Contingency Awareness

The Development of Contingency Awareness in
Individuals Experiencing PMLD (IEPMLD) and beyond: Theory and Practice.

"The interventions and results show that rather simple and easily implemented contingency learning games can have rather dramatic effects on child learning, which included extended benefits to both the child and his or her caregivers. Interestingly, many of the interventions used with young children with profound developmental delays and multiple disabilities do not include the promotion of child behavior competence (Dunst, Raab, Wilson, & Parkey, 2007; Winefield, 1983). Rather, the interventions typically involve non-contingent stimulation to evoke child behavior or passive manipulation of child movements."
(Raab, Dunst, Wilson, & Parkey 2009)

"This suggests that response-contingent learning opportunities, and especially for children who demonstrate few instrumental behavior, is warranted as a form of early childhood intervention"
(Raab, Dunst, Wilson, & Parkey 2009)

"While they were saying among themselves it cannot be done, it was done." (Helen Keller)

"I do not want the peace which passeth understanding, I want the understanding which bringeth peace." (Helen Keller)

Contingency Awareness (often referred to as understanding 'cause and effect') is a consciousness of a relationship between two different events; that is, an understanding of a relationship between actions and the outcomes those actions elicit in the environment. A baby in a cot kicks its legs in a certain way and accidentally makes the mobile, suspended above the cot, move. After some repetitions of the leg kicking, the child begins to form an association between his actions (kicking his leg in a certain way) and the movement of the mobile. At this stage, the child may not understand how the action of his leg is causing the mobile movement but nevertheless still recognises that s/he can exert control and has thus made a connection.

Contingency Awareness is an important milestone for Individuals Experiencing PMLD. However, the combination of cognitive, physical and sensory impairments experienced by many acts as a obstacle to block the typically developing pathway. Indeed, the (inadvertent) actions of Significant Others may have a detrimental contributory effect further increasing the size of the obstacle. As Significant Others routinely:

anticipate and fulfill the needs of the IEPMLD (Individual Experiencing Profound and Multiple Learning Difficulties);
block access to experimentation by the IEPMLD;

the process begins to teach the Learner that s/he is not an active player in controlling the environment. Indeed, the Significant Other fulfillment of the needs of the individual can eventually lead to the development of learned helplessness and passivity:

"Learned helplessness occurs when it is unclear to the learner that he or she is able to exert control over the environment... For many learners, their social history has offered few opportunities to self-select desired objects, people, or activities. At meal times plates are prepared and distributed. Additional serving are provided automatically. Coats are handed out and doors opened when it is time to go. Thus, throughout the day, the caregivers do virtually everything for the learners. Initially, some learners may have attempted to self-select items of interest, but were actively encouraged not to do so." (Reichle, J. 1991 p.141)

"The children's physical disabilities place considerable restrictions on their personal development. There are activities in which they will be unable to participate, and many fields where they will gain only limited experience Part of this limitation is caused primarily not by the motor handicap, however, but by the fact that, due to negative experiences, they believe they are unable to do anything. Later on they will no longer try to do things that they perhaps would have been capable of. They learn that they are dependent on others because others do things for them which they would be unable to manage alone. At the same time they will experience that they are an inconvenience, that they are a hindrance and that the adults are most content when they are passive. The adults' attitude to the children, which the children to a great extent assume themselves (cf. Madge and Fassam 1982), therefore plays a significant role in forming their life and opportunities for personal growth." (Von Tetzchner, S. & Martinsen, H. 1992)

"All children are dependent upon adult caretakers for fulfillment of their physical and emotional needs. In the process of becoming autonomous, children explore and test their world and begin signalling their growing independence to caretakers through physical actions and spoken messages. If provided with an adequate climate for growth, an increasingly solid foundation for independence in adult life will be formed. However, for children with severe communication and/or physical limitations this process of self growth may be overlooked or suppressed. Because many children experiencing the aforementioned challenges are not able to signal their readiness for exploration or independence in traditional ways, parents and other caretakers (e.g. professional service providers, educators, etc.) are inclined to continue to act as direct or indirect agents for fulfilling the child's needs. When later provided with adequate means to express, query, or explore, (e.g. assistive technology) the child may persist in a more passive state due to learned helplessness or learned dependency." (Sweeney, L. 1993)

"The view of oneself as dependent, even as 'helpless' can be hard for many children to shake off. Those with a communication problem may be even more entrenched in patterns of looking to others to speak for them, decide for them and of setting up their parents, siblings and friends as more competent and more responsible than themselves. In some ways it makes for an easier life. It also detracts from the child's potential." (Dalton, P. 1994, page 133)

Over 100 years ago, in a 1895 publication, James Baldwin outlined a relationship between a child's beginning to see actions as the cause of environmental effects and increases in responses of a social/emotional nature such as excitement, laughter, and smiling. Likewise, in studying his own children, similar observations were made by Jean Piaget (1952). In support of these claims, Haith (1972) and McCall (1972) pointed out that, because such cognition is pleasurable, the ability of a child to understand s/he is the cause of a particular environmental consequence produces social-emotional behaviour.

Almost all IEPMLD show at least some contingency awareness:

Those that hit themselves or poke themselves in the eyes must be 'aware' that doing so brings sensory stimulation: they have made the link between the action (self harm) and response (sensory stimulation);
Those that rock back and forth must be doing this for some reason. It is generally assumed that this is stimulatory behaviour which brings some reward. At some point the individual must have made this connection and continued the behaviour;
Those that twirl or flap objects by their eyes or their face at every available moment must have, at some prior point, made a connection between the action and a favourable sensation.
Those that will reach out and repeatedly tap a switch surface must be doing that continually (until they grow tired of it or until the switch is removed) for some reason. It must be providing the person with some sensory feedback which is fulfilling / motivating in some way. The repeatedness of the actions seems to suggest an awareness of a relationship between the behaviour and the response to it.

The fact that these actions are repeated seems to be indicative of a connection between an action (slapping, rocking, flapping, tapping...) and an (internal) event (favourable sensation). In a sense, these actions, often viewed by staff members pejoratively, have, at least, a positive aspect: if a Learner is behaving in this manner then s/he must have made a connection and, having made one connection, the Learner must be capable of making other connections given the opportunity to do so.

The words 'given the opportunity' begs the questions: 'how do we give?' and 'what opportunities?'. This webpage hopes to provide at least some answers to those questions. One avenue, worthy of further exploration, is the use of (switch activated) assistive technology as a means to this end. This has been recognised since the earlier days of electronic assistive technology:

Research has demonstrated that switch technology can be used successfully to facilitate the formation of contingency awareness in individuals with severe and/or multiple disabilities
(York, Nietupski, & Hamre-Nietupski, 1985).

It is extremely important that we address this area of development by providing frequent, structured opportunities to help Learners gain an understanding of contingency awareness and, thus, discover that they can exercise control over their surroundings. Below are a number of suggestions for ways to assist with the development of contingency awareness. You are, of course, free to adopt, adapt or abrogate any of them. However, Talksense hopes that at least some of what follows will inspire your thinking. Should you have any feedback or wish to suggest further approaches, a form has been provided at the bottom of this webpage for the purpose.

BEST POLEs

BEST = Best Ever Stimulating Thing

What is it the the Learner loves? Is it sweets/candy? Is it a particular game, a TV programme, a particular person? In other words, what is the Best Ever Stimulating Thing for a particular individual? Let's start working with this BEST as the motivator.

POLE = Person Object Location Event

The BEST thing will be a POLE. POLE is an acronym for Person, Object, Location, or Event.

If we can place a tangible POLE at the end of a Learner action (For example: provide the Learner with a POLE as a result of a request using an Augmentative Communication system or activating a switch) then we have a way of moving forward. Not just any sort of POLE! What sort of POLE? Well, a BEST POLE of course.

Here are some ideas:

For those that can touch: Start with a single BIGmack (or equivalent device). Label it with an appropriate symbol or a Sensory Surface for the Learner's BEST POLE. By demonstrating, modelling, prompting, or even waiting for accidental access, allow the Learner to 'see' that the activation of the device leads to ( is always followed by) the provision of a BEST POLE. Hopefully, after a number of activations of the BIGmack, the Learner will begin to understand that his/her action (activating the BIGmack) results in a particularly favoured and rewarding event. However, even though a Learner may activate such a device repeatedly, it is difficult to establish intentionality: the Learner may continue to activate a device accidentally (for example) or just be exploring (and thus repeatedly activating) anything that has been placed in the Learner's reach without making any cognitive connection between his or her action and the rewards that seem to be occurring. How could we be more certain of some form of Learner cognizance?

If a baseline is taken in which the BIGmack (or equivalent) is utilised in a different manner (with a different sensory surface or symbol) such that it just plays a short piece of relatively uninteresting music (for example) then, when it is placed within the reach of the Learner, the number of activations (accidental and or purposeful) in a specified time period can recorded. Perhaps such practice might result in 4 activations in the first minute but this tails off afterwards such that it averages at less than one activation a minute. This is our baseline. If we now introduce the BIGmack resulting in the BEST POLE and this results in an increase in activations over time it would seem a reasonable assumption that the difference in Learner behaviour is as a result of some level of cognisance of the situation. As it is always good practice for staff to look for alternative explanations for changes in Learner behaviour, this situation should be no different. Perhaps the Learner is attracted to the BIGmack because it is a different colour (ensure that the same BIGmack is used). Perhaps the Learner is stimulated by the sensory surface that has been used and it is this that is causing the increased response level. How could we eliminate this possibility from our findings? We could swap the sensory surfaces used in the first experience (baseline) with the second and see if this provides similar results. While it is not good practice to use sensory surfaces it such a manner normally, in this instance it is justified. If the repeated baseline with the new sensory surface yields similar results to the original baseline then it cannot be the sensory surface itself that is responsible for the change in Learner response.

"Eliminate all other factors, and the one which remains must be the truth." (Sherlock Holmes, The sign of Four, Chapter 1, p. 92)

Once basic contingency awareness has been established and we have a Learner activating a BIGmack (or equivalent) to obtain a reward, it becomes necessary to step up the level of difficulty of the task very slightly, further to ascertain Learner cognisance. If we add a second BIGmack of a different colour (New BIGmacks come with four different colour interchangeable tops) which, when activated, says "Please remove the BIGmacks for five minutes" in a voice that is neutral in tone (such that the sound itself does not become a motivator) complete with a different symbolic label or sensory surface (or a lack of symbolic label or sensory surface) and both BIGmacks are placed within the reach of the Learner, we can now assess if the Learner activates the BIGmack which leads to a BEST reward more than the one which leads to their removal. Thus, as you can see, the activation of the original BIGmack leads to a reward while the activation of the other different BIGmack leads to their removal (and therefore no possibility of BEST) for a specified period of time. Initially, to assist the Learner in achieving success, the BEST BIGmack can be positioned on the preferred side of the Learner such that it is likely this is the one that will be activated. However, before moving to the next stage, it is important to swap the BIGmacks about such that, in wherever order they are positioned, the Learner still demonstrates that s/he can achieve success.

On success with two BIGmacks, step it up once more to three! Two of the BIGmacks lead to the removal of the setup (for a specified short time period) and only the original BIGmack obtains the BEST POLE. If the Learner learns to activate the BEST BIGmack no matter what position it occupies relative to the other two then there are a number of things that we might justifiably claim:

the Learner is retaining and recalling the function of a specific BIGmack;
the Learner is discriminating between the symbols or the sensory surfaces or the colours (if all the BIGmacks used were red then it must be either the sensory surface or the symbol used that is discriminated);
the Learner is connecting a specific action (his/her activation of the device) with a particular environmental effect (his/her obtaining a BEST).

No, s/he's not doing that at all! S/he is just attracted to red BIGmacks and is going for the red one each time - no recall is taking place.
OK, that is a good point. So what should we do about that possibility? If it is known in advance that the Learner is attracted to the colour red then we should not use red as the BEST BIGmack but rather for the distractors! Alternatively, we can make all the BIGmacks red and just vary the attached symbols or the sensory surfaces.

We haven't got three BIGmacks!
It is Talksense's advice that every classroom should have at least three BIGmacks (AbleNet are not sponsoring me to say that! ) available for use. However, it does not have to be a BIGmack system, it can be any SGD (Speech Generating Device) or a device that has at least three cells (the other cells can remain blank). Alternatively, it is possible to use the Microsoft PowerPoint program on a touch sensitive screen although difficult to provide sensory surfaces by this methodology.

It's working too well: the Learner is asking for BEST all the time and we cannot support this!
Then remove the BIGmacks once the task has been completed and work on another area. You may also need to consider the use of 'limiting factors' was detailed on the fundamentals page of this website.

The BIGmacks can either have symbols on their surfaces or be presented with sensory switch caps. Only one BIGmack leads to the reward of a BEST POLE, the others either do something innocuous such as saying 'This BIGmack does nothing' or request their removal as stated above. The BIGmacks are positioned in front of the Learner. Beginning with a single BIGmack, the Learner will eventually activate it by accident. On so doing, the Learner is rewarded with the BEST. It is important that the reward follows the rules for BEST as outlined on the fundamentals page (follow link to go there).

My Learner is not interacting with the BIGmack even by accident.
For Learners that do not interact with the BIGmack it may be necessary for another member of staff to model the required behaviour such that the Learner can experience the staff member obtaining the BEST through the activation of a particular BIGmack. Should even that approach yield no result, the Learner can then be assisted to activate the BIGmack through hand-under-hand physical prompting.

You might provide an intermediate stage in which the BIGmacks are presented but only one has a symbol attached as depicted in the illustration right. We are not trying to trick the Learner or make it difficult for him or her: we want the Learner to succeed and therefore you can provide as may intermediate stages as you think fit that will assist Learners on their way. Initially, for example, you might put the 'correct' BIGmack in the Learner's favoured position and then move it one place from there. You may also start with the Learner's preferred colour but this must be changed before the final stage of the procedure.

If a Learner can activate (on more than one occasion) the correct BIGmack by selecting a colour (and or a symbol) from three choices of colour (and or symbol) then it is party time! This a momentous achievement. Suppose all three BIGmacks are the same colour and all have symbols and yet the Learner still selects the reward (on more than one occasion) and with the BIGmacks in different relative position on each occasion - what can we now assert? The Learner must be discriminating between symbols! If a Learner can discriminate between symbols then the sky is the limit. Ensure you reward both yourself and your team for a job well done!

For those that cannot touch (but can see): At least five cards may be prepared. Each of the cards depicts a different random shape which has no specific meaning. One of the cards is selected to represent the BEST. This is taught to the individual Learner through a combination of association and modelling (see below) until the Learner can select the card (without error) using a their own specific yes/no response in a 'blind' staff presentation.

In a blind presentation, the staff member concerned shuffles the cards and then presents them, one by one, face towards the Learner such that the Learner can see the card but the staff member cannot. In this way, there cannot be any unintentional cueing of the Learner as to when to respond. The Staff member continues to present the cards one by one, returning rejected cards to the back of the pack, until the Learner provides his/her 'yes response' to indicate this is the card selected. Only at this point can the staff member look at the face of the card at the front of the pack. If it is the card that has been selected as BEST then the reward must be provided. If it is any other card, then the opportunity to obtain BEST is withdrawn for a specified time (at least five minutes) while something else is done.

You're joking! That's way too advanced. My Learner will simply ignore the cards altogether.
Of course it is! That is why you have to begin with the single BEST card and teach the Learner it's meaning. Once you believe that the Learner has a grasp of the concept then you can add a second card into the mix and see if the Learner can select the one that represents the BEST. Selection of the other card should always lead to the withdrawal of the possibility of obtaining BEST for a specified
time period.

You're joking! My Learner cannot associate a card with a BEST. She'll just sit and rock.
You may be correct, but what are you doing in place of this? How do you know if you do not try? Each time you give the Learner the BEST for a whole term ensure that the card is presented just before. You could make the card shape tactile by drawing around the shape with a glue gun to raise its borders and then filling the shape with a sensory surface such as sand and glue and, when set, painting it the
appropriate colour. After a whole term you could try to ascertain if the Learner goes for that particular card when mixed in with a couple of plain cards. If that works then add a small dot to one of the plain cards and see if the Learner can still do it. Gradually increasing the distractors.

You're joking! My Learner cannot see.
In that case, why not try it with five distinct sounds (or with tactile tops to BIGmacks to make sensory surfaces as outlined earlier)? One of the sounds you have linked to the BEST.

Why does it have to be so abstract? Why can't I use real pictures of real things?
You can, at least for the BEST link. If you were to use pictures for the others then it might be claimed that the Learner was simply confused and is requesting the image on the card. If a Learner fails at the task as outline, it means nothing but if s/he repeatedly succeeds then it has a great deal of meaning!

My Learner loves stars so she always goes for that one even though it is incorrect.
What you're saying is that 'stars' are a BEST! Therefore, you should not be using a star image as one of the cards but one of the cards can lead to some starry reward!

Not all our pupils have favourites.
Please do not say that! Yes, they do. It is just that with some individuals the BEST may be very hard to discover. I remember a school that told me they had thought that a particular Learner was not motivated by anything, until one day a group of musicians came to the school, and this young man was sat near to the tuba player and, every time he played, the young man's face lit up. It was a certain frequency of sounds that was motivating. Talk to Significant Others first - they are likely to know things that may be motivating or, at least, they may suggest a possible avenue of investigation. I am always concerned when a Learner is self harming as a form of stimulation. Trying to discover something that is more motivating than poking your own eyes or slapping your own face or biting yourself (and other such behaviours) is difficult (this is covered in greater detail in a following section). Thus don't say, 'This Learner is not motivated by anything' rather state more positively, 'We haven't yet discovered what motivates this Learner but we are still trying'. There will be something it just may not be obvious!

What if a Learner's BEST is not age appropriate?
So what if it isn't? If it is a favourite, it is a place to start and an entry into their world. It is not that everything in the school day will be age inappropriate or that you will be treating them in an age inappropriate way - it is possible to use age inappropriate items in an age appropriate manner. Furthermore, the goal is not to remain with this item, the goal is to use the item as a springboard for moving forward. For me, providing it's ethical and it's a platform for development, then its an acceptable tool. Furthermore, the guiding factor should be 'Preference Not Deference' (see section on this below for further information). However, when the inspectors are around - I wouldn't recommend the use of age inappropriate things; some inspectors tend not to like them!

My Learner has no reaction to card presentation whatsoever even when paired with his BEST.
Try making the card more tactile. Use a glue gun to outline the shape and then infill it with some appropriate sensory surface. Present the card and assist the Learner to explore it before providing the BEST. Always provide the minimum amount of a BEST that will be still motivating to the Learner. Do this for an entire term! Try repeating the technique in the following term.

The staff are getting around the blind presentation by allowing the Learner to make multiple guesses until she gets it 'correct' and then rewarding this response. Is this wrong?
Yes! It may be OK for a short time in a teaching phase to help the Learner to see that only one specific card gets a reward but that should be a planned period of time. After this period, the staff must treat the selection of one of the other cards as a request (communicative act by the Learner) to stop the activity for (at least) five minutes and do something else instead.

My Learner's BEST is horse riding and we cannot provide that at any time.
In that instance, there are at least two things that you can do instead: select a second favourite (a second BEST) or, see if access to a short video of the Learner horse riding (or some other available connection) will act as a substitute.

The Learner gets it correct about 50% of the time but can have 'off periods'. What is the procedure in this eventuality?
The procedure is always consistent: if the Learner selects an incorrect card staff should treat it as though the Learner had said, "I'm fed up with this, let's stop for five minutes and do something else instead." If the Learner has had a seizure earlier or is known to be 'off' for whatever reason then perhaps you should not undertake the procedure, especially if it is likely that all choices at this time will not be correct. However, if you go ahead, an incorrect choice must always result in the termination of the procedure for a set period of time.

The Learner's BEST is chocolate. We can't keep feeding him chocolate all morning!
You need to review the Limiting Rules on the Fundamentals Page of this website. First, you need to establish what is the smallest amount of BEST that you can provide and yet still be motivating. Thus, it need not be a whole bar of chocolate as a reward but rather one square. Indeed, would a half of a square still suffice? What about a quarter? What about a quarter of a chocolate button? Also, once you have done this four times, perhaps it's time to stop and do something else instead. If the Learner has managed to get it correct four times then 'whoopee', what a success! Party time! Furthermore, that would equate to one whole chocolate button! That's not going to make him sick or ruin his appetite. Of course, if he chooses incorrectly, the process is terminated for a period of time and no reward is given. As such, it may take a whole session to get even a fraction of a chocolate button!

Stepping Up

So the Learner succeeds at one of the above techniques after quite a long period of time. What does that prove? And what then? Well, it shows that the Learning is capable of recalling - remembering a previous event and applying that knowledge to obtain another reward. Isn't that a form of contingency awareness? Maybe at a very basic level but isn't that where we are at?

What then? Ah! Now we leave an increasing time period between presentations of the technique: first, we may do it twice or more a day but then we limit it to once a day. Is the Learner still successful? OK. Now we present every two days, then three days, then once a week, once a month ... what does this tell us if the Learner is successful on each presentation? Suppose we left it an entire year and then we did it again with the Learner and s/he still got it correct?! Unlikely I know but not impossible. What we are assessing is the extent of a Learner's memory for a particular POLE.

You're crazy! My Learner will never manage any of this idea.
OK, I am crazy! If you do not believe that this has the slightest chance of succeeding no matter how it is modified for your circumstances then what about trying one of the other ideas on this page? Surely one of then has some merit for your Learner?

Preference Not Deference: a word on age-appropriateness

Click To Enlarge

While age-appropriateness and developmental appropriateness are both important concerns, maybe we should concentrate more on what is ‘person-appropriate’" (Smith, 1996, page 79).

" ... stating that of course the chronological age of a person is one of the aspects of the person to be addressed in our education and care. However, we must not allow this issue to become paramount over the need to give regard to where the person is ‘at’ developmentally, psychologically, emotionally and communicatively. Additionally, people of whatever age can want or need physical stimulation and support." (Hewett, 2007, page 121)

"The storytelling has generated much discussion on what is age-appropriate material - for example, at what age, if any, do fairy tales become inappropriate?" (Birch et al., 2000, page 4)

"A principle operating in services throughout Australia, the UK, and the USA is that of age-appropriateness. The principle of age-appropriateness is widespread throughout government policy and non-government practice guidelines, but the exact meaning of the term is rarely defined. It is commonly assumed to mean activities and approaches commensurate with an individual’s chronological age. Dress, furnishing, object selection, and the style of interactions, are all supposed to be age-appropriate, according to many policies. However, when this principle is applied to people with profound intellectual and multiple disabilities, I argue that instead of promoting a good life, the principle contributes to practices that compromise individuals’ health, well-being, quality of life, and their human rights." (Forster, 2010, page 129)

My guess is that everyone reading this webpage has something they like which is not particularly age appropriate. For example, I must admit to both watching and enjoying 'Sponge Bob Square Pants' from time to time. A friend (over 21) admits to taking a pink rabbit with her to bed. The issue is that we chose to like these things, they are our preferences. We did not defer to some other person's choice on our behalf (deference). Had I been taught Mandarin by using Sponge Bob when I had never seen him before or, had my friend been lectured on the curriculum in special education by use of a pink rabbit the, we might have questioned the (age) appropriateness. Actually, while working in Taiwan and trying to learn some Mandarin, I did watch children's cartoons because I thought that the language might be simpler for me to understand. However, again, it was by choice and my preference. There have been several studies and many papers concerning the use of dolls as therapy with older people with dementia that highlight the positive outcomes of such an approach and, which reflect and reinforce the notions made in the quote by Forster above (for a review of doll therapy see Turner and Shepherd 2010). However, the dolls are not imposed on the individuals. Indeed, Ellingford et al. (2007) argue that dolls should be introduced indirectly by leaving dolls in communal areas and on chairs, to allow for freedom of choice and free interaction.

In relation to Contingency Awareness practice therefore, items used should relate to Learner preference and Learners should not have to defer to another's choice that is not age appropriate. Thus, a reward provided to young adult might involve a doll (as in the cartoon) if that person has a preference for dolls. If dolls are this particular Learner's B.E.S.T. (Best Ever Stimulating Thing), their use in any contingency awareness program might help to captivate and engage the Learner in the process. B.E.S.T. practice, by definition, is highly motivating and may therefore be used within contingency awareness without fear of accusations of age inappropriateness (although some unenlightened individuals might claim otherwise!).

The Goal is Control

"Handicapped infants may begin to lose interest in a world that they do not expect to control" (Brinker & Lewis, 1982)

"Learned helplessness occurs when it is unclear to the learner that he or she is able to exert control over the environment.....For many learners, their social history has offered few opportunities to self-select desired objects, people, or activities. At meal times plates are prepared and distributed. Additional serving are provided automatically. Coats are handed out and doors opened when it is time to go. Thus, throughout the day, the caregivers do virtually everything for the learners. Initially, some learners may have attempted to self-select items of interest, but were actively encouraged not to do so." (Reichle, J. 1991 p.141)

"When children who are deafblind are young, and especially if they have additional difficulties, they may experience the world as much too large and complicated for them to exercise any control. Their experience may only be of having things done to them, not of doing things for themselves. They may have objects put in front of them to look at, but may not have any choice in the matter." (Wyman 2000 page 82)

"By providing people with PMLD the opportunities to exert control and actively participate we help to facilitate the development of contingency awareness; the knowledge that you are able to have some effect on the environment. ... If we are to prevent individuals either from resorting to self stimulatory behaviours or from withdrawing completely from the external world then it is essential that we ensure they are able to engage with their world in an active and meaningful way." (Hogg 2009. page 20)

While undoubtedly there are a plethora of goals for standard education, and many of these may have equal relevance to those experiencing PMLD, there is one particular goal that Talksense believes is a vital component of any curriculum designed to prepare Individuals Experiencing PMLD for a better quality of future life: that goal is 'control'.

"The provision of positive control experiences early in life will be a primary factor in helplessness immunization." (Sweeney, L. 1993)

"a high quality of life is one in which people receive individually tailored support to become full participants in the life of the community, develop skills and independence, be given appropriate choice and control over their lives, be treated with respect in a safe and secure environment”. (Emerson et al 1996)

"Empowerment occurs when control, or power, is passed to an individual or group. In rehabilitation, medicine, social work, psychology, education, and many allied disciplines, it is gradually becoming recognized that the healthiest and most effective individuals have personal control and make decisions for themselves with advice and input from others. The belief here is that, for best results overall, final decisions should be made by the individuals who are most closely affected by the decisions."
(Brown and Brown 2003 page 227)

"Students become empowered by taking control of their own learning." (Sutcliffe 1990 page 13)

"Good quality support is to do with giving people power." (Virginia Moffat 1996 page 37)

Generally speaking, the more independent people are and the less external control they receive from others, the more satisfied they are (higher quality of life) (See Legault 1992).Thus, a fundamental goal of all special education should be equipping Learners to live as independent a life as possible. This has long been recognised:

"... citizens with a mental retardation have a right to receive such individual habilitation as will give each of them a realistic opportunity to lead a more useful and meaningful life and to return to society." (Bannerman, Sheldon, Sherman, & Harchik 1990)

"even children with profound learning difficulties , given suitable conditions provided by modern technology, can make choices; in this case between sounds, voices, and rhymes provided on speakers. Moreover, they show enjoyment while so occupied and are motivated to further choice making. At the beginning of this chapter, the opinion was expressed that every step on the way to having more control over our lives is worth taking. In the case of these children, opportunity to exert control, however limited, appears to be leading to increased motivation and increasing self-regulation." (Beryl Smith 1994)(Page 5)

In order to meet this goal, staff within special education should be developing ways in which more and more control can be passed to Learners. Staff should rarely ever be doing it 'for' (there are some exceptions to this rule) and should hardly ever be doing it 'with' (again with some exceptions) but, rather, be facilitating individuals to do it for themselves. The goal of control therefore is one in which the Learner is at the centre of all that we do and the role of Significant Others is to help the Learner to take that control. An important aspect of taking control is an understanding that the things you do have an effect on both your environment and the people within the environment: in other words 'contingency awareness'.

While we may find a philosophical commitment to a particular idea or an approach fairly easy, often it is much more difficult to make that approach a reality. In observing any session involving Individuals Experiencing Profound and Multiple Learning Difficulties one should be constantly asking 'who is in control?' If the answer to that question, for the majority of the session, is other than the Learners involved then something is amiss. In observing any sessions involving Learners Experiencing PMLD look to see who is:

directing the action;
operating any visual accompaniment (PowerPoint for example);
activating the switches to create sound effects;
operating the augmentative communication technology;
making choices;
mostly in control!

It is not the Staff's role to do these things for the Learners, it is the Staff's role to teach and to facilitate the Learners in learning to do it for themselves.

Accidental Awareness Award

During Piaget's Sensorimotor Stage of development which lasts from birth to approximately two years of age, the newborn is attempting to make some sense of the world that s/he has entered. The stage can be divided into six separate sub-stages through which each infant progress:

Reflex (0 - 1 month);
Primary Circular Reactions (1 - 4 months);
Secondary Circular Reactions (4 - 8 months);
Coordination of Reactions (8 - 12 months);
Tertiary Circular Reactions (12 - 18 months);
Early representational Thought (18- 24 months).

It is during the stages that involve circular reactions, the child gradually starts to make connections between his or her actions (body movements) and the things that happen in the environment. For example, a baby might accidentally hit a mobile in a cot and cause it to move or some music to play. If this pleases the child and it happens again, the child begins to understand that his/her movement is somehow linked to the reaction. The child will repeat approximations of the movement until s/he can consistently activate the mobile in a desired manner.

Our Learners, likewise may not understand they have an ability to control a favourite event (music playing, lights coming on, fan blowing). While they may show pleasurable responses when these events occur, their understanding of why they occur may be extremely limited (even non-existent). However, if we can:

put a favourite event at the end of a switching system;
position the switching system so that it is likely to be activated by a Learner by accident from time to time;
establish a baseline measurement of how many times the event is triggered by accident alone in the first time period (few minutes);
leave the Learner with the switching system;
check to see if the number of events increases over time.

we have a system through which a Learner can educate themselves about his/her ability to effect the environment.

AbleNet's String Switch is but one tool that can be used to promote accidental awareness of cause and effect. It comprises a small plastic box from which protrudes a short loop of string. Pulling on the string causes a switch activation. Only a very slight force is required to pull the string to activate the switch. While the majority of other switches are directional, the String Switch is not. For example, to operate a Jelly Bean type of switch, a Learner has to target the switch and move his hand (or other body part) to the switch. However, by setting up the String Switch (for example, as illustrated below) it does not matter in which direction the Learner's arm moves (or other body part) as sufficient movement in any direction in any plane will activate the switch. What is sufficient movement? That can be set by the Significant Other involved! By attaching an elastic band (or conjoined elastic bands) to the string at one end and to a wrist band at the other, it is possible to vary the length of travel of the Learner's arm/hand before a switch activation is made. Thus, if the Learner is continually moving his/her arm a little, it would be possible to allow for this without any operation of the switch but, when the arm/hand moves slightly more beyond this allowable range the switch is activated! If the switch is plugged into a BEST (Best Ever Stimulating Thing: See section above) an accidental movement of the Learner's arm can cause a BEST to occur. As the BEST, by definition, is highly motivational for the Learner, it is likely that the Learner will want that to happen again. With repeated accidental activations of BEST over a period of time, the Learner may come to realise that s/he is in control of it through a movement of his or her arm. Activation of the switch should therefore increase over time from the ('accidental') baseline. The use of elastic bands as a joining agent between the switch and the Learner prevents a jarring sensation which might occur when the Learner's arm (or other body part) reaches the maximum distance of travel allowed by an alternative medium. The elastic also affords some protection to the switch itself. Please note that elastic bands and wrist bands are not supplied with the String Switch at purchase.

Learners exhibiting behaviours that staff may find challenging involving some form of self harm may also be assisted by this method. For example, a Learner self stimulated by eye poking, staff may splint arms in an attempt to reduce the behaviour (or strap Learner arms to wheelchairs). While such techniques do serve to reduce the instances of self harm they do little to eliminate its cause and, once the splints are removed, the behaviour returns. Why is this Learner poking himself in the eye? He must find it rewarding in some way. Either he gains attention from staff or he finds the sensation more stimulating than his environment. Suppose we could provide a means for this Learner to gain the same effect with less harmful consequences and, at the same time, develop contingency awareness? If we:

place a large fan directly in front of the Learner's face and set it to a high speed (the fan must be protected by a sturdy metal cage such that the Learner cannot put his fingers into the blades as they turn);
attach the fan to a PowerLink (or equivalent system);
add a wrist band to the Learner's wrist attached by a rubber band and a length of string to a string switch such that as the Learner moves his arm/hand upwards to poke his eyes the string switch is activated before his hand can reach his eye;
attach the string switch to the PowerLink such that it operates whatever item is attached;

then, as the Learner raises his hand, he activates the string switch which turns on the fan. The fan blows directly into the Learner's eyes! The Learner gets the same form of stimulation that he finds rewarding (maybe even better) but provided by a means which is much less harmful. The PowerLink device should be set to 'direct mode' which means that as the Learner relaxes his arm and the string switch is no longer activated, the fan stops. It is the Learner's natural behaviour which triggers the fan and thus it is an action that he not only will occur but occur repeatedly. In so doing, the Learner continually activates the fan. Is the Learner able to make the connection between simply raising his arm and getting the stimulation he desires? How could we tell if he had made such a connection? Possible answers to this question will be provided later on this page.

The elastic band does not have to be attached to a wrist band, it could be attached to a head band or be operated by a leg/ankle or some other body movement. Furthermore, the string does not have to be attached to a body part at all: It might be attached to a favourite object such that, as the Learner reaches for the object and attempts to take it, this action pulls on the string which, in turn. activates the switch. In the past, I have suspended a soft sponge ball from a string switch which dangled down in front of a Learner such that he could operate a device by grasping the ball and pulling down as in a light cord in a bathroom.

The string switch might be used in such a way that it does not have to be operated by the Learner at all! For example, it would be possible to set up a toy car (or other moving toy or object) under a Learner's control. The Learner would be tasked to move the car into some form of barrier. The string switch could then be attached to the barrier such that, when the car moved the barrier, the barrier operated the string switch which, in turn provided a reward for the Learner!

I like the idea of the string switch and the fan but what do we do when this has been established? How do we progress from here?
That is a good question! First you can try reducing the stimulation to see if you can get similar results from less input. For example, you can turn the fan setting down to a lesser speed and keep reducing its speed over several days if the results are positive. You can also start moving the fan further and further away from the Learner's face such that over time less reward is acceptable for a particular behaviour. Also, once established, you can trial other forms of stimulation via the switch to demonstrate to the Learner that he can control his environment through his actions.

We can't have him attached to a fan all the time. What do we do in other areas?
As suggested in the response to the previous question the fan serves more than one purpose: if successful, it can also lead to the use of a natural Learner movement in the control of items in the environment. For example, it might be used to turn on music in the Learner's bedroom. The fan is a means to an end. The possibilities are much greater.

Everyone's a Winner

Teaching an individual contingency awareness does not just bring benefits for the Learner but also for the the people involved in the teaching:

"Findings support the hypothesis that response-contingent learning, and a child’s recognition of his or her capabilities (contingency detection and awareness), evoked a sense of child pleasure and enjoyment, and that a caregiver providing a child learning opportunities that resulted in increased child competence derived gratification from both the child’s and her own efforts."
(Raab, Dunst, Wilson, & Parkey 2009)

Thus, the Learner not only acquires the skills but such learning also brings pleasure and enjoyment to the Learner and the Significant Others involved. The pleasure a Learner gains from becoming 'contingency aware' has also been reported by others:

"he reports pupils make clear gestures and indicate through smiles and laughs they are aware it is them who are creating and affecting the sounds they hear." (Williams, Petersson, Brooks 2006)
(see also Ellis 1995)

Adversity Bringeth Cognition

Individuals Experiencing PMLD often have a strong startle reflex:

Johnny hits a switch and a toy rocket launcher makes a bang or a stationary toy suddenly springs into life;
Johnny startles and his face shows signs of upset;
Staff notice Johnny's state and remove the offending toy stating that he had an adverse reaction and they will find him something which will not scare him so.

While, seemingly, the staff are acting in the best interests of Johnny, they are missing a unique opportunity! If Johnny's reaction is not life threatening or likely to bring about a seizure or some other misfortune then it may be a better strategy to encourage Johnny to continue and to monitor his reactions over time.

Let us suppose that Johnny has a switch attached to a POLE event (Person Object Location Event) that causes him to startle as stated above. The first time he hits the switch he startles. The second time he hits the switch he startles. The third time, however, there is an obvious reduction in Johnny's reaction and, by the fourth switch activation, there is no discernible startle reaction whatsoever. What does this tell us? What can we state about Johnny after observing his behaviour? Surely, it must, at least, suggest that Johnny has become accustomed to the POLE action caused by activating the switch. If this is the case, how has he become accustomed? It is not by magic! He must be anticipating what is about to happen and if he is anticipating then:

he must have linked the switch to the event (cause and effect - see cause and effect this page);
he must be remembering previously encountered experiences.

Continuing with the example of Johnny. Let us suppose he interacts with the switch and the toy for ten minutes during the session, after which the switch and toy are removed so that he might participate in some other activity. Approximately 30 minutes later, the switch and the toy are re-presented and Johnny begins to activate the switch once more. The first time he startles. However, unlike his first experience, the startle response is absent on his second switch activation. Furthermore, when Johnny returns to the classroom after lunch and works with the switch and the toy for a third session, there is no startle response at all. What can we now begin to assume?

Suppose Johnny works with toy the following day still with no adverse reaction. Then, we let two days pass before we reintroduce the same toy to Johnny: still no adverse reaction. Indeed, it seems to require a week of absence from the toy before the startle reflex returns as strong as it was initially. Does this not suggest an observable means of establishing the retention of specific contingency awareness for an Individual experiencing PMLD over a period of time? Not only can we claim that Johnny is making a link but he is remembering it and we can also measure for how long!

Of course, we are not setting out to deliberately startle any individual (nor is this being recommended) but, if it happens in the course of a daily event (and it is my experience at least that it occasionally does), then we can turn the situation to our advantage as well as helping Johnny to work with a toy which we believe he will ultimately find pleasurable and also has educational merit.

It's a chore but someone's got to do it.

"As children many of us learned about work and to work for others by mowing lawns, baby-sitting, or delivering papers. While none of these experiences are part of our adult resumes, they were our first jobs and part of the foundation upon which we learned what we liked to do, what we were good at doing, and what we could realistically do & get paid for doing. For Sara, she had none of these experiences."
(Van Tatenhove, G. 1993)

"Work for pay opportunities (e.g. chores for allowance, paper route, bottle collection, etc.) should be provided at appropriate times in childhood" (Sweeney, L. 1993)

"As our interview was drawing to a close, Jacobson said that his parents kept preaching the work ethic to him and that they expected him to make it in the world of work. He laments that disabled children today have no responsibilities around the home. This is very important in nurturing the first feelings of the value of work." (Williams, M. 1994)

Differential and preferential treatment of individuals experiencing learning difficulties may not assist in preparing them for the world. As the 'goal is control' and chores are a means of assigning control to a particular individual, chores are important. One of the typical features of many a child's life is having to do chores, some of which may result in some form of remuneration. It is through such chores that a work ethic is fostered. Furthermore, chores help to develop both a sense of responsibility and an awareness that the chore helps to serve a purpose in the environment. An individual, sheltered from such early experiences (for whatever reason), may be unintentionally denied an early appreciation of these areas (work ethic, responsibility, awareness of purpose). Some may argue that individuals with severe disabilities or experiencing a severe of profound learning difficulty are physically and or cognitively incapable of coping with the average chore. This is not true and not helpful. Even a person who requires a single switch to access his or her environment can manage some carefully selected chores.

Every chore need not end with remuneration but each should have some result which is meaningful to the individual (a child should be expected to keep a bedroom tidy without any reward other than praise and the 'knowledge' that things are easier to locate and it is easier to move around the room). 'Remuneration' does not always have to be money: tokens; stars; house points; a pat on the back; a trip out; first in the dinner queue; etc. may all be equally rewarding (and, in some cases, better) alternatives.

Appropriate chores might include:

assisting (or controlling) another in tidying a (bed)room;
the use of a single switch to operate an electric can opener to help with meal preparation (or controlling a food blender or an electric kettle or ...);
a requirement to remind you to purchase an item or items that are needed on a shopping trip. The item could be recorded onto a BIGmack (or equivalent device for example and the Learner's task is to activate the BIGmack at the supermarket to remind you to buy the product);
reminding members of the family to do things at certain times;
showing visitors around school or college. Pre-programmed phrases could be used for the differing environments. This will require a voice output device;
involvement in preparing a hot drink for visitors. Use a teas-maid with a single switch interface for example. This also helps to demonstrate that people with disabilities are not helpless or incapable;
collection of monies from differing people or classrooms for regular events;
passing messages between staff and other staff, staff and parents, parents and staff, etc;
preparing a regular information poster (on a computer?) detailing school events for the week;
laminating (yes, laminators can be made to work from a single switch!);
putting toys away into boxes or drawers;
presenting in assemblies, leading prayers, singing songs, etc.
operating the forwarding of slides in a PowerPoint presentation;
vacuuming (many individuals have never vacuumed, some other person always does that for them);
caring for a pet;
litter picking duties.

There is no pretence that the above list is anywhere near comprehensive: you can already think of several other things that a Learner can be tasked to do. The Learner has to be given a 'responsibility' which is theirs and theirs alone; something in which they can take pride and can 'see' an outcome (something they have done has had an effect on the environment). If the Learners in your classroom (or your son or daughter) have no responsibilities then, unintentionally, you may be promoting passivity and missing out on an important tool to assist in their development. Therefore, 'TRICK a Learner today':
   Task Responsibility Involvement Control Knowledge
Task: Give the Learner a task for which the Learner is;
Responsible: The Learner has the responsibility for the task for a number of weeks/months.
Even if the Learner needs assistance s/he is;
Involved: It does not matter if the Learner cannot undertake the task without assistance as long
   as s/he is both involved and in;
Control: Remember 'The Goal is Control'. Ensure the Learner has controlling experiences.
All this will eventually result in a gain in;
Knowledge: The Learner will grow as a result of the above and come to understand that task
has environment consequences.

You are Crazy! My Learners have got PMLD. They cannot be made responsible for looking after the school rabbit!
Crazy? I have been called worst things! Seriously, if we wrap any individual up in cotton wool and shield that person from the world isn't it all the more likely that a result will be a limiting of knowledge about the world? You have a school rabbit and therefore someone must be responsible for the rabbit, why not change the nature of their responsibility slightly by making one of your Learners responsible for feeding the rabbit at a certain time each day?

The rabbit will starve! My learners are not able to do that.
The Rabbit will not starve; it will be fed every day just as usual. Let's suppose it is Mrs Smith's, the caretaker's present responsibility to feed the rabbit. We task one of your Learners (let's call him John) to feed the rabbit each day. To get the rabbit food, John has to go and see Mrs Smith and ask for it. Therefore John has to see Mrs. Smith every day at some set point. If John does not go then Mrs. Smith will know and can come and find John after waiting a certain amount of time to remind him of his responsibility and to ensure that he takes it seriously.

John doesn't understand the concept of time. He cannot 'go' and see Mrs. Smith.
He cannot 'ask' her for rabbit food'.
You are missing the point here! None of those things matter! If John does not independently notify staff that it is 10 o'clock and time to feed the rabbit then staff (at around 5 past ten must remind him). We are not expecting that John will go to see Mrs. Smith on his own (though if he can so much the batter), he will be accompanied by a member of staff who has the responsibility for this aspect of John's education. We are also not expecting that John will have fluent speech but he can be given a speech device (BIGmack or equivalent) that has a symbol for rabbit attached on which is recorded a message about 'rabbit food'.

My Learner would not feed the rabbit even if the food were to be placed in his lap.
He would probably just push it off.
How do you know until you try? If he can push the rabbit food off his lap he can push rabbit food into the rabbit's cage! If he doesn't have the physical capability of doing either of those things then, you plan for that and involve him in the process. It may be that you can have some switch adapted truck that pushes the food into the rabbit's cage that John can operate for example. If John pushes the food off his lap then the staff member can carry it for John to the cage and still involve John in the process. In that way, John will hopefully come to see over several days that the food is for the rabbit and it's a fun thing to do and therefore become more tolerant of taking the food from Mrs Smith. The task has to be completed consistently each day (with maximum involvement of John) for there to be any chance of John coming to comprehend it over time (Knowledge).

So if John does not feed the rabbit, Mrs Smith does it as usual?
No! John always feeds the rabbit at the same time every day (well, approximately the same time). The situation is planned thoroughly so that it cannot fail and no rabbit gets left hungry. It's John duty (Responsibility) to feed the rabbit and, as such, staff ensure that this happens but allow John to take more and more control of the situation. Of course there is a high probability that John will not understand anything of what is happening on day one and his supporting team will be facilitating his actions throughout entirely but, over time, their instructions are to create the situation ('scaffolding' - see the work of Jerome Bruner) in which John can take the initiative and the control more and more.

What about the weekends and holidays?
What happens at the weekends and in school holidays presently? That can continue. If John were to get agitated at home at around ten in the morning on a Saturday that would be a truly amazing result and one of which the team could be proud. The team would have to decide what to do about that of course but it's a nice problem to have!

I still think you are crazy and that it will not work!
So I am crazy. What have you got to lose? More importantly, what has John got to gain?

I have eight students in my class I can't just have a Learner going off on his own.
I need the support staff.
Then why not give them all a daily task to do at around ten? Build it into each day as a part of the session? There must be eight things that need doing each day.

I just haven't got the staff to support eight students doing eight separate things even if I thought it was a good idea.
Staffing is always an issue of course. Therefore you need to work around it. If not eight tasks why not four and put two Learners on one task? Now does the staffing allow this to happen? Is there a time in the day when the staffing does make it possible? Why not set the tasks to occur at this time?

How can Jane remind me to buy coffee at the supermarket when she is not able to understand what she has to do nor is she able to speak?
With the availability of assistive technology being physically able to speak is not a prerequisite: Jane can use a BIGmack (or equivalent system) simply to say 'coffee'. The issue is how do you get her to comprehend that she needs to say coffee at the supermarket as she is unlikely to understand what is required? The answer is, you don't! There is simply no use in saying to Jane in School or at home, "Jane here is a BIGmack. It says coffee. When we get to the supermarket remind me to buy some more coffee please using the BIGmack." Anyone capable of understanding that level of language is not, by definition, experiencing PMLD. However, that's not what needs to be done. 'Coffee' is being used as just an example here. While it can be any product, what we really need to purchase is something that is a real motivator for Jane. Let's assume Jane loves chocolate buttons. Jane is provided with a BIGmack (that has a symbol [or sensory surface] for chocolate buttons on its top) that says 'chocolate' and you go to the supermarket. If Jane activates the BIGmack at any point prior to the supermarket you simply respond by saying, "We are going to the supermarket now" in neither a positive or negative manner. However, if Jane activates the BIGmack at any point in the supermarket you make a big fuss of her and immediately go and get some chocolate, showing it to Jane and thanking her for reminding you. This is repeated each time you visit the supermarket: almost ignoring activations outside the supermarket and responding positively to an activation within. Over time do the activations outside the supermarket reduce?

What if she activates the BIGmack several times in the supermarket?
If it is before you have obtained the chocolate simply say, "Yes Jane. We are going to get the chocolate". Once the task is complete you can remove the BIGmack such that there is no opportunity for Jane to activate it again.

Jane will not hold a BIGmack and will not keep it on her lap in her wheelchair.
She will simply push it on the floor.
There are at least two possibilities: mount the BIGmack to the wheelchair such that it is accessible but cannot be removed; carry the BIGmack for Jane and present it to her in the supermarket.

Isn't that just 'fly-swatting'? She is almost certain to activate it if I put it in front of her.
It does not mean that she has any clue about what she is doing.
Exactly! However, how is Jane going to learn what she is doing? How is she to learn that activating the BIGmack (with it's symbol or sensory surface for chocolate) relates to you taking her to that part of the supermarket that houses the range of chocolates and making a purchase? The point is that every time you visit the supermarket and she activates the BIGmack you consistently go and get some chocolate. The BIGmack becomes an Object Of Reference communicating her requirement to get chocolate. You are trying to foster a link: cause and effect ... with the cause under Jane's control.

What if Jane doesn't activate the BIGmack at all in the supermarket?
You are probably not just going to the supermarket for one item so go and get the other things that you need even walking right by the chocolate and pausing there pretending to look at some other item on the shelves allowing Jane every opportunity to active the communication system. As the item is something that Jane really, really likes and every time she responds in the desired fashion you, not only buy some, but she also gets some of this as a reward, then you are proving the means, the motivation, and the opportunity. You are 'engineering the environment' to foster the development understanding.

What if she still does not activate the BIGmack?
The first few visits you will probably have to prompt Jane but plan on the gradual fading of all prompts over time. Leave more and more time before you prompt. If the item is something that Jane loves then she has every incentive to active the communication device. However, if Jane has asked for chocolate on previous occasion and does not on this then simply do not buy chocolate! Give Jane every opportunity but also show her that if she does not take control the she will not get what she wants. If you go ahead and buy chocolate anyway she will soon learn that she does not have to do anything because 'all things come to she who waits!'

Jane doesn't like chocolate! She isn't motivated by anything.
Please see the section on BEST POLEs above. If you haven't yet found a motivator for Jane and you believe that this idea is unlikely to be successful then try working with one of the other 'chore' ideas. Which can you implement? Which of these is the more likely to have a chance of success? Work on a plan for that chore.

I don't like either of those chores.
Then don't select those and choose a chore that you think will work for you and your Learner

Multi-Sensory Referencing and Objects Of Reference

Multi-Sensory Referencing is a didactic system that seeks to develop awareness of self in time and space in order to raise cognition and understanding of the world as it is experienced.
It is not a single approach but comprises a range of techniques that are used together to form a holistic system. The techniques include Spatial and Temporal Sensory Referencing, Sensory Cueing (often confused with Objects Of Reference), Environmental Engineering, creating a responsive environment, Tangible Symbol development, and Objects Of Reference.

"I realised that these pupils were at the simplest levels of development and needed an education that gave them the opportunity to reach out and sense the world around. A
more formal education had to wait patiently until they were ready"
Flo Longhorn (2010) PMLD Link, Vol. 22, 2 issue 66 page 2

MSR is a technique that assists Learners to establish links between specific stimuli and POLEs (People, Objects, Locations, and Events). As such, it can be extremely helpful in the development of contingency awareness. As there is a complete page within this website dedicated to the exploration of MSR it is not necessary to develop it further here: please click on the image above left to move to the MSR page and return here when required (it will open in a new window).

Catalogue of Contingent Considerations

There are several factors that help support (or otherwise detract from) learning of contingency awareness. Included in these are:

Temporal: time between (switch) action and the (POLE) consequence (between the cause and effect). The consequence should immediately follow (up to but no more than three seconds) but not be concurrent with the action (Dunst and Trivette 2009). Delays of more than five seconds have been shown to impede learning (Ramey & Ourth, 1971; Millar, 1972).
Spatial: The distance between the (switch) and the (POLE) consequence is of equal importance to temporal considerations. For a Learner to make a connection between the action and its consequence the two should be spatially proximal. The increasing use of wireless switches allows for greater distances between action and event. As such, it may be uncertain that the action is the cause of the event. Generally, the nearer the two the more likely that their will be Learner cognition.

Repetition: The opportunity for repeated exposure to the relationship increases the likelihood of Learner understanding (Watson, 1966, Silverstein & Lipsitt, 1974). The greater the time between exposure to a specific action and consequence the less likely the Learner will make a connection (Merriman, Rovee-Collier, & Wilk, 1997). Thus, Learners should be provided with several sessions in which repeated exposure to the relationship is within their control. In the use of switches with timed actions of toys, the timing should be set to no more than 10 seconds of reward.
Motivation: the use of rewards that the Learner finds the most motivating will lead to sustained interest and action. Thus actions should be linked with consequences that are the BEST for the Learner.
Interference: Significant others may unintentionally divert a Learner's attention from the relationship between action and consequence if they keep interfering in the process by (for example) repeating the original instruction over and over or chatting to another nearby. Indeed, any distraction in the Learner's environment is likely to reduce the likelihood of Learner cognition.

Where these conditions are met then there is a greater probability that an Individual Experiencing Significant Learning Difficulties will develop awareness of cause and effect:

"Evaluation of the effectiveness of the learning games with children who are profoundly delayed and have multiple disabilities indicates that with carefully designed interventions informed by research evidence, all the children afforded the learning opportunities demonstrated considerable progress in their learning as well as contingency awareness and increased social-emotional responding."
(Dunst & Trivette 2008 page 5)

It should be noted that the more significant the person's learning disability the more time is likely to be required for an individual Learner to make a connection:

"This indicates that the same kinds of experiences afforded children without disabilities are likely to be effective with children with disabilities but that children with disabilities are more likely to need additional learning opportunities and more time to learn that they are the agents of environmental consequences." (Dunst & Trivette 2008 page 5)

Contingency Mapping

Functional Equivalence Training (FET) and Functional Communication Training (FCT) seek to analyse Learner behaviours Significant Others may find challenging and replace them with a more socially acceptable and appropriate 'functional equivalent' which produces a matched (if not better) reward/outcome for the Learner. Thus, a Learner who:

when getting stressed in the classroom;
typically resorts to some form of behaviour (that staff may find challenging);
is removed from the classroom;
is taught to use a communication aid to ask the period of time out;
is able to 'escape' the stress by using a more socially acceptable means to the same end.

FET and FCT approaches include conducting a functional assessment of the behavior that staff may find challenging. The variables that predict and maintain the behavior are then delineated and socially acceptable, functionally equivalent skills are identified and taught such that the Learner will be less likely to use such behaviour if s/he has a readily available socially appropriate way to achieve the same function.

What part has contingency awareness to play in FET? In order for a FET schema to operate, a Learner must be aware of the contingencies involved in any functionally equivalent alternative; the Learner must be capable of comprehending that a given behaviour (Bg) leads to a desired goal (Gd). At some, perhaps subconscious, level of understanding, the Learner has already linked a behaviour (one that staff may find challenging) (Bc) to the desired goal (Gd).

Contingency Mapping (Brown and Mirenda 2006) is a means of making FET more comprehensible to a the Learner through pictorial representations of Antecedent – Behavior – Consequence (ABC) routes to a desired goal. The Contingency Map depicts alternate behavioural pathways illustrating the consequences of both the desired socially acceptable behavior and the behaviour that others are seeking to avoid. A Contingency Map should therefore comprise the following components:

a common antecedent (A) which has been identified as an initiating factor;
a pictorial representation of the behavior that staff have found challenging (Bc);
a pictorial representation of the desired socially acceptable behaviour (Bg)
the payoff (Consequence Cg) if the Learner selects the Bg branch of the map;
the lack of payoff (Consequence Cc) if the Learner selects the Bc branch of the map.

For such an approach to work:

the Contingency Map has to accessible at the Learner's current level of understanding;
the payoff has to be something that is desirable to the Learner (a BEST);
the Bg branch option has to be easier (or, at least, as easy as) for the Learner to achieve than the Bc option;
the Bg branch has to be something the Learner is currently capable of achieving;
the Bc branch has to have a less desirable end point.

In the video below posted on YouTube by AutismHelper.com, a variety of behavioral contingency maps are outlined

As you can see, they advocate a colour coded approach that uses mathematical symbols (if you do this + this then that will = this) that is laid out as follows:

Note: the above map layout, as well as the example detailed below can be downloaded free of charge for non-commercial use by clicking on it. The map aims to make explicit the contingencies and consequences involved in choosing to behave in one particular way rather than another with the green option (green for go, safety, and acceptable) being the most socially desirable and the red (red for stop, danger, and unacceptable) being the least desirable. The Learner can see the consequences of each route graphically and clearly.

Social Stories

Carol Gray, former consultant to students with autism spectrum disorders (ASD), first defined Social Stories™ in 1991. Gray defines a social story as describing:

"a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Half of all Social Stories developed should affirm something that an individual does well. Although the goal of a Story should never be to change the individual’s behavior, that individual’s improved understanding of events and expectations may lead to more effective responses."
(http://www.thegraycenter.org 2012)

An example of a Social Story from the Gray Center website is:

"My name is Tommy. I am an intelligent second grader at Cottonwood Elementary School. Sometimes, I have to use the bathroom. This is okay.

Bathrooms need to have a toilet or urinal, and maybe sinks. Sometimes, when people need to find a place to keep something until they need it, they might place it in the bathroom. My teacher keeps her overhead projector in the bathroom when she is not using it to make more room in the classroom. It's okay to store an overhead projector in the bathroom, but usually most bathrooms do not have overhead projectors in them.

Sometimes, my teacher uses the overhead projector to teach the children. If she were to bring all the children into the bathroom where the overhead projector is, it would be too crowded! So my teacher brings the overhead projector into the classroom to use it.

It's okay to use our bathroom with the overhead projector in it. It's also very okay and intelligent to use our bathroom when my teacher is using the overhead projector with the class.

The custodians work very hard to keep our bathrooms clean. They use disinfectant to keep everything nice for the children. If the custodians notice bugs, like spiders, they might use bug spray. Bug spray, and other things that custodians have, are used to keep bathrooms free of spiders and things. People never use overhead projectors to keep an area free of spiders; it just would not work. If I should ever see a bug in the bathroom, it's okay to tell an adult. The adult may know how to use a tissue or toilet paper to get rid of the bug, or we may choose to use another bathroom."

As can be seen, a social story is about a real life event for a real life person. The person does not have to be autistic to benefit. A Social Story seeks to explain to the person (Learner) something about a real event in a way that they can comprehend. It has a positive focus and it is hoped that a Learner's understanding of the story will result in the Learner being better able to deal with the real life event and its consequences in the future.

There are seven types of sentence that may be used in a Social Story:

Descriptive sentences:

Perspective sentences:

Directive sentences:

Affirmative sentences:

Control sentences:

Cooperative sentences:

Partial sentences:

are truthful and observable sentences (opinion- and assumption-free) that identify the most relevant factors in a social situation. They often answer "wh" questions.

refer to or describe the internal state of other people (their knowledge/thoughts, feelings, beliefs, opinions, motivation or physical condition) so that the individual can learn how others' perceive various events.

present or suggest, in positive terms, a response or choice of responses to a situation or concept.

enhance the meaning of statements and may express a commonly shared value or opinion. They can also stress the important points, refer to a law or rule to reassure the learner.

identify personal strategies the individual will use to recall and apply information. They are written by the individual after reviewing the Social Story.

describe what others will do to assist the individual. This helps to ensure consistent responses by a variety of people.

encourage the individual to make guesses regarding the next step in a situation, the response of another individual, or his/her own response. Any of the above sentences can be written as a partial sentence with a portion of the sentence being a blank space to complete.

Can we use an AAC device for Social Stories? Sure. A Social Story could be illustrated and stored into a simple AAC system such that an individual Learner could read the story by him/herself to him or herself or to a group of other Learners for whom the story may be relevant. The illustrated iPad overlay below conveys a Simple AAC Social Story in just nine cells. If you have a stepping single surface system available, a simple AAC Social Story can also easily be viewed one frame at a time. A whole library of Social Stories can be prepared over time in this way and saved for future use.

PowerPoint is an alternative presentation medium to an AAC device for a Social Story. Each 'frame' of the story might comprise a separate PowerPoint page which that then be navigated using a single switch. The image (right) shows the screen (or projection to a whiteboard could be used) on which the first part of the social story is presented from within PowerPoint. A BIGtrack trackball system has been attached to the computer's USB, A BIGtrack is simply a very large alternative mouse but one in which mouse key functions can be operated by using either the blue left and right buttons or by plugging in switches to jack sockets on either side of the system. If a Jelly Beamer transmitter and receiver is used in place of a direct switch then the whole system becomes remote and can be operated by a Learner from a distance with a single switch action. Each click of the Jelly Beamer transmitter acts as a left mouse click which advances the PowerPoint presentation to the next slide. Each slide contains a single part of the story together with a recording of the sentence accompanying the image such that the Learner can see and hear the story as it progresses. Indeed, in addition to the recording of the story line, additional sound effects could also be added. For example: the sound of running water from a tap as in the image. Furthermore, there is no real limit to the number of frames that may comprise the social story.

A further variation on a theme would be to let the Learner tell the Social Story using a Bookworm (or equivalent)(see image right) from your AbleNet dealer.. The story would have to be made up into the form of a small book and then recorded and stored onto the SD card of the Bookworm. It could then be played back at any time as necessary either by direct selection or via a single switch.

Assessing Contingency Awareness

"Adapted switches can bring desired environmental events, such as cool air from a fan or music from a favorite radio station under the control of people with profound motor and communication deficits. A number of investigators have reported difficulties, however, in assessing whether people supported with switch-device configurations show cause-and-effect or contingency learning"
Saunders & Saunders (2005 page 23)

The provision of evidence of contingency awareness in Individuals Experiencing Significant Learning Difficulties is often problematic as numerous variables may impede learning and contribute to performance variability. So, how is it possible to know if a Learner has acquired contingency awareness? As this aspect is problematic, it is my experience that staff in special education settings around the globe tend to assume Learner understanding: they might assume because a Learner activates a switch and causes a toy to operate on more than one occasion, therefore the Learner must have 'cause and effect' skills. This is a potentially dangerous assumption as it may be untrue. Repeated activated of switches may be explained by other rationales... The Learner:

moves a part of his/her body in the area of the switch and activates it by accident on occasion;
likes to interact with things in his/her personal space and will play with anything placed there. In the course of this interaction the switch is activated several times;
finds the click made by the switch stimulating in some way and repeated activates it for sensory feedback. 'switch-Tapping' is not indicative of cause and effect skills as the Learner is not making any connection between the switch activation and the POLE (in this case an event: toy operation);
other ...

What means can we employ to ascertain contingency awareness, an understanding of cause and effect? If one or more of the following are present then Learner awareness of cause and effect is likely. The Learner:

increases the frequency and duration of switch activation during subsequent sessions;
activates the switch to begin the POLE action but then ceases all switch contact until the POLE stops;
repeatedly tries to activates the switch until successful and then ceases any further attempt;
goes out of his/her way to activate the switch;
is consistent in switch activation in different environments and on different occasions;
is troubled (shows concern) when a switch fails to cause a POLE event;
is able to select between two switches in response to specific environmental stimuli;
on presentation of an Object of Reference, moves/travels unprompted by staff to the correct POLE;
the above behaviours cannot be explained by alternative means.

While, one of the above alone may be indicative of contingency awareness, the more of these criteria the Learner exhibits, the more likely an understanding of cause and effect is evidenced. Although Talksense likes to be thorough, the above listing does not claim to be complete; there may be other factors that demonstrate contingency awareness in an individual which we have not highlighted. As the items in the list may not be self explanatory each is detailed further below.

Increase in frequency and duration of switch activation during subsequent sessions;
What might explain an increase in the frequency of switch activation in sessions following the item's introduction? Given that the POLE (Person, Object, Location, or Event) that the switch initiates is a BEST (Best Ever Stimulating Thing: i.e. extremely motivating) the resulting increase in switch activations over baseline assessment could be indicative of a Learner understanding of the connection between the switch activation (action/cause) and the POLE (consequence/effect). However, the final item in the listing above instructs us that we should not be able to explain this behaviour by other means. What other explanations for the increase is possible?

the Learner is attracted by something about the switch and or its sensory feedback and thus begins repeated activations;
the baseline was artificially lowered as the Learner was not felling well on that day;
the switch is not in the same position as at baseline and is easier to activate;
the baseline was conducted in an afternoon session on a rainy day. Following sessions were in the morning on sunny days and the sun was shining through the windows and illuminating the switch making it more attractive and more visible to the Learner;
other?

While you might consider the above rationales fanciful, they are fairly easier to check and eliminate. As Sherlock Holmes said, "When you have eliminated all which is impossible, then whatever remains, however improbable, must be the truth" (This is stated in varying forms in at least three of the Sherlock Holmes mysteries: 'The Adventure of the Blanched Soldier;' 'The Adventure of the Bruce-Partington Plans'; and 'The Adventure of the Beryl Coronet'); we must eliminate other possible explanations before assuming that the Learner has grasped the concept of Cause and Effect.

Along with frequency, an increase in duration of the activations would tend to suggest an increasing contingency awareness. That is, the Learner maintains switch activation for longer periods than at baseline, This assumes that the POLE consequence is directly linked to the switch. However, this may not be the case. Modern switching systems, as well as some toys themselves, may operate in other than direct modes. In a direct mode of action, the action of the POLE corresponds directly with the activation of the switch: when the switch is released, the POLE action ceases. However, the POLE may be set to 'timed' such that any activation of the switch causes a POLE action of a specific duration. A further option is 'latched' mode , in which the switch acts as a sort of light switch, one activation turns the device on and a second turns it off. Thus while on, the device would continue to operate until the switch was activated once more or the device itself reached the end of its program. Furthermore, the POLE may only operate on 'complete cycle': any single activation of a switch will cause the POLE to go through its entire repertoire before it finally comes to a rest and requires a further switch activation. By far the best option for assessment is the 'direct' situation. The other alternatives obfuscate the situation and should be avoided. Let us suppose, in the direct mode situation, the switch activation duration increases overall during our period of observation. The toy (or other POLE) is therefore operating for significantly longer periods at any one time. Might this be indicative of Learner contingency awareness? What other possible explanations might there be for this occurrence?

the Learner has poor muscle control and finds it difficult to remove his/her hand (or other body part) from the switch after activation;
the continuing activation of the switch provides some other sensory feedback OTHER than the POLE consequence itself;
other?

A Learner is unlikely to develop poor muscle control from baseline through assessment stages. Therefore, the first of these explanations for an increase in POLE duration is unlikely. If the Learner as difficulty in removing his/her hand from a switch during assessment, s/he would have had the same issue at baseline. However, if the Learner has varying muscle tone over periods of time, it may be that the baseline occurred during a particularly good period for the Learner and s/he was able to operate the switch at that time with reasonable ease. On subsequent occasions, the Learner's muscle tone was not as good and s/he found it much more taxing to remove his/her hand from the switch accounting for the increased duration of the POLE event.

As the baseline assessment and subsequent assessment sessions should all be using the same equipment, any alternative sensory feedback from the switch itself should be a constant and therefore not afford any change in Learner behaviour unless the Learner has only just started to realise that the alternate sensory feedback is from the switch itself. This is easily eliminated: select a switch system that does not provide any real amount of sensory feedback. Many switches make a clicking sound on activation but do not repeat the sound if the switch is held in an activate state. If the Learner were repeated activating the switch (switch tapping) then this would be indicative of his/her awareness and preference for this alternate sensory feedback.

Again, it should be possible to eliminate these considerations from prejudicing any assessment of Learner competence. Are there other possible rationales to explain the increase in duration other than a Learner choice to do so? If there are, these too must be eliminated.

Activation of the switch to begin POLE action but then Learner ceases all switch contact until the POLE stops
This assumes an other than direct relationship between switch and POLE. With a direct relationship (as explained in the prior section) the switch must be continuously activated for the POLE to action: once the switch is released, the POLE will cease to function. Thus, this point has no meaning with a 'direct' setting. However, many special education setting used a 'timed' approach to switch use. In a timed approach, the POLE operates for a predetermined amount of time from a single switch activation. Thus, a toy will continue on for a set period even after a single short click of the switch. In this 'time' mode, a Learner's non activation of a switch during the continuing action of a toy or other POLE is indicative of contingency awareness providing the Learner only attempts to activate the switch on cessation of POLE action: the toy is working , the learner makes no attempt to operate the switch; the toy ceases to operate and the Learner activates the switch once more. This is repeated over and over.

How can such behaviour be explained by any other rationale than a Learner awareness of cause and effect?

Fluke? Not if the behaviour is consistent: once may be an accident, twice chance but, any more cannot be explained in such terms;
Alternate sensory cueing from other than the POLE? There may be a switch that buzzes when its POLE is inactive (for example, the LIP switch from Excitim is one such system that is designed to prompt an inactive Learner). However, this is unlikely and we can easily ensure that this is not the case.

Thus, a Learner's activation of a switch at only appropriate moments in POLE cycles is fairly indicative of contingency awareness.

Repeated attempts to activate a switch until successful then ceases any further attempt until appropriate.

The majority of switches require targeting. That is, a Learner with limited physical prowess may miss the switch target and therefore fail to operate the switch. If the Learner keeps on attempting to activate the switch and then makes no further attempts (when s/he is successful) until the POLE action ceases, then we might conclude that the Learner is aware of the relationship between the switch and the POLE.

In the little video right, the young lady repeatedly attempts to activate the switch but misses. However, once she is successful, she settles down to listen to the music that results and her attention is focused on the other things happening around her. However, once the music stops, she once again attempts to activate the switch.

Please note that this video clip has no sound.

The Learner goes out of his/her way to activate the switch.

I once worked with a young lady who loved to interact with staff in some form of dance routine from her wheelchair while music was playing. She had an ability to self-propel her chair and could manage her brakes. I had set up a BIGmack communication aid with a short recording of about 15 seconds with a piece of popular music. I placed the BIGmack on the table top adjacent to where she was sitting and stood opposite her. I activated the BIGmack and began to play a form of pat-a-cake dance with her while the music played which she obviously enjoyed. However, when the music stopped, I stood silent and upright and folded my arms and waited. Sure enough, 'K' operated the BIGmack and we began to play pat-a-cake once more. Again the music stopped but this time while she was reaching out to operate the BIGmack to continue the fun I side stepped to the left away from her and the table top. K had to unlock her brakes and re-position herself in front of me to continue the game. This she did and once again the music stopped. K could no longer simply reach out to activate the BIGmack, she had to move her char to do so. While she was doing this (without any prompting from me), I took another side step to the left! This process continue throughout the session until I was across the other side of the room! K was travelling back and forth across the room, activating the BIGmack and then returning to dance with me.

How can we explain K's behaviour in any other way but by invoking contingency awareness? K knew the BIGmack played the music and that i would only dance with her while the music was playing. She went out of her way to activate the switch in order to obtain the action. This is indicative of contingency awareness.

The young man in the images right had a few BESTs. One was the 'Police, Camera, Action' type of television series. His parents had reported that he loved videos of such car chases and would sit quite content for hours watching them if he was allowed to do so. Normally, to enable him to watch the video, we positioned a switch on the TV screen (we used stick and suck pads to attach the switch) itself such that, when the video stopped (we allowed him about twenty seconds of viewing before it paused and required re-starting), he only had to reach out and activate the screen switch right in front of him to continue his viewing pleasure. However, on this occasion, for assessment purposes, we positioned the switch on his left in a very awkward placement. He really had to use some effort to activate it. However, he continued to activate the switch even in it's new 'awkward' position when the video was paused to restart his favourite program. Even when we positioned a second switch that operated a fan nearby, he would figure out which switch operated his video and not touch the fan switch at all. We could even swap the switches while he was not watching and he would still figure out which switch operated which item and then continually opt for the video control.

Can this young man's behaviour be explained by any other rationales other than contingency awareness? He did not attempt to operate the switch at any other point except when the video paused. Indeed, after a few switch activations to his left, he 'decided' on a new strategy: he didn't keep reaching for the switch every time the video stopped but kept his left arm out in place with his hand resting over the switch (but not activating it) such that he could easily, and almost instantly, tap it when the program paused such that he didn't have to continue exerting too much effort! He did this without any prompting from staff whatsoever. This young man had been given a 'PMLD tag' prior to our time together: it was fairly obvious that such a label was incorrect or that he had made sufficient progress at some point to no longer be classified in this way.

In both real-life examples, the Learners went out of their way to operate a switch to continue a favourite activity (BEST). Such behaviour is indicative of contingency awareness (unless you can think of an alternate explanation?!)

Consistency in switch activation in different environments and on different occasions

If a Learner consistently performs any of the actions listed in different curricular activities and over a period of time this adds increasing weight to our claim of contingency awareness. However, simply switch activating in differing sessions is not, of itself, indicative of such understanding. Why not? because we can explain it by other rationales. The learner maybe activating the switch because s/he:

is attracted by its sensory feedback (the click?);
always plays with things in his/her personal space;
accidentally hits it as it is in line with her natural body movements.
other?

Therefore, this criteria, on its own, is not sufficient a reason to claim contingency awareness in any Learner. However, when couple with one of the other rationales adds weight to the existing evidence.

Learner is troubled (shows concern and or surprise) when a switch fails to cause a POLE event.

If a Learner reacts in an untypical manner to a failure of a switch to provide a BEST action then this too is indicative of contingency awareness. Reactions might include:

surprise;
concern;
upset;
behaviours that staff may find challenging.

As each Learner might display these behaviours in different ways, it is for Significant Others to decide as to whether the y are such and they are resulting from an inactive BEST POLE. However, as such behaviours are open to interpretation and are therefore subjective in nature, any claim of demonstrating a Learner understanding of cause and effect maybe somewhat problematic: "Johnny appeared surprised that the music did not play and therefore he must understand the connection between the switch and the Music/CD player." While, indeed, this may be true the interpretation is subjective. If however, Johnny's altered behavioural state was witness by more than one member of staff/ Significant Other, and they concurred that it was because of a lack of response to his switch activation, then this adds extra credence to the claim. As Learner behavioural changes are not uncommon in special education settings, it would be difficult to ascribe them to one particular causal factor but if they immediately follow a failed attempt (or repeated attempts) to action a POLE via a switch activation then this is indicative of contingency awareness.

The Learner is able to select between two switches in response to specific environmental stimuli

The young lady in the video (left) is selecting between two switches one of which is asking her mother to 'do it again please' and the other instructing Mum to terminate an action (in this case: close a window) by using the command 'finished'. The young lady is not simply moving from one switch to another in some endless pattern but, rather, responding appropriately to the current environmental condition: when her mother accidentally (on purpose) fails to close the window, the young lady goes back to the same switch and repeats the command. This is indicative of contingency awareness. Could we explain this behaviour by an alternate means? Yes! It might be that the young lady:

forgot where she was in the routine of moving from one switch to the other and this just happened to coincide with Mum's 'forgetfulness';
is being prompted by an outside agent not seen on the video (somewhere off camera);
activated the switch by accident.

However, these possibilities are eradicated by the second video of the same young lady doing exactly the same thing in a different setting (this time with taps) in the video below. There appears to be little room for doubting this young lady's awareness of the functions of these switches and her grasp of cause and effect. If someone off camera (the camera man or woman?) is prompting the young lady, she must be remarkably talented because she does not look at them or acknowledge their presence in any way and there is no pick up of any verbal prompting. It seems evident that this is all the work of the young lady herself. In addition, the fact that she seems able to transfer these skills from one situation to another also speaks volumes for her abilities.

On presentation of an Object of Reference, moves/travels unprompted by staff to the correct POLE

Not all contingency awareness has to demonstrated through the use of switches and switch adapted devices. One such other demonstration of awareness would be through a Learner's correct interpretation of POLE when given an Object of Reference. As OOR are covered extensively on another page of this website, I will not spend a great deal of time or space devoted to detailing it here. However, on being presented with an OOR, if a Learner were to move independently to the POLE represented this would be indicative of contingency awareness. Of course, not all Learners involved with OOR are independently mobile and, thus, they may not be physically able to demonstrate such a skill even if they were able to comprehend it. However, it is but one example of contingency awareness that is not reliant on switch control. There are many others. Significant others may recognise some Learner action or behaviour as being indicative of contingency awareness: they might ask, 'why would the Learner act in this way if s/he is not aware of the consequences'? Once again, it is important that alternative explanations for Learner behaviour are considered and ruled out.

Not explainable by other means
In each of the above sections, it was noted that Significant Others should always consider alternate explanations for Learner behaviour. If these cannot be ruled out or eliminated then it cannot categorically be claimed that the Learner is acting with contingency awareness. Therefore it is wise to ask another if s/he can think of an alternate explanation for a particular behaviour (the more people asked the more likely you will cover all possible alternative explanations) and rule each out in turn. Possible alternate explanations include:

alternate form of sensory feedback available to Learner (the click of a switch, the sun shining on a switch and illuminating its surface);
Learner simply interacting with or attracted to item (switch) in his/her personal space;
accident;
fluke;
other...

If the Learner repeatedly activates the switch because it provides sensory feedback in the form of a click then can't we say that s/he has a basic grasp of cause and effect because the Learner is repeatedly causing the click to occur?
That is true and this has been covered earlier on this page. However, as Piaget pointed out, the Sensorimotor stage is divided into six sub-stages in which contingency awareness develops over a period from primary circular reactions, through secondary t o tertiary circular reactions. Thus, contingency awareness should be considered as a continuum. Learners who are 'switch-tappers' are at some point near the entry level of the continuum; we need to progress their awareness by moving them further along..

Thus, 'switch tapping' has a positive aspect (even though it is generally considered to be problematic) in that the Learner must be doing it for a reason (sensory feedback) and therefore must be associating the switch with the feedback.

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Wacker, D.P., Wiggins, M.M.,  Fowler, M., & Berg, W.K. (1988). Training students with profound or multiple handicaps to make requests via microswitches. Journal of Applied Behavior Analysis, Volume 21 (4), pp. 331 - 343

Ware, J. (1991). Helping the Most Handicapped to Progress: The Contingency-Sensitive Environment'. Presentation at the Seminar on The Application of Caregiver Infant Interaction Research to the Education and Development of People with PMLDs, Edinburgh November 1991.

Ware, J. & Healey, I. (1991). Interaction: The Way Forward in Helping the Most Handicapped to Progress: (2) Creating a Contingency Sensitive Environment'. Presentation at the 2nd Conference of IATSE, Dublin, June 1991

Ware, J. (1994) Using Interaction in the Education of Pupils with PMLDs i)Creating Contingency-Sensitive Environments. In Ware, J. (ed.), Educating Children with Profound and Multiple Learning Difficulties, London: David Fulton, pp 126-149

Ware, J., Thorpe, P., & Mehigan, P. (2003). Teaching Contingency Awareness in the Classroom to Pupils with Profound and Multiple Learning Difficulties, Presentation at the Annual Conference of BERA, Edinburgh.

Ware, J & Thorpe, P. (2004). Developing a Psychologically Based Method for Teaching Contingency-Awareness, Presentation at IASSID 12th World Congress, Montpellier, France.

Ware, J. Thorpe, P., Gray, C., & Behan, S. (2005). Developing Contingency Awareness in Pupils with PMLD in the Classroom, Presentation at ISEC (Inclusive and Supportive Education Congress), Glasgow, Scotland, 1st - 4th August 2005.

Watson, J.S. (1966). The Development and Generalization of Contingency Awareness in Early Infancy: Some Hypotheses, Merrill-Palmer Quarterly of Behavior and Development, Volume 12 (2), pp. 123 - 135

Ceri Williams, C., Petersson, E., & Brooks, T. (2006): Picturing Sound – An overview of its efficacy. Proceedings Art Abilitation

Wilder, J., & Granlund, M. (2003). Behaviour style and interaction between seven children with multiple disabilities and their caregivers. Child: Care, Health and Development, Volume 29, pp. 559 – 567.

Winefield, A.H. (1983). Cognitive performance deficits induced by exposure to response-independent positive outcomes. Motivation and Emotion, Volume 7, pp. 145 - 155.

Wyman, R. (2000): Making Sense Together: Practical approaches to supporting children who have multisensory impairments. Human Horizons Series, Souvenir Press

York, J., Nietupski, J., & Hamre-Nietupski, S. (1985). A decision making process for using microswitches. Journal of the Association for the Severely Handicapped, Volume 10, pp. 214 - 223.