Noncompliant behavior of people with mental retardation.
Reward packages beat timeout alone for noncompliance in ID, so layer social and tangible reinforcers from day one.
01Research in Context
What this study did
Walker (1993) pulled together every study on noncompliance in people with intellectual disability. The author also looked at work with oppositional children to see what might cross over.
The paper is a narrative review, not a meta-analysis. It maps which variables make noncompliance better or worse and notes how clients respond to different treatments.
What they found
Programs that mix social praise with small prizes cut noncompliance the most. Timeout by itself rarely worked and sometimes made the problem grow.
Clients with ID often needed more practice trials and clearer cues than oppositional children without ID.
How this fits with other research
Evenhuis (1996) extends these lessons. That later review adds 20 years of clinic data and warns that staff turnover and weak maintenance plans can still sink good behavior plans.
Taylor et al. (2017) and Chiviacowsky et al. (2013) move from single behaviors to full life domains. They show the same rule holds: combine rewards, teach in many places, and keep data.
There is no clash with Cook et al. (2011). Fay urges tight definitions of social skills; Walker (1993) shows that once you define noncompliance, reward packages still win.
Why it matters
If you run plans for adults or kids with ID, stop relying on timeout alone. Stack social praise on top of tokens or snacks, then practice in every room the client uses. Plot data each day so you can spot when the plan starts to slip and reboot it fast.
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Add a 30-second praise burst right after each token delivery in your current plan and track drops in refusal.
02At a glance
03Original abstract
Literature pertaining to noncompliant behavior of people with mental retardation was reviewed. Noncompliant behavior was considered in terms of antecedents (characteristics of instructions), behaviors (characteristics of tasks being refused), and consequences (environmental results of noncompliance). Literature pertaining to nondisabled "oppositional" children was incorporated along with literature pertaining to persons with mental retardation. Research involving antecedent conditions suggested that noncompliance is more likely when instructions are vague and interrupted with other instructions. It also suggested that a series of high probability requests could enhance compliance to a subsequent low probability request. Research into behavior variables suggested that noncompliance is more likely when task demands are too difficult. Research into consequent conditions indicates that either positive or negative reinforcement may maintain noncompliant behavior. Treatment studies suggested that oppositional children respond poorly to verbal reward alone and somewhat better to tangible rewards and to programs utilizing timeout. By contrast, noncompliance by people with mental retardation appears to respond well to programs utilizing combinations of social and tangible rewards, but results also suggest that results of timeout programs are mixed. Implications for treatment were discussed along with suggestions for future research.
Research in developmental disabilities, 1993 · doi:10.1016/0891-4222(93)90014-b