Educational advocacy for children with autism

There exists a great divide between parents' demands for intensive behavioral interventions for their children with autism and the public education system's reluctance to support early intensive behavioral intervention programs. More and more, professionals with expertise in applied behavior analysis are being asked to advocate for effective, early behavioral intervention for autism in education litigation brought about by frustrated parents. The progress made in recent years in the behavioral treatment of children with autism and the schools' lack of adherence to the requirements of IDEA have made it possible for educational policy change through effective advocacy by behavioral interventionists. This paper discusses preparing for educational advocacy on behalf of young children with autism. We explore the personal and emotional reasons why parents choose to engage in the financially risky endeavor of educational litigation. We then outline an approach to developing expert testimony based upon evaluation of the target child and his/her educational history. Issues related to assessment, training, and ethical practice are addressed. Copyright © 2002 John Wiley & Sons, Ltd.     

Effects of two levels of treatment intensity on a young child with severe disabilities

This single-case study evaluated the effects of two levels of center-based behavioral intervention for a young child with diagnoses of autism, severe attention deficit hyperactivity disorder, bipolar disorder, and severe developmental delay. The child entered an applied behavior analysis school and residential program at age 4 years. At that time he was receiving fluoxetine and valproic acid for control of challenging behavior. Six other medication trials had been attempted previously. Assessments completed just before the child entered the behavioral program estimated his overall functioning at the 8–16 month level. Throughout the study, the child participated in comprehensive behavioral programming for about 30 hours per week. For the first (A) phase of the study, the teacher:student ratio was 1:1. This phase lasted 12 months. At that point resource limitations necessitated changing the teacher:student ratio to 1:2 (the B Phase), which continued for 9 months. Then 1:1 intervention was reinstated. Dependent variables included out-of-seat behavior, aberrant behavior, motor imitation, stereotypic responses, matching to sample, and appropriate communication (recognizable signs and pictures used as mands). By the end of the first A phase (1:1 intervention), substantial improvements were documented in five of six dependent variables, and fluoxetine was discontinued. These improvements were maintained for all dependent variables three months into the B phase, but after an additional six months of 1:2 intervention gains were maintained on only one dependent variable. Nine months after a return to 1:1 intervention, improvements over B-phase levels were evident for five dependent variables, four of which returned to levels comparable to those at the end of the first 1:1 phase. © 1998 John Wiley & Sons, Ltd.     

Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial

Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20–55 years completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n = 19) or a time equated supportive psychotherapy (n = 25). At baseline, posttreatment, and 3-month follow-up, all participants received the Overt Aggression Scale–Modified, which was conducted by an interviewer who was blind to the participant’s study condition. During these visits, participants also completed self-report measures of relational aggression (Self-Report of Relational Aggression and Social Behavior), anger (State-Trait Anger Expression Inventory-2), cognitive biases (e.g., Social Information Processing Questionnaire Attribution and Emotional Response Questionnaire), and associated symptoms (e.g., Beck Depression Inventory). Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multicomponent cognitive behavioral intervention in treating aggression in IED.     

Differential rates of skill acquisition and outcomes of early intensive behavioral intervention for autism

Intensive behavioral intervention for very young children with autism has received increased attention in recent years. Researchers have documented unprecedented success in educating some young children with autism, although not every child makes dramatic developmental gains. It might be useful to identify early in treatment those children who will benefit most from the current methodology and who might require slight variations in instructional format or curricular focus. The present study suggests that initial learning rates are moderately correlated with treatment outcomes after two years. Among 20 children receiving early, intensive behavioral intervention, initial acquisition of skills was correlated with later learning rates, severity of autism symptomatology and adaptive behavior profiles two years into treatment. Implications are discussed, especially in light of the universal need for intensive intervention in this population. Copyright © 1999 John Wiley & Sons, Ltd.     

Choice as an Intervention to Improve Behavior: A Review of the Literature

In recent years, choice making has been evaluated as an intervention for people with disabilities. This review examines applied research during the past two decades using choice as a distinct intervention or as part of an intervention package. Fourteen studies published between 1975 and 1996 were identified that implemented choice as an intervention to increase or decrease a target behavior. These studies applied choice-making in the following three broad areas: (a) vocational or domestic activities; (b) academic activities; and (c) leisure, recreational, or social activities. All of the studies indicated that choice-making procedures resulted in behavioral improvements with some, if not all of the participants.     

Threatening communication: A qualitative study of fear appeal effectiveness beliefs among intervention developers,policymakers, politicians,scientists, and advertising professionals

Threatening communication is a widely applied method in behavior change interventions, which at the same time has been heavily criticized in the psychological literature. The current paper describes a study of the reasons for this persistent wide application of threatening communication. We conducted qualitative interviews with 33 key actors in behavior change intervention development in The Netherlands. Specifically, we interviewed intervention developers, policymakers, politicians, scientists, and advertising professionals. The interviews were transcribed and subsequently coded using NVivo. We found that participants most closely involved with the actual intervention development were generally convinced that threatening information was to be prevented, but often did not understand the exact processes involved. They were often under the impression that rather than a potent efficacy enhancing element, a behavioral suggestion would suffice to prevent threatening communication from backfiring. As participants were further removed from the actual intervention development, they generally tended to be more in favor of threatening communication. The main reasons for use of threatening information were to attract attention or prompt self‐reflection through confrontation, because target population members were assumed to like threatening information and respond rationally to increased risk perceptions by changing their behavior, or simply because no alternatives were available. In addition, intervention developers frequently had to deal with supervisors or funders who preferred threatening communication. Thus, when communicating with practitioners, it seems fruitful to provide them with a toolbox of evidence‐based behavior change methods that promote adaptive, rather than maladaptive, behavior; to promote basing interventions on the most relevant behavioral determinants as identified by determinant analyses; and to equip intervention developers with the tools to persuade other key stakeholders that fear is a bad counselor.     

Employing the Principles of Positive Behavior Support to Enhance Family Education and Intervention

Positive behavior support (PBS) is an evidence-based approach for supporting adaptive behavior and addressing behavioral challenges. It is critical that families have access to effective evidence-based behavior support practices for both intervention and prevention because they lead to better outcomes for families, and counter-productive family management practices have been shown to further escalate children’s behavioral challenges. PBS has been demonstrated to be effective with individual children with serious behavior challenges in family homes and features of PBS are evident in common family-based intervention approaches. Unfortunately, complete application of PBS in family contexts has not been fully explored or conceptualized. The purpose of this paper is to define the core features of PBS including lifestyle enhancement, assessment-based intervention, and comprehensive support plans (i.e., including strategies for prevention, teaching, and management). Examples of how the features of PBS are currently being employed within the field of PBS and within other evidence-based parent education and support programs are provided. Suggestions for how collaboration, assessment, data-based decision making, comprehensive intervention, and tiered approaches to service delivery may be used to enhance behavioral support for families are offered. Lastly, future directions for research and practice are recommended.     

The utility of tracking child behavior

To assess the impact of observation training and tracking of child behavior, each of 20 elementary school teachers participating in a behavior modification practicum was assigned to either an experimental or a control group. For each teacher, a disruptive, distractible child was identified as appropriate for behavioral intervention. All teachers were taught identical intervention strategies, but the two groups differed in the degree to which teachers were initially trained and subsequently required to observe and record discrete child behaviors. Multiple measures were used to assess the influence of monitoring child behaviors. These included observed child behavior, observed teacher behavior, teacher ratings, and correspondence between teacher perception and child behavior. Results showed that tracking the behavior of children had little or no effect on any measure.Support for this study was provided by the Molson Foundation and the Grant Foundation. Computing assistance was furnished by Health Sciences Computing Facility, UCLA. The author wishes to thank Marc Wilchesky, John Corson, Dick Jones, and Gerald Patterson for assisting in various aspects of this study.     

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF ) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EX ecutive function and AT tention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6–12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants’ parents and teachers completed the Conners’ Rating Scales‐Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT . The parents reported statistically significant decreases with medium effect sizes for the CPRS ‐R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ , and simultaneous learning support. In conclusion, EXAT – a structured multilevel group intervention – has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.     

Social problem solving training: A follow-up study of cognitive and behavioral effects

The long term effects of Spivack and Shures' social problem-solving training were assessed and compared to an attention-placebo control. Thirty-seven preschool age children were involved in this year's long intervention project and six month follow-up. All subjects received 46 sessions of intervention by specially trained assistants. Support was found for the cognitive effectiveness of social problem-solving training with aberrant children at post test in that they gained significantly in their ability to generate alternative solutions to interpersonal problems. This differential effect was not sustained at follow-up. Blind teacher ratings of behavioral adjustment and independent observers' ratings of behavior (using a naturalistic observation scale developed for this study) revealed no significant behavioral training effects at post test or at follow-up. Findings are discussed with the suggestion that behavior change in young children may not be mediated through a strictly cognitive intervention, and may more logically require an integration of behavioral and cognitve techniques.     

Motivation and Problem Solving (MAPS): Motivationally Based Skills Training for Treating Substance Use

Over 10 years ago, Baer and colleagues proposed the integration of skills training and motivational strategies for the treatment of substance abuse. Since that time, several studies evaluating the efficacy of such hybrid approaches have been published, but few have been efficacious. Motivation and Problem Solving (MAPS) is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework, and has been demonstrated to be effective in a randomized clinical trial focused on the prevention of postpartum smoking relapse. MAPS was designed to be applicable to not only relapse prevention but also the cessation of substance use, and is relevant for individuals regardless of their motivation to change. MAPS views motivation as dynamically fluctuating from moment to moment throughout the behavior change process, and comprehensively addresses multiple issues important to the individual and relevant to change through the creation of a wellness program. As a result, we believe that MAPS enhances the likelihood that individuals will successfully achieve and maintain abstinence from substance use, and that its comprehensive focus on addressing diverse and salient issues enhances both engagement in treatment and its applicability in modifying other health risk behaviors. The current paper introduces MAPS, distinguishes it from other hybrid and stage-based substance use treatments, and provides detailed information and clinical text regarding how MAPS is specifically and uniquely implemented to address key mechanisms relevant to quitting smoking and maintaining abstinence.     

Pavlov and the foundation of behavior therapy

The foundation, achievements, and proliferation of behavior therapy have largely been fueled by the movement's foundation in behavioral principles and theories. Although behavioral accounts of the genesis and treatment of psychopathology differ in the extent to which they emphasize classical or operant conditioning, the mediation of cognitive factors, and the role of biological variables, Pavlov's discovery of conditioning principles was essential to the founding of behavior therapy in the 1950s, and continues to be central to modern behavior therapy. Pavlov's reliance on a physiological model of the nervous system, sensible in the context of an early science of neurology, has had an implication for behavior therapists interested in the study of personality types. However, Pavlov's major legacy to behavior therapy was his discovery of "experimental neuroses," shown by his students Eroféeva and Shenger-Krestovnikova, to be produced and eliminated through the principles of conditioning and counter-conditioning. This discovery laid the foundation for the first empirically-validated behavior therapy procedure, systematic desensitization, pioneered by Wolpe. The Pavlovian origins of behavior therapy are analyzed in this paper, and the relevance of conditioning principles to modern behavior therapy is demonstrated. It is shown that Pavlovian conditioning represents far more than a systematic basic learning paradigm. It is also an essential theoretical foundation for the theory and practice of behavior therapy.     

儿童行为与心理水平的特质推理的发展

选取4岁组、5岁组、7岁组、10岁组、12岁组儿童和成人共192名(各年龄组32名, 男女各半)为被试, 采用个别测查法考察学前和小学儿童行为与心理水平的特质推理发展。结果表明: (1)4岁时儿童已能进行行为水平的特质推理, 5岁时才能进行心理水平的特质推理, 即使用特质引发规则进行特质推理, 10岁时两者均达到成人水平。(2)4岁、5岁时儿童心理水平的特质推理显著落后于行为水平的特质推理, 至少7岁时两者处于同一水平上。(3)儿童使用概念相似规则而不是情境匹配规则进行行为预测。(4)4岁儿童不使用简单效价规则进行行为预测, 5岁及以上儿童使用简单效价规则, 但他们是在区分同一特质范畴和不同特质范畴的基础上、在较低的确定程度上使用该规则。     

Development and Refinement of a Targeted Sexual Risk Reduction Intervention for Women With a History of Childhood Sexual Abuse

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age = 34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age = 33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.     

Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism

The current study used an AB crossover design to directly compare the effects of sensory integration therapy (SIT) and behavioral intervention (BI) on the challenging behavior of 10 participants with autism spectrum disorder. During the intervention phase, all participants received both treatments. Follow‐up probes were conducted 1 month following intervention for 4 participants implementing the more effective intervention. The results showed that BI successfully reduced challenging behavior to low‐ or near‐zero levels. In contrast, SIT resulted in higher and more variable rates of challenging behavior. One exception was noted for Participant 4 who engaged in a decreased level of challenging behavior during SIT. The findings are discussed in relation to implication for practice and future research.     

A system for recording individualized behavioral data in a token program

A data matrix system used to record and summarize individual behavioral data is described. The major characteristics of the system are: (1) it provides a place to record and summarize all patient token exchanges, whether for standard contingencies or for idiosyncratic behavior; (2) it serves as a record and summary for time samples observed during a 24-hr period and as a record of reliability data on time sample measures; (3) it provides a place where the new token balance for each patient can be calculated and recorded for use the next day; (4) it provides for calculation of an individual patient's token balance at any given moment; and (5) it is a permanent record of each patient's daily participation in the program and documents progress in terms of his economic status as well as in changes in critical target behaviors.     

Females in the forefront: time-based intervention effects on impulsive choice and interval timing in female rats

Impulsive choice has been implicated in substance abuse, gambling, obesity, and other maladaptive behaviors. Deficits in interval timing may increase impulsive choices, and therefore, could serve as an avenue through which suboptimal impulsive choices can be moderated. Temporal interventions have successfully attenuated impulsive choices in male rats, but the efficacy of a temporal intervention has yet to be assessed in female rats. As such, this experiment examined timing and choice behavior in female rats, and evaluated the ability of a temporal intervention to mitigate impulsive choice behavior. The temporal intervention administered in this study was successful in reducing impulsive choices compared to a control group. Results of a temporal bisection task indicated that the temporal intervention increased long responses at the shorter durations. Further, results from the peak trials within the choice task combined with the progressive interval task suggest that the intervention increased sensitivity to delay and enhanced timing confidence. Overall, these results indicate that a temporal intervention can be a successful avenue for reducing impulsive choice behavior in female rats, and could contribute to the development of behavioral interventions to prevent impulsive choice and maladaptive behaviors that can be applied to both sexes.     

A Case of Partial Biotinidase Deficiency Associated With Autism

We report the case of a child with partial biotinidase deficiency and autistic developmental disorder. We arrived at the diagnosis of biotinidase deficiency when the child was almost 4 years of age. Consequently, he began cofactor biotin treatment (10 mg daily) which did not resolve his autistic behavior. His younger brother was affected by partial biotinidase deficiency diagnosed at birth through our neonatal screening program. He was precociously treated with cofactor biotin therapy (10 mg daily) and did not show any behavioral abnormality or developmental delay. Since the brain is quite vulnerable to biotin deficiency, delayed biotin therapy could result in neurological damage. Our patient is the first case of partial biotinidase deficiency associated with autism. We hypothesize that the low biotinidase activity could have caused biotin deficiency in his brain and cerebrospinal fluids and consequently serious neurological problems, such as stereotyped and autistic behaviors, which were irreversible in spite of biotin supplementation.     

A case of partial biotinidase deficiency associated with autism.

We report the case of a child with partial biotinidase deficiency and autistic developmental disorder. We arrived at the diagnosis of biotinidase deficiency when the child was almost 4 years of age. Consequently, he began cofactor biotin treatment (10 mg daily) which did not resolve his autistic behavior. His younger brother was affected by partial biotinidase deficiency diagnosed at birth through our neonatal screening program. He was precociously treated with cofactor biotin therapy (10 mg daily) and did not show any behavioral abnormality or developmental delay. Since the brain is quite vulnerable to biotin deficiency, delayed biotin therapy could result in neurological damage. Our patient is the first case of partial biotinidase deficiency associated with autism. We hypothesize that the low biotinidase activity could have caused biotin deficiency in his brain and cerebrospinal fluids and consequently serious neurological problems, such as stereotyped and autistic behaviors, which were irreversible in spite of biotin supplementation.     

Behavioral Versus Nonbehavioral Guided Self-Help for Parents of Children With Externalizing Disorders in a Randomized Controlled Trial

Self-help interventions for parents, which have a behavioral basis, are considered to be an effective treatment option for children with externalizing disorders. Nonbehavioral approaches are widely used but have little empirical evidence. The main objective of this trial was to compare the efficacy of a behavioral and a nonbehavioral guided self-help program for parents. Families of children (aged 4–11 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) were randomized to either a behavioral or a nonbehavioral guided self-help program including 8 parenting booklets and 10 counseling telephone calls. The analyses considered the ratings of 5 informants: blinded clinician, therapist, participant, (her or his) partner, and teacher. Of the 149 families randomized to treatment (intention-to-treat sample [ITT]), 110 parents completed the intervention (per-protocol sample [PP]). For the 4 primary outcome measures (blinded clinician- and participant-rated ADHD and ODD) at post-assessment, the analysis revealed a treatment advantage for the behavioral group in blinded clinician-rated ODD symptoms (ITT: d = 0.37; PP: d = 0.35). Further treatment differences, all in favor of the behavioral group (ITT and PP), were detected in therapist ratings (i.e., ODD) and participant ratings (e.g., parental self-efficacy [only PP], negative parenting behavior, parental stress). In both samples, no differences were found at post-assessment for ratings of the partner and the teacher, or at the 12-month follow-up (only participant ratings available). Behavioral guided self-help shows some treatment advantage in the short term. No superiority over nonbehavioral therapy was detected 12 months after treatment termination.