Brian was 9 years old when he was involved in a motor
vehicle/pedestrian accident. He was an energetic, healthy young boy who had
always been extremely bright and inquisitive. Following the accident, Brian
was in a coma for 9 months. When he came out of the coma, he received
rehabilitative therapies and returned to school. At age 16, he was still in
school and needed all related services for support. He also experienced
significant cognitive difficulties. Because of his age, the school was
actively trying to place him on a supervised job-site for possible future
employment. One of the many difficulties with a job-training situation was
Brian’s lack of personal insight. Even though he had severe cognitive
and physical limitations, he still saw himself as the same person he had been
prior to the accident. If he was given a task that he considered beneath his
skill level, he would become aggressive.
Brian was placed on a cafeteria job-site stocking the drink cooler. As a
control. This made placing the drinks in rows a very difficult task. He also
showed decreased attention to task and would become lost or bored during an
activity and forget or lose interest in what he was doing. When Brian had
down time, he would become physically and verbally aggressive and extremely
noncompliant. On numerous occasions, he had to be physically removed from the
worksite because of aggression toward the staff.
After several work site complications, an assessment was
done to determine if the cause of the aggression was interaction with staff,
the actual work task, Brian’s physical limitations or the environment in
which he had been placed. Behavioral data, direct teacher observation and
staff/family interviews were used to collect data for this assessment.
Through data collection and direct observation, it was determined that Brian
needed much more positive verbal interaction to stay engaged in the activity.
Involving Brian in the assessment process gave the staff valuable insight
regarding his actual needs. Of the various components considered in the
assessment, it was determined that the staff member coaching Brian was
critical for the success of the task. The staff members he chose most often
were very outgoing and used lots of humor when working with him. Humor used
by a staff member was very influential for keeping him engaged in his
activity and reducing aggression. He was placed on a reinforcement
schedule that relied only on verbal praise from staff. This praise was
initially given at 5 minute intervals. On this plan, his aggression
frequency dropped to one time every two weeks from the original one to two
times daily as recorded in previous data collections prior to intervention.
By using the data collected, it was also determined that too many people in
the cafeteria during Brian’s work time would also lead to heightened
aggression. His time to stock the cooler was changed to a time when he was
in the area alone with a staff member. By adding verbal praise at 5-minute
intervals and reducing the number of individuals in the work area, instances
of aggression dropped to zero in an 8 week period. The cafeteria staff was
no longer afraid of Brian and would interact with him. The interactions
served as another form of reinforcement for him.