A Behavioral Treatment of Child Abuse:

The following case presents the behavioral analysis and treatment of abuse in an 18-year-old unmarried mother. Both her children were being abused. Treatment involved teaching child management techniques, thought-stopping, programming activities incompatible with abuse, and increasing the mother's sources of reinforcement. A foster home was also arranged for use in emergencies and types of behavior and levels of attainment expected from children at various ages were outlined. Combined instances of abuse decreased from 10 in the week prior to intervention to 0 by week nine and remained at this level for the rest of the 21 week treatment period. A follow-up 18 months later indicated no further occurence of abuse.     

Behavioral Treatment of Self-Choking in a Developmentally Normal Child

ABSTRACT

In the past, self-choking behavior has been associated with individuals who were either developmentally disabled or experienced psychosis symptoms, and has usually been treated with aversive procedures. A time-series design using several different non-aversive behavioral procedures was used to analyze these treatment effects on an 11-year-old girl whose habit of self-choking interfered with normal functioning. Habit reversal procedures, which implement an incompatible response in place of the target behavior, did not, as first hypothesized, have a positive effect on self-choking behavior. However, attention from a male therapist as a positive reinforcer initially decreased the frequency of self-chokes and percent of time spent self-choking. Attention contingent on performance was not as effective on the child's behavior as attention administered noncontingently. Overall, the behavioral treatment approach applied here does not appear to reduce the target behavior in a clinically significant manner. Implications for future treatment approaches for this behavior are discussed.     

A Behavior-Analytic Approach to Behavioral Reflexivity

The Psychological Record - The purpose of this paper is to examine the issue of behavioral reflexivity from a behavior-analytic perspective. Two quotations from behavioral researchers are first...     

A Sensory Integrative Approach to the Psychotic Child

Current knowledge provides ample evidence of widespread neurological and developmental impairments underlying the behavior of psychotic youngsters. Occupational Therapy can now assess, treat, and make "sense" of the psychotic child's disturbed systems. A case study of a severely disturbed, self-abusing, childhood schizophrenic patient is presented. The treatment process and behavioral changes are discussed and augmented with statistical analysis.     

A Two-Systems Approach to the Treatment of a Disturbed Adolescent

Abstract

This article is based upon die rich conceptual and technical framework for understanding and treating sadomasochistic psycho-pathology presented by the Novicks (this volume). Specifically, the Novicks' “two-systems” approach to self-regulation is applied to the treatment of a disturbed adolescent boy. Examples of “open” and “closed” functioning are presented as well as the role of underlying defensive omnipotent beliefs and fantasies. The clinical utility of this model, the pivotal role of the therapeutic alliance, and the significance of clinical work with the family through all stages of the treatment process are illustrated.     

Developmental Play Therapy: A Treatment Approach for Child Victims of Sexual Molestation

The author describes the use of developmental play therapy as a treatment approach for young children who have been sexually molested.     

Group Psychotherapy: A Behavioral Approach

Abstract

This clinical report highlights some of the processes arising in a therapy group of persons with persistent and chronic psychiatric illnesses as they cope with the stress of their long–standing therapist’s impending retirement. Members were initially disbelieving that the therapist would leave and were also concerned about their future care, particularly in terms of medications. Gradually they were more able to experience their feelings of loss and their genuine caring for the therapist and the group, using higher level defenses and increasing their ability to tolerate strong affects. They became increasingly able to demonstrate empathy, notably in their ability to consider the therapist’s emotions. The clinical material also illustrates the therapist’s personal involvement, countertransferences and expressions of concern.     

Child Sexual Abuse: A Multidisciplinary Approach to Case Management

Treatment for child victims of sexual abuse is a complex and sometimes lengthy process involving members of numerous social service agencies. Coordination of services can be accomplished through the use of a multidisciplinary team approach to case management. The author provides information about the roles of various team members as well as suggestions for organizing a child sexual abuse multidisciplinary team.     

Applying a Behavioral Epidemiology Framework to Research Phases in Child Health Psychology

The purpose of this study was to apply a behavioral epidemiology framework reported in J. F. Sallis, N. Owen, and M. J. Fotheringham (2000) to the field of child health psychology and describe the resulting distribution of research phases. Recent volumes of the Journal of Pediatric Psychology were analyzed and their articles classified as belonging to one of five sequentially-ordered phases of behavioral epidemiology research: Phase 1—relationship between behavior and health; Phase 2—measurement and method; Phase 3—factors influencing behavior; Phase 4—intervention; Phase 5—translation. The results indicate that Phase 3 studies (46%) were the most well-represented in the field, followed by Phase 2 (11%), Phase 1 (9%), Phase 4 (8%), and Phase 5 studies (2%). Compared to the journal Health Psychology, the shape of the research phase distribution of articles published in the Journal of Pediatric Psychology was similar. Overall, an encouraging amount of data in the field of child health psychology is being amassed in preparation for behavioral intervention. As research in the field matures, it will likely have a greater impact on public health via chronic disease prevention and control and health promotion interventions.     

Toward a Synthetic Approach to the Rorschach: The Case of a Psychotic Child

Much Rorschach research on case material focuses on the utility of a single scoring system, set of variables, or scale in isolation from other systems, scales, or perspectives. This approach fails to acknowledge the complexity of the Rorschach and to reflect the manner in which sophisticated clinicians select and synthesize various perspectives during the clinical inference and decision-making process. A case of a psychotic child is presented to illustrate the utility of a synthetic approach to the Rorschach. The strengths and weaknesses of various Rorschach perspectives in addressing specific diagnostic issues is explored through the case material.     

The Open Door: A Structural Approach to a Family With an Anorectic Child

This commentary on a videotape of an initial interview with a family of an anorectic girl demonstrates a set of therapeutic techniques based on a structural view of family organization and dysfunction. In the commentary, the interventions of the therapists are analyzed move by move throughout the session. The goal of the therapists is to assist the family to reorganize itself so that its dysfunctional structure will not support the symptom in the child. During the interview, they probe the characteristic interaction patterns of the family and engage with the family subsystems, making changes in the husband-wife relationship, the parent-child relationships, and the sibling relationships. The connection between the anorectic symptom and the structural organization of the family becomes clearer as the interview unfolds, with the result that the child's eating at the end seems incidental compared to the many changes in family relationships that precede it.     

Behavioral Pediatrics: A Team-Based Interprofessional Approach

An interprofessional approach to pediatric behavioral care is increasingly important in the care of pediatric patients, who present to healthcare settings with a wide variety of concerns ranging from potty training to depression. Previously, much of the care of these patients have focused on a narrow approach to the problem, based on the expertise of the professional providing care. Faculty from three disciplines: Social Work, Psychology, and Medicine collaborated to design a course for students from these three disciplines to collaborate in attaining three goals: (1) reinforce the importance of multidisciplinary collaboration, (2) share clinical techniques and skills in a simulated interprofessional setting, and (3) practice collaboration within interprofessional teams. We detail the course goals and design and topics covered and discuss implementation of this course. Suggested module content and pedagogical design are discussed, and case examples are detailed with the goal of encouraging the adoption of similar courses.

     

A Systems Approach to the Treatment of Chemical Addiction

Therapists are increasingly considering chemical addiction from a family systems perspective. Effects of chemical dependency upon the family are discussed and intervention approaches aimed toward assisting the family as families redefine themselves and change their structure are considered. The integration of chemical dependency treatment and the family therapy is also discussed as it is practiced in an intensive outpatient program at a psychiatric hospital.     

The Behavioral Score Approach to Dependent Variables

Theoretical explanation is most often confined to the independent or predictor variables in most consumer research. Consumer behavior itself is either not measured or measured as a single manifest variable, usually of the form, How/will you buy/use product––in a period of time? Dependent variables should be considered from a more theoretical point of view. To this end we develop an approach to dependent variables using behavior scores that span the theoretical domain of a behavior. We apply this approach to develop a specific measure of newspaper readership using data from a national sample of 37,000 consumers.     

A Narrative Approach to Child and Family Therapy in Africa*

Professional family therapy in Africa is heavily influenced by theories and principles of Western family practice. Its practice structure and philosophies are however grounded on African family values and the principles and orientations of traditional African psychology. This paper presents a clinical report that illustrates adaptations we make to incorporate compatible aspects of narrative family practice in African and Western cultures. A summary of African family values and child psychology intended as a background perspective is provided. The paper is significant against the background of the current need for forging multiculturally relevant healing methods that fit well with the globalized nature of the contemporary world. Augustine Nwoye, PhD, is Associate Professor and Chairman, Department of Psychology, Kenyatta University, Nairobi, Kenya (amnwoye@avu.org). Professor. Nwoye has developed an African paradigm for mental health and, in particular, for family and couple therapy. He also has experience in dealing with stress and multiple losses, especially surrounding HIV/AIDS within an African context. *An earlier version of the paper was presented to the members of staff and students of the Faculty of Education, University of Cambridge, England, UK, and the initial version was presented to the members of the Family Therapy Program of the Faculty of Medicine of the University of Calgary, Calgary, Canada. I wish to thank Dr. Colleen McLaughlin (University of Cambridge) and Professor Karl Tomm (University of Calgary) for their invitation, assistance, time, attention, and suggestions.     

A Family Systems Approach to Behavioral Training with Parents of Autistic Children

This paper reviews briefly the use of behavioral procedures and parent training techniques with parents of autistic children. Potential hazards that may arise when the clinician fails to be sensitive to the family context are examined. Behavioral clinicians are urged to undertake behavioral parent training from a family systems context and thereby enhance the likelihood of more enduring changes for the autistic child and the family as a whole. Case illustrations are provided.     

A Prospective Study of Maternal Exposure to Smoking during Pregnancy and Behavioral Development in the Child

Prenatal smoke exposure (PSE) is a risk factor for adverse outcomes in the offspring, including those affecting psychological development. However, it is uncertain whether these associations are the direct result of PSE or other confounding factors. The aim of this study was to examine the possible relationship between PSE and behavioral development in children at 7.5 years of age, considering several prenatal, neonatal and postnatal covariates. A cohort of 266 mother-child pairs was followed from the first trimester of pregnancy until the children reached 7.5 years of age. PSE was assessed using a questionnaire from prenatal clinical records and corroborated by plasma cotinine determinations in the first and second trimesters and in the cord. Mother-child pairs were classified into one of four groups: unexposed, exposed to passive smoking, first trimester active smoking only and active smoking throughout pregnancy. Child behavior was assessed using the Child Behavior Checklist for ages 6–18 and the Childhood Autism Spectrum Test. In multiple linear regression models, smoking during pregnancy was associated with higher scores in affective problems (β?=?0.298; p?=?0.004). No significant associations were found between smoking during pregnancy and externalizing problems. Findings indicate that PSE is negatively associated with behavioral development in childhood.

     

A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.