Three intensive community-based programs for children and youth with serious emotional disturbance and their families

Systems of care for children with serious emotional disturbance and their families have generally lacked intensive community-based programs. We describe three types of newly established community-based programs in New York State and present a general evaluation plan for determining which programs work for various children and their families. The three community-based programs are Intensive Case Management, Family-Based Treatment, and Family-Centered Intensive Case Management. Process and outcome evaluations are being conducted for each of these programs. These evaluations make use of common intake and termination instruments, based on a minimum data set, standardized assessment instruments, and a common logic model, thus facilitating the comparison of findings across evaluations.     

Sex stereotypes in Norway revisited: 1977–87

In 1977 sex-trait stereotypes in Norway were measured at the young adult level and at the level of five-year-olds. At the young adult level the Adjective Check List was used, and the results were analysed according to an affective meaning scoring system, and a scoring system based on Transactional Analysis. The instrument used for children was a picture-story technique (Sex Stereotype Measure II). Persistence and change in sex-trait stereotypes were examined by replicating the study in 1987. Quantitatively, young adults' sex-trait stereotypes seemed to have changed little during the last decade, but qualitative analyses indicated that stereotypes have changed in the direction of greater favourability, activity and strength towards women and in the reverse direction towards men. The children in the 1987 sample expressed less stereotype knowledge than children in the 1977 sample concerning traits which traditionally have been ascribed to men.     

ACQUISITION,GENERALIZATION, AND MAINTENANCE OF QUESTION-ANSWERING SKILLS IN AUTISTIC CHILDREN

We conducted an investigation to evaluate the effects of a training strategy for teaching autistic students generalized responses to three forms of wh— questions (what, how, and why). Students were taught, using modeling and reinforcement procedures, to answer questions with magazine pictures as the referents. Each question form was divided into two or more subcomponents reflective of common social usage and was taught within the context of a modified multiple probe design across subcomponents. Following acquisition of each subcomponent, generalization to natural context and storybook questions was assessed; additional probes were conducted to assess responding over time and whether acquisition of responses to questions promoted question-asking skills. Results showed that the picture training procedure was effective in teaching a generalized response to questions for which the relevant cue was visible, whereas specific generalization programming was required for situations in which the relevant cue was not visible. All acquired responses were durable over time.     

Children's choice: Sensitivity to changes in reinforcer density

Two experiments were carried out in which children's sensitivity to changes in reinforcer density (number of reinforcers per session) was measured in a choice paradigm. In Experiment 1, 24 girls (ages 6, 9, and 12 years) performed on concurrent-chain schedules of reinforcement. The initial links were variable-interval 10-s schedules. One terminal link always gave three tokens after 30 s, but the parameters associated with the other were varied. Independent manipulations of reinforcer size (two tokens or four tokens) and prereinforcement delay (25 s or 65 s) led to equal changes in the relative density of tokens that could be earned on the schedules. Subjects at all ages were sensitive to changes in reinforcer density brought about by changes in reinforcer size, whereas only 3 12-year-olds showed sensitivity to the changes brought about by manipulation of prereinforcer delay. In Experiment 2, titration procedures were used to test the extent of this insensitivity to delay in 32 6- and 12-year-old children. In these procedures, a repeated choice of the large reinforcer increased the delay to its delivery, and a repeated choice of the small reinforcer reduced the delay to the delivery of the large reinforcer. Whereas 6-year-old boys and girls tended to maintain a strong preference for the large reinforcer, so increasing the delay to its delivery, 12-year-olds tended to distribute their responses to both alternatives, thus producing a stable level of delay to the large reinforcer. The results from the two experiments support the idea of two stages in the development of adaptive intertemporal choice.     

DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

EFFECTS OF WAIT-TIME AND INTERTRIAL INTERVAL DURATIONS ON LEARNING BY CHILDREN WITH MULTIPLE HANDICAPS

We investigated the influence of teacher wait-time and intertrial interval durations on the performance of 4 multiply handicapped students during instruction in 10 skills. Four experimental conditions were evaluated: long wait-time and long intertrial interval, long wait-time and short intertrial interval, short wait-time and long intertrial interval, and short wait-time and short intertrial interval. Instructors attempted to keep short intervals as close as possible to 1 s and long intervals as close as possible to 10 s for both variables. Results showed that student performance was superior under the long wait-time conditions irrespective of the length of the intertrial interval.     

THE RELATIVE MOTIVATIONAL PROPERTIES OF SENSORY AND EDIBLE REINFORCERS IN TEACHING AUTISTIC CHILDREN

We compared the effects of sensory and edible reinforcers on resistance to satiation in three autistic children while learning visual discrimination tasks. Within-subject designs were used to compare a single sensory reinforcer with a single edible reinforcer and to compare multiple sensory reinforcers with multiple edibles. Results indicated that multiple sensory reinforcers maintained responding over more trials than did multiple edible reinforcers; however, the use of single sensory reinforcers and single edibles resulted in about equal numbers of trials to satiation. Both multiple and single sensory reinforcers produced higher percentages of correct responses than edible reinforcers. The findings are discussed in terms of the advantages of sensory reinforcers in teaching autistic children.     

USE OF ESCAPE AND REWARD IN THE MANAGEMENT OF YOUNG CHILDREN DURING DENTAL TREATMENT

A reinforced practice procedure was used to facilitate cooperative behavior in five children, aged 3 to 6 years, during dental treatment. In a multiple baseline design across subjects, the children were rewarded with escape, inexpensive stickers, and praise for cooperative behavior in the presence of the sights, sounds, and some sensations of the dental instruments prior to actual dental treatment. Direct observations of disruptive behavior via a 15-s interval recording system indicated baseline levels as high as 90% were reduced to less than 15% by the final treatment visit. In addition, the procedure was effective in reducing overall heart rate and blood pressure reactivity to dental treatment. All children were rated by the involved dental professionals as more cooperative and relaxed following exposure to reinforced practice.     

SOCIAL INFLUENCES ON “SELF-STIMULATORY” BEHAVIOR: ANALYSIS AND TREATMENT APPLICATION

We tested the hypothesis that the “self-stimulatory” behaviors exhibited by some individuals may be socially mediated. Four developmentally disabled children who exhibited hand flapping and body rocking participated in a series of three experiments conducted to assess the influence of social variables on stereotyped behavior and to develop a treatment based on the assessment. Experiment 1 used an assessment procedure to determine the relative influences of social attention and task demands on stereotyped behavior. For all four children, hand flapping and body rocking increased when difficult academic tasks were introduced. Experiment 2 involved the use of a procedural time-out and demonstrated that removing task demands contingent on stereotyped behavior resulted in increased rates of hand flapping and body rocking. In Experiment 3, these results were used to develop a communication treatment that consisted of teaching the children to request assistance on the difficult tasks. This treatment resulted in significant reductions in self-stimulatory behavior. These results are consistent with the hypothesis that some forms of repetitive stereotyped behavior may come to serve social functions (e.g., escape from aversive situations). Teaching a functionally equivalent communicative alternative to escape-motivated stereotyped behavior can be an effective form of intervention for this problem.     

MAINTAINING PERFORMANCE OF AUTISTIC CLIENTS IN COMMUNITY SETTINGS WITH DELAYED CONTINGENCIES

To facilitate the classroom and workshop integration of three autistic clients, we examined the feasibility of teaching them to respond appropriately without the continual presence of specially trained treatment providers. Within a multiple baseline design, a 4-step treatment process was implemented to promote durable responsive performance. Results indicated that the therapist could be removed from the treatment environment and that appropriate behavior could be successfully maintained in community settings with only infrequent and delayed contingencies.