BEHAVIOR THERAPY 6, 627-63• (1975)

The Use of Positive Practice to Eliminate Persistent Floor Sprawling by Profoundly Retarded Persons

N. H. AzmN AND M. D. WESOLOWSKI

Anna State Hospital

A problem among some profoundly retarded persons is that they persistently and continually sprawl on the floors. In a ward where this problem existed, the floor sprawling was not eliminated by a program of intensive reinforcement for sitting on chairs, by making many more chairs available, nor by continually inter- rupting instances of floor sprawling. A re-educative procedure then was used in which the residents were given a period of required practice in seating themselves on several different chairs, this Positive Practice being given whenever the resi- dent had been sprawling on the floor. Sprawling on the floor was eliminated after 8 days, and the residents used the chairs and sofas instead. Only a verbal re- rninder was needed after the fourth day. This Positive Practice procedure is a rapid, effective, and lasting method of eliminating this deviation from normaliza- tion.

When supervised instruction is given to retarded persons, no problem usually exists in their utilizing the chairs and sofas that may be essential to the nature of the instruction. When the profoundly retarded person is not being supervised, a strong tendency often exists to sit or sprawl on the floor, especially by the more passive individuals. The overall appear- ance of such a ward is that the floor is covered by individuals who are stretched out or sprawling on the floor rather than standing, sitting, or walking about in a normal fashion as is usual when this problem is not present. This floor sprawling seems to be but one more instance of a lack of socialization, normalization, and learning by the profoundly re- tarded and demands an educational effort on that basis alone. (See Wol- fensberger, 1972 for a discussion of this normalization principle.) In ad- dition, our experience has been that this floor sprawling in the corridors on institutional wards sometimes resulted in serious injury to those sit- ting on the floor by the attempts of the other residents to step around them in using the corridor. The most common procedure observed for dealing with this problem has been to lift the individual into a standing

This research was supported by the State of Illinois, Department of Mental Health. The authors thank Phil Egelston and the staff of Living Unit 4A for assistance in the conduct and maintenance of this study. Requests for reprints should be addressed to either author, Behavior Research Laboratory, Anna State Hospital, Anna, IL 62906.

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Copyright © 1975 by Academic Press, Inc. Pall rights of reproduction in any form reserved.

628 A Z R I N A N D W E S O L O W S K I

position accompanied by a statement of disapproval. This procedure often is not effective.

Positive Practice requires an individual who has engaged in a problem behavior to practice the correct manner of performing. This procedure has been used effectively in teaching the retarded to toilet themselves (Azrin & Foxx, 1971; Foxx & Azrin, 1973), to eat properly (Azrin & Armstrong, 1973), to stop engaging in self-stimulatory behavior (Azrin, Kaplan & Foxx, 1973), to eliminate self-injury (Azrin, Gottlieb, Hughart, Wesolowski & Rahn, 1975), to stop stealing (Azrin & Wesolowski, 1974), to stop bedwetting (Azrin, Sneed & Foxx, 1973), and to stop vom- iting (Azrin & Wesolowski, in press). It has also been useful with nonretarded persons for rapid toilet training (Azrin & Foxx, 1974), elimi- nating enuresis (Azrin, Sneed & Foxx, 1974), and managing classrooms (Azrin & Powers, in press).

For the present objective of eliminating floor sprawling, the correct manner of performing would be to walk to a chair or sofa and seat one- self on it. The Positive Practice rationale applied to floor sprawling suggests that whenever the resident sits on the floor, he should be re- quired to arise and to practice for several trials the appropriate action of walking to several different chairs and seating himself on them consecu- tively, each time for a brief period. A brief reminder to correct oneself is given before the Positive Practice. Typically, the Positive Practice re- quirement is rarely needed after a few days since the simple reminder is then usually sufficient for the individual to correct himself.

The present study applied this approach in an institutional ward for the retarded where floor sprawling represented a major problem for the ward staff and for the other residents.

METHOD

Subjects The ward of an inst i tut ion was observed every 30 min for 8 hr each day for 12 days , and

a record taken for each of the 28 res idents as to whether the res ident was standing, seated on a chair, or sprawled on the floor. The residents had been t ransferred to this ward f rom other large, unders taffed insti tutions where little or no supervised instruct ion had been available. The t ransfer was part of a cont inuing program to reduce the populat ions of the more overcrowded insti tutions. The present s tudy began about 3 mo after the transfer. Since no ambiguity existed regarding the definition of the responses , no reliability mea- sures were taken. If the res ident were sprawled on the floor, he was required to s tand up, thereby providing simple correct ion for floor-sitting. The participants in the rest of this s tudy were the 11 persons who had been found on the floor on three or more of the obser- vations. Three were male, eight were female. The average age was 35 yr with a range of 22--43 yr. They had been insti tutionalized for an average of 29 yr. All were classified as profoundly retarded. All could walk, but one was blind. All lacked speech. The average age equivalent on the Vineland Social Maturi ty Scale (1965) was 1.5 yr. The average mental age on the Merr i l l -Palmer Scale of Mental Tes ts (1965) was also 1.5 yr.

ELIMINATION OF PERSISTENT FLOOR-SPRAWLING 629

Prior to the present study, an unsuccessful effort had been made to eliminate floor sprawling by providing more chairs and by intensive positive reinforcement. Twelve extra chairs were placed at the locations where the floor sprawling was most common. In addi- tion, two behavior therapists spent 5 days, 8 hr/day, continually reinforcing the residents with praise, stroking, and favored snack treats for sitting on chairs and requiring them to arise should they sit on the floor. The floor sitting was reduced only slightly. Conse- quently, that program was discontinued and the present program attempted.

Procedure

After 12 days of recording and simple correction of floor sprawling, Positive Practice was initiated. Two trainers, exclusively assigned to this program, continually observed the residents. When a resident sat on the floor, he was told that he must not do so and was re- quired to arise, walk to a nearby chair, seat himself on it for about 1 min, then proceed to another chair to sit for another rain. When he had sat in 10 chairs for 1 min each, he was left sitting in the last chair. The instruction period lasted for about 12 min. The trainer's manner was designed to promote independence of action by the resident. He guided the resident only if the resident did not react to the verbal instructions. When guidance was re- quired, he used the Graduated Guidance procedure (Azrin & Armstrong, 1973; Azrin & Foxx, 1974; Azrin, Kaplan & Foxx, 1973; Azrin and Wesolowski, in press) whereby the least amount of manual guidance or contact is used at any moment. The Positive Practice procedure was faded out after the first 2 days by using only a verbal reminder to a resident the first time he sat on the floor on a given day. The Positive Practice was given him only if additional instances occurred that day. After 12 days, the regular ward staff conducted the program.

For residents not included in the study, the trainer applied the same training as to the 11 principal trainees on the rare occasions when they were observed to sprawl on the floor, These data were not included in the analysis of the behavior of the 11 persistent floor- sprawlers.

RESULTS W h e n Pos i t ive Prac t ice was ini t ia ted, floor sprawl ing decreased after

2 days by 67% to four in s t ances , and after 8 days was comple te ly absen t

for the fol lowing 12 days of obse rva t ion (Fig. 1). Per iodic obse rva t ions

thereaf ter , as well as the repor ts of the ward a t t endan t s 6 mo later, indi- cated that a s imple verba l r e m i n d e r was sufficient for a res ident to cor- rect h imse l f in the rare i n s t ances in which floor sprawl ing recurred . Al though Pos i t ive Prac t ice was still scheduled for use for mul t iple in- s tances of floor sprawling, on ly verba l r eminde r s were needed after the fourth day of t ra in ing s ince n o n e of the res idents sat on the floor more

than once dur ing a g iven day af ter the four th day as ind ica ted by the ar row in F igure 1. Visi tors to the ward f requen t ly c o m m e n t e d on the

more no rma l appea rance of the res idents .

DISCUSSION

The no rma l use of chairs and sofas for sit t ing seems to require no more effort or skill t han si t t ing on a floor. Yet , the r e s iden t s ' floor sprawling pers i s ted e v e n when ample chairs were avai lable in the same locat ion. E v e n the in t ens ive 5-day per iod of pos i t ive r e in fo rcemen t pre-

630 AZRIN AND WESOLOWSKI

SEattLe CORRECTION J POSITIVE PRAC;SCE

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FIG. 1. The effect of Positive Practice on the floor sprawling. Each data point desig- nates the number of times/day, averaged over 2-day periods, that the 11 retarded residents sat on the floor. During Simple Correction, the trainer required an individual found sprawling to stand up. During Positive Practice the trainer required him to practice sitting on several chairs for a brief interval on each. The data points are for a 2-day period until the third week after Positive Practice was initiated, and for a sample day, 6 mo later. The arrow designates the point after which only reminders were given and no further Positive Practice periods were needed since all residents arose when given the simple reminder.

ceding this study did not eliminate floor sprawling. Nor was floor sprawling decreased by the 12-day period of simple correction during which the trainer required the resident to arise from the floor. This floor sprawling apparently was a strongly established "habit" that had been tolerated over decades of institutionalization in understaffed facilities. The Positive Practice procedure was effective in eliminating the problem for all residents within 8 days, after which the regular ward staff main- tained the benefit by simple verbal reminders and simple correction.

As important as it may be to eliminate the inconvenience, physical injury, and disorder caused by having many residents sprawling on a floor, the existence of this habit is equally important as an indicator of the lack of socialization of the individual. Teaching the resident to sit in a chair, walk, or stand instead of sprawling, brings him *one step closer to normalization, so that he is more likely to be viewed as amenable to other forms of instruction and functional interaction.

REFERENCES Azrin, N. H., & Armstrong, P. M. The "mini-meal"- -a method for teaching eating skills

to the profoundly retarded. Mental Retardation, 1973, 11, 9-13. Azrin, N. H., & Foxx, R. M. A rapid method of toilet training the institutionalized re-

tarded. Journal of Applied Behavior Analysis. 1971, 4, 89-99.

ELIMINATION OF PERSISTENT FLOOR-SPRAWLING 631

Azrin, N. H., & Foxx, R. M. Toilet training in less than a day. New York: Simon & Schuster, 1974.

Azrin, N. H., Gottlieb, L., Hughart, L., Wesolowski, M. D., & Rahn, T, Eliminating self- injurious behavior by educative procedures. Behaviour Research & Therapy, 1975, 13, 101-111.

Azrin, N. H., Kaplan, S. J., & Foxx, R. M. Autism reversal: Eliminating stereotyped self- stimulation of retarded individuals. American Journal of Mental Deficiency, 1973, 78, 241-248.

Azrin, N. H., & Powers, M. A. Eliminating classroom disturbances of emotionally dis- turbed children by positive practice procedures. Behavior Therapy, in press.

Azrin, N. H., Sneed, T. J., & Foxx, R. M. Dry-bed training: Rapid elimination of child- hood enuresis. Behaviour Research & Therapy, 1974, 12, 147-156.

Azrin, N. H., & Wesolowski, M. D. Theft reversal: An overcorrection procedure for elimi- nating stealing by retarded persons. Journal of Applied Behavior Analysis, 1974, 7, 577-581.

Azrin, N. H., & Wesolowski, M. D. Elimination of psychogenic vomiting (Emesis) of a re- tarded adult by positive practice and self-correction. Journal of Behavior Therapy and Experimental Psychiatry, in press.

Foxx, R. M., & Azrin, N. H. Toilet training the retarded: A rapid program for day and nighttime independent toileting. Champaign, IL: Research Press, 1973.

Merrill-Palmer Scale of Mental Tests. Beverly Hills, CA: Western Psychological Service, 1965.

Wolfensberger, W. The principle of normalization in human services. Toronto: National Institute on Mental Retardation, 1972.

Vineland Social Maturity Scale. Circle Pines, Minnesota: American Guidance Service, 1965.