealth,and theneurologicalexaminationrevealednothingremarkable.Apsychiatricevaluationwasperformedseveralmonthslater.Samwasbroughttoatreatmentfacility specializinginbehaviordisturbancesofchildhoodandwasobservedforaday. Duringthattimethepsychiatristwasabletoseefirsthandmostofthebehaviors thatSam’sparentshaddescribed—handflapping,toewalking,smackingsounds, andpreferenceforbeingleftalone.WhenthepsychiatristevaluatedSam,she observedthataloudslappingnoisedidnotelicitastartleresponseasitdoesin mostchildren.Theonlyvocalizationshecouldelicitthatapproximatedspeechwas arepetitive“nah,nah.”Samdid,however,obeysomesimplecommandssuchas “Come”and“Gogetapotatochip.”ShediagnosedSamashavingautismspectrum disorderandrecommendedplacementinaday-treatmentsetting.
ConceptualizationandTreatment Samwas4yearsoldbythetimetherewasanopeningforhimatthetreatment center.Heattendedthespecialschool5daysaweek,spendingtheremainderof histimeathomewithhisparentsandsister.Theschoolprovidedacomprehensive educationalprogramconductedbyspeciallytrainedteachers.Theprogramwas organizedmainlyalongoperantconditioningprinciples.Inaddition,Sam’sparents attendedclassesonceaweektolearnoperantconditioningsotheycouldcontinue theschoolprogramathome.Theschool’spersonnelconductedanotherevaluation ofSam,observinghimintheschoolandlaterathome.Interviewswiththeparents establishedthattheywerebothwelladjustedandthattheirmarriagewasstable. Bothparentswere,however,experiencingconsiderablestressfromhavingtocope withSamonaday-to-daybasisandfromtheirfearsthathisconditionmighthave beencausedbysomethingtheyhaddone.
OneofthefirsttargetsofthetrainingprogramwasSam’seyecontact.When workingwithSam,histeacherprovidedsmallfoodrewardswhenSamspontaneouslylookedathim.Theteacheralsobeganrequestingeyecontactandagain rewardedSamwhenhecomplied.Alongwiththistraining,theteacherworked onhavingSamobeyothersimplecommands.Theteacherwouldwaitforatime whenSamseemedattentiveandwouldthen,establishingeyecontact,saythecommandandmodelthedesiredbehaviorbydemonstratingit.Forexample,theteacher
wouldsay,“Sam,stretchyourarmsuplikethis,”liftingSam’sarmsupandrewardinghimwithpraiseandasmallamountoffood,suchasagrape.Thisprocedure wasrepeatedseveraltimes.WhenSambegantobecomemoreskilledatfollowing thecommand,theteacherstoppedraisingSam’sarmsforhimandhadhimdoit himself.Thesetrainingtrialswereconducteddaily.
AsSam’sresponsetoaparticularcommandbecamewellestablished,the teacherwouldexpandhislearningtofollowingcommandsinothersituations andbyotherpeople.Sam’sprogresswasslow.Itoftentookweeksoftraining toestablishhisresponsetoasimplecommand.Afterhisfirstyearintheschool, herespondedreliablytoseveralsimplerequestssuchas“Come,”“Giveittome,” and“Putonyourcoat.”AtthesametimethatSamwaslearningtorespondtocommands,otheraspectsofthetrainingprogramwerealsobeingimplemented.While Samwasintheclassroom,histeacherworkedwithhimontryingtodevelopskills thatwouldbeimportantinlearning,forexample,sittinginhisseat,maintaining eyecontact,andlisteningandworkingforlongerperiodsoftime.Histeacherused thesamerewardstrategytoteachSameachactivity.
Astheseskillsbecamebetterestablished,theteacheralsobeganworkingon expandingSam’svocabularybyteachinghimthewordsforpicturesofcommon objects.Apictureofoneobject,suchasanorange,wasplacedonatableinfront ofSam.AfterSamhadlookedattheobject,theteachersaid,“Thisisanorange. Pointtotheorange.”WhenSampointedtotheorange,hewasrewarded.Ifnecessary,theteacherwouldmovehishandforhimatfirst.Nextanotherpicture,such asacat,wasselectedandthesameprocedurefollowed.Thenthetwopictures wereplacedinfrontofSamandtheteacheraskedhimtopointtooneofthem: “Pointtotheorange.”IfSampointedcorrectly,hewasrewarded.Ifhedidnot,the teachermovedhishandtothecorrectobject.AfterSamhadcorrectlypointedto theorangeseveraltimesinarow,theteacheraskedhimtopointtothecat.Withthat responseestablished,theteacherswitchedthepositionofthepicturesandrepeated theprocess.WhenSamhadbeguntopointcorrectlytotheorangeandthecat,a thirdpicturewasintroducedandthetrainingprocedurewasstartedanew.During1 yearoftraining,Samlearnedthenamesof38commonobjectswiththisprocedure.
Sam’sspeechtherapist,whomhesawdaily,wasalsoworkingwithhimon languageskills.Initially,theyworkedongettingSamtoimitatesimplesounds. SittingacrossatablefromSamandwaitinguntilSamwaslooking(orprompting himtolookbyholdingapieceoffoodnearhismouth),theteacherwouldsay, “Saythis,ah,”takingcaretoaccentuatethemovementsrequiredforthissound. Atfirst,Samwasrewardedformakinganysound.Subsequently,rewardswere givenwhenSamapproximatedmoreandmorecloselytherequiredsound.As soundsweremastered,Samwastrainedtosaysimplewordsinasimilarfashion. Overthecourseofayear,Samlearnedafewwords—“bye-bye,”“nomore,”and “mine,”butoverall,hisverbalimitationremainedpoor.
TeachingSamtodressandundresshimselfwasanothertargetduringthefirst year.Initially,histeacherhelpedhimthroughtheentiresequence,describingeach stepastheydidit.Next,theywouldgothroughthesequenceagain,butnowSam
hadtodothelaststephimself(takingoffhisshoes,puttingonhisshoes).More difficultsteps(tyingshoes)wereworkedonindividuallytogiveSammorepractice onthem.Whensomeprogresswasbeingmade,thisaspectofthetreatmentwas carriedoutbytheparents.TheyfirstobservedtheteacherworkingwithSamand thendiscussedtheprocedureandwereshownhowtomakeacharttorecordSam’s progress.Overaperiodofweeks,thenumberofstepsthatSamhadtocomplete byhimselfwasgraduallyincreased,movingfromthelasttowardthefirst.Sam wasrewardedeachtimehedressedorundressed,usuallywithaspecialtreat,such asafavoritebreakfastfood.Inthiscase,thetrainingwassuccessful.Bymidyear, Samhadmastereddressingandundressing.
ToilettrainingwasanotherareathatSam’sparentsandteacherstackled.At homeandatschool,Samwasrewardedforusingthetoilet.Hewascheckedevery hourtoseeifhispantsweredry.Iftheywere,hewaspraisedandremindedthat whenhewenttothetoilethewouldgetareward.Shortlythereafter,Samwould betakentothetoilet,wherehewouldremovehispantsandsit.Ifheurinatedor defecated,hewasgivenalargereward.Ifnot,hewasgivenasmallrewardjustfor sitting.Asthistrainingwasprogressing,Samwasalsotaughttoassociatetheword “potty”withgoingtothetoilet.Progresswasslowatfirst,andthereweremany “accidents,”whichbothteachersandparentswereinstructedtoignore.ButSam sooncaughtonandbeganurinatingordefecatingmoreandmoreoftenwhenhe wastakentothebathroom.Thentheparentsandteachersbeganworkingonhaving himtellthemwhenhehadtogo.Whentheycheckedtoseeifhispantsweredry, theywouldtellhimtosay“potty”whenhehadtogotothetoilet.Althoughthere weremanyupsanddownsinSam’sprogress,bytheendoftheyearhewashaving anaverageoffewerthantwoaccidentsperweek.
Sam’stempertantrumsslowedhisprogressduringhisfirstyearinthespecial school.Theyoccurredsometimeswhenhewasgivenacommandorwhenateacher interruptedsomethinghewasdoing.Notgettingarewardduringatrainingsession alsoledtotantrums.Samwouldscreamloudly,throwhimselftotheground,and flailawaywithhisarmsandlegs.Severalinterventionsweretried.Sam’stantrums usuallyledtogettinghisownway,particularlyathome.Forexample,atantrum hadoftenresultedingettinghisparentstokeeptheceilingfanon,evenwhenthey wantedtoturnitoff.Ignoringthetantrumwasthefirstapproach.Sam’steachers andparentssimplyletthetantrumplayitselfout,actingasifithadnothappened. Thisdidnotreducethenumberoftantrums,so“time-out”wastried.Everytimea tantrumstarted,Samwaspickedup,carriedtoaspecialroom,andlefttherefor10 minutesoruntilthescreamingstopped.Thisprocedurealsofailedtohavemuch ofaneffectonthetantrumsandscreaming,evenwithseveralmodificationssuch aslengtheningthetime-outperiod.
DuringSam’ssecondyearoftreatment,manyofthefirstyear’sprograms werecontinued.Sam,now6yearsold,wasrespondingtomorecommands,and hisabilitytorecognizeandpointtosimpleobjectsincreased.Inspeechtherapy, helearnedtoimitatemoresoundsandsomenewwords(“hello,”“cookie,”and “book”),buthisprogresswasslowanduneven.Hewouldseemtomastersome
soundorwordandthensomehowloseit.Hewasstilldressingandundressing himselfandusingthetoiletreliably.
Feedingskillswereoneofthefirsttargetsforthesecond-yearprogram. Althoughhisparentshadtriedtogethimtouseaknife,fork,andspoon,Sam resistedandatewithhisfingersorbylickingthefoodfromhisplate.Drinking fromacupwasalsoaproblem.Hestillusedababycupwithonlyasmallopening atthetop.ThefeedingskillsprogramwasimplementedbybothSam’steachers andparentsandinvolvedacombinationofmodelingandoperantconditioning. TrainingsessionsconductedatmealtimefirstinvolvedgettingSamtouseaspoon. Samwasshownhowtoholdthespoon;thentheteacherpickedupthespoon, saying,“Watchme.Youpushthespooninlikethisandthenliftituptoyour mouth.”Samdidnotinitiallyimitate,sotheteacherhadtoguidehimthroughthe necessarysteps:movinghishandandspoontopickupfood,raisinghisarmuntil thespoonwasathismouth,tellinghimtoopenhismouth,andguidingthespoon in.Praisewasprovidedaseachstepinthechainwascompleted.Aftermany repetitions,hewasrequiredtodothelaststepbyhimself.Gradually,moreand moreofthestepsweredonebySamhimself.Successeswerefollowedbypraise andfailuresbysaying“no”orremovinghismealforashorttime.Wheneating withaspoonwaswellestablished,thetrainingwasexpandedtousingaforkand drinkingfromacup.Inseveralmonths,Samwaseatinganddrinkingwell.
Sam’sfailuretoplaywithotherchildrenwasalsoamajorfocusduringthe secondyear.Thefirststepwastogethimtoplaynearotherchildren.Mostofhis playtimewasspentalone,evenwhenotherchildrenwereintheplayroomwith him.HisteacherwatchedSamcarefullyandrewardedhimwithsmallbitsoffood wheneverhewasnearanotherchildwithautismspectrumdisorder.Aprocedure wasalsousedtoforceSamtointeractwithanotherchild.Samandanotherchild wouldbeseatednexttoeachotherandgiventhetaskofstackingsomeblocks. Eachchildwas,inturn,givenablockandpromptedtoplaceitonthestack.In additiontopraisingthemindividuallyastheystackedeachblock,bothchildren wererewardedwithpraiseandfoodwhentheyhadcompletedtheirblocktower. Afterrepeatingthisprocessseveraltimes,theprogramwasexpandedto includethecooperativecompletionofsimplepuzzles.“Sam,putthedoginhere. Okaynow,Hannah,putthecathere.”Graduallythepromptswerefadedout, andthechildrenweresimplyrewardedfortheircooperativeplay.Althoughthis aspectoftherapyprogressedwell,transferringtheseskillstothenaturalplay environmentproveddifficult.AttemptsweremadetohaveSamandanotherchild playtogetherwithtoyssuchasafarmsetorasmalltrain.Theteacherencouraged themtomovetheobjectsaround,talkingtothemaboutwhattheyweredoingand rewardingthemforfollowingsimplecommands.AlthoughSamwouldusually followthesecommands,hisplayremainedsolitary,withlittleeyecontactor cooperationwiththeotherchild.
Sam’sself-stimulatorybehaviorwasafinaltargetofthesecondyear.Sam’s handflappingandeyerollinghadalreadydecreasedsomewhatoverthepastyear, perhapsbecausemoreofhisdaywasbeingfilledwithconstructiveactivities.Now
Another random document with no related content on Scribd:
Section 4. Information about Donations to the Project Gutenberg Literary Archive Foundation Project Gutenberg™ depends upon and cannot survive without widespread public support and donations to carry out its mission of increasing the number of public domain and licensed works that can be freely distributed in machine-readable form accessible by the widest array of equipment including outdated equipment. Many small donations ($1 to $5,000) are particularly important to maintaining tax exempt status with the IRS.
The Foundation is committed to complying with the laws regulating charities and charitable donations in all 50 states of the United States. Compliance requirements are not uniform and it takes a considerable effort, much paperwork and many fees to meet and keep up with these requirements. We do not solicit donations in locations where we have not received written confirmation of compliance. To SEND DONATIONS or determine the status of compliance for any particular state visit www.gutenberg.org/donate.
While we cannot and do not solicit contributions from states where we have not met the solicitation requirements, we know of no prohibition against accepting unsolicited donations from donors in such states who approach us with offers to donate.
International donations are gratefully accepted, but we cannot make any statements concerning tax treatment of donations received from outside the United States. U.S. laws alone swamp our small staff.
Please check the Project Gutenberg web pages for current donation methods and addresses. Donations are accepted in a number of other ways including checks, online payments and
credit card donations. To donate, please visit: www.gutenberg.org/donate.
Section 5. General Information About Project Gutenberg™ electronic works Professor Michael S. Hart was the originator of the Project Gutenberg™ concept of a library of electronic works that could be freely shared with anyone. For forty years, he produced and distributed Project Gutenberg™ eBooks with only a loose network of volunteer support.
Project Gutenberg™ eBooks are often created from several printed editions, all of which are confirmed as not protected by copyright in the U.S. unless a copyright notice is included. Thus, we do not necessarily keep eBooks in compliance with any particular paper edition.
Most people start at our website which has the main PG search facility: www.gutenberg.org.
This website includes information about Project Gutenberg™, including how to make donations to the Project Gutenberg Literary Archive Foundation, how to help produce our new eBooks, and how to subscribe to our email newsletter to hear about new eBooks.
