Efficacy of Videotape Self-Modeling in Treating an ...

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Efficacy of Videotape Self-Modeling in Treating an Electively Mute Child H. Edmund Pigott & Frank P. Gonzales Published online: 07 Jun 2010.

To cite this article: H. Edmund Pigott & Frank P. Gonzales (1987) Efficacy of Videotape Self-Modeling in Treating an Electively Mute Child, Journal of Clinical Child Psychology, 16:2, 106-110, DOI: 10.1207/s15374424jccp1602_1 To link to this article: http://dx.doi.org/10.1207/s15374424jccp1602_1

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Journalof ClinicalChid Psychology 1987,VoI. 16,No. 2,106-110

Copyright 1987by Lawrence Erlbaum Associates, Inc.

Efficacy of Videotape Self-Modeling in Treating an Electively Mute Child H. Edmund Pigott Klingberg Family Centers, Inc.

Frank P. Gonzales

Downloaded by [Henry Pigott] at 11:03 09 August 2015

Fuller Theological Seminary We evaluated the efficacy of videotape self-modeling to treat a black thirdgrade male who had been selectively mute in the school environmentfor 4 years. Two self-modelingvideotapes were made via a staging-and-editingprocess.The first self-modeling videotape showed the child answering direct questionsfrom his teacher. The second self-modeling videotape showed the child volunteering to answer questions asked of the class as a whole. A multiple-baseline design across the two behaviors was used to assess the effectiveness of the interventions. Thefirst selfmodeling videotape produced a clear increase in the child's rate of answering direct questionsfrom his teacher. The second tape produced equivocal results. Elective mutism is a rare communication disorder that normally does not come to the attention of professionals until the child enters school. The predominant feature of the disorder, according to DSM-111(American Psychiatric Association, 1980) is the "continuous refusal to talk in almost all social situations, including at school" (p. 63). Electively mute children, however, "may communicate via gestures, by nodding or shaking the head, or, in some cases, by monosyllabic or short, monotone utterances" (p. 62). Elective mutism has been successfully treated utilizing a variety of behavioral interventions. These have included stimulus fading (Conrad, Delk, & Williams, 1974; Wulbert, Nyman, Snow, & Owen, 1973), contingency management (Williamson, Sewell, Sanders, Haney, & White, 1977), avoidance conditioning (van der Kooy & Webster, 1975), in vivo desensitization (Rasbury, 1974), and shaping procedures (Blake & Moss, 1967). Generally, these procedures sought first to elicit speech, and then to increase the frequency of speech via reinforcement procedures. Though successful, the procedures cited above were generally costly with respect to professional time. Dowrick and Dove (1980) defined self-modeling as "the behavioral change that results from the repeated observation of oneself on videotapes that Requests for reprints should be sent to H. Edmund Pigott, Klingberg Family Centers, Inc., 370 Linwood Street, New Britain, CT 06052.

show only desired target behaviors" (p. 51). The modeling tape is made via a staging-and-editing process. The child then observes the short, edited videotape of himself or herself performing the desired behavior at a level superior to his or her present functioning. This strategy has been utilized successfully to treat a variety of behavioral deficits in children (e.g., Creer & Miklich, 1970; Dowrick, 1979, 1983a, 1983b; Dowrick & Dove, 1980; Dowrick & Raeburn, 1977; Gonzales & Pigott, 1986). Videotape self-modeling is an appealing intervention for discrete behavioral deficits on multiple accounts. First, because the "intervention" takes place on the client's home videocassette recorder, the psychologist's time is spent performing a behavioral assessment of the problem and constructing the 2- to 4-min videotape. Thus, it is economical with respect to professional time. Second, there is greater reliability in the intervention's implementation, as it does not rely on parents or teachers to carry out elaborate behavioral procedures. Third, most children have a positive association with television, and so they like seeing themselves "on TV." Fourth, we know that model similarity enhances the modeling effect (Rosekrans, 1967), and no model could be more similar than the child himself. Finally, and perhaps most important, there is strong theoretical support that self-modeling enhances children's self-image and perception of selfefficacy (for a review, see Dowrick, 1983a). In our case study, we evaluated the efficacy of videotape self-modeling in treating a third-grade

VIDEOTAPE SELF-MODELING

male vvho had been electively mute in the school environment since kindergarten. Self-modeling was se1ecte:d as the treatment strategy after school personnel stated that they did not have the resources to implement a shaping-and-reinforcement intervention, given the needs of the other children in the classroom. The social validity of the intervention was assessed by comparing the treated child's perfol-mance with that of two skilled classmates (Walker & Hops, 1976). Method


Participant Chiuck was i l black 9-year-old male whose parents referred him to an outpatient clinic. Chuck's parents reported that for the past 4 years, they had received notes from his teachers saying that Chuck did not talk in school even when directly addressed. Chuck's parents also reported that he had always been the only lblack child in his classes. Playroom observations in the clinic revealed that the child was completely mute and would not engage in any play behaviors when he was alone in the room with a theralpist. Once, when the therapist repeated a question, the child curled up in a fetal position in the corner of the room. When the therapist provided the child with paper to write on, the child wrote "yes" to "Do you feel sad?" and "Would you like to learn h~owto speak in school?" When his younger brother or parent was in the room, the child would answer questions from the therapist and engage in play behaviors with the therapist. When his family members left the room, the child would no longer engage in any interactive behaviors with the therapist. School personnel reported that: 1. 'The boy',s academic performance was above average. 2. He was extremely shy and socially withdrawn. 3. He generally had a very sad/depressed look ton his face. 4. He would not answer direct questions from his teacher. 5. We woulcl appear to talk very quietly, and infrequently, to one select peer. 6. He would not initiate interactions or volunteer to answer questions. 7. He evidenced severe psychomotor retardation when called on to do a motor task (e-g., Ihe reportedly took approximately 45 min to pass out papers, whereas it would have taken !Gome other student 4 to 6 min).

During a prebaselime observation, Pigott observed Chuck curl up in a fetal po,sitionon the floor when a direct questioin was repealted to him by his teacher. Three of four other children then circled around him pleading with him to give a response. Two of the children even provided him with the correct response. Chuck. never did respoind to the question and only resumed B sitting position after the teacher directed the students' attentio~nto herself. Afterward, the teacher stated that this was a common response from Chqrck whenever she pressured him to respond,, Experimental Design and ~bneradProcedlure A multiple-baseline: design across behaviors was used to evaluate the efficac(y of the self-modeling intervention. Observations were made once or twice a week during i l regularly scheduled 50-min reading group. This time wa? selected because there were only 12 to 15 studends in the class; and the teacher had a high rate of inferactions with her students during this time peri+d. The observer, who trained not to intersat in the back of the elass, act with any of the childre . Thie observer kept a frequency count of the num er of times Chuck was asked a direct question by is teacher, thle number of times he answered her dilect questions within 4 sec in a volume loud enoughfor the teacher to hear, and the number of times he raised his hand following a question that she lhadasked to the class as a whole. When Chuck iraised his hand and answered a question after being called on by his teacher, both volunteering to answer a qu stion and answering a direct question were count d. During the fourth week of the study, the obse ver began monitoring the same behaviors in tw children whom the teacher identified as being particularly skilled in volunteering for, and answering,, questioins.

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Videotape session. Th chidd's mother and brother attended the class along with the authors, who did the videotaping. I Churck's mother and brother always remained within his line of sight but "off camera.'' We staged dumerous hand-raising and question-answering scpnes with Chuck and those classmates whose pardnts h~adsigned releases allowing them to be videota~ed.'To gain a response or increased voice volume, some questions asked by the teacher during the class wetre repeated by his mother after class.

PIGOTT & GONZALES


Postvideotape session. The class was observed 1 week after the videotape session. Self-modeling for answering direct questions. A 3%-min videotape was made of Chuck answering direct questions asked by his teacher. Chuck's answer was then followed by some form of social reinforcement from his teacher. We made the videotape during a 2%-hr editing session (this time could have been brought under 1 hr if we had been more skilled in use of video and if we could have worked with less antiquated and more compatible equipment). We were able to utilize several "complete" classroom interactions; we also "dubbed in" numerous responses from the afterclass session. The videotape was then given to the parents, and they were instructed to have the child observe it prior to school each day for 2 weeks. They were instructed to praise him mildly for the good job he was doing on the videotape. Data collection began on the fourth day of this phase and continued for four observations over a 3-week period. Self-modeling for volunteering to answer questions. In a separate 1%-hr editing session, we made a 3-min videotape of Chuck's volunteering to answer questions. This was edited from the same raw footage. The tape had several scenes of the teacher's presenting a variety of questions to the class, of Chuck's raising his hand along with other students to answer the questions, of the teacher's calling on Chuck, of Chuck's answering the questions, and of Chuck's being socially reinforced by his teacher. The videotape was then given to Chuck's parents with the same instructions as for the previous tape. Data collection began on the fourth day of this phase and continued for four observations over a 2-week period. At the end of this period, we discovered that the videotape had malfunctioned during Chuck's second viewing of it. We then gave the parents a backup tape and repeated the instructions. Three observations were then made over a 3-week period. Self-monitoring reinforcement for volunteering to answer questions. During the last month of school, Chuck recorded his behavior on a 3- x

5-in. card each time he raised his hand during his reading period. At the end of the period, he took the card to his teacher for her to circle the number written down and sign the card. She did not track the number of actual hmd raises, but verified that there was not a gross distortion in the number Chuck had written down. Chuck then took his card home to his parents. For every day that Chuck had 6 or mQre hand raises, he earned a point toward a backup reinforcer of his own choosing (he chose a

family trip to an amusement park). Chuck could not earn more than 1 point per day toward the backup reward. Data collection began on the first day of this phase and continued for five observations over a 3-week period.

Results Interobserver reliability was calculated on two of the class sessions that had been videotaped. There was 100% agreement between the observers for answering direct questions and volunteering to answer questions. Chuck averaged 95% accuracy (range = 88% to 100%) in self-monitoringhis volunteering to answer questions. The lower percentage was due to 2 days when he slightly underestimated his hand-raising behavior. With his mother present during the videotape session, Chuck's rate of answering direct questions (percentage) and volunteering to answer questions (number) increased from a baseline of 0 for both behaviors to 73.3% and 7, respectively. In the postvideotape session, his rate decreased to 16.6% direct questions answered and 1 instance of volunteering. Figure 1 displays Chuck's rate of answering direct questions and volunteering to answer questions across all phases of the study. The selfmodeling videotape for answering direct questions increased Chuck's average percentage of responding from a baseline of 0% to 80% during the 3 weeks following the intervention (range = 75% to 90%). This gain was maintained for the duration of the study (M = 79%, range = 50% to 100%). The self-modeling videotape for volunteering to answer questions produced equivocal results. Chuck's teacher indicated that he had high rates of volunteering in the 2 days prior to the first day of observation. He volunteered 6 times on the first day of observation (2 days after the tape had ceased functioning), 3 times on the second day, but 0 times on the third and fourth days. When the videotape was reintroduced, it seemed completely ineffective in increasing Chuck's volunteering behavior, although it appeared to have increased his rate of answering direct questions to a moderate extent over the previous four observations (from 65% to 80%). The self-monitoring reinforcement for volunteering to answer questions produced a clear and stable increase in Chuck's rate of volunteering during reading. On the first day of the intervention, he volunteered to answer 16 questions. On the subsequent days, he volunteered at a level that generally matched the reinforcement threshold of 6. The two "skilled" classmates answered direct questions an average of 98.5% (range = 88% to

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Figure 1. Rate of answering direct questions and volunteering to answer questions for Chutk anti his skilled peers. 100%1).They volunteered an average of 8.3 times per reading period (range = 5.5 to 12).

Discussion The self-modeling videotape produced a clear increase in Chuck's rate of answering direct questions from his teacher. A comparison of Chuck's performance with that of his two "skilled" peers validates the social significance of Chuck's treatment gains (Walker & Hops, 1976). By the end of the schoc~lyear, his rate approximated that of these two classmates. The child's parents and teacher reported that they were pleased with this outcome. The effectiveness of the self-modeling intervention on volunteering to answer questions is less clear. It appears as though there was an initial, strong response after only 1% viewings of the 3-min tape that completely extinguished by the 10th day. There are several possible reasons for this rapid decline. Perhaps there was not enough initial exposure to the videotape to solidify the new skill. Most clinical studies to date have had 6 to 12 viewings of the self-modeling tape (Dowrick, 1983a). This elxplanation is argued against, however, by the child's failure to respond to the backup tape.

A more likely explmation is that Chuck was on too "thin" a schedule of sopial reinforcement for hand raising in the classrooq conipared to the continuous schedule embedded in ithe self-modeling videotape. In the vi~deotafle,every time Chuck raised his hand, this resulted, in hi~sbeing called on, answering the question accurately, and receiving social reinforcement. 'This did not match what happened in Chuck's cla!;srooq. There, a number of children would raise tlheir hands to volunteer to answer a question, only lone ofwhoim would be called on. In contrast to this condition, Chuck was on a continuous schedule of reinforcement for answering direct questions. Epch time he answered a direct question accurately, it was socially reinforced. The hypothesis that it was the "thinness" of the reinforcement schedule that accounted for the rapid extinction of hand rai$ing is supported by his increased rate under the self-monitoring condition. Under this condition, every time he volunteered, he was reinforced, up to a specified limit (i.e., 6). Chuck soon learned this, and only volunteered enough to ensure that he had earned a point toward his backup reinforcer. It is likely that his rate of volunteering would have been significantly higher


GONZALES

under this condition if every sixth hand raise earned him a point towards his backup (i.e., a fixed ratio schedule of reinforcement). In our study, the self-modeling intervention effectively treated a child who had been electively mute in the school environment for 4 years. The intervention was economical and had an immediate impact on the child's communicative behavior. Furthermore, the intervention was both sensitive to the child's ethnicity (because he was his own model) and did not draw undue attention to him from his classmates (because the "intervention" took place at home). Although other responses were not targeted, anecdotal observations revealed that the child started to interact frequently vvith a variety of classmates, smiled more frequently and evidenced more normal psychomotor speed. In a 6-month telephone follow-up, the child's mother reported that Chuck was making "straight As in school" and had several classmates with whom he frequently talked over the phone, and she reported receiving numerous positive reports from his fourth-grade teacher. Thus, it appears that the self-modeling intervention had a significant and global impact on Chuck's behavior. The extent to which these findings apply to other electively mute children is qualified by the specific characteristics of the child (i.e., a third-grade black male). Although the conclusions derived from this case study may be of limited generalizability, these findings are nevertheless consistent with those of other investigators, documenting the efficacy of self-modeling to treat a variety of behavioral deficits in children (e.g., Creer & Miklich, 1970; Dowrick, 1979, 1983b; Dowrick & Dove, 1980; Dowrick & Raeburn, 1977; Gonzales & Pigott, 1986). Future research is needed with a larger sample of electively mute children. This research should focus on the potential advantages of matching the self-modeling videotape to the likely level and types of naturally occurring reinforcement. This may reduce any discrepancies between the child's expectancy and the actual consequences the child experiences from performing the desired behavior. References

American Psychiatric Association. (1980). Dingnosfie and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

Blake, P., & Moss, T. (1967). The development of socialization skills in an electively mute child. Behaviour Research and Therapy, 5, 349-356. Conrad, R. D., Delk, J. L., & Williams, C. (19741. lJseof stimulus fading procedures in the treatment of situation specific mutism: A case study. Journal of Behavior Therapy and Experimental.Psychic~try,5, 99-100. Creer, T. L., & Miklich, D. R. (1970). The application of a selfmodeling procedure to modify inappropriate behavior: A preliminary report. Behaviour Research and Therapy, 8, 91-92. Dowrick, P. W. (1979). Single dose medication to create a self model film. Child Behavior Therapy, I , 19'3- L98. Dowrick, P. W. (1983a). Self-modeling. In P. W. Dowrick & S. J. Biggs (Eds.), Using vrdeo. New York: Wiley. Dowrick, P. W. (1983b). Video training of alternativesto crossgender identity behaviors in a Cyear-old boy. Child and Family Behavior Therapy, J5,59-65. Dowrick, P. W., &Dove, C. (1980). Theuse of self-modelingto improve the swimming performance of spina bifida children. Journal of Applied Behavior Analysis, 13, 51-56. Dowrick, P. W., & Raeburn, 3. M. (1977). Video editing and medication to produce a therapeutic self model. Journalof Consulting and Clinical .Psychology, 45, 1156-1 158. Gonzales, F. P., & Pigott, H. E. (1986, February). TheefJcacy of video self-modeling to treat a 2% year old preschool child with Down's syndrome. Paper presented ,atthe meeting of the California State Psychological Association, San Francisco. Rasbury, W. C. (1974). Behavioral treatment of selective mutism: A case report. Jour~ralof Behavior Therapy and Experimental Psychiatry, 5, 103-104. Rosekrans, M. A. (1967). Imitation in children as a function of perceived similarity to a social model and vicarious reinforcement. Journal of Personality and SociabF'sychology, 7, 307-315. van der Kooy, D., & Webster, C. D. (1975). A rapidly effective behavior modification plrogram for an electively mute child. Journal of Behavior Therapy and Experimental Psychiatry, 6, 149-152. Walker, H. M., & Hops, H. (1976). Use of normative peer data as a standard for evaluating classroom treatment effects. Journal of Applied Behavior Analysis, 9, 159-168. Williamson, D. A., Sewell, Mr. IR., Sanders, S. H., Haney, J. N., & White, D. (1977). The treatment of reluctant speech using contingency management procedures. Journalof Behavior Therapy and Experimental Psychiatry, 8, 151-1 56. Wulbert, M., Nyman, B. A., Snow, D., &Owen, Y. (1973). The efficacy of stimulus fading and contingency management in the treatment of elective mutism: A case study. Journal of Applied Behavior Analysis, 6, 435-441.

Received January 31, 1986 Revision received April 17, ,1986