Acquisition and generalization of manual signs by hearing-impaired adults with mental retardation

Behavioral procedures have been used to teach manual communication skills to individuals with mental retardation, although few studies have examined the assessment of generalization of such skills beyond the teaching environment. In this study, we investigated the effectiveness of directed rehearsal for teaching and facilitating the generalization of manual signs by six hearing-impaired adults with mental retardation. The effects of directed rehearsal, alone and combined with positive reinforcement for correct responses, were compared to a no-training control condition in an alternating treatments design. Although directed rehearsal was superior to the no-training control condition in teaching manual signs, the procedure was more effective when combined with positive reinforcement. The combined procedure was used to facilitate the generalization of learned signs across a number of variables. The results showed that there were high levels of generalization by all participants across novel phrases, settings, and trainers but variable levels of generalization to another response mode by some subjects. Further, increased levels in overall vocal communication were found for most participants.     

RELAXATION EXERCISE WITH CEREBRAL PALSIED ADULTS SHOWING SPASTICITY

A method for improving the muscle incoordination associated with cerebral palsy was empirically tested. Relaxation exercises, involving the successive tensing and relaxing of the major muscle groups of the body, were performed by four adults with spastic quadraplegia. All four subjects were sheltered workshop employees. Their IQs ranged from normal to mentally deficient. Testing consisted of two timed-trials of both the Placing Test and the Turning Test from the Minnesota Rate of Manipulation Tests. These tests measured the amount of time required to complete various manual manipulations involving pegs and pegboard. A multiple baseline across subjects design was employed to provide experimental control. All subjects showed significant improvement over baseline performance on the tests following the relaxation training. Limitations of this preliminary investigation and implications of these results for future research were noted.     

Including Manual Signing as Nontargeted Information When Using a Constant Time Delay Procedure to Teach Receptive Identification of Packaged Food Items

This investigation extends the constant time delay research base by embedding nontargeted information in the task direction when teaching communication skills. Specifically, instructors taught receptive identification of packaged food items to 4 secondary students with moderate to severe disabilities and evaluated generalization to the community. In addition, instructors included the manual sign for each food item. The instructional strategy was a constant time delay procedure using a 5-s delay interval. The intervention, conducted within a multiple probe design across behaviors replicated across students, resulted in the acquisition and generalization of receptive identification of packaged food items by 3 out of 4 of the students. In addition, the students acquired the nontargeted manual signs with an average of 60% percent in the final probe session.     

Attachment-based family therapy for depressed adolescents: programmatic treatment development

Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. ABFT is a promising new treatment for depressed adolescents and more research on it is warranted.     

Developing a cognitive behavioral therapy manual for delayed sleep–wake phase disorder

This article reports the development of a treatment protocol, based on cognitive behavioral therapy (CBT) principles, for delayed sleep–wake phase disorder (DSWPD). The protocol consists of psycho-education, presenting a CBT model for DSWPD, case formulation, motivational interviewing, registering sleep in a diary, strategies to improve the rhythm of sleep and wakefulness, relaxation training, cognitive restructuring, strategies to cope with daytime symptoms, constructing an individualized CBT program, and learning how to deal with relapses. Qualitative data, focusing on how the patients perceived the protocol, were collected within the realm of a trial exploring the efficacy of the protocol. These findings highlighted several advantages but also disadvantages of the therapy. It is our hope that this paper might act as a platform for further clinical work and future research efforts in patients with DSWPD.     

PRIVATE THEORIES AND PSYCHOTHERAPEUTIC TECHNIQUE

That if real success is to attend the effort to bring a man to a definite position, one must first of all take pains to find him where he is and begin there. This is the secret of the art of helping others (Kierkegaard [] 1962, p.?27)

The aim of this study is to explore the importance, to the therapeutic process, of the relation between the patient's and the therapist's problem formulations and private theories of pathogenesis and cure. Four cases of young adults in psychoanalytic psychotherapy were compared, two with unequivocally positive and two with more ambiguous outcome at termination. The patients and therapists were interviewed about their private theories initially and at termination of therapy, and a qualitative comparison was made between the cases. In the two more successful cases the therapists had early in therapy perceived obstacles for the therapeutic work in the patients' ways of thinking, feeling, and relating, and made interpretative interventions focusing on these. This was not observed in the less successful cases. In the more successful cases the patient's and the therapist's private theories were more similar at termination than initially, whereas the opposite development was found in the less successful cases. One hypotheses generated is that the therapeutic process can be facilitated by a therapist listening to the patient's private theories, making interpretative interventions focusing on obstacles to the therapeutic work, including contradictions between their private theories, and monitoring the patient's reactions to these interventions.