Stokesetal.2004
The article reports an applied behavior‑analytic study evaluating a multi‑component training package—an empirically derived 10‑step task analysis, correspondence training (say‑do‑report), and general case instruction—to teach three adult men with developmental disabilities appropriate personal hygiene after bowel movements. Baseline data showed poor hygiene (high scores on a three‑point Likert cleanliness scale and low independence on the task steps). Training involved daily sessions aligned with each participant’s routine, using total‑task presentation, prompting, and embedding correspondence training at the critical seventh step (clean vs. soiled wipe decision). Participants reached criterion (100% independent task performance and a cleanliness rating of 1) after 22–36 sessions. General case instruction exposed participants to four varied bathroom configurations to promote stimulus‑generalization; all three generalized successfully, with only one minor error. Follow‑up probes at one and nine months demonstrated perfect maintenance. The authors evaluated the skill against the five criteria for a behavioral cusp, concluding that the intervention provided access to new reinforcers (employment, social inclusion), was generative, competed with inappropriate behavior, benefitted others, and had high social validity. Qualitative outcomes included medical healing (ulcer resolution), vocational placement, and improved family/social interactions. The discussion highlights the scarcity of hygiene research, the importance of integrating multiple procedures, and the need for component analyses to isolate active ingredients.
Topics
Rationale for Targeting Personal Hygiene as a Behavioral Cusp
Explains why teaching post‑bowel hygiene is a high‑impact skill, linking health, social, and vocational outcomes, and frames it within the behavioral cusp model.
Design of the 10‑Step Empirical Task Analysis
Details the systematic development of a step‑by‑step chain for bowel hygiene, including the specific actions (e.g., reach for paper, wipe front‑to‑back, flush) and the use of binary prompting to record independence.
Integration of Correspondence Training at the Critical Discrimination Step
Describes the say‑do‑report procedure embedded in step 7, where participants evaluate wipe cleanliness, decide to repeat or continue, and verbally report the outcome, fostering verbal control over non‑verbal behavior.
General Case Instruction to Promote Stimulus Generalization
Outlines the four varied bathroom configurations (paper roll placement, dispenser cover, glued paper, rotating roll) used to teach participants to apply the hygiene chain across contexts.
Acquisition, Generalization, and Maintenance Outcomes
Presents quantitative results: sessions to criterion (22‑36), independence percentages (>90%), cleanliness ratings (mean ≈1), perfect performance on generalization probes, and 100% maintenance at 1‑ and 9‑month follow‑ups.
Behavioral Cusp Evaluation Using Bosch & Fuqua Criteria
Maps the observed changes onto the five cusp criteria—new reinforcers, generativeness, competition with maladaptive behavior, benefit to others, and social validity—illustrating the broader impact of the skill.
Clinical and Social Implications of Improved Hygiene
Narrates qualitative case anecdotes: healing of a lineal ulcer, vocational hiring, restored family visits, and reduced public discomfort, highlighting real‑world relevance.
Methodological Reflections and Future Directions
Discusses the limitation of using a treatment package without component analysis, suggests future dismantling studies, and notes the scarcity of hygiene research in behavior analysis.