Automatic Prompting and Positive Attention to Reduce Tongue Protrusion and Head Tilting by Two Adults With Severe to Profound Intellectual Disabilities

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Abstract
This study assessed a simple behavioral strategy for reducing stereotypic tongue protrusion and forward head tilting displayed by a woman and a man with severe to profound intellectual disabilities. The strategy involved (a) auditory prompting (i.e., verbal encouragements to keep the tongue in the mouth or the head upright) delivered automatically at fixed intervals via a portable device, and (b) social approval delivered by a research assistant at adjustable intervals for the absence of the inappropriate behavior. The intervals arranged for the delivery of approval were extended if the inappropriate behavior occurred in concomitance with the expected delivery. Data showed that the intervention strategy was effective in reducing the stereotypic tongue protrusion and forward head tilting. Their occurrences dropped from above 40% (tongue protrusion) and close to 80% (head tilting) of the observation instances during the initial baseline to around or slightly above 10% of those instances during the second intervention period and the 3-month postintervention check.