Choice and Preferred Activities Research

Summary of Choice and Preferred Activities Research

The purpose of this literature review was to determine the effectiveness of choice and preferred activities as an intervention for students with emotional and behavioral disorders (EBD). Areas of effectiveness that were evaluated included: (a) age/grade, (b) diagnosis, in addition to EBD, (c) racial/cultural background, (d) setting (3) targeted behavior, (f) duration of evaluation, (g) procedural integrity, (h) consumer satisfaction, (i) link to assessment information. Below is a description of the findings.

Six choice and preferred activity studies were identified, with a total of 18 students. The students ranged in age from 5 years old to 14 years old and attended elementary through high school. The majority (59%) of students fell in the late elementary to middle school age range (i.e., 9 yrs old to 13 yrs old). In addition to EBD, some students also had diagnoses of Attention Deficit Hyper Activity Disorder, Bipolar disorder, Conduct Disorder, Depressive Disorder, Intermittent Explosive Disorder, Mild MR, Mood Disorder, Oppositional Personality Disorder, Post Traumatic Stress Disorder, Schizophrenia, Specific Developmental Disorder, and Adjustment Disorder of Childhood with mixed Disturbance of Emotion and Conduct.

The majority of the studies (83%) did not give racial/cultural background information; however one study identified 2 students as African-American. The research took place across four settings. The majority of the studies were conducted in either segregated day schools (33%) or self-contained classrooms within public elementary schools (33%). Seventeen percent of the studies were conducted in a residential school while the remaining 17 % were conducted in a partial hospitalization setting with a school component.
The target behavior most often identified was task engagement (67% of studies). Of these studies, two (50%) targeted task engagement in isolation while one targeted destructive behavior and one targeted off task behavior, disruption, number of attempted problems, and number of correct problems, in addition to engagement. Of the studies that did not target task engagement (33%), one targeted both task completion and accuracy, and one targeted disruption.

The duration of time across which choice and preferred activities were assessed ranged from 14 days to 50 days. Procedural integrity was assessed in 33% of the studies. These studies, which assessed procedural integrity, did so 100% of the time. Any sessions where treatment was not delivered as prescribed were not used in the studies. Consumer satisfaction was ascertained in 33% of the studies by use of the Treatment Acceptability Rating Form-Revised (TARF-R). Results of the TARF-R indicate overall satisfaction with the intervention. Despite one teacher mentioning the amount of time involved in implementing the intervention, in 100% of the studies assessing treatment acceptability the teachers stated a willingness to use the intervention again. None of the studies completed functional assessments to determine cause of behavior.

Effectiveness was assessed using effect size, percentage of non-overlapping data points and level of change. The majority (69%) of the effect sizes in the studies reviewed indicated overall improvement in the target behaviors. For a small percentage, however, choice was not effective as an intervention. In fact, for one participant, negative effect sizes were observed for four target behaviors indicating that behavior was not affected by the intervention as hypothesized. For task engagement the effect sizes ranged from -.28 to 4.41, with a mean of 1.82. Task accuracy and completion effect sizes ranged from 2.83 to 4.84 with a mean of 4.09. Off-task behavior effect sizes ranged from -1.07 to 4.11 with a mean of 1.60. Disruption effect sizes were variable, indicating small to large effects (.09 to 3.48) and had a mean of 1.16. The effect sizes for number of problems attempted ranged from medium to large (-7.17 to 17.80) with a mean of 3.71. The effect sizes for number of problems correct ranged from -3.24 to 11.97 with a mean of 3.26. For the one study looking at destructive behavior the effect size was .81, which indicates a large effect. The percentage of non-overlapping data points ranged from 0% to 100% with a mean of 69.63%. Change in level for each target behavior was large. Change in level for task engagement ranged from 3.59 to 357.23 with a mean of 95.77. For task accuracy and completion change in level ranged from 148 to 300 with a mean of 199.53. Off-task behavior change in level ranged from 37.31 to 69.58 with a mean of 53.96. The change in level for disruption ranged from 14.29 to 96.11 with a mean of 68.02. Number of problems correct change in level ranged from 51.65 to 84.38 with a mean of 67.93. Number of problems attempted change in level ranged from 17.23 to 68.46 with a mean of 50.71. For the one study looking at destructive behavior the change in level was 89.06.

In summary, the data indicate that overall, choice and preferred activities is an effective intervention with E/BD students 5 to 14 years old, from kindergarten to ninth grade, and having a variety of comorbid conditions. The one negative effect size for task engagement was caused by the participant’s increasing trend of task engagement beginning at the start of the choice intervention. The negative effect size in off task behavior was caused by a high mean in the first intervention condition; however, the second, and final, intervention condition resulted in the lowest mean of the study. There are some gaps in the research reviewed. None of the interventions were linked to a functional assessment; only 17% of the studies gathered data regarding ethnicity, and all the research was conducted in non-regular educational settings. Research that would increase the knowledge base of educating students with EBD regarding areas of ethnicity, functional assessment and interventions within regular education classrooms is needed.