A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities.
Person-centered plans alone mislabel preferences for people with profound disabilities—always run a brief systematic preference assessment before programming.
01Research in Context
What this study did
The team checked how well person-centered plans match real likes and dislikes.
They watched adults with profound multiple disabilities interact with items listed in each plan.
Staff had said, "She loves the radio," or "He hates soft toys." The researchers timed how long each person touched or moved toward the items.
What they found
Plans were wrong one quarter of the time.
Three out of four listed "favorites" were really liked or moderately liked, but the rest were ignored or even pushed away.
Some "dislikes" turned out to be favorites once the person could show choice with simple body movements.
How this fits with other research
Horrocks et al. (2008) got the same message with teens and sounds. They used a quick paired-stimulus test and found real reinforcers that plans missed.
White et al. (2021) looked at ten studies and saw no fixed pattern of edibles beating tangibles. Their review shows method choices, not plans, drive what looks preferred.
Bigby et al. (2009) found another gap: only 44% of reflux-drug orders had a clear medical reason. Both papers flag weak documentation in services for people with profound disabilities.
Why it matters
Never trust the plan alone. Run a five-minute observation or paired-choice probe before you build a program. You will avoid using "favorite" items that the client actually avoids, and you will find hidden reinforcers that make teaching faster and happier.
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02At a glance
03Original abstract
Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.
Journal of applied behavior analysis, 1999 · doi:10.1901/jaba.1999.32-467