Current limits to reinforcer identification for some persons with profound multiple disabilities.

The team watched adults with profound multiple disabilities during simple preference tests. They noted who reached for items and who did not move at all.

Next they used the chosen items as reinforcers in a small task. They wanted to see if high-preference items actually increased work.

Only people who approached items on at least eight out of ten trials later worked for those items. Many high-preference items had no effect.

Some clients barely moved during tests. These non-responders rarely showed any reinforcement later, even when staff were sure they "liked" the item.

Geckeler et al. (2000) looked hopeful: their MSWO test picked true reinforcers for six of nine similar clients. The gap shows brief assessments can work, but failures still happen.

Matson et al. (1999) built a new rating scale right after this study, trying to fix the very problem T et al. exposed. The scale was meant to catch people who cannot reach.

Robertson et al. (2013) went further, giving non-moving clients micro-switches that detected smiles or tongue flicks. Choice responses appeared, proving the issue was access, not preference.

If a learner barely approaches items, do not assume the top pick will work. Watch for long latencies or still hands. Offer micro-switches, partner-assisted reaches, or caregiver ratings. Have backup reinforcers ready before you start treatment.