Assessing alertness and engagement of children with severe intellectual and multiple disabilities

Children with profound intellectual and multiple disabilities often appear to be passive and unresponsive to environmental stimulation. A major priority for such children is to increase the amount of time that they are alert and actively engaged. This research study examined the extent to which five children with profound/multiple impairments aged 9 – 13 years were reported by carers to indicate engagement and the extent to which these reported indices of responsiveness varied in relation to differing levels of environmental stimulation. Each child was directly observed across three different environmental conditions that varied in terms of the amount and type of stimulation provided. Carers rated the child’s level of engagement/responsiveness under each condition from videotapes using the Pittsburgh Participation Scale. Findings suggested that the carers identified a number of potential indices of engagement/responsiveness that did seem to vary reliably and consistently in relation to the amount and type of environmental stimulation being provided. These results suggest that children who appear largely passive and unresponsive might show subtle signs of engagement/responsiveness in response to higher levels of environmental stimulation. The presence of these indicators might signal times when the child is actively engaged and more likely to be responsive to instruction.