Western Michigan University ScholarWorks at WMU Dissertations Graduate College 1-2011 Evaluation of Verbal Behavior in Older Adults Amy Gross Western Michigan University Follow this and additional works at: https://scholarworks.wmich.edu/dissertations Part of the Communication Sciences and Disorders Commons, Geriatrics Commons, and the Gerontology Commons Recommended Citation Gross, Amy, "Evaluation of Verbal Behavior in Older Adults" (2011). Dissertations. 412. https://scholarworks.wmich.edu/dissertations/412 This Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact [email protected]. EVALUATION OF VERBAL BEHAVIOR IN OLDER ADULTS by Amy Gross A Dissertation Submitted to the Faculty of The Graduate College in partial fulfillment of the requirements for the Degree of Doctor of Philosophy Psychology, Behavior Analysis Advisor: R. Wayne Fuqua, Ph.D. Western Michigan University Kalamazoo, Michigan June 2010 EVALUATION OF VERBAL BEHAVIOR IN OLDER ADULTS Amy Gross, Ph.D. Western Michigan University, 2010 Older adults make up a large and increasing portion of the population (U.S. Census Bureau, 2008). Approximately 5% of older adults have a dementia diagnosis, and language deterioration is a common symptom associated with this disorder (Kempler, 2005). In order to assess and treat language deficits in older adults, accurate and sensitive measures of verbal skills are needed. Language has traditionally been considered an existing entity that resides inside individuals, but the entity of language is unobservable and difficult to study or manipulate. Skinner (1957/1992) proposed that language was simply operant behavior. He classified a number of verbal operants based on their function, describing the antecedents and consequences that control various forms of verbal behavior. A conceptualization based on the function of verbal behavior allows for altering the occurrence of verbal responses by manipulating the controlling conditions. To the author's knowledge, there are no empirical studies evaluating verbal behavior in older adults using Skinner's analysis of functionally independent verbal operants. The purpose of this study was to develop assessments using Skinner's functional verbal operants and apply those assessments to the evaluation of verbal behavior in older adults with and without dementia. The research addressed two questions. First, in what way do verbal behavior problems differ between older adults with and without dementia? Second, does language deteriorate in a pattern compatible with Skinner's analysis of functionally independent verbal operants? Thirty-one participants were categorized into Control (n=15) and Dementia (n=16) Groups based on their score on the Dementia Rating Scale-2. Verbal behavior assessments were administered to participants on two occasions, separated by one week. Results revealed individuals with dementia performed significantly more poorly on the Tact Assessment than those without dementia; however, no significant differences were found on the other assessments. These findings suggest tacts are sensitive to language decline associated with dementia. Results also indicated participants from both groups performed better on measures of tacts than on measures of intraverbals or mands, even though topographically identical verbal responses were required across these assessments. Differential performance across these assessments provides support for Skinner's conceptualization of functionally independent verbal operants. UMI Number: 3470404 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMT Dissertation Publishing UMI 3470404 Copyright 2010 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Copyright by Amy Gross 2010 ACKNOWLEDGMENTS I would first like to thank my advisor, Dr. Wayne Fuqua, for his guidance and support through this and many other projects during my graduate career. I also want to express gratitude for the time and assistance provided by my committee members: Dr. Cynthia Pietras, Dr. Amy Naugle, and Dr. Raymond Miltenberger. Many thanks to my research assistants: Todd Merritt, Lauren Flannery, and Erica Kasemodel. Their dedication and hours of work made this project a success. Thank you to Dr. Alan Lewandowski for his generosity with both time and clinical resources. I would also like to thank my family and friends for making me who I am today. Thank you to my parents, Roger and Cathy Mackner, for always believing in me and for providing unending guidance and support. Finally, I would like to express my gratitude to my husband, Samuel Gross, for showing tremendous patience and continuously encouraging me to pursue my goals and dreams. Amy Gross u TABLE OF CONTENTS ACKNOWLEDGMENTS ii LIST OF TABLES vi LIST OF FIGURES vii INTRODUCTION 1 Language in Older Adults 2 Conceptual Models of Language Decline 3 Neurological 3 Cognitive 4 Linguistic 5 Behavior Analysis 6 Assessment of Language Deficits in Older Adults 11 Purpose 13 METHOD 14 Participants and Setting 14 Measures 14 Demographic Questionnaire 14 Dementia Rating Scale-2 (DRS-2) 15 Boston Naming Test (BNT) 15 Verbal Behavior Assessment Battery (VBAB) 16 Selection Assessment 16 Echoic Assessment 16 iii Table of Contents—continued Tact Assessment 17 Intraverbal Assessment 17 Mand Assessment 18 3D Mand Assessment 18 Procedure 21 Session One 21 Session Two 21 Target Behaviors, Data Collection, and Data Analysis 21 Interobserver Agreement 22 Procedural Integrity 23 RESULTS 26 Between Groups Differences 29 Within Subject Differences and Non-Statistical Error Analysis 30 Regression Analyses 35 Test-Retest Reliability 37 Correlations with Short-Form BNT 38 DISCUSSION 39 Group Differences 40 Functional Independence 45 Limitations 49 Future Research 51 Conclusion 53 IV Table of Contents—continued REFERENCES 55 APPENDICES A. Demographic Questionnaire 59 B. Selection Assessment Form 61 C. Echoic Assessment Form 63 D. Tact Assessment Form 65 E. Intraverbal Assessment Form 67 F. Mand Assessment Form 70 G. 3D Mand Assessment Form 72 H. Verbal Behavior Assessment Raw Scores During Session One and Session Two 73 I. HSIRB Approval Letter 74 v LIST OF TABLES 1. Summary of Test Instructions 20 2. Interobserver Agreement Data 24 3. Procedural Integrity Data 25 4. Participants' Level of Impairment 26 5. Assessment Score Means, Standard Deviations, and Ranges 28 6. Number of Participants with Consistent Errors Across Tact, Intraverbal, and Mand Assessments 33 7. Number of Participants with Inconsistent Errors Across Tact, Intraverbal, and Mand Assessments 34 8. Regression Analysis Summary for Total Score 36 9. Regression Analysis Summary for Intraverbal 36 10. Regression Analysis Summary for Mand 37 VI LIST OF FIGURES 1. Verbal Behavior Assessment Mean Correct 28 2. Between Groups Mean Rank Differences 30 3. Within-Subjects Mean Rank Differences 31 vn 1 INTRODUCTION Based on results from the 2000 census, adults 65 years old and older made up 12.4% of the population (U.S. Census Bureau, 2001). Projections indicate that this age group will grow in the coming years, reaching 17.8% of the population in 2025 and 20.1% in 2050. Baby Boomers will begin entering older adulthood in 2011 and will continue to enter this age category until 2029, contributing greatly to the increase (U.S. Census Bureau, 2008). With growing numbers of older adults, the number of individuals with age-related disabilities also increases. In 2000,43% of women and 40.4% of men who were 65 years of age and older indicated some type of disability, as compared to 17.6% and 19.6% of the 16-64 year old women and men, respectively. Of the disability types, 10.8% of the older adults endorsed a mental disability, defined as difficulty with learning, remembering, or concentrating, whereas only 3.8% of working adults indicated a mental disability (U.S. Census Bureau, 2003). Approximately 5% of adults over 65 years old suffer from some form of dementia (Kempler, 2005). Dementia is a condition characterized by memory loss and at least one other area of cognitive dysfunction including aphasia, apraxia, agnosia, or disturbed executive functioning. (American Psychiatric Association [DSM-IV-TR], 2000). There are several subtypes of dementia (e.g., Dementia of the Alzheimer's Type, Vascular Dementia), each defined by specific courses or neurological findings. Estimates indicate that the number of adults with dementia diagnoses worldwide will grow from 25 million in 2000 to 63 million in 2030 (Kempler, 2005). With the increasing numbers of older adults diagnosed with dementia, developing appropriate assessment and treatment methods is of critical importance. 2 Language in Older Adults Aphasia, one of the cognitive dysfunctions included in the dementia diagnosis, is a "deterioration of language function (DSM-IV-TR, 2000, p. 148)." Aphasia often occurs after a specific, focal brain injury. However, the term aphasia also describes language difficulties that